chapter 23

1. chapter23 Mindful Exercise for Fitness Professionals Ralph La Forge, MS

2. Where Mindful Exercise Programs Are Generally Taught • Athletic training programs • Yoga studios and ashrams • Personally individualized instruction and therapy on location (e.g., home, fitness center, or office) • Professional fitness and sports medicine meetings • Clinical rehabilitation programs (e.g., cardiac, pulmonary, musculoskeletal) • Pain management programs • Senior and retirement centers

3. Common Benefits of Mindful Exercise • Improved muscular fitness (e.g., muscular strength) • Improved muscular flexibility • Improved balance control • Enhanced self-efficacy and mood • Tendency to concomitantly improve other lifestyle behaviors (e.g., stress control)

4. Mindful Exercise and Rehabilitation(Types of Rehab and Sample Modalities*) • Pulmonary rehabilitation: yogic breathing therapy; yoga styles with particular emphasis on breath work such as Viniyoga, Integral yoga, Ashtanga yoga, and Iyengar yoga • Balance control(especially in elderly patients): tai chi, qigong, tai chi chih • Cardiac rehabilitation (with emphasis on aerobic exercise): neuromuscular integrative action (NIA) • Musculoskeletal rehabilitation (e.g., sport rehab): Feldenkrais method, Alexander technique, therapeutic Iyengar yoga, individualized Pilates exercise (continued)

5. Mindful Exercise and Rehabilitation(Types of Rehab and Sample Modalities*) (continued) • Arthritis and carpal tunnel syndrome: individualized therapeutic yoga • Stress reduction: virtually all forms of skillfully taught mindful exercise, particularly with yogic breathing, restorative yoga, qigong exercise, tai chi, and Ananda yoga • Overall muscular fitness and flexibility: Iyengar yoga, Ashtanga yoga, Pilates * These forms of rehabilitation do not exclude other mindful exercise modalities.

6. Essential Components of Mindful Exercise • Meditative or contemplative qualities Mindful exercise includes a self-reflective, present-moment, and nonjudgmental sensory awareness that is process centered rather than strictly goal oriented. • Proprioceptive awareness Mindful exercise includes the perception of movement and spatial orientation arising from low to moderate muscular activity. • Breath centering In mindful exercise cognitive centering activity is focused on the breath and breath sounds. This breath centering process includes a variety of breathing techniques as employed in yoga, tai chi, and qigong exercise. (continued)

7. Essential Components of Mindful Exercise (continued) • Anatomic alignment or proper physical form Disciplining oneself to follow a movement pattern or spinal alignment characterizes many forms of mindful exercise, particularly Hatha yoga, Alexander technique, Pilates, and tai chi. Not all mindful exercise uses set choreography or disciplined alignment. Exceptions are NIA and expressive ethnic dance (e.g., Native American and Alaskan dance). • Energycentric process This is the perceived energy flow in tai chi and Chinese qigong (energy medicine). The awareness of movement and flow of intrinsic energy, vital life force, chi, and prana is common to many classical mindful exercise programs (e.g., yoga).

8. Factors Determining the Response to Hatha Yoga • Level of mental focus or kinesthesis • Position of the asana (e.g., head down or head up) • Duration of each asana • Pose sequence • Duration of entire pose sequence or yoga session • Breathing technique • Skill level of the student (i.e., years of yoga experience) • Anthropometric characteristics of the student (e.g., BMI, body structure, musculoskeletal health)

9. Popular Hatha Yoga Styles • Iyengar yoga • Restorative yoga • Ashtanga yoga • Anusara yoga • Viniyoga • Kripalu yoga • Integral yoga • Bikram yoga • Kundalini yoga • Sivananda yoga • Ananda yoga

10. Yogic Breathing • Hatha yoga combines yogic breathing with yoga exercise in a very logical way. Whenever a yoga movement expands your chest or abdomen, you inhale. Conversely, when a movement compresses your chest or abdomen, you exhale. • Breathing is done through the nose during both inhalation and exhalation. Each breath is intentionally slow and deep with an even distribution, or smoothness, of effort.

11. Research-Supported Medical Benefits of Qigong • Reduced asthma-related symptoms (bronchospasm) • Increased cerebral blood flow • Reduced pain in patients with chronic pain • Reduced mental tension and state anxiety • Reduced blood pressure • Increased bone density • Improved cognitive performance (continued)

12. Research-Supported Medical Benefits of Qigong (continued) • Improved immunocompetence • Reduced blood coagulation • Reduced blood lipid levels (total cholesterol and triglycerides) • Improved sexual function • Reduced risk of stroke * From K. Sancier and D. Holman, 2004, “Multifaceted health benefits of Qigong,” Journal of Alternative and Complementary Medicine 10: 163-166.

13. Examples of Tai Chi Styles • Yang style. Yang style is the most widely practiced form of tai chi in the West today. The original Yang long form consists of 108 movements; however, the Yang 24 short form is a popular modification practiced today. • Chang style. Chang style is a relatively new style of tai chi developed by Chang Tung-Sheng in the 1930s. Chang style consists of more than 100 movements and is based on modifications to the Yang long form. (continued)

14. Examples of Tai Chi Styles (continued) • Wu style. Wu style is an easier form of tai chi with smaller steps. Its movements, which involve less twisting, impose less stress on the legs and knees. The condensed Wu style includes 36 postures. • Sun style. Sun style combines elements of the Wu and Yang styles. Sun style is characterized by very energetic steps. • Mulan Quan style. This is a modern form based in traditional tai chi movement and wushu (Chinese martial arts). However, it adds aspects of Chinese folk dance and gymnastics for a very expressive movement process.

15. Qigong and Tai Chi Key Point The ancient qigong and tai chi practice has inspired many contemporary mindful exercise programs. The calming and introspective qualities of qigong and tai chi rank nearly highest among those of the mindful exercise modalities seen in the West today. Qigong exercise and tai chi are best suited for those who are older, those with low functional capacity, and those who wish to improve balance and coordination. Patient populations ideally suited for qigong and tai chi are cardiac rehabilitation patients, especially those in early phases after myocardial infarction or cardiovascular intervention procedures, hypertensive patients, and patients with stress-related disorders.

16. Contemporary Mindful Exercise Programs • Pilates • NIA (neuromuscular integrative action) • Alexander technique • Feldenkrais method • Asian martial arts • Others such as Gyrotonics, Chi Ball, walking meditation, E-Motion, Brain Gym, Yogarobics, Yogilates, aqua tai chi, yo chi, ChiRunning, ChiWalking, Flow Motion, mind–body circuit exercise, and contemporary ethnic dance routines

17. Indicators of Mindful Exercise Outcomes • Quality of life measures (e.g., SF-8, SF-12 quality of life scale instruments) • Measures of mobility and physical function • Flexibility and muscular strength measures that closely replicate the training program • Resting blood pressure • Forced expiratory volume in 1 sec (FEV1)—a measure for mindful activities focusing on breath work, such as yogic breathing and Hatha yoga (continued)

18. Indicators of Mindful Exercise Outcomes (continued) • Balance control measures (e.g., standing balance test, backward tandem walk)—measures for mindful activities requiring neuromuscular balance (e.g., tai chi, qigong exercise) • Mood alteration measures (e.g., state anxiety measures, Profile of Mood States) • Pain or symptom measures • Spirituality measures (e.g., Spiritual Well-Being Index)

19. Research-Supported Benefits of Hatha Yoga and Tai Chi Exercise: Cardiorespiratory Benefits • Lower resting systolic blood pressure • Increased pulmonary function (e.g., FEV1) • Lower resting respirations • Improved respiratory function in patients with asthma • Increased parasympathetic tone • Decreased resting blood lactate and resting oxygen consumption • Enhanced arterial endothelial function • Improved risk factor profile for cardiovascular disease (e.g., reduced blood lipids) • Reduced cardiac ventricular arrhythmias

20. Research-Supported Musculoskeletal and Neuromuscular Benefits of Hatha Yoga and Tai Chi Exercise • Increased muscular strength and flexibility • Increased balance control • Improved posture • Decreased fracture risk and falls in older individuals • Reduced low-back pain

21. Research-Supported Psychophysiological Benefits of Hatha Yoga and Tai Chi Exercise • Increased cognitive performance • Improved relaxation and psychological well-being • Decreased stress hormones (e.g., norepinephrine, cortisol) • Decreased state anxiety and depression scores • Enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients • Reduced frequency of panic episodes • Decreased symptoms associated with pain, angina, asthma, or chronic fatigue

22. Other Research-Supported Benefits of Hatha Yoga and Tai Chi Exercise • Increased physical functioning in older persons • Improved glucose tolerance • Decreased HbA1c (glycated hemoglobin) and C-peptide levels in patients with type 2 diabetes • Increased baroreflex sensitivity • Decreased obsessive–compulsive disorder symptoms • Decreased osteoarthritis symptoms • Decreased carpal tunnel symptoms • Adjunctive therapy for cancer and cardiovascular disease * From R. LaForge, 2003, Mind-body exercise for personal trainers. In American Council on Exercise personal trainer manual, 3rd ed. (San Diego: American Council on Exercise).

23. Approximate Energy Costs of Mindful Exercise Modalities

24. Psychobiological Mechanisms of Mindful Exercise • Psychological changes—expectancy (Rosenthal effect) and special attention (Hawthorne effect) • Cortical and hemispheric lateralization changes in the brain • Deactivation of the hypothalamic pituitary adrenal axis resulting in reduced catecholamine production • Central endorphinergic changes, or acute endorphin changes in the brain that act on neurotransmission (continued)

25. Psychobiological Mechanisms of Mindful Exercise (continued) • Respiration-induced affective changes (e.g., pulmonary parasympathetic stimulation) • Musculoneurocognitive mechanisms in which ascending neural pathways carry sensory information from the muscles and joints to a variety of thalamic and cortical structures of the brain that affect mood and cognition • Thermic neuroendocrine affective changes induced by mindful exercise programs taught in high temperatures, as experienced with Bikram yoga

26. Hypothalamic, Pituitary, and Adrenal Mechanisms Involved in Meditation and Mindful Exercise