Yoga research

Self-perceived

health effect

from hatha yoga

What self-perceived health effects can we register from a 7-week hatha yoga

course in a healthy Norwegian population using a standard questionnaire

measuring quantitative and qualitative data?

Yoga

chitta vritti

nirodha

“ Yoga is the cessation of the fluctuation of the consciousness”

1 Cand Scient, Jan Petter Engvig

Bachelor report: 2010, Oslo University College / Høgskolen i Oslo.

Bachelor report 2010 – Jan Petter Engvig

Fysioterapiutdanningen, Avdeling for helsefag.

Table of content:

SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1.1 Background for research questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Life style as cause for non-communicable diseases – Physical activity & Stress . . . . . . . . . . . . . . 4

1.2 Research question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.3 Background and Aim of study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1.4 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1.5 Topics and hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2. THEORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

2.1 Historical overview of yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Table 2.1.1 The eight limbs of yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Table 2.1.2 Health effect of yoga . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2.2 What is health? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2.3 What is health effect? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

2.4 What is physiotherapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.5 Physical activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.6 Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.7 Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2.8 The role of the physiotherapist in the field of physical activity and stress reduction . . . . . 13

2.9 Behaviour change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2.10 Are there similarities between physiotherapy and yoga philosophy? . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

3. METHOD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.1 Study design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3.2 Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Table 3.1 – Content of a 90 min yoga class . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

4. RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Table 4.1 – Overall results as bar graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Table 4.2 – Overall results in numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Table 4.3 – Effect distribution in the population as bar graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Table 4.4 – Effect distribution showed as percent (%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

4.5 –Personal comments (Question 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

5. DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

5.1 Method discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

5.2 Results discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

1 & 2 – Musculoskeletal issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

3 – Flexibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

4 – Muscular strength . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

5 – Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

6 – Relaxation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

7 – Body awareness and awareness about physical posture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

8 – Respiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

9 – Mood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

10 – Stress reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

11 – Tension headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

12 – Life energy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

13 – Personal comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Bachelor report 2010 – Jan Petter Engvig

6. CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

7. APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Appendix 1 – Questionnaire / research questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Appendix II – Question 13 / Personal comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Appendix III – Informasjonsskriv og samtykke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

8. REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

SUMMARY

The title for this report is “

Self-perceived health effect of hatha yoga”, and the researchquestion is “

What self-perceived health effects can we register from a 7-week hatha yogacourse in a healthy Norwegian population using a standard questionnaire measuring

quantitative and qualitative data?”

In this study 80 healthy Norwegians mean age 30.4 years (SD = 9.9) were asked 13 questions

about self-perceived health effects of a seven weeks yoga course. The question form is

inspired by e.g. Short Form 36 Health Survey Questionnaire (Ware & Sherbourne 1992) and

similar existing self-reporting sheets, but was adjusted to the subjects most interesting for this

particular study. The questions are mainly related to many of the common topics we meet in

physiotherapy practice like musculoskeletal problems and pain, and also problem related to

stress and psychosomatics. The results indicated a positive effect on all the questions asked.

Regarding musculoskeletal problems there were shown positive effect on the following; legs,

hips, lower-back/back, shoulders, neck and head (tension headache). The strongest effects

were found for stress reduction and for better mood.

The present study supports a large amount of previous scientific studies that have shown

similar positive results of yoga for a broad range of health problems. Maybe the most

interesting finding in this study is the positive results regarding stress reduction and

improvement of mood. Since stress and depression are among the largest public health

problems in the western world today there is a great need for effective interventions for these

client groups (Merson et al. 2006). Based on today’s evidence, yoga is considered to be a

promising intervention for clients with these kinds of problems (IAYT 2010). Findings from

literature suggest that the active ingredients in yoga might be the effect of physical activity,

respiratory exercises and elements from the yoga philosophy that seams to achieve selfefficacy

and self-realisation. To obtain stronger empirical data it would have been interesting

to have done the 7-week yoga intervention in a randomised controlled study, and also with

objective measuring parameters, and not only self-perceived health effects.

Bachelor report 2010 – Jan Petter Engvig

Keywords: yoga, holistic health, health promoting interventions, stress-reduction,

complementary and alternative medicine, physical activity, self-perceived health effect, stress

and life-style health problems, non-communicable diseases.

1. INTRODUCTION

1.1 Background for research questions

Life style as cause for non-communicable diseases – Physical activity & Stress

Physical inactivity, is an independent risk factor for chronic diseases, and overall is estimated

to cause 1.9 million deaths globally (WHO 2010). As a response to this there is an increased

emphasis globally on physical activity as a heath effector. This is also one of my reasons for

putting focus on yoga as an intervention related to physical activity.

Beside physical inactivity, many of today’s most common non-communicable diseases and ill

health are due to stress or distress, which means that people have more challenges in their life

than they have resources (Aldwin 2007). When this condition becomes chronic, and there is

lack of restitution, it may give several health problems (Greeson 2009). Musculoskeletal

problems are also often correlated to a stressful modern life style with monotonous work and

limited physical activity (Brudevold 2008). Musculoskeletal problems are right in the core

domain of physiotherapy, and among the major challenges in public health. As an example: in

Norway approx 50% of long term sick leaves and 33% of new disability pensions are based

musculoskeletal diagnoses (Wærsted 2008).

An historical overview shows that hatha yoga has been considered as a way to improve health

in a holistic aspect for more than 2000 years. But as for other traditional forms of medicine

from the same period e.g. tai-chi, acupuncture and various massage techniques, these early

interventions had no evidence-based reports or controlled studies, only the evidence based on

experience and observation. Today hatha yoga is not mainly considered as “medicine” in the

western world, but never the less widely used as intervention in complementary and

alternative medicine. Furthermore, a large number of scientific studies where yoga has been

used as the method of intervention for health improvement have been published in the last

decades (NCCAM 2009). A review of scientific research on yoga and health effects (e.g.

Lipton 2008; Lundgren et al. 2008; NCCAM 2009; Oken et al. 2006; Raub 2002; Williams et

al. 2005; Yang 2007) suggests that yoga might have effect on several issues correlated to life

Bachelor report 2010 – Jan Petter Engvig

style, stress and non-communicable diseases. It also seems like the interest for this kind of

intervention studies are rapidly increasing (Ross & Thomas 2010). One of the main reasons

for doing an effect study on yoga is that previous studies are indicating good effect regarding

non-communicable diseases and health issues related to stress, and hence would it also be of

both public health interest and of national economy interest to know more about this (Granath

et al. 2006). Modern scientifically studies from psychology, psychosomatics, physiology

medicine and physiotherapy may help illuminate the “active ingredient” in yoga.

1.2 Research question

What self-perceived health effects can we register from a 7-week hatha yoga course in a

healthy Norwegian population using a standard questionnaire measuring quantitative and

qualitative data?

1.3 Background and Aim of study

The background for writing this report regarding health effect of hatha yoga started out with a

personal experience and a curiosity to learn and understand more about this topic. Being a

physiotherapy student I started to reflect on how hatha yoga might have a positive effect on

general health problems and non-communicable diseases like musculoskeletal and

psychosomatic issues as reported from science? (NCCAM 2009).

The purpose of my study is to see if I can find some of the same positive health effects gained

from hatha yoga in a Norwegian population as earlier reported in numerous international

scientific publications (Ibid). Furthermore, I’m also discussing what might be the active

ingredient(s) in hatha yoga, and for which health problems yoga has the best effect. Since this

is a report related to physiotherapy I especially wanted to look at hatha yoga from a

physiotherapy perspective. E.g. find out if hatha yoga is supported by evidence based science

in such way that we as physiotherapists can give advise regarding hatha yoga as an suitable

intervention regarding life style health issues and non-communicable diseases. Can we also

find evidence showing that hatha yoga is compatible and in harmony with modern

physiotherapy theory and clinical practice?

Bachelor report 2010 – Jan Petter Engvig

1.4 Definitions

Yoga

– A Sanskrit word which means “to unite” or “union”, and is one of the orthodox lifephilosophies from ancient India.

Hatha Yoga

– This is the form of yoga that is best known outside India and is typicallyassociated with exercise containing the physical postures (

asanas) and dynamic sequences(

vinyasas).MBSR

– Mindfunlness Based Stress Reduction is a modern holistic intervention using manyof the ideas from hatha yoga and eastern philosophies. MBSR is showing well-documented

effect by a large amount of scientific studies on non-communicable diseases.

Non-communicable diseases

– Health problems / diseases often correlated to life-style, stress,genetics or environment.

1.5 Topics and hypothesis

Central overall topic in this report will be to discuss the empirical data from a 7-week course

in hatha yoga. I’m also using results obtained from this study to compare with data from

previous scientific studies. Information from previous scientific studies is also used to discuss

what might be the active ingredients in hatha yoga. Furthermore, I’m discussing the research

method where I’m emphasizing the questionnaire and study design. On the individual level

I’m looking at personal aspects of physical activity, experience of mind-body, health through

movement and self-perception of health. On the more therapeutically level I will highlight

hatha yoga as a health promoting intervention. Treatment philosophy will also be discussed

with respect to similarities between physiotherapy and yoga.

My hypothesis is that hatha yoga has the benefits we can get from physical activity, breathing

exercises and from the yoga philosophy included mindfulness meditation. I will argue for this

statement because these elements are so closely joined together in the yoga practice that they

function as one unity.

Bachelor report 2010 – Jan Petter Engvig

2. THEORY

In the following I will first introduce the historical background and philosophy of yoga.

Second, I will go on to describe three fundamental issues addressed in this report, namely

“health”, “health effect”, physiotherapy and the role of the physiotherapist. Third, I will

compare yoga to physiotherapy and search for similarities.

2.1 Historical overview of yoga

The word yoga is originally a Sanskrit word and means, “join together”, “uniting” “union” or

“communion”. Union of body, mind and soul. Yoga has also been described as wisdom in

work or skilful living. The ultimate meaning of the word yoga is in Sanskrit: “chitta vritti

nirodha”. Literary this means to cease the waves in the mind. The yoga tradition comes from

the cultures around the Hindus River Valley – the ancient India (Iyengar 1979). The yoga

tradition in this area is estimated to be several thousands years old and consists of a wide

spectre of life philosophy guidelines where the most important one is the Yoga Sutras of

Patanjali (Ibid.). Outside India, the term

yoga is typically associated with Hatha Yoga and itsasanas (physical postures) and vinyasas (dynamic sequences), or as a form of exercise. Hatha

yoga has today developed into several different directions, but in general most brands of hatha

yoga remains the idea of unity. There is much emphasise on mindfulness, awareness and a

holistic philosophy in a yoga class, and this is always integrated to the postures and the flow

sequences (Lea 2009). These factors are mainly what make hatha yoga “yoga”, and not just

another form of sport activity.

Hatha Yoga, is also known as

hatha vidya or the «science of hatha» yoga. The wordHatha comes from combining the two Sanskrit terms «ha» meaning sun and «tha» meaning

moon (Feuerstein 1997). However, when the two components of the word are placed together,

«hatha» means «forceful», implying that powerful work must be done to purify the body. Yoga

means to join two things together, hence hatha yoga is meant to join together sun (masculine,

active) energy with the moon (feminine, receptive) energy, thus producing balance and

greater power in an individual. This is also an analogue known from the yin and yang

symbols of Chinese philosophy. Hatha represents opposing energies: hot and cold (fire and

water, similar concept as yin-yang), male and female, positive and negative. Hatha yoga

attempts to balance mind and body via physical postures, purification practices, controlled

breathing, and the calming of the mind through relaxation and meditation. Asanas teach poise,

balance and strength and are practised to improve the body’s physical health and clear the

mind. “

The true power of yoga is the process by which an individual enters into an authentic 7

Bachelor report 2010 – Jan Petter Engvig

relationship with the multidimensional aspects of one’s whole being”

(Stapleton & Stapleton2002). Hatha yoga is also easy to fit into modern training philosophy where there is focus

both on the exercise and restitution – catabolic and anabolic processes in the body (Østerås &

Stensdotter 2002).

The first know written comprehensive material on yoga philosophy is by Yogi Patanjali who

lived sometimes between 200 B.C and 200 A.D. In the 15

th-16th century we got the mostcomprehensive text of Hatha Yoga, the Hatha Yoga Pradipika, by Yogi Swatmarama. This

work is nonetheless derived from older Sanskrit texts on Yoga besides Yogi Swatmarama’s

own yogic experiences. Many of the concepts formulated by Pantanjali and Swatmarama are

still central for the yoga teaching. The core values of yoga philosophy are often referred to as

“The eight branches, or limbs, of yoga” (Iyengar 1979) and to fully understand the content of

yoga and the values it is build upon I will briefly introduce it in table 2.1.1.

Table 2.1.1 The eight limbs of yoga

Yamas: (ethical restrains / moral behaviour) – non-violence, truthfulness, generosityetc.

Niyamas: (healthy habits) – purity, contentment, self-study, devotion and simplicity.3. Asana: (physical postures) – a calm body position, lying, sitting, standing or moves

where the practitioner is resting and present in the Self – although the yogi moves, he

is still. What make an asana a “yoga posture / movement” is the whole intention,

mindfulness and awareness brought into the experience. Personal experience is the

goal – not to perform the asana “perfect”.

Pranayama: (breathing exercises) life energy through respiration.5. Pratyahara: withdrawing the senses form an external focus (taught) to an internal

experience of pure sensation (somatic sensory, proprio sensory perceptions /

sensations).

Dahrana: concentration.7.

Dhyana: meditation / contemplation.8.

Samadhi: (higher consciousness) the state of balanced knowing, oneness; the ultimateunion of individual self and the universal.

Bachelor report 2010 – Jan Petter Engvig

The eight branches of yoga are more precisely viewed as eight levels of progress, each level

providing benefits in and of it self and also laying the foundation for the higher levels. All

eight levels are interconnected (DeBarra 1983). Furthermore, these eight branches very

clearly shows that yoga practice has a deeper foundation than a regular sport activity. There

are reasons to believe that this mindful approach and holistic yoga philosophy are involved in

many of the stress reducing and well being effects of hatha yoga (Hoffman 2008; Lea 2009).

Furthermore, I will briefly mention that many ideas of modern psychology and life

counselling have taken up much of the philosophy from yoga. On example might be gestalt

therapy which is based upon field theory (Lewin 1943); an holistic theory which says that all

things are interrelated, phenomenology (Husserl 1913); believing that experience is the source

of all knowledge, and existensialism (Britannica 2010); which emphasise that the individual is

solely responsible for giving one’s own life meaning. The focus in gestalt is the experience of

mind-body in the “here and now” context. From this experience the client will have a more

clear awareness of the Self and in this way be able to cope with his life in the best way trough

empowerment and self-actualisation (Clarkson et al. 1993). Much of the same is to be said

about Psychosynthesis (Assagioli 1965) and Mindfulness Based Cognitive Therapy (Segal et

al. 2002). All the main philosophical fundaments we find in these well documented methods

is also to be found in yoga (Iyengar 1979). Therefore there are reasons to belive that these

factors may be considered as “active ingredients” regarding general psychological /

psychosomatic health effects from yoga. The final aim of yoga is self-realisation (Iyengar

2001).

Table 2.1.2 Health effect of yoga

A review of scientific research on yoga and health effects (e.g. Lipton 2008; Lundgren et al.

2008; NCCAM 2009; Oken et al. 2006; Raub 2002; Williams et al. 2005; Yang 2007)

suggests that hatha yoga might have effect on the following:

Improve mood and sense of well-beingo

Counteract stresso

Reduce heart rate and blood pressureo

Increase lung capacityo

Improve muscle relaxation and body composition9

Bachelor report 2010 – Jan Petter Engvig

Low back paino

Help with conditions such as anxiety, depression, and insomniao

Tension headacheo

Improve overall physical fitness, strength, and flexibilityo

Positively affect levels of certain hormoneso

Positive effect regarding MS and epilepsy2.2 What is health?

WHO (1948) has defined health by the following words:

“Health is a state of completephysical, mental and social well-being and not merely the absence of disease or infirmity”

.As described here we see that the term “health” contains several aspects of life, and these

parts are often interconnected with each other. This way of looking at health is often called

holistic, meaning that the individual as a part of social system cannot be determined or

explained by its component parts alone. Instead, the system as a whole determines in an

important way how the parts behave. It may be difficult to set common measurements, or an

objective numeric rating scale, for what is “good health” or “poor health”, because the

understanding of this is very much a subjective perception on the individual level. On the

other hand there are several tools for surveillance of health status in populations and

individual levels (Merson et al. 2006). As an example there exist standardized questionnaires

and from these kinds of investigations we can have a measure of self-perceived health, e.g.

the SF-36 Health Survey questionnaire (Ware & Shareborne 1992)

.2.3 What is health effect?

“Health effects (or health impacts) are changes in health resulting from exposure to a source.

Health effects are an important consideration in many areas, such as hygiene, pollution

studies, workplace safety, nutrition and health sciences in general”

(Wikipedia 2010). Ahealth effector or a determinant for health is the factors that may have positive (or negative)

influence on a person’s health status (Merson et al 2006). As for surveillance of health status,

there exist several standardized questionnaires for measure the effect. This might be effect

from different interventions, determinants or effectors. In my study I’m interested in a

measure that is giving the results as self-perceived health effect – how the individual

Bachelor report 2010 – Jan Petter Engvig

experiences the health effect in his or her mind-body in a subjective way. A typical example

would be the Patient Global Impression of Change, PGIC (Hurst & Bolton 2004).

2.4 What is physiotherapy?

The Norwegian Physiotherapy Association (NFF) has stated the following:

”The field ofknowledge for the physiotherapist are body, movement and function. The theoretical

fundament for the profession is based on natural science and social science, and a

recognition that there are several different factors contributing to the health status, and

furthermore also for pain and disability. In addition to injuries and illness, may also the life

situation and experiences, together with social and cultural conditions lead to afflictions and

functional disabilities, due to that both physical and psychological strain are likely to be

bodily incorporated. This means that the different parts of the body, body-person, bodysociety

are all interconnected.”

(NFF 2006). From the World Confederation of PhysicalTherapy (WCPT 2010) we know that movement enhancement and functional training are

among the core interventions used by physiotherapists both as treatment and for health

promoting. As emphasised by the profession’s title, “physical therapy”, physical activity is

essential in this professional field. The Norwegian Physiotherapy Association (NFF 2008) put

much focus on physical activity as a health effector, and is recommending the use of physical

activity both for health promoting purposes and as intervention in rehabilitation.

2.5 Physical activity

In Norway the Department of Health has given its guidelines regarding physical activity and

health promotion in several important documents e.g. “Recipe for a healthier Norway” (2002-

3) and “Handbook for Physical Activity” (2008). There is now a broad consensus that

physical activity is of great importance regarding health, both in a global public health

perspective (WHO 2010) and on the individual physiotherapist-client level (NFF 2008).

Furthermore, physical activity seams to have a positive effect on several aspects of health

such as musculoskeletal issues, cardio vascular disorders, diabetes type 2, weight control

regarding obesity, colon cancer, Alzheimer, psychological problems, psychosomatics, general

well-being and perception of life (Larson et al. 2006; Martinsen 2004; Merson et al. 2006;

NFF 2008; WHO 2010).

2.6 Stress

Bachelor report 2010 – Jan Petter Engvig

Beside physical inactivity, stress is a major contributor to non-communicable diseases in

public health (Larsen 2001). Stress or distress is a topic of great concern in heath care and is

often connected to psychosomatics. Stress may also be perceived as a problem in daily life for

many of us even if we are healthy. There are still some disagreement of the term “stress” –

should it rather be called “distress”, “strain” or something more medical term like “sustained

arousal”? (Wyller et al 2009). Stress may be psychological, physical or both. E.g. to many

activities on to many arenas at one time, physical overload, to many personal conflicts, lack of

control in life, perceived threats, anxiety and insecurity, and to little time to restore and

restitution. The susceptibility of stress is highly subjective, but is commonly increased when a

person experiences little control over the situation, when there is little predictability and little

sense of coherence (Antonovsky 1979; Brodal 2007). In yoga terminology “stress” could be

called imbalance in hatha, or in traditional Chinese philosophy; disharmony in yin and yang.

Stress is in medical terms defined as a condition of increased state of alarm on psychological,

physiological and behaviour levels (Jonsdottir & Ursin 2008). This condition triggers the

nevro-endocrine “fight-or-flight” response which include the Hypothalamus-Pituitary-

Andrenal (HPA)-axis, stress-hormones and physiological responses (Seyle 1936;1956;1982).

These responses are closely related to the autonomous nervous system with an increased

sympathicus activity and decreased parasympathicus activity (Brodal 2007). In short term the

physiological stress response is normal and beneficial in order to cope with a challenge. On

the other hand, when stress becomes chronic, and there is lack of restitution, it may give

several health problems (Greeson 2009; Larsen 2001; Selye 1982). What most scientists agree

upon is that “stress” over a long period of time may be a treat to your health (Brudevold

2008). Stress is also recognised by WHO as a determinant for health in a global perspective.

The problem is increasing in the western world and it is estimated that stress cost the EUcountries

approx. 20 mill Euros per year in health expenses (Knardahl 2007).

It’s a common problem related to stress that people get a reduced ability to relax, and

this may lead to both physical and mental symptoms (Brudevold 2008). Lack of ability to

relax may lead to muscular tensions, shortening of muscle fibres and reduced flexibility. But

because our body is a holistic system, one unit, our physical tensions may also lead to inner

disturbance of e.g. the digestive apparatus, respiration, circulation and muscular pain. Lack of

relaxation is also correlated with increased sympaticus activity in the autonomous system. On

the other hand, relaxation response will induce parasympaticus activity (Ibid). All these

factors above are interconnected. Therefore the ability to relax will be beneficial for the whole

human mind-body, and especially regarding stress reduction, anabolic processes and recovery

Bachelor report 2010 – Jan Petter Engvig

(Benson 1975). More about stress reduction and relaxation response related to yoga will be

discussed later in this report.

2.7 Respiration

Respiration is one of the keystones in yoga and it’s a part of my hypothesis that this is one of

the active ingredients regarding health effect of yoga. Therefore I think it’s useful to present

some theory regarding this. Respiration is also an issue of great concern in physiotherapy

because it’s so tightly linked to body posture, musculoskeletal issues, and physiological

processes in the body and also to psychological factors (Bunkan 2008). The diaphragm

muscle is the most important muscle during normal breathing and separates the abdominal

cavity from the thorax cavity. The diaphragm muscle is attached to the sternum bone in front,

along the lowest rib bones and back to the spine at level Th.10-12 (Netter 2003). One special

feature regarding the diaphragm is that it has double nerve innervations, which means that the

breath can be regulated both by the autonomous nervous system and by will. Consequently

we are able to do specific breathing exercises controlled by our own mind. According to Berit

Bunkan (2008) both muscular tension and psychological distress can lead to an unfavourable

way of breathing by the use of accessorial respiratory muscles and increased tension of the

diaphragm. This condition may lead to reduced circulation for blood and lymphatic fluid. It

can lead to poor conditions for the abdominal organs, and also for the hearth and lung. An

overextended way of breathing will also make it hard to let go of general muscular tension in

the body (Bunkan 2008). Regarding more musculoskeletal problems it is suggested that an

overextended and tensed diaphragm muscle can give rise to lower back pain because it’s

attached to the spine at Th. 10-12 level and also interconnected with the m. lumborum and m.

ilopsoas. Extensive respiration using the accessory muscles may also give musculoskeletal

problems in the neck and shoulder, for example “thoracic-outlet syndrome” (Caillet 1964),

and may irritate the Vagus nerve inducing problems for the organs innervated from this nerve

(Dahl & Rinvik 1999), neck pain and tension headache (Bunkan 2008). Inadequate respiration

patterns may also lead to unfavourable body posture and have influence on the balance (Ibid).

As listed here the respiratory function is closely interconnected with almost everything in the

body. Last but not least, the respiratory system is also strongly connected with emotions and

mind.

2.8 The role of the physiotherapist in the field of physical activity and stress reduction

Bachelor report 2010 – Jan Petter Engvig

From the Norwegian Physiotherapy Association we know that a professional physiotherapist

should be competent in leading organized physical training, and be able to give qualified

advices and coaching in this field (NFF 2008). From the Bachelor program in physiotherapy

we have also learned that knowledge about physical exercises is one of the main fundaments

in our education and an important intervention in treatment and health promoting (Fyrand

2002). Stress reduction techniques aiming to reduce sympaticus activity and the HPA-axis

are also well known in physiotherapy theory. Several methods are described e.g. by Berit

Bunkan (2008) and by Elise Thornquist (2003). On the basis of this the physiotherapist should

be able to give qualified, evidence-based, advises both regarding physical activity and stress

reduction. Since hatha yoga often is advertised as a method for physical activity and stress

reduction, and since there are currently over 430 million people training hatha yoga word

wide, it should also be natural for a physiotherapist to be able to give clients advices

regarding this topic (IMY 2010).

2.9 Behaviour change

From theory in public health we know that behaviour change on the individual level is of

great importance regarding life style illnesses (Nutbeam & Harris 2005). So with respect to

physical activity there is much we can do as physiotherapists to inform and motivate the client

regarding behaviour change, but we also know that the person himself must mobilise will and

trust himself in order to gain results. Our goal would be that the client himself would gain

empowerment and self-efficacy, so that he feels that he is in charge and have control over the

situation himself (Bandura 1997). As physiotherapists we can give advices about physical

activity such as yoga and inform about the evidence-based health benefits from this (NCCAM

2009). However, it will necessarily be up to the client himself to experience what this activity

means for him on a personal level. In a general point of view it’s essential to find an activity

that suits each and one of us, and that is meaningful to us. Regarding yoga there is substantial

evidence to say that this activity might have a philosophical content that will increase selfefficacy

and empowerment, maybe more than in an ordinary physical activity, and than again

induce a positive behaviour change. The reason for this statement is the fact that much of the

yoga philosophy is taken up by modern psychology and life coaching, and is supported by

scientific evidence to improve self-efficacy (Assagioli 1965; Clarkson et al. 1993; Iyengar

2005; Segal et al. 2002).

2.10 Are there similarities between physiotherapy and yoga philosophy?

Bachelor report 2010 – Jan Petter Engvig

There are substantial arguments for calling hatha yoga a kind of physical activity. In addition,

yoga includes breathing and mindfulness exercises, all with a holistic approach. Another

important factor is that yoga is a non-striving and non-competitive activity. The yoga

philosophy is also important. A mentor in Norwegian physiotherapy, Berit Bunkan, PhD, has

dedicated a chapter about yoga in one of her books. She writs the following:

“The principlesfor yoga can be recognized in many other good systems for physical exercise, also in physical

therapy”

(Bunkan 2008). Another physiotherapist and author, E. Thornquist (2003), alsowrites about yoga as a useful intervention in physiotherapy. Furthermore, prominent

physiotherapists such as Nina Schriver, PhD, senior researcher at University of Oslo, and

Professor Gunn Engelsrud, at Norwegian School for Sport Science, both emphasises the

positive value of yoga (Høiland 2010; UIO 2010). Gunn Engelsrud as a physiotherapist is

emphasizing the holistic view of the human and that the mind is one integrated part of the

body. The life is lived and experienced through our body and as individuals we are

interrelated to each other. Sensations and emotions are always present in our body and can

both be expressed and released trough movement (Høiland 2010). Many of these words are

the same as in the statement on “what is physiotherapy?” by the Norwegian Physiotherapy

Association (NFF 2008). In other words, this means that the physiotherapy approach should

be holistic. It is therefore also of great interest for the present study to know that these values

are shared by the yoga philosophy (Iyengar 2001). Consequently, it exist reasonable

arguments for saying that yoga easily could be a suitable intervention used in the field of

physiotherapy regarding health promotion. As an example “Medical Yoga” has now in

Sweden become a natural part of the public health services in combination with regular

physiotherapy at several hospitals and other health institutions (IMY 2005).

3. METHOD

3.1 Study design

This study is based upon 80 normal healthy volunteers, participating on a seven-week

classical hatha-yoga course. The participants were not send to this course from general

practitioner or other health personnel, but were there for personal reasons. Experienced yoga

teachers at a health and fitness center in Oslo, Domus Athletica, held the course. The study

had no control group and was not randomised. The participants were informed about the study

and the confidentiality handling of data before they chose to fill in the questionnaire or not.

Bachelor report 2010 – Jan Petter Engvig

The average age of the study population was 30.4 years (SD = 9.9 years). The population was

dominated of women containing 90 % and 10 % men. This roughly also represents the

distribution numbers in the total population practicing yoga in Norway and western countries.

The study’s data collection is based upon a questionnaire containing twelve standard

questions regarding health. The answers is reported on a numeric rating scale from 0 to 4: 0 =

zero effect, 1 = slightly positive effect, 2 = moderate positive effect, 3 = good positive effect

and 4 = very good positive effect. The reported numbers are meant for quantitative

measurement of the self-perceived health effect of yoga. The questionnaire form and content

was designed particularly for this study. It is inspired by the most widely used self reporting

forms regarding personal health, e.g. Short Form 36 Health Survey Questionnaire (SF-36),

Perceived Stress Scale (PSS), Patient Global Impression of Change (PGIC) and other short

form self reporting health questionnaires. In addition there was one open question for personal

comments on what the yoga has meant for each person in particular, question thirteen. This

question was included to obtain qualitative information. All questions are shown in

Appendix-I.

3.2 Intervention

The yoga course was held one time a week for seven weeks. Each session lasted 90 minutes

and consisted of classical hatha yoga. The yoga class had a regular structure that contains

typical issues put in order given by the yoga philosophy (Iyengar 1979).

Table 3.1 – Content of a 90 min yoga class

Table 3.1 shows the content of a typical 90 minute class of hatha yoga (Studentidretten 2010):

Introduction:

Approx. 10-15 min.

“Warming up” starting with approximately very easy yoga / sitting or

lying meditation / body scan / breathing exercises / easy dynamic

movements.

Main part:

Approx. 60-70 min.

Physical postures and dynamical postures (asanas). Dynamical

sequences often referred to as vinyasas or “flows”. Main focus here will

be muscle training for strength in basically all body parts, core muscles

and stability, flexibility, physical balance, coordination and to a certain

level also cardio vascular training e.g. with dynamic flow sequences

such as the “Sun Salutation”. In between the physical activity there will

Bachelor report 2010 – Jan Petter Engvig

often be short breathing spaces; meditative short breaks for selfobservation

and just feeling your body and breath relaxing. Furthermore

it is quite essential to emphasize the intention that is integrated in all the

yoga exercises; all exercises should be performed with full awareness of

the postures and movement, feeling your body and to be present with all

senses. The breath is also at most time included as a part of movements

and sequences. Hatha yoga is also often referred to as “meditation in

movement”. It is from these elements the holistic body-mind aspect of

yoga is most clearly, and it is here yoga differ most from other “sport

activities”. The goal is the personal experience of body and movement,

and than a stronger consciousness of the Self.

Calm down:

Approx. 10-15 min.

The yoga class would typically end similar to the way it started.

Typically, very gentle yoga containing guided meditation, supine

position body scan, breathing exercises.

4. RESULTS

Table 4.1 – Overall results as bar graphs

This bar graph is showing the over-all results from the quantitative study. Y-axis represents

perceived health effect after a 7-weeks yoga course in a scale from 0 to 4, included standard

deviation (SD) error bars. 0 represents no positive effect, 1 = slightly positive effect, 2 =

moderate positive effect, 3 = good positive effect and 4 = very good positive effect.

Bachelor report 2010 – Jan Petter Engvig

0,00

0,50

1,00

1,50

2,00

2,50

3,00

3,50

4,00

1. Musc.skel.

3. Flexibility

4. Strenght

5. Balance

6. Relaxation

7. Body awareness

8. Respiration

9. Mood

10. Stress reduction

11. Headache

12. Life energy

Average

Table 4.2 – Overall results in numbers

The overall results (N = 80) presented as numbers, average score and standard deviation (SD).

A numeric rating scale is from 0 to 4 was used, ranging from no effect to very good positive

health effect. The last column shows how many percent of the population who reported a

positive health effect (rating 1 or better) on each topic.

Question / topic Population

(N)

Average

score

Standard

deviation

% of pop. reported

positive health

Bachelor report 2010 – Jan Petter Engvig

effect

1. musc.skel. pain 56* 2.30 0.71 100%

3. flexibility 80 2.24 1.00 95.0%

4. muscularity 80 1.36 0.97 78.8%

5. balance 80 1.74 1.00 88.8%

6. relaxation 80 2.51 0.94 97.5%

7. body awareness 80 2.36 1.10 96.3%

8. respiration 78** 2.29 1.20 94.9%

9. mood 78** 2.63 1.28 91.0%

10. stress reduction 78** 2.90 0.99 98.7%

11. headache 30* 2.00 1.19 96.7%

12. life energy 77** 2.32 1.11 94.8%

Average of all 80 2.24 0.41 Not calculated

*Only those who had any problems at start point are reported.

**Not reported by all informants.

Table 4.3 – Effect distribution in the population as bar graphs

Table 4.3 shows the distribution of the average health effect score for each individual of the

study population (N=80). On a scale from zero to four, seven people scored less than one, 21

people between one and two, 37 people between two and three, and 15 people scored higher

Bachelor report 2010 – Jan Petter Engvig

than three.

Number of persons

less than 1 between 1 and 2 between 2 and 3 higher than 3

Health effect score

Table 4.4 – Effect distribution showed as percent (%)

Perceived health effect Percent (%) of total population (N=80)

No effect – slightly effect 8.8%

Slightly effect – moderate effect 26.3%

Moderate good effect – good effect 46.3%

Good effect – very good effect 18.8%

4.5 –Personal comments (Question 13)

The personal comment reflects in many ways the results from the quantitative data as many of

the comments are regarding stress reduction, relaxation, life energy and better mood. On the

personal level it’s also clear that the yoga class this once a week has meant much for the

Bachelor report 2010 – Jan Petter Engvig

quality of life for many informants. Some of those who reported to be in very good shape

before the yoga and are doing much additional training, reports also the lowest score on the

quantitative results. For all personal comments, see Appendix II.

5. DISCUSSION

The results of this study suggest that there are several potential health benefits from hatha

yoga. Especially there was shown positive results for health indicators such as relaxation,

stress reduction and better mood. I will in this section discuss the method, the results from my

study, and try to explain what could be the active ingredients in hatha yoga. Furthermore, I

will also discuss if yoga practice is compatible with physiotherapy theory and western health

care of today.

5.1 Method discussion

Regarding the method I want to discuss the fact that this study has focus on self-perceived

health effects and not on objective measurements. It is the personal benefits experienced from

yoga; including mind-body in movements, breathing exercises and meditations I want to

illuminate. Since the study population consists of volunteers, and not everybody in the course

chose to fill in the questionnaire, there might be a different result if all participants had to

answer. Weakness in the study is that I have limited control of what physical activity other

than yoga the study population might do. However, one informant was excluded from the

study because she reported to attend two yoga classes each week instead of one. Furthermore

I don’t have any exactly measurements regarding health status for the start point. However,

information regarding musculoskeletal and headache issues before the course is reported in

the questionnaire. On the other hand, the focus in this study has been the self-perceived

change and the personal experience of health effect after the 7-week course. From a scientific

point of view it would have been of interest to have both empirical data from start-point and

end-point, and also data from objective tests. This might have been e.g. blood pressure and

heart rate-variability regarding stress, serum levels regarding stress hormone cortisol,

oxytocin level in serum regarding relaxation / well-being. On respiration we could have tested

e.g. lung vital capacity, peak expiratory flow. For muscle strength we could have used

standardised test for the main muscle groups. On the other hand, this is far beyond what’s

possible regarding time and resources for a student project. The strength in my study is that I

Bachelor report 2010 – Jan Petter Engvig

have bout a wide range of relevant questions and a quite large study population (N = 80). It is

also a strength that the research questions was design with several established questionnaires

in mind, and the scaling system was inspired from the Patient Global Impression of Change

and Numeric Rating Scale. To have such standardised systems as guidelines is an advantage

for making an adequate questionnaire. The reason for choosing a 7-week course is that this is

the standard length for all yoga courses at Domus Athletica. There are also reasons to believe

that such a long period of time is needed in order to register any significant effects. This 7-

week yoga course can also to some degree be compared with the 8-week MBRS program, a

well-established intervention method that is frequently used regarding non-communicable

diseases and health issues often related to stress and life style.

5.2 Results discussion

1 & 2 – Musculoskeletal issues

In this study 56 informants reported that they had some kind of musculoskeletal problems at

the starting point of the 7-week yoga course. All of these reported a positive effect of the

intervention and had an average score of 2.30 (SD = 0.71), indicating that they had a

moderate to good positive effect for their issues. Most of the reported problems were related

to back, neck and shoulder pain. We know from yoga theory about the different ansanas

(physical postures) and vinyasas (dynamic flows), that many of these are quite similar to

those used in typical physiotherapy sessions for back, neck and shoulder problems (Iyengar

1979; Kisner & Colby 2002). As examples for lower back pain the physiotherapist, after a

physical examination, will typically recommend exercises for motor control and strengthening

of core musculature for better stability (Hodges 2003). Similar exercises are also among the

most common asanas in traditional hatha yoga. It should therefore be logical that these asanas

might have a positive effect on musculoskeletal issues. Furthermore, there exist also several

scientific studies supporting the beneficial effect of yoga for issues like for example low back

pain (Hem 2006; Sherman et al. 2005; 2007; Williams et al. 2005; 2009). For a general

review on the psychophysiologic effect of hatha yoga on musculoskeletal function I refer to

Dr. James A. Raub’s article from 2002 (Raub 2002). My postulate will therefore be that the

active ingredients in yoga regarding musculoskeletal issues might be the asanas and vinyasas.

Other ingredients might be the respiratory exercises and relaxation techniques. Both these

factors are important regarding muscular tension and pain (Bunkan 2008). Nevertheless, from

a physiotherapy point of view, one should be critical to some of the yoga postures if the client

Bachelor report 2010 – Jan Petter Engvig

is suffering from severe back pain. If the client is new to yoga and not very flexible, some of

the asanas might be to extreme and do more harm than good. In such cases it would an

advantage if the yoga teacher also had good knowledge about physiotherapy. If not, the client

should receive some advices from a physiotherapist or a medical doctor before attending a

yoga class. However, it’s in the yoga philosophy not to push limits regarding pain, but always

listen to the body (Iyengar 1979).

3 – Flexibility

Of all 80 informants in my study 95 % reported that they had a positive effect regarding this

topic. The average score was 2.24 (SD = 1.0), indicating that the participants had a personal

experience of a moderate to good effect. Since much time is spent on stretching during the

yoga class, this result must be considered reasonable. 8.8 % of the study population reported

very good effect (score 4). In yoga flexibility is also considered to be of great importance, and

much emphasise is put on this issue. Hatha yoga includes hundreds of exercises for stretching

and flexibility (Iyengar 1979). There should be reasons to say that these exercises are the

active ingredients regarding the effect of increased flexibility. Flexibility will be a result of

joint mobility and muscle length and is one of the core elements physiotherapists will look for

in a physical examination (Fyrand et al. 2006).

From a physiotherapy point of view it’s considered that to have a flexible body is a

fundament for being able to do the normal movements for activities of daily living. Advises

regarding flexibility exercises should be an important issue in physiotherapy. There are also

reasons to look critically at some of the most extreme stretching asanas in yoga and know that

these are not advisable for beginners.

4 – Muscular strength

This issue showed the lowest score in the study. However, as many as 78.8 % of the test

population reported a positive effect and the average score was 1.36 (SD = 0.97). From sport

science theory we know that if we are going to gain good effect from strength training there

should be a minimum of two-three practices a week. For the best effect regarding maximum

dynamic muscular strength the energy level during training should be 80-100 % of max, 1-6

reps x 3 (Fyrand 2002). In the yoga intervention the persons had only one class each week.

Furthermore, since yoga techniques don’t use external weights there are only infrequently

sessions of 80-100 % maximum intensity in a beginner’s class of hatha yoga. I have reasons

to believe that these factors may contribute to the low score for this topic. On the other hand

Bachelor report 2010 – Jan Petter Engvig

the 1 RM value (one repetition of maximum, kg) would differ much from person to person,

and those who is not used to weight training before starting with yoga might experience many

of the asanas as 80-100 % of 1 RM. However, from the personal comments I noticed that they

who do much training besides yoga scores low on the muscle strength topic (e.g. informant

#31). Other forms of yoga, like Ashtanga or Power yoga, would probably give a better effect

regarding muscular strength since in these forms of yoga there is more focus on this issue.

Muscular strength is a topic of great concern in physiotherapy. We need a certain level of

muscular strength to be able to have a normal active life (Kendall et al. 2005).

Physiotherapists with knowledge in sport science and training theory should be well qualified

to give advices regarding how to increase muscular strength.

5 – Balance

In the present study 88.8 % of the informants reported positive effect regarding balance with

an average score of 1.74 (SD = 1.0). This result indicates that the effect was perceived as

close to moderate good. In a typically yoga session there are several balance exercises, and

there exist dozens of different asanas for this purpose. In yoga philosophy balance training is

also considered as an exercise for concentration and mental balance. However, as for the

result for muscular strength, the result regarding balance in this intervention showed only

moderate effect. This may be explained due to the fact that also balance training needs more

sessions a week to gain higher effect (Johannessen 2009). Balance or postural control is also

one of the keystones in physiotherapy. Postural control is of great importance for the

development of motor control for infants. For adults, especially for elderly people, postural

control is important in maintenance of function in daily activities. Research has also shown

that good postural control is positively correlated with better mental balance and vice verca

(Brodal et al. 2006). From a physiotherapy perspective, focus on balance training is advisable

for many aspect of quality of life.

6 – Relaxation

The question here was if the person experienced an increased bodily relaxation response,

ability to relax, from yoga. 97.5 % of all participants in this study reported that they had

experienced a positive effect regarding relaxation ability. The average score was 2.51 (SD =

0.94), meaning that they perceived the effect as moderate to good positive effect.

Furthermore, 10 % of the study population reported that they experienced very good effect

(score 4) regarding relaxation. The results indicate that regular yoga practice for 7-weeks

Bachelor report 2010 – Jan Petter Engvig

contribute to a self-perceived relaxation response. Since yoga practice have so much focus on

this topic the result in this study seems logical. Commonly for this 7-week course the class

would both start and end with relaxation response inducing sessions. As for other kinds of

training, the results often follow a dose-response correlation (Østerås & Stensdotter 2002). In

this intervention we had a relatively large dose of relaxation exercises and gained a response

that seems to be reasonable according to this. From physiotherapy theory we also have similar

approaches for inducing a relaxation response. As an example we can use postures that gives

wide support and grounding, and that improve basal respiration, relaxation techniques, and

different respiratory exercises as described by e.g. Bunkan (2008) and Thornquist (2003). In

physiotherapy relaxation inducing exercises might be recommended e.g. regarding

psychosomatics, muscular tensions, fatigue and also for asthma (Ibid).

7 – Body awareness and awareness about physical posture

96.3 % of the study population experienced an achieved effect regarding body and posture

awareness. The average score was 2.36 (SD = 1.10) meaning between moderate and good

effect. However, as much as 18.8 % of the people reported that they had very good positive

effect (score 4) on this topic. In the yoga classes during the 7-week course there was

extensively emphasize on body awareness and posture. This is one of the most important

factors in yoga philosophy – doing yoga exercises without awareness is simply not yoga. The

thorough focus on awareness during all yoga classes might explain the good result on this

topic.

Body awareness is also a core issues in physiotherapy. Some of the first things we

learn during physiotherapy education about patient examination are to observe and analyse

the person’s physical posture; supine, sitting standing and walking (Gross et al. 2002). This

observation and analysis is often the basis for finding out what is wrong with the patient.

From these findings we try to see if we can improve the patients problems by doing

corrections of the posture. For the patient to be able to feel any incorrect posture pattern at all,

he also needs to have some degree of awareness of his body. And furthermore, to be able to

do the corrections he certainly needs to have awareness of his body. Therefore, body

awareness can be said to be a fundament for a good physical posture and for being able to

perform adequate, stable and flexible movements. For this reason working with body

awareness and postures are important in a physiotherapy intervention (Thornquist 2003). This

focus on body awareness is also shared by therapeutically methods like e.g. Mencendieck

(1937), Feldenkrais (1972), “Awareness through movement”, Alexander technique (Brennan

Bachelor report 2010 – Jan Petter Engvig

1997) and “Body Awareness Therapy” (Roxendal 1985) which are methods often used by

physiotherapists.

8 – Respiration

Several informants reported positive personal experiences regarding respiration like informant

# 61: “ I have trouble with my breathing in stressful situations e.g. during exams, where I feel

that I’m not able to inhale. This problem is completely gone now”. Informant # 62 is saying:

“The best parts are breathing exercises, the focus and inward observation. Breath and

meditation dissolve much of my tensions and stress”. The quantitative results on this topic

showed that 94.9 % of the study population experienced a positive effect. The average score

was 2.29 (SD = 1.2), meaning that they perceived the effect as moderate to good. However as

much as 19.2 % of the people reported very good effect (score 4). These results would be

reasonable in contrast to the focus there is on breathing in yoga practice, and the doseresponse

relationship seems to be as expected.

Breath is one of the keystones in yoga philosophy and “Pranayama” is the common

yoga-word for breathing exercises, meaning “breath control” or “life force”. Pranayama is one

of the eightfold paths of yoga philosophy and is regarded as one of the main means for

rejuvenating the body and clearing of the mind (Feuerstein 1997). There are several specific

breathing exercises where the breath is the main focus, but breath will also always be a natural

part of the asanas and vinyasas (Iyengar 2001). Several of these postures and exercises has the

intension to open up the thorax, stretch the m. pectoralis minor and major,

sternocleidomastoideus, accessory respiratory muscles and to give more free space for the

lungs. Other common breathing exercises have a more mindful approach where you just

observe your breath and the motion your breath is making in your body (abdomen, back,

thorax etc). In this exercise you don’t try do control anything, just observe – be aware of the

perception of breathing. This approach is also very much used in the Mindfulness Based

Stress Reduction program as described by PhD Jon Kabat-Zinn at University of

Massachusetts Medical School (1990), and also by professor emeritus Andries Kroese at Aker

University Hospital, Oslo Norway (1999).

Respiration is an issue of great concern in physiotherapy because it’s so tightly linked

to body posture, musculoskeletal issues, and physiological processes in the body and also to

psychological factors (Bunkan 2008). Therefore, focus on the breath is considered important

also in physiotherapy.

Bachelor report 2010 – Jan Petter Engvig

9 – Mood

Questions about a persons mood is frequently used for scaling the “quality of life” or in

mapping health status regarding psychological factors and psychosomatics. If a person is in a

good mood he is also likely to tackle stress better and have a lover perception of pain (Holden

1996; Villemure 2002). Furthermore, several studies shows that to generally be in a good

mood might also contribute to a better health status overall (Holden 1996). There exist special

yoga classes where the focus is to stimulate laughter (laughter-yoga). However, in a classical

session of hatha yoga, there is little directly focus on humour, but the intention for the class is

always gently and friendly. Relaxation techniques and meditation for calming the mind and

body will also lead to a experience of better mood, simply because this a part of the

physiological relaxation response. Taking away tension and fear induces peace and joy

(Benson 1976). There are reasons to believe that these factors are among the active

ingredients in mindfulness and yoga regarding bettering the mood (Vøllestad 2007).

91 % of the study population reported a positive effect regarding better mood from yoga

practice, and 28.2 % experienced very good effect (score 4). However, the average score was

2.63 (SD = 1.28). As a general comment of this positive result I think that the high score on

this topic might be explained by the fundaments of yoga, the yoga philosophy, that have much

attention on loving kindness, non-violence, stress reduction, meditation, energy flow and life

force. These aspects are well documented in scientific studies by for example PhD Jon Kabat-

Zinn (1990). Furthermore there are reasons to believe that physical activity in it self, such as

hatha yoga, will have a positive effect on a persons mood and feeling of well-being (Hoffman

2007; Martinsen 2004). This ingredient may also contribute to the positive result on this topic.

The fact that the yoga class is a group, commonly 10-20 people, may also contribute to a

positive effect regarding better mood due to psychosocial group dynamics (Ibid). The holistic

approach f yoga might be another important psychological factor that explain the positive

effect regarding better mood. The focus on the awareness of the whole mind-body – the

experience of being a human; bodily sensations, pain, itching, temperature, hearth-beat, your

breath, emotions and thoughts. And at the core of this you will experience the Self – the core

feeling of your personal self, being who you are. The psychiatrist Roberto Assagioli argued

that this can contribute in obtaining personal insight and bring clarity, peace and enhanced

well-being (Assagioli 1965). Another factor of psychological character is the perception of

the “here and now” or “being present” which is greatly emphasized in mindfulness and yoga

(Iyengar 1979; Kabat-Zinn 1990). Many of the positive effects about this are described by

Bachelor report 2010 – Jan Petter Engvig

world known psychiatrist Fritz Pearls (Clarkson & Mackewn 1993). Furthermore the research

scientist Benjamin Smith is describing the feeling of “ecstasy” that may appear during a yoga

class where the mind-body are in harmony (Smith 2007). Some of the same phenomena is

described as “flow” or to be in the “zone”, by Mihaly Csikszentmihalyi (1988), when your

body seems to be in perfect harmony during a movement in physical activity. All factors

described above might help us understand what kind of “active ingredients” which exist in

yoga, and this can in a rational way explain the positive effect regarding mood.

With respect to physiotherapy theory I would look to Per Brodal (2007) and try to

understand the effect on mood according to reduced sympaticus activity and maybe increased

serum levels of oxytocin as a results of the “active ingredients” listed above. Theory from

physical activity and mental health can also be applied here (Martinsen 2004).

10 – Stress reduction

Stress reduction is one of the core topics in yoga philosophy. This is also the general

impression many people have about yoga – and its stress reducing qualities is also well

documented in many scientific studies (Lamb 2004). In the present study 98.7 % of the study

population experienced a positive stress reducing effect from yoga. This means that only one

person of 78 in total reported no effect (score 0). 23 persons out of 78 reported very good

effect (score 4) on this issue. In other words – one out three persons had a very good positive

effect from yoga regarding stress reduction. A normal pharmaceutical intervention on

psychosomatic issues will typically be much lower (Masi et al. 2010). The average score in

the yoga intervention was 2.9 (SD = 0.99), meaning that most people experienced the effect as

“good positive effect” (score 3).

The positive result and high score on the stress reduction topic may be explained by

the fact that many of the activities in a typical hatha yoga class has the intension to induce a

relaxation response – and the experience of such a response is typically perceived as “stress

reduction” (Lamb 2004, Benson 1975). On a psychological level, we can say that “stress

reduction” is for example increase of subjective well-being, decrease of anxiety, increase in

somatic awareness and self-acceptance. On the physiologically level it may involve decrease

of muscular tensions, decreased blood pressure, pulse rate, stabilizing the autonomous

nervous system, EEG alpha waves increase, respiratory and cardiovascular efficiency

increases, better conditions for circulation, and stimulation of the psychonevroendocrine and

psychonevroimmune-systems (Berntson et al. 2007; Booth 2005; Kiecolt-Glaser et al. 2010,

Kroese 1999; Lamb 2004).

Bachelor report 2010 – Jan Petter Engvig

To understand this effect from a physiotherapist viewpoint I will refer to Bunkan

(2008) and Thornquist (2003). Many of the techniques described there have also the same

intention as in yoga, namely to reduce sympaticus activity and to increase parasympaticus

activity.

11 – Tension headache

In the present study 30 informants reported to have problems regarding tension headache at

the beginning of the 7-week yoga course. 29 of these people (96.7 %) reported a positive

effect with an average score of 2.0 (SD = 1.2), which means moderate good positive effect.

However, as many as 20 % of the individuals in the headache group reported very good

positive effect (score 4).

Tension headache is also named stress-headache in Norwegian physical medicine (Juel

1999). This issue is of great concern for many people in daily life, and in severe cases tension

headache might develop or be the first stage of migraine. In these cases headache can be

disabling and is perceived as a major health problem (Bond 2006). The pathogenesis of

tension headache is not fully known in detail, but literature suggest that the problem is

connected with tensed muscles in the region of the shoulder arch, neck, jaw or head (Juel

1999). Typical muscles involved are m. trapezius, levator scapulae, sternocleidomasoideus,

splenius, semispinalis capitis, suboccipitalis, masseter and others (Davies 2004; Fyrand et al.

2006). Furtermore it’s most likely to believe that psychologic factors like anxiety, depression

or stress are major factors involved in tension headache (Bond 2006). One of the commonly

non-pharmacological interventions used against tension headache are relaxation techniques

(Ibid.) Some of the effect is than explained by the fact that you will reduce the tension both in

muscular structures and emotional tensions. We also know from Butler & Moseley (2003)

that a reduced level of stress and anxiety will reduce the central modulation of pain signals

and so will the perception of pain. Since there is scientific evidence of the stress reducing and

relaxation effect from yoga, there should be reasons to believe that this will induce a positive

effect regarding tension headache. The fact that there is much emphasizing on stress

reduction, relaxation and stretching of muscle groups in relevant areas might explain this

positive result.

The understanding of a headache problem from a physiotherapy perspective would be

based on an anamnesis and physical examination in order to difference tension headache from

cervicogenic headache. Treatment of tension headache would be based on the understanding

Bachelor report 2010 – Jan Petter Engvig

that the cause of the problem often is referred to tensed muscles in the head and neck area

(Fyrand et al. 2006).

12 – Life energy

Life energy is considered very important in yoga and the Sanskrit word for life energy or life

force is “prana” (Feuerstein 1997). Prana is one of the goals in yoga practice and much

emphasize is put on this issue in yoga philosophy. In my study as many as 94.8 %

experienced a positive change regarding life energy from doing yoga. The average score was

2.3 (SD = 1.1), which means between moderate to good positive effect. 17.9 % of the study

population experienced a very good positive change (score 4).

Life energy is not an easy issue to measure in an objective way because the term “life

energy” or vitality is not something that can be calculated by a physic parameter like Joule,

the SI standard for energy. Therefore must this “unit” for life energy in human in this study be

measured in a client centred way, and the outcome must reflect the individual’s perspective.

This way of thinking is common for several health survey forms and often referred to as

individualized outcome measures (Carswell & Donnelly 2002). Life energy is for example a

topic on the questionnaire used by the Norwegian association for the study of pain (Fredheim

et al. 2008). Life energy will often be positively correlated to mood and well-being, and

negatively correlated with stress. Life energy is also closely related to vitality, and can be an

indicator on quality of life (Ware & Sherbourn 1992).

I will try to explain the positive result in the present study by looking at the correlation

with stress reduction, relaxation and mood. All these factors also gave high scores in the study

and there are reasons to believe that an increase on these fields will achieve a better feeling of

life energy. There should also be reasons to listen to more than 3000 years of experience from

the yogi masters and take into consideration that their philosophy about prana might have

some significance (Iyengar 2005). As said about yoga in the personal comment from

informant #21: “a source for the joy of life”, informant #60: “it gives me more energy rest of

the day” and informant #68: “It gives me life energy and well being”.

In a physiotherapy context I can understand this issue with the background on what is

described in the literature about the autonomous nervous system, psychosomatics and

physical activity by e.g. Brodal (2007), Bunkan (2008), Martinsen (2004) and Thornquist

(2003).

Bachelor report 2010 – Jan Petter Engvig

13 – Personal comments

Issue 13 was an optional question and 25 out of 80 informants gave feedback on this. The idea

here was to have some qualitative information from the participants and reflects what the 7-

week yoga course has meant on an individual level, but no names are mentioned. However,

what we can read from these personal comments reflect much of what we read out of the

quantitative results. Many of the comments are highly positive and tells about increased body

awareness, breath control, relaxation, stress reduction and a sense of well being. These

comments seams to be logical when compared to the quantitative results for these topic. On

the other hand there are people who report that they probably would have gain a better effect

if there had been more than one yoga class each week. This is also as expected if we look to

theory on dose-response in physical training. One session a week is probably not enough

regarding muscle training. On the other hand the general impression from the personal

comments are highly positive and it seams like the yoga really means much for the everyday

quality of life for many of the informants on a personal level. Examples which can reflects

this may be: “This has been the highlight of the week for me”, “Yoga has been of great help

for me”, “It gives me life energy and well being”. (For all personal comments see table

Appendix II. The comments are anonymous.)

6. CONCLUSION

This study indicates that there are several health benefits from a 7-weeks hatha yoga course.

Positive effect is reported on all 12 questions asked typical for physiotherapy issues like

musculoskeletal problems and psychosomatics. The weakest effect was shown for muscular

strength and the strongest effects were found for stress reduction, relaxation response and

better mood. The results indicate much of the same trends that are reported in previous

scientific papers on this topic. From literature studies I have found arguments that might

illuminate the active ingredients in hatha yoga with respect to health effect. First, hatha yoga

is a form of physical activity, and there is now a broad consensus among scientists that

physical activity is an effective intervention with respect to several important health issues

and non-communicable diseases (WHO 2010). Second, the focus on breathing exercises in

yoga is shown to have a positive effect on the respiratory system, and also on

psychophysiology since breath and mind-body are so closely interconnected (Coulter 2001).

Third, the yoga philosophy with its focus on mindfulness, awareness, “here-and-now”

attention, non-striving, non-judgemental, acceptance, insight to Self, and self-compassion is

proven by modern psychology to be important factors in psychological processes leading to

Bachelor report 2010 – Jan Petter Engvig

improvement regarding depression, empowerment and self-efficacy (Assagioli 1965; Iyengar

2001; Vøllestad 2007). When all these active ingredients are put together in one unity (literary

yoga), the outcome seams to be positive. Regarding physical therapy I have discovered that

many of the physical exercises in hatha yoga are much the same as found in therapeutically

exercises from physiotherapy (Kisner & Colby 2002). In this respect yoga can be said to be

compatible to physiotherapy. Both systems are also based on a holistic philosophy regarding

humanity (Iyengar 1979; NFF 2006). We know that non-communicable diseases and life style

problems related to stress and physical inactivity are a major public health problem in Norway

and the western world (Brudevold 2008; Merson et al. 2006). With the background from

existing scientific data there should be reasons to look at hatha yoga as a suitable intervention

for fighting these problems. For further research it would have been interesting to have done

the 7-week yoga intervention in a randomised controlled study, and also with objective

measuring parameters, and not only self-perceived health effects.

7. APPENDICES

Appendix 1 – Questionnaire / research questions.

Question no Research questions as given in the questionnaire

# 1 If you have had any problems related to musculoskeletal pain, has it become

Bachelor report 2010 – Jan Petter Engvig

better after the yoga course?

# 2 If there have been an improvement, in which part(s) of the body has it been?

E.g. back, neck, shoulders, …?

# 3 Have you noticed any improvement regarding your body flexibility?

# 4 Have you noticed any improvement regarding your general muscle strength?

# 5 Have you noticed any improvement regarding physical balance?

# 6 Have you noticed any improvement regarding body relaxation?

# 7 Have you noticed any improvement regarding body awareness / become more

aware of your own body posture?

# 8 Have you noticed any improvement regarding your breathing?

# 9 Do you think that yoga practice sets you in a state of better mood?

# 10 Do you think yoga practice has a stress reducing effect for you?

# 11 If you use to have tension headache, has this become better after yoga

practice?

# 12 Do you feel that yoga practice gives you more excess energy for the activities

of daily living?

# 13 Personal comment: Write more specific if there is aspects of particular interest

that has been of great importance for YOU during this yoga curse.

Appendix II – Question 13 / Personal comments

The table shows the personal comments from section 13 in the questionnaire. The quotations

are anonymous regarding name of the informants, so only gender and age are referred. This

was an additional question so not everybody has filled in comments (N = 25 of 80).

Informant Gender Age Comment

# 11 Male 41 “The highlight of the week”

# 17 Female 26 “I’m in the last phase of my master degree study and feel that

yoga have been my way to hinder muscular tension due to

extensive work on pc this period. In particular it has been of

special importance to look forward to 90 min where I HAD to

Bachelor report 2010 – Jan Petter Engvig

relax. This has been the highlight of the week for me in this

period”

# 19 Male 40 “I’m think it is exciting to do strength training combined with

the breath, in addition to martial art training”

# 20 Male 31 “”Yoga really does something with you…You become addicted

in a way, and are looking forward to the next yoga class. It’s

good for the soul!! Yoga is also dependent on how the teacher

behave.”

# 21 Female 32 “Yoga is a space liberation, and a source for the joy of life”

# 22 Female 24 “Very good”

# 23 Female 23 “Respect for the body. Awareness about muscular tensions.

Works as a general relaxation (also in between the classes).

Great in combination with other kinds of physical training”

# 24 Female 25 “Yoga is beneficial for mostly everything, stress, mood etc..”

# 25 Female 22 “I think I would have had greater benefits from yoga if it was

more classes each week. Anyway, the point is that I can bring

this knowledge from the class back home and make beneficial

on my own.”

# 29 Female 54 “I really want to keep on and integrate yoga as a life-style. Very

inspiring and relaxing.”

# 31 Female 25 “I was in a very good shape before the yoga course. I do yoga

for stretching / flexibility and relaxation. Because of this I don’t

think the yoga classes alone is the reason for my progress, but

the sum of all training I do. I’m positively surprised that

relaxation techniques actually works – I believed that this was

superstitious only” (OBS – This persons had one of the lowest

individual scores.)

# 35 Female 26 “I believe more yoga classes are necessary before I can gain any

positive effect. This is my first course”

# 38 Female 23 “Yoga class day has become my day of relaxation. Very lovely

in hectically periods

”# 40 Female 27 “What has been important to me is: time for relaxation and to

learn about relaxation techniques”

# 51 Male 51 “Yoga has been of great help for me”

# 52 Female 26 “It has been important to learn how to find time for taking care

of my own body, not just rush / stress in everyday life. To

increase my body awareness, where are the tensions located, to

learn about health prevention, relaxation techniques”

# 55 Female 21 “The yoga course has given me a better body posture, and better

respiration”

# 59 Female 33 “It is nice to really calm down this one time a week”

# 60 Female 21 “Lovely and relaxation, stress reducing and it gives me more

energy rest of the day”

# 61 Female 21 “I have trouble with my breathing in stressful situations, e.g.

during exams, where I feel that I’m not able to inhale. This

problem is completely gone now. In general I have also become

more relaxed in my whole body”

# 62 Female 37 “The best parts are breathing exercise, the focus and inward

observation. Breath and meditation exercise dissolve much of

Bachelor report 2010 – Jan Petter Engvig

my tensions and stress. It also makes me more aware of how I

cope with stress in daily life”

# 64 Female 21 “I’m looking forward to every yoga class

”# 65 Female 22 “I’m learning to stay focused and to relax. I really want to

continue with yoga”

# 68 Female 29 “I’m addicted to this weekly class of yoga with exercise,

stretching and relaxing. It gives me life energy and well-being”

# 78 Female 55 “I have become aware of the sensation of the breath and the

connection to the exercise movements and how this works on the

body – it was fun. After yoga training the body feels very nice

and smooth – it is so relaxed. It’s a good feeling”

Appendix III – Informasjonsskriv og samtykke

Du som deltager på yogakurs ved Domus Athlectica inviteres herved til å delta i en

spørreundersøkelse angående selvopplevd helseeffekt av yoga.

Undersøkelsen er anonym slik at personlig informasjon ikke kan spores til deg. Ingen navn og adresse skal skrives på

skjemaet. Kun kjønn og alder nteres.

Det er frivillig å delta, og du trenger ikke oppgi grunntil å si nei. Samtykke gjøres muntlig på stedet. Data fa denne undersøkelsen skal brukes til en

Bacheloroppgave i fysioterapi ved Høgskolen i Oslo.

Bachelor report 2010 – Jan Petter Engvig

Prosjektets tittel er ”Self-percived health effect from hatha yoga” og formålet med oppgaven

er å se om deltagerne ved et 7-ukers yogakurs ved Domus Athletica kan oppleve noe

helsegevinst av dette. Spørsmålene vil være typiske for det som er vanlige innenfor

fysioterapi.

Spørsmålene (1-12) er standardiserte og det skal svares med utkryssing på en skala fra 0 til 4,

og resultatene skal brukes til kvantitativ metode i oppgaven.

Spørsmål 13 er ment for utfyllende opplysninger om hva yoga har betydd for deg personlig,

men navn oppgies heller ikke her. Dataene brukes i kvalitative metode.

Spørreskjema utdeles og samles inn etter siste yogatrening i uke 7 av kurset. Utfylling skjer

på stedet. Spørsmål kan stilles hvis det er noe dere lurer på. Skjema legges i konvolutt slik at

ingen uvedkommende ser hva dere har skrevet. Kun undertegnende vil se skjemaene i ettertid

for databehandling av resultatene og har taushetsplikt om evt personlige forhold. Evt.

personlig data holdes konfidensielt.

Prosjektet avsluttes 5.mars 2010, og resultatene fra studien leves da som en bacheloroppgave.

Ingen personlige opplysninger kommer frem her utover data fra spørsmål 13 som kun er

korrelert til kjønn og alder. Utfylt spørreskjema makuleres etter at oppgaven er levert.

Forsker er underlagt taushetsplikt og evt. personlig data behandles konfidensielt.

Fysioterapistudent:

Jan Petter Engvig

Høgskolen i Oslo

Avd for Helsefag

Pilestredet 50

0130 Oslo

8. REFERENCES

Antonovsky, A. (1979)

Health, Stress and Coping. San Francisco: Jossey-Bass.Anderberg, U.A. & Horwitz, E.B. (2008) Fibromyalgi –

Årsak og behandling. Oslo: Cappelenforlag.

Aldwin, C. (2007)

Stress, coping and development. Second edit. New York: The GilfordPress.

Assagioli, R. (1965)

Psychosynthesis. New York: The Viking Press.36

Bachelor report 2010 – Jan Petter Engvig

Benson, H. (1975)

The Relaxation Response. New York: William Morrow & Co, Inc.Berntson, G. et al. (2007)

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