All right. So let's start with this. Why do we need research? validate, in a way extra validation. Okay, so extra validation. What does that do?

Why? Why is that useful? Especially in the medical community, more complimentary over the years. 30 years ago, they weren't but now they are. They might be more inclined to send somebody for the yoga. There's lots of chiropractic research, right?

It's like amazing, and they'll send people you can talk to them more. I mean, it's a way of just reaching out to getting more people who might be skeptical, especially as medical professionals, people. Yeah. So especially as the field of yoga therapy expands and more People are coming to yoga who have a variety of health conditions and concerns. Having research that suggests that yoga could be helpful for those populations or even just safe for those populations is likely to increase referrals. So medical professional sending people with those concerns to yoga professionals, but also, it fosters better communication and collaboration between people who speak the language of evidence informed practice and integrative health professionals such as yoga teachers and therapists.

Yeah. Right. Yes. So. So Dean Ornish, his program is covered by Medicare. And that is Because the research is very strong, and and there is a lot of debate in the yoga therapy community about whether or not it's a good thing to work with insurance companies.

It's a mixed bag. But But if we're talking about accessible yoga, making yoga accessible to all people, that also includes making yoga accessible to people who can't necessarily afford $20 a class right? So the research can be helpful in getting reimbursed reimbursement. So that's another way that it could be helpful. Anything else come to mind? You're cutting down on the likelihood Yeah, okay, so this is a really great point because there's conflicting information in the public sphere right now about whether or not Yoga is safe.

And there are some sources that suggests that actually yoga may be unsafe, and it may be the cause of injuries. And then there are other sources that say that Yoga is incredibly safe and it's a great way to prevent injuries or recover from them. And so how is that possible to have conflicting information? I see a lot of yoga teachers. Yeah. Doing poses incorrectly.

Yeah, so training, right, right. Okay. So it only takes 200 hours to become a yoga teacher. two weekends. Right you I actually think you There may be people who call themselves a yoga teacher who have gotten an online. Right.

So right. So there is no regulation, there is a registry, but there isn't licensure or certification or any sort of demonstration of competency that's required. Anyone can call themselves a yoga teacher. It's not a protected term, right? And even 200 hours, whether or not that's enough to teach a basic class is one thing, but it's probably not enough to learn about the whole variety of health conditions and how to adapt a yoga practice to people who have special needs, right of various kinds. So the the yoga that's available, is very diverse and therefore what you could expect from experiencing it runs the gamut and Research, yoga that happens in the context of research is going to be more consistent than yoga that happens outside of that context.

Because in research, there has been a process by which the specifics of what is going to happen in the yoga practice have been decided, usually by several people, oftentimes people who have a unique skill set and some specific training related to a certain population. So for example, if we're designing a yoga research study, for people with arthritis, we're probably going to have people involved in that process, who know a lot about arthritis and also know a lot about yoga, which is not necessarily the same as what would happen if you were to wander into your local community center. Do I need to adjust the temperature in here? Okay. So it is possible that someone might go into a yoga class where they could get injured. And it's also possible that someone could go into a yoga class and experience, benefits, health benefits, injury prevention, or disease management.

And the one way for us to gather information about what makes a yoga practice, beneficial or harmful is to study the differences. In order to get to that point, there's a whole lot of groundwork that has to be laid. So who knows what an asymptote is. That sounds like a familiar term. asymptote. Okay, so an asymptote is a mathematical concept.

And an asymptote approaches a value, but never reaches it. So it approaches a line and never crosses it. Okay? So imagine if I were traveling in a certain direction and each moment I get halfway, and then I get half of the remaining distance and half of the remaining distance and half of the remaining distance. Each time I get a little bit closer, but I'm never actually going to get there. You follow me?

Okay. So think of that line, that uncrossable line as capital T truth. We will never actually get there because we can never know anything with absolute certainty. Does everybody agree with that? Yeah, okay. But when we start out knowing very little about something, every piece of information we get is a big leap.

And the more we learn, the smaller those leaps become as our understanding gets more nuanced. In the beginning of a new field of research study, the early studies are very simple because there is nothing known yet from a Western medical research perspective. And as time goes on, studies are answering more nuanced questions. The early studies in yoga research, where is it safe? Will people do it? Right, safety and feasibility.

And so we had to do that. Is it safe and will people do it in every population you can possibly think of? Is it safe per boot for people with heart disease? And will they do it? Is it safe for people with diabetes? And will they do it?

Is it safe for people with arthritis? And will they do it? Is it safe for people with depression? And will they do it? Is it safe for children with ADHD? And will they do it?

Etc, etc, etc. There were a whole lot of those. Those tend to be pretty small studies. They're called pilot studies, where we're figuring out how to do it best how do we how can a study like this be done in this particular population? And then we go from safety and feasibility to understanding whether or not there are any benefits. So is it safe and will people do it?

Yes. All right, then what does it do? Does it lower cholesterol? Does it improve improve blood pressure? Does it change cognition? Does it affect posture?

So then there are a whole bunch of questions to answer about whether Yoga has a variety of effects and given that yoga has been applied for many different populations with the expectation of many different types of benefits. There are a whole lot of studies to ask those questions. Does it do this? Does it do that? And does it do the other thing? So those are a whole lot of studies to do.

And we haven't even gotten to what practices to use. So the next set of studies that happen are how does it compare to other things? How does yoga compared to walking? How does yoga compared to meditation? How does yoga compare to aerobic exercise? How does yoga compare to physical therapy?

There's a great study that came out recently comparing yoga with physical therapy for low back pain. So you can imagine how many what we call comparative effectiveness studies. There could be how does yoga compare to this? How does yoga compare to that? And again, we still haven't gotten to what our The best practices, then we start to compare Well, you know what if you spend most of the time doing breathing practices and only part of the time doing Asana, what if you include Shavasana? Or you don't include Shavasana?

What if you have balancing poses? What about chair practice versus standing practice? What about restorative versus yen? What? You know, all of those have yet to be done. So those are asking more and more nuanced questions.

And we get to a point where not only is the research helpful in being able to validate what we're doing, but at a certain point, it can even be useful in helping to guide what we're doing. Because if we know that this particular practice can be useful for this particular thing, like for example quadricep strength can delay knee replacement. Well then I'm going to consider including Chair Pose. it you know, for people who have arthritis in their Right. So the more we can learn that sort of thing, the more it can help us use what's called evidence informed practice. So evidence informed practice is a three legged stool.

Some people think that evidence informed practice means you read the research, and then you do what the research says. But actually, it's not evidence informed practice unless it has three things unless it has the best current evidence in in conjunction with expert opinion, okay, so expert opinion, who is expert opinion in yoga? Yeah, that's excellent. Yeah, expert opinion or the ancient texts, right, expert opinion or you know, all everything that has been written about yoga up to this point, which also includes your team. You're training and everything that you've learned and studied. And it also includes your own professional expertise based on your experience of working with all of the people that you've worked with.

All of that is expert opinion. So if you just take a research study, and you act on it in isolation of everything else, you know, that's not evidence informed practice. And the third is client preference. Okay? So if you use the best of what you know, combined with the best available research evidence, and you don't take into consideration the very people in front of you and what matters to them, then it's not evidence informed practice. So there are people who believe that evidence informed practice is out of step with yoga philosophy.

And actually, we just wrote a paper on this that I hope will be published soon. evidence informed practice is very much in alignment with yoga philosophy, because it does involve being totally present and in relationship and using all available sources of wisdom, including your own intuition. So, the research evidence is just one piece of how we can best serve the people that we work with. Have I convinced you that it's useful? Yes. All right, fabulous.

Okay. So this program that you are studying, is based on a randomized control trial that we first conducted at Johns Hopkins University that was then replicated at the National Institutes of Health. And I will say that remember when I was talking about that asymptote, I cannot tell you that this is the best possible yoga program for people with arthritis. Because it's never been compared to any other yoga program. I can only tell you that it was safe, and it was effective. And that's the best we have right now.

And, you know, and I hope that in the future, we're able to learn more about what best practices are. And in the meantime, you do have some evidence that suggests that this works, and that it's safe for people who have arthritis. A s YMPTOT. It's really hard to spell in my head without writing it. The National Institute of China It was replicated at the National Institutes of Health. They are, they are.

And so you can talk about this study and that the work that you're doing is based on this protocol, because this is what I use to develop this program. And, and it lends credibility to the work that you're doing, especially in the eyes of the medical community. And it's been really well publicized. So these are just a few of the articles that have been written about this work. It's been in Time magazine and Huffington Post and the Baltimore Sun and a variety of other places. It's been a popular topic in the many years that I've been doing it because this is a big deal because it You know, it used to be that people thought that if someone was having arthritis symptoms, they should rest.

And then we discovered that actually no, you really need to move. But even when I started in 2003, rheumatologists were not ready to send their patients to me. In fact, we were having trouble recruiting patients for the study. And my mentor told me that I needed to present at rheumatology rounds. So how many of you have heard of Grand Rounds at a hospital? Yeah.

So it's where you talk about different cases. And it's an opportunity for for people to learn from each other and to develop new knowledge in their field. So rheumatology rounds, as you could imagine, is that same concept applied specifically to rheumatology and I was 23 or Something like that and did not know the magnitude of me presenting at rheumatology rounds at Johns Hopkins about yoga no less. So I got up there and I gave the theoretical foundation for why yoga could be helpful for people with arthritis. I talked about the review article that we had written that suggested that there were a few pilot studies, and that it needed further study. And then I asked them all to stand up.

And they looked around for a minute and you know, then one by one, they started to stand up. And I led them through a very short practice. And so we did a few, a little bit of warming up a few simple poses some breathing. I had them sit and do a progressive relaxation, and they realized that I wasn't going to hurt their patients. So And this is what my mentor suggested, because she knew people had the wrong notion about what this would be like that I wasn't going to put people on their heads or twist them up in knots. Because that at the time was the concept of yoga that I hope is starting to change a little bit.

But there were many celebrities who are practicing yoga and the image of it was a very vigorous athletic practice. And so I had to show them that that's not what we were planning to do. And then they started sending people to me and now we have some evidence that suggests that it's helpful. What I think is really important to the the underlying approach here is that it is not a prescriptive Osten up program. So I'm not suggesting that someone comes to me with arthritis in They're hip and I say, you know, do two of these and call me in the morning. And there are people who do that there are people who use yoga Asana, like physical therapy so that it's prescriptive.

The idea here is that the the package of a comprehensive yoga practice, that includes balancing, stretching, strengthening poses, breathing practices, meditation, mindfulness, relaxation, chanting that that whole package has a set of health benefits associated with it. And in order for people to experience all of that, we have to make the Asana accessible to those folks, right. We have to make the whole practice accessible. So the idea is to adapt the practice Just so that it's accessible not to use the practice as a prescription. Do you see that distinction? Okay, you're with me.

Because I'm not looking to necessarily change the physiological structure of a particular joint using a particular pose. I'm looking at health related quality of life, the whole person, the whole experience, because remember, we talked at the beginning about the coaches how we are not just the physical body. And that is aligned with the Western model of the bio psychosocial spire psychosocial spiritual model that says that we have many aspects to ourself and so if there is some sort of disease, imbalance, illness, injury, that that doesn't just affect one layer of our being And therefore the practices that we use to bring ourselves into better balance and wholeness also should not be operating only on one layer of our being. health related quality of life is a concept that's used throughout the research literature that always includes a variety of different domains. There are different measurement tools that are used to assess health related quality of life, but they always have different components, physical, mental, emotional, social, spiritual, etc.

And so that's really my main concern. And then I'm curious about well, you know, if y'all get improved health related quality of life, how and why does it do that? Why I think health related quality of life is the important characteristic for people with arthritis is that it is a very disabling condition. It is the leading cause of disability And it's chronic, it's irreversible. And there are effects to other domains of health. social health is affected when people can't live their life in the way that they're accustomed to emotional, mental health is affected.

As we talked about earlier, there's a high level of mood disorders among people with arthritis. And when someone is experiencing changes in their physical ability, it also can impact a sense of self. The roles that you play in the world, your concept of who you are, your relationship to others, all changes. And that's an opportunity for the practices of yoga, including the underlying philosophy to make a difference in the way that someone is experiencing that disease. So yoga Of course can be helpful because it's a form of physical activity. We know that physical activity is helpful for arthritis and yoga is a physical activity.

It happens to be a form of physical activity that has a lot of different components to it. Some forms of physical activity, stretch, but don't strengthen. Or the other way around, right? So Yoga is unique in that it does incorporate balance and flexibility and strength, and even cardiovascular engagement depending on the practice. It can also accommodate the limitations that anyone is experiencing because all of the practices can be adapted. And the mind body aspects of it, we also know can be helpful for some of the struggles that people with arthritis have.

Right so the stress management because we know that there's a relationship between stress and pain and stress and arthritis. symptoms. So if some of these strategies can be helpful in changing the responsiveness of the nervous system and the way that we process pain, then that could impact life with arthritis on a totally different level aside from maintaining physical fitness and reducing disability. And then, as I said, just the the awareness of what's happening in the body, right? So we talked about how sometimes people who are in pain kind of shut off all the information from the neck down because it's painful, because it's only bad information. Why would I want to pay attention to that?

And so helping people to gain a sense of awareness of the useful messages that are coming from the body and how to respond to them appropriately and frame them in a productive way. Their body? Mm hmm. Do they stopped Yeah, that's a good question. There. I think in some cases there is sort of a numbing out that happens.

Where so there there is definitely some research to suggest that people who have chronic pain, minimize their pain because they consider a certain amount of pain to be normative, or baseline. And so they will rate themselves as a zero, even though they're not in no pain, right? You think of zero on like a scale of one to 10 zero is no pain. 10 is the worst pain you've ever had. people with chronic pain will rate themselves as zero because they never have less pain than that. Even though it's not no pain.

Right? say there's 10 people in the room right asking Walk the energy level. Right? Is your God, Marilyn Monroe? And then I asked where that pain is right now. Right?

And then I structured the class around that. Right? The reason I do that is to get them to understand. Yes. Physical, not mental, right? Yeah.

So body awareness, right. So am I increasing the likelihood well, of getting in touch with the pain? Yes. And that's not a bad thing. Okay. So, okay, all right.

So let me let me expand upon that. So pain is now considered the fifth vital sign. Okay, it has to be asked at every medical visit, you might notice that you go to a doctor for something that is not even associated with pain, and they'll ask you for your pain on a scale of one to 10. And that's because we've realized that it's actually very important. It turns out though, that rating your pain on a scale of one to 10 is not that informative. because well, which pain?

First of all? Where is the pain? What kind of pain? And I mean, this is probably more nuanced than you can get to at the beginning of a class. But it's more helpful to think about what the characteristics of the pain are. Where am I noticing it?

How would I describe it? Is it sharp? Is it radiating? Is it diffuse? Is it dull? Is it numb?

Is it throbbing? And I think that and they don't even have to tell you. But I think well, you certainly you couldn't do that, but I think encouraging people to just observe so for example, standing into dossena Notice where you're feeling sensation in your body. Are there words that come to mind that could describe that sensation that you're feeling? So you're encouraging them to become aware of what they're feeling in their body. But it's more information than just where would I put it on this line?

I'm not saying that that line of one to 10 couldn't be useful to you very well, maybe. But I think that the body awareness that we're talking about is not just, oh, I'm in pain, but Hmm, what exactly is that? Is that arthritis is that because I was sitting in a certain position is that actually a sort of good kind of sensations? Yeah. Yeah. Yeah, yeah, I do do is a fair in a lot of pain.

Yeah. I lost a stroke. Yeah. Right, and they're going to be related. And so you come down and their pain level, right? Because there's a direct relationship between stress and pain most certainly.

But I also think that even just noticing where where it is that you're feeling something and then later in the class notice, are you feeling something different now? Are you feeling the same thing, just giving them an opportunity to pay attention, and suggesting that it be with equanimity? So this is not about a story. It's not about a judgment. It's just being curious about what's happening in your own body. And that is very hard to do.

I and I don't say it flippantly like, Oh, just don't care about whether or not you're in pain. You know, that's not what I'm suggesting. But I think to be able to practice, eventually contentment with whatever is right starts with just being able to be curious and notice something without attaching a story to it. So it's something to play with In any case, but it is true that if you just like, remember when I was talking about my minister guy, and it started to hurt, of course, you pay attention to your body and you're going to notice. And that's true. You pay attention to your thoughts, you're going to notice, oh, wow, I'm thinking some bat crazy stuff.

If you don't pay attention, you might not realize it's there. But I do think that the paying attention is a useful step on the way to having a different relationship to it eventually. Yeah, if people are willing to go on that journey with you. Yeah. Okay, so I use this model that that I think is really helpful for thinking about how we might Be able to affect change in the way that people live with arthritis. So on the left, you see biological function.

So let's say that that is the underlying disease that you have or you don't have, okay? And the way that that disease behaves so we're talking, you know, what the, what level of inflammatory markers you may have in your blood or how what the level of disease activity is, that's influenced by characteristics of the environment, you know, is there trigger is there you know, and characteristics of the individual like, what is your genetic makeup for example, okay. The underlying biological function is associated with a set of symptoms of some kind. So if we're talking about, let's say rheumatoid arthritis, then symptoms may include fatigue, swelling, stiffness, etc. However, those symptoms are affected by characteristics of the individual in the environment. So, not everyone who has this underlying biological function has the same experience of symptoms.

And we have an opportunity to intervene and affect how that underlying disease manifests in a set of symptoms, what those symptoms are and what the severity of them is, can be affected by changes in the individual and in the environment. Additionally, whatever set of symptoms exist may have an impact on functional status. Okay, so someone has fatigue and pain, and therefore it's difficult for them to walk around the block. But again, there's an opportunity to intervene both on the level of the individual and the environment. So you can think about the role that a yoga practice might play on each of these levels. Could a yoga practice affect the underlying disease process?

Sees maybe can a yoga practice affect the experience of symptoms? Absolutely. Can a yoga practice affect functional status? Most certainly. Okay, and then how about general health perception? So let's say I can't walk around the block.

What is my perception of my general health? Well, that's my story, right? That's what I think about this. So no matter what my functional status, individual and environmental and environmental characteristics of fact affect an individual's perception of their health, regardless of what actually is going on with the underlying disease processes, and that affects overall quality of life. Okay, so the yoga practice can fundamentally change the world. That an underlying disease affects quality of life by intervening on any of these levels.

So, yoga research in general, is experiencing exponential growth. When I started doing this work, it was in the range of 2001 to 2005. Okay. So remember I said that there were only two studies. So I did that initial review. And there were two on Tai Chi, two on yoga and two on dance.

Right. So these are the two clinical trials right here in the 2001 to 2005 range. This is how many were published in each range, so it's not cumulative. And you can see that all Already by 2014, we were up from just four papers published in a five year span to actually, you know, at the top there, that's a six year span on the bottom 32. That's just a three year span, right? So it's half the time, and it's a lot more papers.

And if I had added 2015 to 2017, it would be another giant leap. It's really and this is just yoga and arthritis. If you plugged in anything, yoga and cancer yoga and back pain, it would be the same pattern. And actually, there's a great paper written by a colleague of mine, Pamela Jeter, who she's with NIH. Now, we've done a lot of collaborating. And she published a bibliometric analysis looking at the yoga literature, and it showed the same pattern in the yoga literature more broadly, which is that not only did the volume increased your dramatically and exponentially, but the rigor, the quality, so you're seeing more and more clinical trials and systematic reviews that synthesize all of the literature.

So the yoga researches really exciting. That's a great question. So, um, so I recommend a site called research gate. It's research gate dotnet. And it's like LinkedIn for researchers. You do have to have an institutional affiliation, I think to create a profile.

But you can follow researchers or you can follow certain topics and then you get an alert when something new gets published, which is pretty cool. And also oftentimes researchers will Share full texts of their papers there. You could follow me also in our, in our social media and in our newsletters, we really tried to highlight some of the studies that are coming out that are related to this work to keep people abreast of what's going on. And always in the level two training. I do a bunch of discussion around the current literature because I want people to really stay current with what is happening in science in real time. There also is a great site called yoga mate.

And yoga mate is a little bit more accessible for yoga, teachers and therapists. There are some summaries that are written of the research there are cases that are written up Actually I whitey the International Association of yoga therapists has started putting out summaries of research papers that are written in lay language. There is also a really great book, to which I contributed a chapter Yes. Ay ay ay yt.org Oh, yoga mate. I think that's dot org as well. If you Google yoga, mate, it'll come up.

Okay, so there's a great book. The principles and practices of yoga and health care. I think the editors are sloppier, Khalsa and surely tell us and Lorenzo Cohen. principles, principles and practice of yoga and healthcare or something like that. And what's great about that book is that they got researchers in each area to summarize the existing literature for their area. So my chapter is in musculoskeletal conditions.

And I wrote it with my mentor who's at McGill and a colleague of ours in Germany. And the same was done for, you know, every health populate health related condition and population that you can imagine. So, it's a great resource to have. And I suspect that as the literature grows, we'll write new editions of that book to keep it up to date. Yeah, okay, so the International Journal of yoga therapy, which is published by AI yt. If you join IO YT, you'll get their subscription to their journal, the research journal, they also have a journal that's more for yoga therapists and that's yoga therapy today.

But if you Have a subscription. You can go into the archives, and you can look at anything that's ever been published in their journals. So that's a great resource as well. Yoga therapy ij YT is the journal. The website is iat.org i AYT. Got it.

Awesome. Okay. All right. So here's the study design that we used. As I mentioned, it was a randomized control trial. What does that mean?

What's a randomized controlled trial intervention, as opposed to being randomly randomly placed in the intervention group. Fabulous. That was well described. Okay. So in this particular study, the two groups were the yoga intervention and what we call usual care, which is treatment for their arthritis as usual. So we didn't tell them to stop taking their medication or stop doing whatever it is they were already doing for their arthritis.

They continued with their usual care. And the other group did their usual care plus the yoga. Why do we need a control group? Why can't we just give people yoga and see how they feel? So our control group, right, we don't just want to see what improves. We also want to see what would have improved if they didn't get the yoga.

Okay, so an example might be if we let's say, we started the study in December and we ended it in May Everybody's going to feel better between December and may. So in order to be more certain that the yoga was the differentiator, we need to have a group that got everything else but the yoga. And the reason they need to be randomized is that we want to be fairly certain that these groups are relatively similar. And that means that there isn't any systematic bias in their selection to one group or another. So if we said for example, everybody who can make it on Tuesday afternoons should come to the yoga class and then everybody else will be in the control group. Why couldn't we do that?

Yeah, why? What might be different about people who can come on Tuesday afternoons? They don't work, right dressed, right? They're retired so they're likely to be older or They're likely to maybe be homemakers or they're let you know there are a whole bunch of things that could differ by between the groups if we selected them in any other way than random. Right? So that matters is that it's randomized.

There's a control group. And if we were to do this study today, we wouldn't just have usual care in the control group, we'd compare it to something else. We compare it to something else that took the same amount of time. Why would we do that? So the people who got the yoga, were also getting attention. Right?

They got two hours a week of attention. That was their usual care for somebody else where they got attention. Yeah. Was it the yoga or was it the attendance Because we know you know you spend time with. But if you spend time with anybody and give them some attention, that's gonna have some health effects, right? It's like the equivalent of a placebo pill, you're gonna feel better regardless of the special sauce.

And so, of course, the early studies, we're going to do similar study designs. But nowadays, we would want to know, what would happen if we had what we call an equal attention control. So we did not have that for this. And that's a limitation of it. And what would happen with this study is that we did it in cohorts, right, so as soon as we had about 10 to 20 people who were enrolled in the study, we would randomize them, put them into the two groups and we'd run an eight week class. So it was an ongoing study over several years, and every time we had enough people, we'd run another class and The papers in your binder.

And remember I told you that we just kept getting more funding. And so every time we got more funding, we, you know, we were able to develop the study a little bit more, it became larger and more rigorous than we had initially thought that we could do. And we wanted to compare health related quality of life for people receiving yoga to people who were not receiving yoga, but in addition to that, we wanted to understand what is driving those changes in health related quality of life? Is it because they're more physically fit? Is it because their mental and emotional health is improved? Is it because their disease activity is actually changing?

What's driving that improvement? And here are the people who purchase faded, so they had to be adults, but not the oldest old because when you're starting in a new area of investigation, you want to start with the safest population. So we limited it at the beginning to 18 to 65. When we later did the study at NIH, it was 18 plus. So there was no age maximum. We wanted people who were sedentary because we, we didn't want people who were already getting the benefits of exercise, because part of the benefit of yoga is that it is a physical activity.

So we didn't want to remove that from the equation. They had to be willing to come to class and they had to either have osteoarthritis or rheumatoid arthritis. For those with rheumatoid arthritis. We wanted their rheumatologists permission that they were cleared for exercise and they were excluded. If they had recently had surgery if they were planning to have surgery, if they needed a cane, a walker or a wheelchair, now, it is certainly possible to practice yoga. If you use a cane, a walker or wheelchair.

It's a different class. And so, we started out with a fully ambulatory group and there are other studies that have looked at chair yoga programs that would be appropriate for that population. If they had any other medical condition or psychiatric condition that would interfere with being able to see improvements in their health related quality of life. The rheumatologists did ask that we screen for hypermobility and there was no one who inquired about the study who had characteristics of hypermobility and when I started asking the questions about hypermobility, they laughed at things. Okay, remember, we were Talking about loose ligaments and how Okay, so somebody who's hyper mobile would be, you know, might have been told that they're double jointed, right? I mean, nobody's double jointed.

But that's a term that sometimes used, you know, could you put your foot behind your head? Could you, you know, all of that kind of stuff, extreme mobility. we tended in the other direction toward people calling in who had very limited mobility. So they thought those questions were pretty funny. Or if they had very unstable disease, so they were having a lot of extreme flares, which meant a lot of medication changes, which would have interfered with our findings. And as you know, the program was eight weeks long.

There were two classes a week each 60 minutes, and then they had home practice and the reason for the home practice. Well, one, it was a way for them to practice three times a week without having to come to three classes. Were really not sure what the optimal dose of yoga is. How much do you need in order for it to work? Is once a week okay? Do you need to do it every day those studies haven't been done.

But I had a hunch that three times a week would be more effective than twice. But in addition to that, we wanted it to be sustainable. So it's unethical to go into a community and offer something useful, and get a lot of information about it and then take it away. Right. So if we're going to offer something that could potentially help people to manage their disease, we want them to be able to still have it once the study is finished. And in order for them to still have it, they have to have the self efficacy for home practice, right.

They have to feel confident in their ability to do it on their own. And we built that by having them gradually expand their home practice over the course of the eight weeks. Now, when we were talking about how you might be able to offer this in your communities, and I think it's really important to understand this as a pragmatic study, a pragmatic study happens, the way that the intervention would happen in the real world as opposed to really isolated conditions. Okay, so an extreme example of a pragmatic yoga study would be if we gave people passes to take yoga classes in their community, then you'd know the yoga is happening the way that it would happen in the real world. The opposite extreme is if we controlled absolutely everything that happens so that it was identical from one person to another. And so the study was somewhere in the middle but It's important to know that the practice was adapted to the people in the room.

Remember, that's evidence informed practice, right? So when we talk about the adaptations of the poses how you adjust a pose for one person or another, it depended on who came that day. It depended on who was in that particular cohort. And every time I taught this eight week, eight week series, it was a little bit different. And sometimes, we ran out of time, and we didn't fit the whole thing in, right. So I might skip something because I needed to spend more time on something else.

And then I'd make sure to include it the next time. That's real life, right? So if you're offering this in your communities, and everybody who comes in, needs to be sitting in a chair, then that's what you're going to do. And if everybody who comes in is able to do a full sun salutation without props, then that's what you're going to do and Either of those, as different as they would be, would be aligned with how the study was conducted. Yes. Yeah.

Right. So we incorporated breath integration throughout the entire practice. So, the dedicated breathing practices that we included, were full abdominal breathing, three part breath, box breath where you're expanding the torso in all directions, and lengthening the exhale. We did not do cabala bhakti. And then we did a lot of breathe in as you raise the arm up, breathe out as you lower the arm down. So coordinating the breath with the movement but we wanted to keep the breathing Simple and also usable in everyday life.

Right? So those are practices, those breathing practices you could do standing in the grocery store, whereas, I mean, you could do it standing in the grocery store, but you probably wouldn't. And we wanted it to be accessible. Okay, and as you know, so like an integral yoga class, we included centering and chanting and meditation, relaxation, breathing poses of all varieties as a comprehensive yoga practice and philosophy. So they also had readings that they did, and we talked about the yamas and niyamas. Yes.

Yeah, in the NIH study. So when we do a research study has to go through what's called an IRB, an institutional review board that determines whether or not the research is ethical and protects the human subjects who are participating in it. And when we went through the Johns Hopkins IRB, we had chanting in it and it wasn't a problem. But when we went to NIH, they told us to take out the spiritual aspects of the practice. And that meant not using Sanskrit, not chanting, and I. We do do meditation.

Yeah. Yeah, but it's just a single pointed focus. And so we did do we, in the, in the Johns Hopkins study, we did three ohms at the beginning. And then we did the arm Shanti chant at the end, and I explained to them why we were doing it and what it meant. In the NIH study, we just did breathing. And we did a lot of signing.

So you might have noticed this morning, I did a lot of signing That's sort of a Piniella without the money off. So and you can you can sort of cheat it in this particular way. Ah, oh, hmm. Exactly. So you get all of the sounds of do without ami. Okay.

These are some examples of the kinds of things that we might do. So remember I talked about finding the essence of the pose? And so it's not about the shape that the pose makes. It's about what the Why are we doing this? Is it a heart opener? Is it a hamstring stretch?

Is it grounding? Is it you know, empowering Is it a balance? So we would consider what the essence of that pose was in deciding how to modify it. Oh, good. I'm so glad to hear. Yes, the wall.

Yeah. Yeah, and by the way, if you do chair pose against the wall, so if you do chair pose away from the wall, your your knees have to go past your ankles and remember how we talked about that puts pressure on the knees. If you do chair pose against the wall, you can have your knees behind your ankles, aside from the fact that you've taken a whole lot of weight out of it because you have weight against the wall, but also your knees can be better aligned. So that's a really nice one. And also you can use an exercise ball and roll up and down or just slide up and down the wall. It's really nice.

And not everyone can take their arms up over it. I do a lot of cactus arms. If anybody has shoulder challenges, taking the arms all the way up overhead is a lot All right. So this is my cue to make you stand up. And we've already done a whole lot of chair sun salutations. So let's just stand up stretch.

I know I'm getting you very deep into your left brain. So get into your body for a moment wiggle what you need to wiggle. This diagram is in the book, but also the, the sun salutation with a chair is on our YouTube page, and it's on the back end of the website. So this is this is hanging around a few places and you're the video of the class this morning. Has it in there too. So simple.

Yeah. It's Yeah, it's good. Good. Okay. So the instruments that we used, you don't need to know the nitty gritty of all of these instruments. So that the names of the instruments are on the right, the sort of general concepts are on the left, okay.

So, we were looking at the physical aspects of health related quality of life. They consider all aspects but we felt as though the physical aspects would be most likely to change. But then we also wanted to know what was driving it. So what aspects of physical fitness, what aspects of psychological function what aspects of disease symptoms might be driving those changes in health related quality of life? So you can see there we looked at mobility, flexibility, balance, strength, stress, self efficacy, mental health, positive and negative mood, depression, pain, tender and swollen joints. All right now, for those of you who are have some research background This slide is gonna make sense to you.

And for the others I'm about to explain it. So don't panic. So this is describing who actually participated in the study. And on the left are their characteristics. And then you have a comparison between the people who were in the yoga group and the people who were in the usual care group. And it's important in a research study to do what we call a baseline comparison, because you want to see whether these groups actually were pretty similar.

And as it turns out, there is one way that the groups were a little bit different. And that's age. It's not a big difference, but it's a difference. The usual care group was a few years older on average, than the yoga group. So, when we did our analysis later on, we considered age in the statistical calculations. You can see It's mostly female.

And we talked about all of the reasons that that would be. And it was a diverse group, we're in Baltimore, that makes sense about half of everyone was college educated, it was a nice mix between RA and people had the disease for a broad range of years. So you know, anywhere from a very short amount of time to decades. And it's not important to understand the pain and physical health scales, except that I'll tell you that they were in pain, and they didn't feel very healthy. those are those are lower than you would see in the normal population. Are there questions about this?

Okay. The big news is that it was safe. Okay, so how do we measure safety In a research study, well, nobody got hurt, right? So we what we call adverse events, there were no related adverse events. Now an adverse event is anything that happens to anybody during the time that they're in the study. And I won't tell you that nothing happened to anybody while they were in the study, except that it wasn't related to the participation in yoga.

So somebody was at work and tripped over a box and, you know, fractured a wrist not related to the yoga, somebody cancer came out of remission, not related to the yoga, somebody had an allergic reaction to a carpet, not related to the yoga. So we didn't have any adverse events that we could actually attribute to the yoga. And there were no there there were no exacerbations of joint symptoms, right. Nobody's joint symptoms got worse and that was the main concern of the rheumatologists is we have these patients very stable. their disease is well managed, and we're going to send them to you and you're going to make things worse. And so we could say, we did not make things worse.

And that's not surprising to any of you. But it's it's important. And if we didn't learn anything else from this study, that would be a big thing. It's safe. Now, we can't say that all Yoga is safe for people with arthritis, but we can say this Yoga is safe for people with arthritis. Alright, and here's what happened with participation.

So we had 103, who were screened, not all of them were eligible. Some of them didn't chose not to do it. 75 participants will randomize between the two groups. Half of them did yoga. Half of them were in the usual care group. Now.

Remember, when we're talking about ethics and fair treatment of human subjects, just as it's not appropriate to give somebody something beneficial and take it away. It's also not fair to have somebody participate in your study. Give them nothing, right? So we offered yoga to everyone, whether they were in the yoga group or the control group, they just had to finish their time in the control group first. So once they finish their time in the control group, they could join the next yoga group that was being offered. So anyone who wanted to take the yoga course could eventually do so.

So our main comparison was the people initially assigned to the group and the people initially assigned to the usual care group. But we also looked at what would happen if we took all the data from anybody who got the yoga at all, and we analyze that separately because it added more people so it made it a little more robust. Now, this is a big deal this slide. This is why I wanted to do the NIH study. This is On this, this is the x axis. And the x axis is the number of classes they attended.

Okay, it's not attendance at each class. It's how many total classes they attended. Right? So you can see there were like four people who came to every single class. Okay? There were a lot of people, in fact, most people only had a couple of absences.

Okay, so this is making sense to you. These are the four people who came to every class that the 16 here on the right, okay. And because most people are clustered on the right side of the graph, that means most people came to most classes. Okay. It's interesting that there's sort of this cluster where everybody is either 10 or above or five or below. There's nobody in between, right?

So either you really participated or you really didn't. Now, this zero, I find very fascinating. So what that means is that 20 people, signed up for the study, met the eligibility criteria, came in to Johns Hopkins, did all of the testing got bloodwork filled out the forms, yada, yada, and then it was time to start the classes and they did not come even once. Right, isn't that the interesting question? You have a research background. Okay, so that's, of course what I wanted to know who are these people.

And as it turns out, I collected a whole lot of information. about them, right? Because they did all the baseline testing. So I could look at from all of this information I have on their physical, mental, emotional and social health. What are the differences between the people who came and the people who didn't come? And here comes that?

Okay, so for those of you who understand p values, you'll see this right away, for those of you who don't have a p value is the probability that something is different by chance. Okay, so the lower the p value, the more likely there's a real difference. Okay. And so what you can see here is that the lowest p, these are all of the significant differences. So I looked at a bunch of other stuff, but the three things that were different between people who came in People who didn't come were age, race and flexibility. Okay.

And the differences in some cases were big, meaning that the groups were very different for these things. Your chance of being in one group or another of coming to class or not coming to class, we're very different depending on your age, race and flexibility. Why would age be a predictor of poor attendance? So, older people tended to not come? Why would that be? Getting out of the house?

It's just harder to do things, right. Okay, so that's a possibility. I'm going to get into in a minute how I think all three of these are related. But so that's why it might be harder for them to get to class. So Somebody else wanted to comment. Right?

So that's the interesting thing is that they did sign up, they knew they saw the sign that said, yoga for people with arthritis, you know, call this number, they went through all of this stuff. And then somehow they change their mind. And I'm gonna get to that in a minute. Okay, how about race? Why might someone not come if they weren't so people tended to not come if they were a minority race, which for the most part in this study was African American. There were some, just a few people of other minority races, but most of the people in the study were either African American or Caucasian and if they were African American, they were less likely to come and why do you think that might be?

Right who practices yoga in the West Yeah, okay. And that gets to flexibility too. It's the same. It's now there are other reasons why some where why the African American population in Baltimore City might have trouble getting to a yoga class. Okay, so there are other barriers that might be involved as well. But all three of these age, race and flexibility, so people tended to not come to class if they were less flexible.

All of these three things are related by the fact that they are out of step with yoga stereotypes. Okay, now, well, you might think, Well, yeah, but if they thought yoga was not for people like them, why would they enroll for the study in the first place? Right, if they thought it wasn't for them, they wouldn't have even called. Here's my theory that is completely unfounded. But just bear with me. Okay, imagine me 15 years ago having just completed a Master of Fine Arts in dance and a marathon.

Okay, so I was 20 something years old, totally buff, thin, white, young female. Okay. And you sign up for this yoga for arthritis study. And you do this screening with more over the phone and then you show up. And here I am, and I am the face of this study. And so if you had any trepidation might I have been intimidating or might I have made you think?

I don't know if I really belong. I'm not saying I'm not saying that. That is definitely it, or that that's the whole thing. But it occurred to me. Right, if I were 60 and, and put on a lot of weight, right? I don't know.

But I was really curious. And you can see that even though all three of these are significant, the race one is the strongest. And so I really wanted to know what are the barriers for a minority persons with arthritis related to participation in yoga class. So, when NIH called me, it was an African American yoga teacher at NIH, who said, I would really like to do a study looking at the feasibility of yoga for minority persons with arthritis. And I said, you cannot be serious because that is exactly what I want to do because of She didn't even know about this. And I and I thought, you know, because I had been studying in my doctoral studies about concordance Okay, so, you can have gender concordance or race concordance or language concordance or age concordance, which is that the two people who are in relationship to each other share that identity, okay.

And there is research that in medical encounters, there is a different relationship when there's concordance between the medical provider and the patient, for a variety of reasons, and you know, part of that is human nature. And so in talking with Kimberly Middleton, who's the researcher from NIH, we thought, Well, what would happen if we made this race and language concordant? Meaning, what if all of the representation related to the yoga study was African Americans and Spanish speakers, and that's who she was interested in targeting. So we recreated the manual took out all the pictures of me and put in pictures of people with different kinds of bodies and ages and you know, sizes and colors, and we made sure that everything was bilingual and I was the only white person on the entire study team. And we had Spanish speakers of every you know, not every but many different regions who understood Spanish differently and could communicate differently and understand the nuanced differences between how Spanish is spoken in different places.

And so we found that that was actually very well accepted and feasible. There were certainly barriers and challenges. And many of them had to do with things that were not about race and language at all. But like, it takes me two buses and three hours to get to a yoga class because I don't have a vehicle or I don't have childcare and I'm a single parent or I can't get off work during the time that the classes and all of these things that make it challenging for working people and family You know, people raising families to get to a yoga class that might differentially affect minority persons could have been a play in the yoga study in the Hopkins study as well. But it's also really, really important that our representation of yoga practice is as diverse as the people who can benefit from the practice.

And that is, that's why I feel so strongly about the accessible yoga movement, that Yoga is for every body and mind. And that is every size, every ability, every age, every language, every color, every religion, etc. and if we want yoga to change the world, then we have to speak the language of the people who can benefit from it. Yeah. And I said, Oh, what's that? She said, yoga for Christians.

Yeah, and ice. That's really funny. I think that most everybody teaches. Yes. Right. Right.

Yeah. So and actually, what's funny to me is that, you know, the NIH study, they said, take out all of the spiritual aspects. And, and we were discussing this because there was a case that came up where somebody was opposed to a statue of Patanjali. That was in the studio. Now. Patanjali is a historic figure, but this person took it to be a deity, and was offended.

And once we explained it still didn't solve the problem. I said, it's like a bust of George Washington at the statehouse. You know, it's just a person who was involved in the starting of something. But that got us talking about what is perceived as spiritual in yoga really is likely more cultural than spiritual. But also, it's impossible to make yoga, not a spiritual practice. Because it's impossible to not have a spirit.

So, if you get still and quiet and pay attention, stuff's going to come up. And if you've got physical issues, you're going to notice them, just like we talked about. If you pay attention to your knees, you're going to notice your knees. If you pay attention to your mind, you're going to notice whatever issues are going on in your mind. And if we all indeed have a spirit and therefore spiritual life, if you're having an existential crisis, and you get still and quiet and pay attention, it's gonna come up, and it doesn't matter whether you own or don't own. And interestingly, in the Johns Hopkins study, where we did use Sanskrit and chant, we didn't have any any pushback from people who felt as though it was in conflict.

You notice from the graph previously that once people came to the First class, they pretty much came most of the time with a few exceptions, like somebody had an allergic reaction to a carpet. And but but I think that's partly because I encouraged people to bring what was meaningful to them into the class. So when it was time to meditate, I encouraged them to focus on something that was meaningful to them. Maybe that is your breath, maybe it's a word, maybe it's an image, maybe it's a prayer. And so some people might have been saying the Lord's Prayer, and some people might have been saying, inhale, exhale. And some people might have been saying, I'm grateful for this day, whatever it was, it would resonate with them because they chose it.

So I think that the broader we can make it so that people can bring all of who they are to the practice, the more accessible it becomes. Okay. So these are the things that improved For the yoga group, compared to the control group when we only looked at those initial group assignments, okay, so health related quality of life changed. And then we wanted to know why well, their mobility improved their flexibility, improve their positive moods, their depressive symptoms, their pain and tender and swollen joints, okay? So it's mostly driven by, you know, a little bit of each of these some changes in physical fitness, some changes in physical function, psychological functioning, and some changes in disease symptoms. And I'm not giving you all of the statistics, because those of you who are interested, the paper is available for you to look at those differences.

Now, remember, I said that we did. Another analysis that included everybody who got the yoga at point. And so when you look at that, because the sample size is bigger, the number of people are bigger we have more things that reach statistical significance. So in addition to health related quality of life flexibility and walk time depressive symptoms, positive mood, which we saw before negative moods also improved. stress levels also improved, the tender and swollen joint counts we had seen with the initial comparison. But now the patient global assessment, that's the patient's rating of their health, their how their arthritis health, and then also changes in pain, general health, energy, the roles that they play, physically, their physical function, social function and mental health, and anything that has an asterisk.

When we brought them back nine months later and tested them again, all of those changes persisted. So almost everything was still better, nine months later, and I will tell you, that it's been a decade And there are many people in the study who are still practicing yoga to this day after an eight week series. And it's, it's part of their lives. I mean, and some people will tell you, yoga isn't just something that I do. It's how I live, it's who I am. It's, you know, it's really profound how, you know, when we talk about whether or not an intervention is cost effective, you give somebody you know, 16 hours of your time and they have a lifetime of disease management.

It's Yes, yes. Right, in the nine months afterwards, no teacher, right. Yeah, right. Well, and some of them do go to classes. But they now have, they know how to make adjustments. I have had some people tell me that they've gone To classes and the teacher tells them not to do what I taught them, and then they don't go back.

So that's unfortunate. But you know, that's the difference between yoga in a research study and yoga in the real world. It's a mixed bag, right? So they always have home practice that's always available, right? This is really complicated stuff. And we don't know exactly how it works.

It's a black box. What exactly is driving what when it comes to all of the ways video practice can impact so many aspects of life and that's for someone else to figure out. So, you can imagine how each of these arrows could be a separate study. Right. Okay, so here is one example of the many people who have talked about how much of a difference this He has made. So Jan says, yoga made a huge difference in my life.

I've had almost 10 years of sobriety 16 major joint surgeries, and no trouble with pain medication because I use the yoga of all the things I use to help with my arthritis. Yoga is the biggest one hands down. Yes. Well, yeah, well, you can have more than one surgery on a particular joint. So you know, as I said, many people are still practicing. And I could, this isn't even, you know, doesn't scratch the surface of what I could say, in terms of just profound life changes, as as we've discussed before.

So the study is strengthened by having been a randomized control trial, the people who were doing the measurement, didn't know what group people were in. Okay, so the people who were assessing their joints and measuring their physical fitness, didn't know whether this was somebody who had gotten the yoga or not, which isn't Important to avoid bias. We developed this with a team of people who knew a lot about arthritis and yoga. And we modified everything for the people who were in the room. It's reproducible because we have the protocol. And and in fact, we have reproduced it already.

We measured a whole lot of different aspects of health so that we could look at what was driving those changes. And in fact, there were there were many improvements. And of course, all of those things affect each other. We had a diverse sample, and we also assessed participation. And we found that that there may be some challenges to participation for particular populations. And then that behooves us as a community to do something about access.

Even though it was the biggest randomized control trial yet, it's still small, and we can't necessarily generalize the findings from this study to other populations. We can't say that we would see the same effects on, you know, an 80 plus crowd, or people who use a walker, for example, because they were excluded from the study. Because we ran it in cohorts. Sometimes people had to wait around until the next class started, that could have also affected participation. And we don't know what the dose needs to be to have this kind of effect. We don't know whether if they had one class a week, we would have had the same effect.

Or if we had three classes a week instead of the home practice, what what would have been different, so that still remains to be seen, or how long you have to do it to start to notice a difference. is eight weeks some magical number or do you start to see effects much sooner than that? And this particular group was pretty healthy psychologically. And we did see improvements in psychological health, but there was probably a limit to how much better they could get in that way. Whereas there are plenty of people with arthritis who have more psychological challenges than this group had. Yoga research is difficult because there are so many different practices and so many different ideas about how things can and should be done.

And it's really hard to know what people are doing at home, if they're doing anything at home. People tend to tell you what you want to hear. So while we recommended that they did home practice, and they told us that they did, we don't know whether they actually did and future studies should assess that in a stronger way. And we really do need equal attention controls and to compare yoga to other interventions that we know can be helpful for people with arthritis. So you can say these are sort of the things that you can say. out in the world yoga appears to be safe for adults.

With mild to moderate our airway, people participate in yoga at levels, the same or greater than other physical activity. So, you know, at the gym on Jill on January 2, it's really crowded, and then by March, it's empty. So, people stuck with this more than they might another kind of exercise program. We did have challenges with attrition, particularly for minorities, older folks and lower flexibility and I've talked about the work we have to do there in changing stereotypes and myths about yoga practice. We know that there was an association with improvements in physical health and health related quality of life, as well as changes in physical functioning physical fitness, psychological functioning and disease symptoms. Yeah.

With yogurt sticking sticking with Yeah, they found in the Dean Ornish program for tenants, right. Diet, social support, social support, cardiovascular exercise and yoga. Yeah. If yoga if they do nothing but the yoga, they will keep on with. Oh, right. Yes.

If they drop the diet, right, come back, right. If they drop the exercises, it will come back. Yeah. Drop the yoga. Yeah. Eventually the other four pillars will drift away.

Yeah. So, yoga. There are. There are several studies suggesting and this is actually something that NIH is really interested in. There are several studies suggesting that yoga fosters other health behaviors, that people who practice yoga tend to then start doing a whole bunch of other things that are good for them. And Exercise isn't a cumulative benefits of yoga, which is why they tend to stick with me because it keeps getting better.

Yeah, also when, when Yoga is associated with weight loss, it is not necessarily because the yoga practice is burning a lot of calories, it's because when you start paying more attention, you notice when you're hungry and you notice when you're fooling you notice when you have a bad reaction to a bacon double cheeseburger. And so people start making different choices, eating more mindfully noticing when their body wants to move, going for walks, can noticing that it feels better when they get the right amount of sleep. And so the mindfulness and the awareness and the self care seems to be one of the consequences of yoga practice so that falls in line All right. So of course, there were many supporters that helped to make this happen included, including my mentors, and colleagues and the facilities that provided space and the funding to do this. And then I also did tell you that we replicated it at NIH, and that study is also available for publication.

And then we also did a little pilot in lupus. So we had a few people with lupus come to one of the eight weeks sessions at NIH, and we're now presenting the initial findings of what we think might be appropriate for lupus. It's not handstands. This was this was the meeting where we developed the protocol and we all just needed a break. So we decided to do handstands but they're not in the lupus class. Yeah, Okay, questions?

Yes. I'm a researcher. Yeah. You're gonna take it to another level. Are you going to include more meditation? Stress, stuff like that?

Have you found out? Have you have you included bigger portions of meditation? No, I'm okay. So well. All right. A couple things of interest one.

I just published a paper in the ij yt. about research literacy among yoga therapist, actually first we did one about yoga therapists opinions of evidence informed practice. We just did another one about what yoga therapists should know. about research literacy. And we're writing one about how sorry, I just muffled my. We're doing one about how evidence informed practice is aligned with yoga philosophy.

And that's coming out soon. And that's pretty cool. In terms of the clinical research, we're doing a study now looking at the effects of one on one yoga therapy in our student clinic at the university. And I would ultimately like to compare yoga in groups with one on one, which hasn't been done yet and should be very interesting. I think that there are different benefits. Yeah, because social support is one of the things that we talked about.

They don't have that in the same way from one on one, but it's also a lot more individualized. Thank you. So stay tuned. Yes. The trouble is, it's really hard to get funding for longitudinal research because it takes a long time. Yeah, I mean, I would love to just do a follow up study trying to reach out to the people who did this because I know anecdotally so many of them are still practicing, but to be able to track everybody down and get good data, and all of that is tough.

Oh, I'm fascinated by that. Because I'm just gonna grab something. Because we'll talk tomorrow, or is it tomorrow we'll talk. I think maybe it's the next day about pain in the brain. Yes, exactly right. And so I'm interested in the non physical practices.

So if we did a yoga intervention that was philosophy, breathing, relaxation and meditation without any Asana. I really think that that I think that that's a huge that the Asana is way overplayed, not that it's not beneficial or important or useful, but it's assumed that that's the active ingredient. And I don't know that it is in the late 50s and early 60s, I don't know the exact here when he was in California, you know, he went to UCLA back then they like hooked up electrodes and just had to meditate. So right showed the benefits, go pull that up somewhere, right? Right. But I mean, I even think for arthritis.

I think that of course. The non physical practices are not likely to improve physical fitness. And they're so the effects would be different. But I think that when it comes to overall quality of life, that you wouldn't, it would be interesting because I'll also say that for many people, there was a profound moment that they had in a particular posture that made a big difference for them. And so your relationship to your body changes in asana practice in a way that it might not with the other practices. So who knows it would be it would be fascinating to do that.

I don't know if I could get that funded, but it'd be pretty neat. Well, I'd be interested to see a comparison. Right? What if you had the US versus didn't what would be what would be the same and what would be different? Yeah, because I'm always telling people that you know, you can practice yoga in your bed, you can practice yoga. Going you're in a flare because people do get so fixated on the poses, and lose sight of all of the other practices that can be so beneficial.

Okay, I'm going to read you a poem. This one was actually written by a student in the yoga for arthritis level one training in New York a few years back. Yarrow son and his his name. It's easy to make some simple points about the daily pain inside my joints. I walk I move, but I often ache. Some days resting is all I can take.

Yet things have begun to turn around. As this Yogi culture I have found. We stretch we reach and we do with care and I feel power as I reach through them. Err, I remember a time with no pain, a time when I had nothing about which to complain. I thank my arthritis for what I know that it's okay if I'm a little slow for life is opening up for me with every move. As I pose like a tree.

I see the warrior that is on the inside and I can make it to Shavasana with pride. There was a time when arthritis made me grieve. But thanks to yoga, I've learned peace as I breathe and breathe. Yeah. Isn't that great? He's a yoga teacher.

Yeah. Yeah, he was just a student in the training. That was his sharing. At the end of the tree. No pressure. You don't have to write poetry.

All right, let's go home and go to bed. Oh Shanti Shanti Shanti