Should yoga be part of NHS care? | Healthcare Professionals Net...

https://www.theguardian.com/healthcare-network/2016/apr/26/sh...

Should yoga be part of NHS care?

A Manchester GP practice is prescribing yoga for patients and even plans to create its
own on-site studio to host classes
Rachel Pugh
Tuesday 26 April 2016 08.25BST

ome patients at The Docs city-centre surgery in Manchester emerge from the
consulting room, minus a prescription, but clutching a voucher for a free yoga
class courtesy of sta at the practice who are convinced that yoga deserves a more
prominent part in NHS care.

The tickets entitling the bearers to a 45-minute class at the nearby Studio 25 were
initiated by one of the partners, Dr Matthew Joslin. He developed them following
powerful Facebook support for an open letter he wrote to the NHS in January appealing
for greater incorporation of the Indian exercise and mindfulness techniques into
day-to-day healthcare. The letter received 17,000 Facebook shares.
Astonished at the reaction, 46-year-old Joslin has added to his 16 years as a yoga
practitioner by training to teach the physically-demanding Ashtanga form of the
practice. He plans to start giving one class a week from June onwards at Studio 25, and
later in the the basement at The Docs when work has been carried out to convert it into a
yoga studio, with a physiotherapist also on hand to tackle a range of musculoskeletal
problems.
It is time yoga became the default option to get people moving, improve strength,
exibility and posture and while youre at it to bring a helping of mindfulness to
promote mental health, says Joslin.
This is not just about bad backs and dodgy knees. Joslin has become aware that many of
the men and women coming into the consultation room of his inner-city practice bring
problems that he feels yoga could help. Cardiovascular disease, diabetes, pregnancy,
back pain, obesity, mental health issues, social isolation and a number of the diculties
faced by people in old age fall into this bracket.
Yoga is cheap, sociable and available in a number of forms to suit all ages, tastes and
abilities from the more static and strengthening Iyengar, the therapeutic and
meditative Svastha, to the cardio workout oered by Ashtanga. Could it be a way of
hitting a number of health problems at once?
Figures from Sport England from 2013-14 suggest that 388,200 people over 16
participated in yoga for 30 minutes every week up from 296,800 in 2008-09 and the
NHS England chief executive, Simon Stevens, announced last autumn that yoga was to
be oered to health professionals alongside Zumba and health checks, in a package
aiming to cut the 2.4bn annual cost of sick leave in the health service.
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Should yoga be part of NHS care? | Healthcare Professionals Net...

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However, recently-issued draft guidelines on lower back pain from the National Institute
for Health and Care Excellence (Nice) do not mention yoga specically in
recommendations that people take exercise to improve their condition. Although Nice
says its recommendations do not exclude yoga, there is not enough scientic proof that
it works.
Joslin started yoga to cure a bad back but became hooked by the practice when he was
introduced to Ashtanga during a period of anxiety and depression that nearly made him
quit medicine. He now goes to three classes a week, including a Friday lunchtime class
accompanied by The Docs GP trainee, Shahnawaz Khan, and practice nurse, Wendy
Cooke.
The 45-minute Yoga Express programme, to which he sends his patients, was devised by
renowned yoga teacher Matt Ryan, who used to be a DJ at Manchesters Hacienda
nightclub, and used the practice as his way out of drug and mental health problems.
The GP reels o anecdotal examples of patients who have had similar positive
experiences an adult with neurological damage following meningitis, who now has
better balance and coordination; a woman with serious depression, who communicated
after her rst session of yoga.
A major problem is that the evidence base for yoga is not there. A Cochrane review of
yoga and back pain pointed this out, even though there is a strong support for the
benets of exercise on cardiovascular disease. Another diculty about yoga is that it is
used to describe a number of practices from the meditative to the highly athletic.
Dr James Newham, from Newcastle Universitys Institute of Health and Society, and
researchers from Manchester University have carried out the rst study of antenatal
yoga in the UK published in the journal Anxiety and Depression showing that a single
session of yoga reduced self-reported anxiety by a third and stress hormone levels by
14%.
Dr Kishan Rees, a clinical teaching fellow in medical education at Lincoln UMED,
believes that economic constraints on the NHS call for a broader view of public health.
There may be a lack of evidence to support some complementary therapies such as
Yoga, he says. However, as long as it causes no harm, these approaches should be
implemented as part of a toolkit people can access as they see t.
In the US, the work of the meditative aspects of the yoga by psychologist Dr Richard
Miller have been ocially recognised. He used the state of lucid sleep (yoga nidra) to
treat post-traumatic stress in soldiers returning from Iraq and Afghanistan.
The governments Mindful Nation project backed the concept of mindfulness and
recommended that mindfulness-based cognitive therapy should be commissioned on
the NHS for recurrent depression. In the UK, the Phoenix Prison Trust takes yoga and
meditation to prisoners, to improve their physical and mental wellbeing.
Justin Varney, interim deputy director of health and wellbeing at Public Health England,
says: There are a variety of types of activity that people can undertake to contribute
towards achieving a healthy amount of physical activity, with most people preferring to
undertake a mix. Yoga is an excellent way to achieve the two sessions of muscle

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Should yoga be part of NHS care? | Healthcare Professionals Net...

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strengthening per week in alignment with our guidance.

Yoga is always going to be a turn-o to some who associate it with mysticism and drugs,
but Joslin believes that austerity and the Facebook reaction suggest yoga is worthy of
more careful ocial consideration. I want to see whether there is a way to marry the
amazing healing sustaining practice that is yoga, with the services oered by the NHS,
he says. The NHS already sends people to the gym and to swimming pools. Find me a
physiotherapist who doesnt think yoga is a good idea.
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