Chuck Rosin is a television executive, known in the industry for his talent as a writer and producer. By his early forties he had helped create some of Hollywood's most popular television series, but along the way he suffered a heart attack and after an angioplasty procedure, another artery closure. It was a big wake-up call, and with a little nudging from his wife, Karen, and the support of his cardiologist, he decided it was time to make some changes and try Yoga. I will never forget his responses to the questionnaire we gave him. Under the question “Why have you come to the Samata Yoga Center?” he wrote, “Prevent death for as long as possible.”
I think it is fair to say that in the beginning, Yoga was not Chuck's thing. He was extremely tense and reluctant to slow himself down. We started with some very simple relaxation techniques in the Corpse posture, a serene but very effective posture described in this chapter. Chuck also began making small changes in his lifestyle as he felt ready for them. Because he had a high cholesterol level, he reduced the fat in his diet. His cardiologist also prescribed a medication to lower his cholesterol. He exercised on the treadmill three times a week, and on sunny days he swam. After a few weeks, he graduated to the Lower Back Routine and then after another month we included the Neck and Upper Back Routine as well, which he was able to do at work in a chair. We waited a full three months before graduating to Core Routine I, which Chuck then practiced at least twice a week.
After three months, Chuck had noticed a significant difference in how he felt. His energy was returning, and his exercise tolerance was steadily increasing. At six months he reported that his stress level had dropped remarkably. His cholesterol level also decreased so much that his doctor lowered the dosage of his medication. After a year, Chuck was thrilled to be able to resume snow skiing with his family, and he has avoided any further heart attacks. After five years, Chuck is still practicing Yoga, and recently his cardiologist gave him his best report ever on a heart exam.
When it comes to cardiovascular disorders, Yoga is no longer considered an “alternative” treatment. Doctors now routinely recommend it to heart patients, along with other gentle mind–body practices such as Tai Chi and biofeedback. The physical practice of Yoga and the lifestyle changes inherent in the Yoga philosophy work together to calm your heart and mind, bring your circulatory system back into balance, and help you avoid the number-one killer of Americans today: heart disease.
The circulatory system consists of the heart and the blood vessels. The heart pumps blood into the arteries, which supply the body with oxygenated blood and nutrients. The blood returns from the organs back to the heart through the veins. The circulatory system has many purposes including the following:
Capturing oxygen from the lungs and delivering it to the whole body.
Getting food nutrients from the gastrointestinal system (stomach and intestines) and delivering them throughout the body
Circulating hormones around the body
Removing carbon dioxide, which is a waste product, and taking it to the lungs where it can be released through exhalation.
Getting rid of other waste products by running the blood through the kidneys and liver.
The circulatory system works well when the heart pumps efficiently, not too hard or soft, not too fast or slow, allowing the blood vessels to deliver blood to where it needs to go and to return it back to the heart. Heart failure occurs when, for a variety of reasons, the heart cannot effectively pump blood.
Hypertension, also known as high blood pressure, affects a quarter of all American adults and fully half of those over the age of sixty. Health-care professionals attribute the pervasiveness of this disease to the U.S. lifestyle of excess: smoking, too much alcohol, too much cholesterol and fat, too much salt, too much stress, and too much body weight. Add to this the consequences of not enough exercise, and you can see why many of us are living our lives on the edge.
Blood pressure refers to the amount of pressure in your arteries, which changes with each pump of your heart. Hypertension occurs when the pressure in the system gets high enough to start causing problems in your body. Conditions that cause the blood pressure to rise are usually related to the blood vessels being either constricted or overfilled; in both cases, it takes more force to pump the blood through them.
When blood pressure rises above normal, the blood's normal pulsating is replaced by a pounding. Even a very slight rise in blood pressure is significant, when you consider that the heart beats over one hundred thousand times per day. This relentless battering is very hard on the walls of the blood vessels and weakens them. The high pressure can also cause damage to various organs: In the kidneys the excess pressure can damage the vessels that filter waste products from the blood, making the kidneys ineffective and leading to kidney failure.1In the brain, a type of stroke can result when the damaged vessels rupture. Stroke is the third leading cause of death in the United States (after heart disease and cancer), and high blood pressure is the main risk factor.2In the heart, the hammering damages the arterial linings, hastening cholesterol buildup that can lead to heart attack. Uncontrolled hypertension also causes the heart muscle itself to work harder and eventually lose its ability to pump effectively, a condition that can lead to congestive heart failure. In the last few decades of the twentieth century, very effective medications were developed to control blood pressure, and they've greatly reduced the number of deaths directly attributed to hypertension. But since taking medication does not address the root causes of high blood pressure, cardiovascular specialists and primary-care physicians usually prescribe lifestyle changes first, especially for people whose blood pressure is only slightly elevated. Behavioral adjustments are recommended even for those taking hypertension drugs, because if carried out, modifications in diet and exercise levels can reduce or eliminate the need for medication.3 If you have been diagnosed with hypertension, be sure to read The Yoga Prescription for Circulatory Ailments and Yoga for Hypertension.
Coronary artery disease (CAD) is the most common form of heart disease. Sometimes called ischemic heart disease, it results when the coronary arteries—the fuel lines leading into and out of the heart—are clogged with plaque. The plaque is made of cholesterol, fat, calcium, blood clots, and other debris.4This leads to a number of problems:
Angina (pain, pressure, or burning in the chest, neck, or arm)
Irregular heart rhythms (mild to life threatening)
Breathlessness, fatigue, and loss of tolerance for exertion
Congestive heart failure
Heart attack
Death
The clogging of the arteries begins when the arterial walls are damaged, by the battering force of high blood pressure, by toxic substances entering the body through cigarettes and fatty foods, or by excess adrenaline flowing through the bloodstream because of stress.
Once the arterial wall is damaged, the buildup starts. This is a long, slow process called atherosclerosis that can begin in youth and continue for decades. The plaque is deposited, layer upon layer, making the interior of the arteries smaller and smaller. The crisis occurs when something, usually a blood clot or a piece of the unstable plaque, completely blocks the flow of blood. If this causes a portion of the heart muscle to die, it is called a myocardial infarction, or a heart attack.
The progression of CAD can be so gradual and the symptoms so variable that in half of all people with CAD, the very first symptom is death.5According to recent polls, most women believe that they are most likely to die of breast cancer, but heart disease claims six times as many women.6 If you have been diagnosed with heart disease or CAD, be sure to read The Yoga Prescription for Circulatory Ailments and Yoga for Heart Disease and Coronary Artery Disease.
Doreen is a forty-seven-year-old school teacher in Los Angeles. After seventeen years at the grammar-school level, she accepted a higher-paying position in an inner-city high school. A year later she discovered she had high blood pressure, and for the next five years was on daily hypertension medication. She had side effects from the medicine, but each time she stopped taking it, her blood pressure would spike back up again. Doreen was depressed about her situation and began consultation with a psychologist, who referred her to me.
On our first visit I learned that Doreen was about twenty pounds overweight and was having frequent nightmares. She ate a lot of salty foods and often watched the local news just before bed. I recommended a low-salt, low-fat, vegetarian diet and referred her to Dr. Dean Ornish's book Eat More, Weigh Less. She began daily practice of a Yoga routine designed for people with hypertension, and a separate Yoga breathing practice for her afternoon break, right after the end of the school day. She incorporated a simple walking program three to five days a week, beginning with ten minutes and gradually increasing to thirty and replaced the evening news with a relaxation technique or a few pages from a good book.
After two months of her new way of life, Doreen's physician reduced her blood pressure medicine by half. By the end of the third month she had lost fifteen pounds and was able to discontinue her medication completely. Doreen truly feels like a new person. Her depression has lifted, she maintains a normal weight, and her blood pressure has been normal for more than a year without any medication.
There are a few risk factors for circulatory ailments that we have no control over, such as our family history and our age. However, most of the conditions leading to hypertension and heart disease are within our power to regulate: smoking, the amount of fat and salt in our diet, our weight, how much we exercise, and how much stress we deal with in our lives. Each of these factors affects the state of our blood vessels, determining the health of our organs and our risk of cardiovascular problems. Following the Yoga lifestyle for wellness described in Chapter 1 can help us to overcome many harmful practices. Research has shown that circulatory problems respond well to various Yoga regimens, from a few simple postures performed twice a week to a complete overhaul of lifestyle practices.
A number of reputable studies have established the benefit of using Yoga to treat high blood pressure. A classic study done in 1969 showed that the daily use of just one posture, the Corpse (described later in this chapter), significantly reduced blood pressure after only three weeks.7In another study, twenty-five hypertension patients were given Yoga therapy, and after six months all showed a significant decrease in blood pressure. Five of the patients had been taking hypertension medicine, and all were able to decrease their dosage.8In a study published in 2000, half of the participants practiced an hour of Yoga twice daily, and the other half received drug treatment. After eleven weeks, the researchers noted that Yoga was as effective as the medication in controlling hypertension.9Several studies have shown that stress reduction through various behavioral procedures such as Yoga, biofeedback, meditation, and psychotherapy benefit hypertension patients by lowering their blood pressure.10
In 1990, the International Association of Yoga Therapists (IAYT) conducted a three-month study on Yoga and hypertension. The postures used in this pilot study were similar to those I used for my client Doreen (see Yoga for Hypertension). The subjects in the study changed nothing in their lifestyle except for adding the Yoga routine, yet their blood pressure decreased a statistically significant 6.5 percent.11
Dr. Ornish is well known for his pioneering work in the reversal of heart disease. One of his most famous studies, published in 1998, showed that lifestyle changes can be even more effective than medication for treating coronary artery disease.12Additional studies have verified the benefits of a healthy lifestyle for heart patients, and researchers have gone even further to show that adding Yoga can have a profound impact. One study involved two groups of men with CAD. One group was put on a program of diet and risk-factor control. The other group was given the same diet and risk-factor control program but was also prescribed daily Yoga practice and moderate aerobic exercise. After a year, the Yoga group had better exercise capacity, lower body weight, and significantly fewer bypass surgeries and other medical interventions than the other group.13The researchers attributed the improvement to the combined effects of Yoga, exercise, and diet. Another study conducted in India examined two groups of heart patients. One group was taught Yoga four days a week and was encouraged to practice at home in between classes. After only fourteen weeks, the Yoga practitioners showed markedly greater improvement in measures of heart disease.14
Adding a Yoga routine to your schedule can have tremendous benefits for your cardiovascular health. But why is this true? One of the main reasons is that the stress you allow into your mind is a key player in hypertension. The calming nature of Yoga, particularly breathing exercises, relaxation techniques, and meditation, can transform your experience of the pressures of everyday living. Many type-A personalities find particular refuge in Yoga relaxation techniques.
Yoga's effect on our circulatory health has been explained by the work of Herbert Benson, the Harvard physician we discussed earlier in the book. His research focused on the physiology of our relaxation response. He found that the relaxation breathing we practice in Yoga stimulates the parasympathetic nervous system, which is responsible for telling our bodies to relax. This in turn reduces the heart rate and the intensity of the heart pump, thereby lowering blood pressure.
Light to moderate aerobic exercise is usually recommended as part of a heart-healthy routine, even for those with circulatory ailments, and our overall Yoga prescription for cardiovascular health includes that advice. Yet it is important to note the differences in how Yoga and aerobic exercise affect your heart. Workouts consisting of jogging, running, and other fast-paced aerobics bring more blood flow to the heart while raising your heart rate, pulse, blood pressure, and oxygen consumption. These exercises can be very good for the heart, lungs, muscles, and blood vessels. If you exercise too intensely, and the oxygen demand is greater than your body's ability to supply the oxygen to your muscles, then waste products such as lactic acid begin to build up in your muscles. In contrast, Yoga postures and breathing exercises are gentle aerobic exercises that do not outpace your body's ability to supply oxygen to the heart and other muscles. At the end of a Yoga session, you feel refreshed. In addition, your mind is quiet and calm, which is not usually the case after an hour of working out to loud music in an aerobics or spinning class. We recommend that you work with your doctor to establish an exercise plan that combines an aerobic activity such as walking, swimming, or cycling with a daily Yoga routine.
Practicing Yoga can also help you control other risk factors for heart problems. For example, many people mistakenly believe that smoking or overeating helps them relax or deal with stress. As Dr. Benson demonstrated, the relaxation response that results from Yoga breathing can calm your nervous system, decreasing your cravings, and giving you a greater sense of control over what you put in your body. Richard Usatine and other physicians routinely use Yoga breathing to help patients quit smoking. Dr. Usatine recommends that while you are in the process of quitting smoking, you should take a Yoga Breathing Break whenever you are feeling stress, anxiety, or craving for a cigarette. After a short period of Yoga breathing, you should be able to go on without reaching for a deadly cigarette.
Medications used to treat heart disease and hypertension sometimes have unpleasant side effects. One of the greatest advantages of Yoga is that it can treat circulatory problems without side effects, and it can decrease or eliminate the need for medication. For the millions in the United States who are taking daily medicine for heart problems, this is good news.
Add physical activity to your daily life, particularly light to moderate aerobic exercise such as walking.
If you are overweight, losing just ten pounds can lower your blood pressure up to 30 percent.
Decrease the salt in your diet as much as possible. Read food labels to detect such ingredients as salt, soda, or sodium. While not all hypertension will decrease with a low-salt diet, if it seems to improve your blood pressure readings, then it is important you continue limiting your sodium. A home blood pressure monitor may help you determine how your blood pressure responds to a lower salt intake and other lifestyle changes.
Eat a high-fiber diet, which helps reduce cholesterol levels. Include oat bran and whole grains such as brown rice, buckwheat, millet, and oats.
Eat plenty of fresh fruits and vegetables. The American Dietetic Association recommends at least five servings per day.
Keep your fat intake under control if you have high cholesterol. Fish and poultry are acceptable in moderation, but avoid fatty red meat. The best way to minimize fat intake from fish, poultry, and meat is to trim away the skin and visible pieces of fat. Using fat-free dairy products and eating smaller food portions overall can help keep your fat intake under control. Alcohol and caffeine should be used in moderation. While small amounts of caffeine or alcohol (such as one cup or glass per day) may be safe, too much can raise your blood pressure.
Do not use any tobacco products (cigarettes, cigars, chewing tobacco). There is no safe level of use for any of these. Even secondhand smoke can be dangerous to your heart, lungs, and blood vessels.
Get plenty of sleep. If you wake up groggy in the morning or need large doses of caffeine to get you through the day, you're not getting enough rest.
Take steps to manage your stress. Learn Yoga breathing techniques (see Chapter 4) so that they are at your disposal whenever you need them. Incorporate a Yoga Breathing Break into your regular schedule, at the time of day when you are usually most stressed.
If you're taking hypertension medication, discuss your new Yoga program with your doctor. Measure your own blood pressure or get regular checkups to determine if your dosage can be reduced or the medication eliminated.
Stay involved with other people. Consider clubs, exercise classes, or activities with organizations that represent your faith. Volunteering to work with a charitable association is a great way to be involved with other people and to contribute to your community Numerous studies show that lonely depressed, or isolated people are much more likely to die prematurely.
Practice the appropriate Yoga routine from this chapter. Start with two or three days a week, working toward five to six days a week.
Yog a for Hyp ertension
This program is the one I created for my client Doreen for her hypertension. If your blood pressure is not controlled (higher than 140/90 mm Hg with or without medication) or if you have any uncontrolled heart disease, be sure to talk with your physician before starting. This routine takes approximately fifteen minutes, and should be practiced using Focused Breathing. Ideally, practice the routine twice a day until your condition improves, then practice it once a day. When you feel your condition has subsided, you may cut down to three times a week.
Seated P osture
This simple relaxing posture supports and stabilizes the spine, facilitating good sitting posture.
Sit comfortably in an armless chair, bringing your body slightly away from the back rest.
Let your arms hang down by your sides. Place your feet evenly on the floor at hip width. If your feet do not touch the floor, place a folded blanket or a phone book under them. Your thighs should be parallel to the floor, with your knees and hips bent at approximately a 90 degree angle.
Place your hands on your thighs with your fingers toward your knees. Bring your back up nice and tall, and gently pull your head back until your ears, shoulders, and hip sockets are in alignment. Do not force anything beyond your comfort level.
Use Focused Breathing for 8 to 10 breaths. Gently draw the belly in on the exhale.
This movement improves the range of motion of and increases blood flow to the upper back and shoulders.
Start in the Seated Posture.
Let your arms hang at your sides, palms turned back. Look straight ahead.
As you inhale, raise your arms forward and up overhead.
As you exhale, bring your arms back down as in Step 2.
Repeat slowly, 4 to 6 times.
Standing Forward Bend with Chair
This gentle stretch promotes circulation in the upper torso and head. It stretches the entire back of the body, including the neck, shoulders, hamstrings, and back.
Caution:If you have been diagnosed with an intervertebral disk problem, be careful of all forward bends. Avoid this posture if it causes back pain. Check with your physician or other health-care professional if you are uncertain.
Stand with your feet hip-width apart, arm's distance from the seat of a chair. Keep the spine tall but relaxed. Let your arms hang at your sides, palms turned inward toward your legs. Look straight ahead.
As you inhale, raise your arms to the front, up and overhead.
As you exhale, slowly bend forward from the hips, bringing your arms, hands, torso, and head forward and down until your palms touch the front edge of the chair. Slightly bend your knees.
As you inhale, return to the upright position, keeping your arms raised.
Repeat 3 times. Then stay in the forward bend position for 6 to 8 breaths. Slowly return to an upright position.
This posture relaxes and gently stretches the lower and upper back. (If you have knee or hip problems, replace Sitting Cat with Knees to Chest, described. Thus you will be doing Knees to Chest twice in this routine.)
Start on your hands and knees, looking slightly down, with the heels of your hands directly below your shoulders and the knees at hip width.
As you exhale, sit back on your heels and bring your head toward the floor. Work toward resting your torso on your thighs with your forehead on the floor, but do not force it. Sit back only as far as comfortable.
Repeat 3 times, and then relax with your head down and your arms in front (as in Step 2), for 6 to 8 breaths.
Lying Bent-Legs Twist
This gentle twisting motion tones the abdomen, exercises the spine, and has a calming effect on the nervous system.
Lie flat on your back with your knees bent and feet on the floor at hip width. Move your arms out from your sides in a T, aligned with the tops of your shoulders, palms down.
As you exhale, slowly lower your bent legs to the right side; then turn your head to the left. It is important to keep your head on the floor.
As you inhale, bring your bent legs back to the middle. Exhale, while slowly lowering your bent legs to the left side. Turn your head to the right.
Alternating sides, repeat slowly 3 times to each side. Hold the last twist to each side for 6 to 8 breaths.
This slow stretching motion relieves stiffness and discomfort in the lower back. We also use it for balance after a twist. (Note that Knees to Chest is different from Knee to Chest, which appears elsewhere in the book.)
Lie on your back with your knees bent, feet on the floor at hip width. Bring your bent knees toward your chest and hold on to the top of your shins, just below your knees, one hand on each knee. If you are having knee problems, hold the backs of your thighs, under your knees.
As you exhale, draw your knees toward your chest. As you inhale, move the knees a few inches away from your chest, rolling your hips to the floor.
Repeat 3 times, and then stay in the most folded position for 6 to 8 breaths. Slowly return your feet to the floor in the bent-knee position.
Legs on a Chair with Eyes Covered
This relaxation technique uses a chair to improve circulation to your legs, hips, and lower back. It has a calming effect on your nervous system.
Place a chair in an area where you have room to lie down in front of it.
Lie on your back with knees bent, feet on the floor. The front edge of the chair's seat should be turned toward you, just in front of your feet.
Lift your feet off the floor and lay your calves on the chair seat, with the front edge of the seat tucked into the backs of your knees. Cover your eyes with an eye bag or small folded towel. If your head tilts back, place a blanket under it.
Inhale freely, then gradually increase the length of your exhalation over several breaths until you reach your comfortable maximum. Continue with the long exhalation for 3 to 5 minutes. When finished, gradually bring the breath back to normal and sit for 2 or 3 minutes before standing.
Use Alternate Nostril Breathing for 3 to 5 minutes.
Yoga for Heart Disease and Coronary Artery Disease
If you've been diagnosed with heart disease or CAD, you can immediately benefit from practicing this single Yoga posture, two or three times a day You may eventually be able to graduate to a full Yoga routine.
Corpse (Supported) with Eyes Covered
This is the safest and most popular Yoga posture, a classic for relaxation of the body and mind. It soothes the nervous system and facilitates deep rest.
Lie on your back. Place a bolster, pillows, or folded blankets under your upper back for support. Your arms should be relaxed near your sides, palms turned up. Cover your eyes with an eye bag or folded towel. If your head tilts back or your neck is uncomfortable, place a small pillow or blanket under your head and neck. If your lower back is uncomfortable, place a pillow or rolled blanket under your knees. You may also do the Corpse without supports.
Relax for 5 to 15 minutes, using Belly Breathing with Long Exhalation.
It's important that you work closely with your physician to determine when you're ready to move beyond the Corpse to begin practicing a complete Yoga routine. Here's what to do when you are ready:
Begin with the Lower Back Routine.
Add the Neck and Upper Back Routine when you feel comfortable. Graduate to Core Routine I
