With an increasing trend in western culture toward the use of alternative therapies, yoga is emerging as a primary means for achievement of both physiological and psychological wellness. Traditional yoga utilizes a combination of both physical and spiritual methods for faciliatation of self-improvement. The origin of yoga has not been clearly identified, however archeaological evidence suggests its existence as early as circa 1300BC (Starre 1989). Starre suggests that there are four main branches of traditional yoga practice, one being Raja yoga.
Raja yoga addresses mental and physical control by using techniques to perfect the body, calm the mind, and increase spiritual awareness. Of particular interest to health care professionals is Hatha yoga, a subdivision of Raja yoga. While Raja yoga is considered a more “meditative” form, Hatha yoga involves the practice of specific body postures and deep breathing exercises. These characteristics provide for a yogic practice that is more physical in nature.
Typically, in today’s popular practice, it is the external form, or technique (Hatha yoga) that is empasized, while the internal form, or attitude, intention and mental aspect (Raja yoga) is overlooked (Desai 1985). However, a fairly new approach to yoga, called Kripalu, combines the techniques of both Raja and Hatha yoga, and is emerging as the popular yogic practice. Yogi Amrit Desai created Kripalu yoga in 1970. Previously, Desai had spent nearly twenty years mastering the art of traditional yoga, and is widely regarded as a yogic authority. As stated, Kripalu yoga is a synthesis of both Raja and Hatha yoga techniques.
Desai has termed Kripalu yoga, “meditation in motion,” a practice in which both movement and meditation happen simultaneously and harmoniously (1985). He attributes the creation of Kripalu yoga to the awakening of prana, or intelligent life force within us, and proposes that it restores the cooperative working relationship between the body and mind (Desai). Emphasized with the practice of Kripalu yoga is the importance of pranayama (breath and life force control) and concentration during asanas (body postures). Desai (1985) describes Kripalu yoga as a holistic, integrated five-stage approach in which body and mind play complementary roles.
Since science has been rediscovering that our body and mind are not two separate entities, but one, holistic, interdependent body-mind, yoga practice cannot afford to be either exclusively mental or physical” (Desai, preface). In the art of Kripalu yoga, mastering the asanas is a necessary step, providing an external vehicle of the more significant inner stillness, harmony, and peace. Therefore, the purpose is equally spiritual, as it is physical. Desai explains the external form of the posture is seen as secondary to its primary purpose as a medium for an ecstatic, meditative experience.
Kripalu yoga is composed of sequences of movement, static postures, and breathing patterns known as posture flows. These are performed the same and consistently each time. The aim of posture flows is to awaken the prana, which, as previously mentioned, is considered the all-pervasive, intelligent energy of the universe (Desai 1985). Desai and colleagues believe that it is the presence of the prana-spirit that enables the body to absorb biological prana from the breath, food, and water, and provide for physical, biological, mental, emotional and spiritual energies acting on muscles, vital organs, nerves, glands and the brain (Desai 1985).
Essentially, Desai believes, “prana is our life. ” The components of Kripalu yoga exert numerous physical and mental influences, which can result in pertinent therapautic intervention. Movement of energy through the body creates the core of yoga practice (Starre 1989). Desai suggests that all disciplines of yoga are designed to enhance absorption and storage of prana by improving digestion, respiration, metabolism, and natural immune responses (1985). Yogic postures gently stretch and tone the body while nourishing tissues, stimulating circulation, and removing waste products to revitalize organ funtion and restore health (Starre).
Asansas are the combination of slow, poised movements with rhythm. Starre states that a majority of the postures involve simple, easy movments, allowing participation regardless of age or physical condition. In addition, breath regulation through the practice of breathing exercises, or pranayamas, control and balance body energy. Pranayamas, combined with asanas result in exhalation with forward movements and inhalation with backward movement. Specific breathing techniques, when used in conjunction with physical postures, allow for stilling of the mind and calming of emotions, preparing the body for meditation (Starre).
Psychologically, Kripalu yoga enhances clarity of mind, internalization of attention, and ecstatic states of consciousness. This, in turn promotes self-satisfaction, a greater understanding of cause and effect, acuity and refinement of the learning process, and a sense of freedom and self worth (Desai 1985). Positive changes in patterns of relationships with social, familial and cultural surroundings are generally observed. Kripalu yogic practice is an ideal means for maintenance of health and wellness.
Yoga is easy to learn, especially under the instruction of a competant and knowlegable instuctor, and requires no specific equipment or prior training. It is a form of exercise that is adaptable to various age levels and health status. Some studies have addressed the use of yoga in the management of hypertension (Sudar, Agrawal, Singh, Udupa, and Vaish, 1984; Telles, Nagarathna, Nagendra and Desiraju, 1993; Telles and Naveen, 1997), asthma (Vedanthan et al. , 1998), back pain (Nespor, 1989), pain (Nespor, 1991); and neurotic illnesses (Sharma, 1989).
In summary, due to the nature of Kripalu yogic exercise involving physical activity and stretching, combined with breathing and meditation, desirable effects on the four acknowledged components of physical fitness, as well as mental and emotional well being can readily be observed. In addition to improving components of physical fitness, Kripalu yoga has demonstrated desirable outcomes in terms of psychological and emotional well being. Meditation and relaxation tend to be synonymous with the word yoga. People may not be aware of the physical benifits of yoga; however, most assume some type of mental involvement and enhancement.
Although Kripalu yoga is a synthesis of physical and mental elements, primary psychological involvment is essential. A crucial aspect in the promotion of emotional well being, in today’s hectic society, is that of effective stress management and coping strategies. Stress is a common thread among humans. It is expereinced by, and affects each individual differently. It can be healthy in certain situations, but when not managed efficiently, it can be the cause of physical and psychological breakdown. The general physiology of stress is the same for all individuals.
Heilbronn (1992) reports that the nervous and endocrime systems of the human body take responsibility for stress reactions. Numerous circumstances can precipitate a stress situation. However, the reactions that succeed, follow a well-defined course. Heilbronn summarizes this as follows; the frontal lobe of the brain stimulates the hypothatlamus causing it to secrete a “releasing factor. ” This factor triggers the suprarenal gland to produce large quantities of adrenaline into the bloodstream, immediately impacting the sympathetic (stimulating/enegizing) nervous system.
Nerves to the heart, blood vessels, respiratory system, viscera and skin prepare the body to react. “The whole body is now prepared for fight or flight (Heilbronn, p. 3). During a “healthy” reaction to stress, the pituitary gland receives a feedback signal and secretes a hormone (ACTH) into the bloodstream. This stimulates the suprarrenal cortex to produce corticoids, which reduce inflammatory conditions, protecting the body from excessive stress. Heilbronn explains that this is a homestatic state and represents the body’s adaptation to stress.
In cases where this state cannot be maintained and the body is unable to adapt, a third stage, known as exhaustion is entered. Anger and frustration cause continued production of adrenaline into the bloodstream. Physically, this results in a chronic state of high blood pressure and other signs of acute distress (Heilbronn). Exhaustion is a condition in which physical illness and emotional and mental collapse results. Sharpley and Scuderi (1990) suggest that rapid and dramatic increases in heart rate, in response to a stressful event, have been associated with the development of harmful plaque on the lumen of arterial walls.
The process of atherosclerosis essentially begins in childhood, and is exacerbated by frequent dramatic increases in heart rate throughout adolescence and early adulthood, reports Matthews et al. (as cited in Sharply and Scuderi). For some individuals, this arterial blockage places tham at high risk for coronary heart disease (CHD) in the latter years of life. In addition to physical ailments, stress can negatively impact one’s psychological health. Anxiety and panic attacks, emotional imbalance, withdrawl, and depression are all diagnoses that Americans are dealing with daily.
More frequently, psychiatrists and psychotherapists are recognizing the therapeutic effects of yoga, and are recommending it as an intervention. “Because of the stressful human and technological complexities of our age, we often assume that ours is the worst of times. We create an identity out of what we do, who and what we love, how much money we make, and the things thaa we surround ourselves with,” states psychotherapist and yogi Stephen Cope (as cited in Weintraub, 1999, p. 42).
Additionally, evidence in the study performed by Schell, Allolio, and Schonecke (1993) also supports the utilization of yoga technuques in the therapy of psychosomatic disorders, “possibly in combination with psychotherapy. ” They found that in terms of coping with stress, the group of participants who had engaged in yoga used more self-supporting strategies like minimizing, turning away, attempts at situation control, or positive self-instruction when compared to the control group. Kripalu yoga practice incoporates a number of techniques that facilitate relaxation and calming of the mind and body.
These typically include the asanas, pranayama and guided relaxation. Each of these provide unique therapeutic mechanisms for stress control and relief. Asanas, or body postures, place pressure on selective, related organs. This, in turn, enhances blood flow to the organs, flushing them and removing toxins. This technique has a powerful normalizing and balancing effect on the endorcrine system (Heilbronn, 1992). Also created with asanas, is slective muscle tension. Heilbronn reports that research in the field of Applied Kinesiology has suggested that every muscle is related to an organ.
Ultimatley, the benefit of the postures is that their creative tension clears restriction and imbalances, permitting free flow of energy throughout the organs and around the body. Lastly, as described in the physiology of stressful reactions (Heilbronn), the body readily secretes adrenaline into the blood stream in preparation for the fight or flight response. If such a response is inhibited due to social or other considerations, it is beneficial to sublimate it through a health alternative.
One such alternative would be the posture flow known as the “Sun Salutation,” suggests Heilbronn. In the article by Weintraub (1999), multiple postures are introduced as a means for dealing with stress and depression. She describes that inverted postures are beneficial due to improved blood flow, lyphatic drainage and flow of cranial sacral fluid. According to Dr. Karen Koffler, “If there is increased blood flow to the area, there will be increased bioavailability for oxygen and glucose-the two most important metabolic substrates for the brain.
It follows, then, that those cells bathed in solutions rich in the building bolocks required for the creation of neurotransmitters like norepinephrine, dopamine and seratonin, will be beter able to produce these chemicals” (as cited in Weintraub, p. 44). Postures involving the “opening” of the chest and abdominal area, in conjunction with corresponding breath control, are also used for stress relief and treatment of depression. Pranamaya is an essential component of any yogic experience. Control of breath and inhalation/exhalation patterns are not always easy to learn, but can have profound therapeutic effects.
Starre (1989) reports that the science of breath control commences with learning proper control of the diaphragm and respiratory muscles. “Yogic breathing exercises (pranamayas) sensitize practitioners to the conscious awareness of breath movment” (p. 50). She reports that practicing yogic breathing helps to control and steady the mind, thereby promoting mind-body harmony. This type of therapeutic breathing may be used to relax the nervous system, reduce stress levels and anxiety states. The final therapeutic technique generally incoporated into Kripalu yoga is that of guided relaxation.
With this, individuals position their bodies in supine, eliminating all muscle tone, and with maximum support and comfort. Heilbronn describes this as an awareness exercise in which the individual’s attention is taken, in turn, to every limb of the body for a moment. Tension is built and then released, resulting in even greateer body relaxation. Attention to breath, of course, is emphasized. As part of a course entitled, Management and the Use of Stress, students at Ashorne Hill Management College, in the United Kingdon, sought to analyze how managers from British Steel would respond to yoga as a form of stress management (Heilbronn, 1992).
The three techniques introduced included those mentioned above. Heilbronn reports that following the introductory sessions, the managers were surprised at their own responses, and recognized that yoga did, in fact, have practical relevance to the everyday problems that they faced as managers. Additionally, Schell, Allolio, and Schonecke (1993) observed the different emotions that the yoga participants in their study experienced when compard to a control group.
Most remarkable was the euphoric state of mind in the yoga group, combined with low rates of negative emotions like state of deactivation, irritability, numbness, vexation and excitation” (1994, p. 50). It is important to recognize that participation in Kripalu yoga is indeed both physiological and psychological. Heibronn (1992) concludes, the asanas and paranamayas must be performed with mindfulness and full concentration to the exclusion of all distractions, in order to thourougly experience its effects and improve stress management.
A population of interest when considering effective stress management and psychological health is that of college students. Students who are enrolled in professional health care programs are of particular interest due to the rigrousness of study, clinical training, pressures to succeed, competance evaluation, role development and professional identity (Francis and Naftel, 1983; Frazer and Echternach, 1991; Beck and Srivastava, 1991). Francis and Naftel (1983) sought to explore perceived sources of stress and coping strategies among allied health students.
They report, “academic pressures associated with the study of difficult material, long hours of classroom instruction, and the pressures of student clinical practice may combine to intensify psychological stress associated with the normal pressures of college life” (p. 262). These researchers (Francis and Naftel) used a population of physical therapy assistant students and physical therapy students in each of two years of “initial preparation program (IPP)”.
The first year (IPP 1) is described as placing emphasis on the basic sciences and the theory of physical therapy practice (with little clinical practice), while the second year (IPP 2) emphasizes physical therapy techniques and clinical practice. Students completed both a 27-item stress questionnaire and a coping qustionnaire. Results of this study yield the following; all three academic classes perceived examinations, grades, quantity of classwork, long hours of study, and lack of free time as moderately to highly stressful.
Both PTA and IPP1 students ranked difficulty of classwork and examinations and grades as the most stressful, while IPP2 students felt that research was the most highly stressful item (Francis and Naftel). The authors suggests the following, with regards to lessening the detrimental effects of stress for physical therapy students: an improved evaluation system, a support system for students, and an actice physical activity program (1983).
In another research study, titled, “Response of Physical Therapy Students to Stress Indicators,” by Frazer and Echternach (1991), it was suggested that the majority of physical therapy students were stressed, subject to high health risks from stress and had a tendency to be moderately or severely obsessive-compulsive. Students participating in this study were first and second year physical therapy students from two different universities. The results indicate that 96% of first year students and 53. 6% of second year students at University A were stressed, while 85. 0% of first year students and 86. of second years students at University B were stressed. It was also found that at bot universities, over 90% of first year students, and over half of second year students were at high health risk from stress. The most frequently mentioned classroom stressors included items such as: taking notes, studying for a quiz or test, examinations, fast-paced lectures, and excessive homework. The most freqently reported life-event stressors included: change in sleeping habits, change in social habits, lower grades than expected, change in living conditions, change in eating habits, and change in the number of family gatherings.
This study served to comfirm what educators in the field of physical therapy have long suspected; physical therapy education causes stress in many students (Frazer and Echternach). Due to the fact that the students in the studies mentioned above were in the first two years of pre-professional training, items dealing with clincal experience and stressors related to this were not addressed. Considerable literature is available addressing stress in medical and dental students.
In general, stress in these areas is attributed to information overload, or trying to learn a great deal of often difficult material ina limited amount of time, and a resultant lack of time to meet personal needs (Firth, 1986; Garbee et al. , 1980; Frances and Naftel, 1983). Based on these findings, it would be expected that students completing their professional training in allied health programs would experience similar sources of stress, and express common concerns relating to clinical practice and experience.
The study, “Perceived Level and Sources of Stress in Baccalaureate Nursing Students,” found high levels of stress among nursing students, and indicated that they were at high risk for physical or psychiatric illness (Beck and Srivastava, 1991). The population consisted of second, third and fourth year baccalaureate nursing students and data was gathered via a questionnaire consisting of three main instruments: a General Health Questionnaire (GHQ), a Stress Inventory, and a simple profile sheet. The GHQ is an instrument that provides a measure of general distress and minor psychiatric disorders (Goldberg as cited in Beck and Srivastava).
Items regarding sleep patterns, ability to make decisions and concentration are assessed. The GHQ has been used with many different populations, including students, and has established reliability and validity. The Stess Inventory is a combination of the Stress Incident Report used by Firth (1986) and the stress scales of Firth (1986) and Francis and Naftel (1983). For the purpose of this particular study, the stress scales were combined and slightly modified by the principle investigators, Beck and Srivastava.
Some items were added to include data based on faculty experience and desired insight to student stress. The Stress Inventory has proven to be a useful tool in evaluating health care student’s perception of stress, specific sources of stress, and adopted coping strategies. It has previously been used with dental students, medical students, and physical therapy students. Face and content validity were claimed to have been established based on a panel of experts (faculty and students) (Beck and Srivastava).
In reporting results, Beck and Srivastava (1991) indicate the mean score on the GHQ, for all groups of nursing students, was higher than the general population, as well as higher than the medical students targeted in the study by Firth (1986). Results on the Stress Inventory demonstrate that students perceived stress from a number of sources. The five highest ranking items on the Stress Inventory, expressed by 50% of the students and then rank ordered according to frequency include: long hours of study, exams and grades, lack of free time, financial responsibilities and administration’s response to students (Beck and Srivastava, 1991).
The researchers also report the highest amount of stress can be categorized in the headings of: career choice, academic environment, and financial and personal factors. Qualitative data gathered from the Stress Inventory (Part 1) describe that stressful events were consistent with the quantitative results, with academic program (e. g. , amount of work, lacking skills) being identified as the primary source of stress, according to Beck and Srivastava. Results of the study by Beck and Srivastava indicate relatively high levels and multiple sources of stress for baccalaureate nursing students.
The items ranked as high stress by BN students have also been reported among other professional health care students, including those enrolled in a physical therapy program. Beck and Srivastava (1991) state, “as these factors are predominant in contributing to student stress, they should be minimized where possible” (p. 131). It is implied that students should be taught priority setting, problem solving, and most importantly, stress management techniques so that they are better equipped to handle the pressure, stresses and expectations of being enrolled in such a program (Beck and Srivastava; Francis and Naftel, 1983).
Based on extensive literature review, is has been demonstrated that traditional yoga techniques can have desirable and lasting effects, both physiologically and psychologically. Physical fitness is generally accepted as a measure of health and wellness. Add to this mental and emotional balance, through effective stress management techniques, and an integrated, holistic perspective is utilized. However, in contrast to the increasing popularity of Kripalu yoga, there is limited research documenting its benefits, particularly in a young, “healthy,” student population.
Therefore, the purpose of this study is to examine certain components of physical fitness (heart rate and flexibility) and perceived levels of stress among third and fourth year physical and occupational therapy students. Nine healthy full-time students (one male and eight females) at Russell Sage College, Troy, NY participated in this study after having consented in writing. All nine reported being in their fourth year of undergraduate preparation, with three enrolled in the occupational therapy program, and six in physical therapy. Age ranged from 20 to 25, with a mean of 21. ears. All subjects described their racial/ethnic backgroud to be white/caucasian, with the exception of one student who reported to be of Asian descent. Other demographic information concluded that seven lived on-campus, and two lived off-campus (one participant with parents). None of the participants had ever been married. The only prescribed medication taken was oral contraceptives. In terms of exercise (classified by at least 20 minutes of moderate activity), five reported exercising 1-2 times/week, three reported 3-4 times/week, while one reported exercising 5-6 times/week.
When asked about the average amount of caffeine intake per day (coffee, chocolate, soda, etc), six reported consuming one coffee consistently in the morning. The other subjects reported none, or occasional cups on the morning. Additionally, five participants suggested consuming coffee or soda in the evening, especially the night prior to an exam. A few respondants reported eating chocolate occasionally throughout the day/week, but none suggested consuming execssive amounts.
Finally, the participants were asked to rate the average daily level of stress on a scale of 1 to 10, with 1 being the lowest level of stress, and 10 representing the highest level of stress. Reponses were as follows: three rated 4, one rated 6, three rated 7, one rated 9 and one rated a daily stress level of 10. All of the subjects attended a meeting prior to the start of the study, in which a full explanation of the procedure was given. It was determined at this time that all of the participants were essentially yoga-nave, with the exception of limited classroom discussion that may have occurred in their academic courses.
The nine subjects completed a Beck-Srivastava Stress Questionnaire at the close of the spring semester 1999. This information was gathered to obtain data regarding stress levels relative to finals and the events occuring at the close of a semester. This was used for comparison with data gathered in the Fall 1999 semester. At this time, all of the subjects were concluding their third year of occupational or physical therapy training. The Beck Srivastava Stress Questionnaire is composed of two parts. Part 1 consisted of a stress incident report.
This contained a number of open-ended questions that required the student to: “Please describe a real event (aside from class exams) which has occurred in the past month in your role as an occupational/physical therapy student which has been stressful to you. (Note: A stressful event is one that aroused your feelings in some negative way)” and to describe why this had been a problem. In addition, students were asked to rate the intensity of the feelings that they had experienced during the incident on a five point scale from “not at all” to “extremely.
Mean scores were computed for each feeling and were used to establish the overall intensity of feelings related to each event. Part 2 of the Stress Questionnaire consisted of a 37-item rating scale reflecting stressors from academic, financial, clinical, and interpersonal areas. The stress scales were modified slightly from the original 44-item scale. Ten questions regarding current clinical stressors were omitted since the subjects were not in clinical settings at the time of our study. However, three questions specific to student life stressors were supplemented.
Students were asked to rate items that applied to them on a 5-point Likert scale ranging from 1=not stressful, to 5=extremely stressful. An overall stress score was obtained by summing the item scores. When the students returned as fourth year students in the Fall of 1999, they were ready to commence the study. Participants attended yoga class one night a week, for ten consecutive weeks, with the exception of a one-week layover for the Thanksgiving holiday. Classes were held for ninety minutes, under the instruction of a certified Kripalu yoga instructor.
They were conducted in an athletic lounge, in the basement of the campus physical education and recreation building. The room was dimly lit, carpeted, and had the capacity to hold approximately fifteen yogis, of which a maximum of eleven were present each session. [The average temperature in the room] Two other yogis participated in the class, but did not qualify to be in this study, due to academic status. A typical class consisted of warmups (each joint and/or muscle group), psycho-physicals (sequences of exercises aimed at increasing heart rate in combination with breathing exercises) or posture flows (eg.
Sun/moon salutation), practice of the asanas (static postures), and finally, guided relaxation. Throughout the duration of the class, relaxing and meditative music was played, while the participants were instructed to concentrate on their breath (pranayama). In addition, durning the guided relaxation portion of the class, the lights were extinguished, while candles and incense were lit to further enhance relaxation and concentration. The instuctor also sought to increase the participant’s familiarization with yogic techniques.
She frequently provided the class with book information and literature from yoga magazines and journals, as well as multiple Internet sites for information retrieval. She administered pictures of exercises and postures, and also taught therapeutic breathing techniques for stress relief, to be utilized outside of class. Prior to commencement of the first class, baseline measurements for heart rate and flexibility were obtained. The students were also asked to complete a second Beck-Srivastava Stress Questionnaire. Heart rate was monitored via palpation of the left radial or carotid pulse on each participant.
Two values, a second obtained after a five minute minimum lapse time, were averaged for each subject (location of palpation was kept consistent with each subject). Flexibility was measured using the modified sit and reach (MSR) test of hamstring and low back flexibility. Proir to administrating the MSR test, all subjects underwent a five-minute back and hamstring stretching routine. The following exercises were included: single- and double- knees to chest stretch, single- and double- sit and reach stretch, and seated upper and lower back stretches.
Each stretch was performed twice and held for fifteen seconds, with a 5 to 10 second rest interval between stretches. The subjects were divided into two stretching groups (led by the same instructor) so that flexibilty data collection could be obtained immediately following the stretching routine. The subjects were then ready for their flexibility testing. For the MSR protocol, the subject sits against a wall (assuming hips at a 90 angle) with their feet against a 30. 5 cm high box. A yardstick, [ranging from 0 to 36 inches,] is then placed on the box.
In order for the subject’s zero point to be achieved he/she must place one hand over the other and reach out toward the yardstick. During this reach, the head, back, and hips must all remain in contact with the wall, ensuring that scapular abduction is the only performed movement. The yardstick is then moved along the top of the box unitl it reaches the subject’s fingertip, establishing their specific zero point, while accounting for differenecs in limb length. After establishing the realtive zero point, the subject then completes the test by slowly reaching as far forward as they can.
The end-reach position must be held for a minimum of two seconds to obtain accurate measurements. Three trials were taken and recoreded to the nearest eighth of an inch. The average of these trials was used for analysis. Assessment of the fitness variables mentioned above, as well as completion of a Beck-Srivastava Stress Questionnaire was obtained again after five weeks of yoga participation (mid semester), and following ten weeks (close of the semester/finals). This data was prepared and analyzed for comparison and reporting of results.
