Edward Kim, MD, Portland VA Medical Center
Barry Oken, MD, Oregon Health & Science University
There is significant growing interest in complementary and alternative medicine (CAM) as options for treatment in MS. In fact, it is estimated that as many as 65% of patients with MS have used some form of CAM. Among the variety of different CAM therapeutic approaches, interest has particularly emerged in the mind-body medicine approach of yoga.
Yoga is an ancient Indian, non-religious approach that focuses on meditation, mindfulness, breathing, and postures. In the practice of yoga, the practitioner places their body in a series of stationary positions. Each position is designed to create particular body alignments that utilize an important balance of isometric contractions and relaxations. At the same time that there is an essential relaxation component to yoga, there is also an emphasis on controlled positioning and breathing methods to exercise concentration.
While MS research in yoga and other types of mind-body medicine approaches have been mostly exploratory, the results of the studies support their potential benefits. First of all, many with MS have reported satisfaction with the practice of yoga. In a survey of 1,980 people with MS from Oregon and southwest Washington, 30% responded that they had participated in yoga classes. Of that group, 57% reported that the use of yoga was “very beneficial.” In a 6-month randomized clinical trial of yoga in MS, benefits to fatigue and energy were demonstrated. In this study, 69 people with MS were randomly assigned to one of three groups: weekly yoga class, weekly stationary bicycle exercise, and a waiting list control group. (People in the control group were placed on a waiting list before they enrolled in either the yoga or exercises classes after 6 months.) After the 6 month study period, both of the active groups assigned to either yoga or stationary bicycle exercise demonstrated improvements compared to the control group in the areas of energy and fatigue. As anticipated, there were no adverse events directly related to the practice of yoga in the study.
Mind-body therapies like yoga are also a practical therapeutic approach in MS because of their low risk of physical or emotional stress. In general, the financial cost of yoga therapy is also relatively low. The exercise of yoga also allows people with MS to engage in their treatment in a very active and engaged manner. While the physiologic mechanism of yoga’s symptomatic benefits in MS are not entirely known, there are reasonable theories proposed. First, there appears to be benefit in MS from participation in any regular physical activity like yoga. Multiple studies have suggested that any physical activity alone may be associated with improvements in quality of life, fatigue, and mood. Some hypothesize that yoga may additionally improve cognitive ability by exercising one’s attention on focused breathing and positioning techniques and by generally improving mood and reducing stress.
Despite yoga’s potential symptomatic benefits, it remains important to emphasize here that yoga practice has no evidence for any effect on the underlying MS disease process. Other MS disease modifying medications should be continued as previously prescribed by the treating physician even while practicing yoga.
Before deciding to participate in yoga or other mind-body medicine approaches, there are important choices to consider. First of all, not all yoga practices are the same. Some types of yoga may even be risky for patients. For example, Bikram yoga is performed in very hot temperatures that may worsen MS symptoms in patients vulnerable to heat sensitivity. Other practices may be too difficult due to their demands on physical strength, balance, and flexibility. Certain practices of yoga that incorporate props or supports may actually be better than others for people with strength, balance, or flexibility limitations. We advise consulting with a yoga instructor before signing up to participate in a class. With the right class and instructor, yoga practices may be further modified to better address the needs of each individual with MS. It may just be right for you!
Last Updated: November 2009