A. Specific Aims

Yoga is an exercise practice that involves the union of the mind and body through stillness, meditation, control of breath and movement in order to stretch and strengthen tendons, ligaments and muscles. Yoga has been practiced for thousands of years over which time many different types and styles of yoga have been developed. There are many studies that have validated yoga’s ability to illicit changes in a variety of human conditions.[16] The current study will provide an accurate and comprehensive understanding of the ability of yoga to improve the quality of life of individuals suffering from a variety of human conditions including but not limited to general pain, back pain, fibromyalgia, osteoporosis and stress-related conditions.

My hypothesis is that: consistent yoga practice modified to the conditions of the individual participant will reduce pain, stress and improve the quality of life of the yoga participant.

My goal is: to show that everyone can benefit from a consistent yoga practice no matter what level of human condition, pain or stress the individual is experiencing. Three Specific Aims are applicable in order to do this, but the third Specific Aim, specifically with respect to the dose response of yoga, will be the main focus of this study.

Aim 1:

Define the variety of conditions for which yoga has been studied. Aggregate the various studies that have been done on yoga and determine which are most relevant and effective.
Challenge: To gather enough data on yoga which has been done for thousands of years but has only recently been studied in a scientific setting.
Approach: I will utilize a variety of resources in order to gather the data necessary to show the impact of yoga on pain relief, stress reduction and any other human conditions I can find the necessary studies on.
Impact: The data will provide a comprehensive overview on the effects of yoga on a variety of human conditions and its short and long-term impact on the yoga participants.

Aim 2:

Identify the governing mechanisms of yoga on improvements in quality of life. Identify the specific types of yoga asana postures that are creating the best improvements in quality of life.
Challenge: To determine which yoga asanas are most beneficial to individuals with respect to improving their quality of life by reducing pain, relieving stress or other researched dynamics.
Approach: I will analyze existing studies to find a correlation between specific yoga asanas in order to determine what has been found to be most beneficial.
Impact: The data will provide a measure of the various elements of yoga asanas and their respective impact upon a person’s quality of life.

Aim 3:

Design, implement and validate the most effective yoga practice dose response that will improve one’s quality of life. Design and test a yoga practice with respect to dose response that will show the best results for alleviating pain, stress and improving one’s quality of life.
Challenge: To be able to get individuals to be consistent with their yoga practice either on their own or in a group setting over an extended period of time with which to determine results.
Approach: I will apply the results from a literature review of Aims 1 and 2 to design a dose response study for individuals so that they can use this knowledge to improve their quality of life.
Impact: I will create a new yoga practice and series of twenty postures based upon dose response so that individuals can either practice on their own or in a group setting in order to maximize the benefits from yoga and make the best use of their time available for this ancient practice in order for the individual to see the best improvements in their quality of life.

Background & Significance

(a) Significance

The practice of yoga and more specifically the yoga limb of asana, which is the aspect of yoga that consists of holding postures for extended periods of time, contains great possibilities for improving the health and well being of a variety of populations.[16] Yoga has been utilized for thousands of years by diverse populations and has also been the subject of many scientific studies showing its ability to reduce pain and increase flexibility among many other things.
What the Science Says About Yoga
Current research suggests that a carefully adapted set of yoga poses may reduce low-back pain and improve functionality of the body.[17, 18, 20] Other studies also suggest that practicing yoga (as well as other forms of regular exercise) might improve quality of life; reduce stress; lower heart rate and blood pressure; help relieve anxiety, depression, and insomnia; and improve overall physical fitness, strength, and flexibility.[7]
One NCCIH-funded study of 90 people with chronic low-back pain found that participants who practiced Iyengar yoga had significantly less disability, pain, and depression after 6 months.[7]
In a 2011 study, also funded by NCCIH, researchers compared yoga with conventional stretching exercises or a self-care book in 228 adults with chronic low-back pain. The results showed that both yoga and stretching were more effective than a self-care book for improving function and reducing symptoms due to chronic low-back pain.[7]
Conclusions from another 2011 study of 313 adults with chronic or recurring low-back pain suggested that 12 weekly yoga classes resulted in better function than usual medical care.[7]

Yoga (Sanskrit, Pāli: Yóga) is a physical, mental and spiritual discipline, originating in ancient India.[1][2] “Asana (Sanskrit āsana [sənə] 'sitting down', ās 'to sit down'[1]) is a body position, typically associated with the practice of Yoga, originally identified as a mastery of sitting still,[2] with the spine as a conduit of biodynamic union. In the context of Yoga practice, Asana refers to two things: the place where a practitioner (Yogin (general usage); Yogi (male); Yogini (female)) sits and the manner (posture) in which he/she sits.[3] In the Yoga sutras, Patanjali suggests that Asana is "to be seated in a position that is firm, but relaxed" for extended, or timeless periods.[4]

As a repertoire of postures were promoted to exercise the body-mind over the centuries, to the present day when Yoga is sought as a primarily physical exercise form, modern usage has come to include variations from lying on the back and standing on the head, to a variety of other positions.[5] However, in the Yoga sutras, Patanjali mentions the execution of sitting with a steadfast mind for extended periods as the third of the eight limbs of Classical or Raja Yoga,[6] but does not reference standing postures or kriyas. Yoga practitioners (even those who are adepts at various complex postures) who seek the "simple" practice of chair-less sitting generally find it impossible or surprisingly grueling to sit still for the traditional minimum of one-hour (as still practiced in eastern Vipassana), some of them then dedicating their practice to sitting Asana and the sensations and mind-states that arise and evaporate in extended sits.

Asana later became a term for various postures useful for restoring and maintaining a practitioner's well-being and improve the body's flexibility and vitality, with the goal to cultivate the ability to remain in seated meditation for extended periods.[5]Asanas are widely known as Yoga postures or Yoga positions, but specifically translates to "pose you can hold with ease". By this definition, practices where the participant is not at ease do not qualify as Asana. (Yoga for the Warrior Athlete by Ryan Muetzel)

Many of the current studies have focused on various forms and adaptations of the original idea of yoga asana. However, there have not been any conclusive studies concerning what dose response of yoga provides the best results in terms of reduction of pain, alleviation of stress and improvement in overall quality of life. It would be extremely useful to have data on the dose response of the various yoga asana positions in order to issue the best recommendations to people wishing to achieve various physical adaptations. Current research suggests that a carefully adapted set of yoga poses may reduce low-back pain, improve functionality of the body, improve quality of life, reduce stress, lower heart rate and blood pressure, help relieve anxiety, depression, and insomnia, and improve overall physical fitness, strength, and flexibility.[7, 17, 18, 20] However, there are gaps in these studies with respect to the best dose response for the yoga postures. This study will address these gaps by focusing on the third Specific Aim with respect to dose response. The same yoga postures will be used, but different groups will hold each yoga posture for a different duration of time, thereby determining the best dose response of the yoga postures. This will be achieved by comparing and analyzing the results achieved by each group with respect to reduction of pain, alleviation of stress and improvement in overall quality of life after the study is completed.

(b) Innovation

The current study will utilize and test the original definition of yoga asana by having some of the participants in our study hold the yoga asana postures for significantly longer periods of time than have previously been tested, thereby identifying the dose response of various durations of yoga asana positions. We believe that there will be better results with respect to reduction in pain, alleviation in stress, and overall improvements in quality of life received by the participants for the longer amount of time they hold the yoga asana postures. This is something that has not specifically been studied and yet is quite an important aspect concerning the overall effectiveness of yoga, and it is also something that is mentioned in the revered yoga sutras.

(c) Approach

Our interdisciplinary research team combines significant expertise in a wide-variety of scientific areas related to our proposed study. This team has all of the skills, training and life experience necessary in order to complete the proposed study. In addition, through previous collaborations, we have shown that we can successfully work together in mutually respectful interactions that enhance each other’s collective creativity, innovation and problem solving abilities. We are all quite confident that the outcome of this research collaboration will meet the highest levels of professional and ethical expectations.

Name Affiliation Title Expertise Project Responsibility
Dr. Alyssa Wampole Chinese Medicine O.M.D. L.Ac. Chinese Medicine, acupuncture, medical yoga, herbs, diagnoses
Experimental plan, participant intake, weekly testing
David Burke Chinese Medicine Medical Student Chinese Medicine, acupuncture, medical yoga, herbs, diagnoses Experimental plan, participant intake, weekly testing
Andrew Lichtenberger Statistics
Research Engineer
Statistics, analytics, research Data analysis, statistical significance, results
Ryan Muetzel Kinesiology Research Engineer Sports yoga, medical yoga, kinesiology, statistical application Yoga asana implementation, experimental plan,
weekly testing, results

Study Design

The current study will utilize and test the original definition of yoga asana by having some of the participants in our study hold the yoga asana postures for significantly longer periods of time than have previously been tested, thereby identifying the dose response of various durations of yoga asana positions. The participants will be recruited from the student body at the University of Texas, thereby consisting of both male and female sexes, a variety of races, will range in age from a minimum of 18 to a maximum age of 25, and will have no more than one year of previous yoga experience. They will be recruited by advertising to the local University of Texas community, and the participants will be paid for every yoga session they attend, thereby enticing the students to attend as many yoga sessions as possible for the duration of the study.

The participants will be randomized into several treatment groups. We will use five different groups for our study. Each group will consist of 10 participants who have little to no experience (one year maximum) with yoga for a total of 50 participants needed to complete the study. The subjects will be assigned randomly and will not know there are other groups involved with the study. Each group will only be told that they are going to do an eight-week study on yoga. One group will be the control group. This group will not do any yoga during the eight-week period unless it is already a part of their standard lifestyle. For ethical reasons, this group will also be provided with information and educational programs on stress reduction and a standard exercise program, but their adherence to these programs will not be monitored or required as part of the study. It will be completely up to the control participants whether or not they will choose to take action on the information provided to them. Another group will hold the yoga postures for 30 seconds per posture. The third group will hold the yoga postures for 90 seconds per posture. The fourth group will hold each of the postures for 180 seconds or 3 minutes per posture. The last group will hold the postures for 300 seconds or 5 min. per posture. Each group will use the same set of twenty postures that will be put together in a series based upon a literature review as discussed in Specific Aim 2. They will perform these postures three times a week for a period of eight weeks. Classes will differ in duration depending on which group the subjects have been assigned to and the respective dose response of yoga they will be testing.

We believe that there will be better results with respect to reduction in pain, alleviation in stress and overall improvement in standard of living received by the participants for the longer they hold the yoga asana postures. This will be measured through questionnaires that will be given to the participants both before and after the eight-week study period. This is something that has not specifically been studied, and yet it is quite an important area concerning the overall effectiveness of the dose response of yoga. This will be measured in a variety of ways. The participants will be tested with the same tests both before and after the eight-week study duration. First, basic measurements such as height, weight and blood pressure will be measured. Next, the flexibility of the participants in each of the 20 yoga asana postures will be measured and photographed. These tests will be compared and the improvements in inches from the before postures to the after postures with respect to the ideal yoga asana will be calculated.

A questionnaire will also be given to the participants. This questionnaire will contain a variety of questions using a standard 1-10 scoring system (with 1 being the lowest such as no pain or stress and 10 being the highest such as unbearable pain or stress) designed to determine the amount of pain and stress the participants are in before and after the study. This questionnaire will also contain the WHO (World Health Organization) Quality of Life-BREF (WHOQOL-BREF) questionnaire designed to determine the overall quality of life the person. It is our goal to determine the most appropriate dose response with respect to how long yoga postures should be held for. We believe that no matter what condition the yoga participants are in at the beginning of the study, the subjects who hold the yoga postures for longer periods of times will show the best improvements in flexibility, reduction in pain, reduction in stress and improvement in overall quality of life.

References

1."Patanjali Yoga sutras" by Swami Prabhavananda, published by the Sri Ramakrishna Math ISBN 81-7120-221-7 p. 111

1. Verse 46, chapter II; for translation referred: "Patanjali Yoga Sutras" by Swami Prabhavananda , published by the Sri Ramakrishna Math ISBN 81-7120-221-7 p. 111
   3.a b cPatanjali (± 300-200 B.C.) Yoga sutras, Book II:29
   4.Syman, Stefanie (2010). The Subtle Body: The Story of Yoga in America. Macmillan. p. 5. ISBN 0374236763. But many of those aspects of yoga—the ecstatic, the transcendent, the overtly Hindu, the possibly subversive, and eventually the seemingly bizarre—that you wouldn't see on the White House grounds that day and that you won’t find in most yoga classes persist, right here in America.
   5.Monier-Williams, Sir Monier (1899). A Sanskrit-English Dictionary. Oxford Clarendon Press, p. 159
   6.Arya, Pandit Usharbudh (aka Swami Veda Bharati) (1977/1985).Philosophy of Hatha Yoga. Himalayan Institute Press, Pennsylvania.
   7.https://nccih.nih.gov/health/yoga/introduction.htm
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