“Integrative Medicine (IM) is healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies.”

~ Andrew Weil

Health is undeniably a holistic state. It is influenced by innumerable aspects of our dynamic inner (physical, mental and emotional), and outer (food, exercise, stress, environment…) worlds, and yet there still exists a societal tendency towards a dichotomy of being either in favor of modern medicine or complementary approaches to health.

For those of us who lean more towards complementary therapies, there may be countless motivations, but they often include the holistic view of a person as a complex being within a complex environment, the belief in the body’s ability to heal itself, and/or the awareness of the incredible impact of non-invasive therapies that work with the body without harsh side effects.

For those who lean more towards allopathic medicine, I cannot speak, but I can acknowledge that modern medicine has its place and value. When illness is too far advanced, injuries too severe, and all other treatments have been tried (although this is often reversed in reality), allopathic medicine can and has helped, and in this way has played a role in transforming society.

Much as health is a holistic state, I would suggest that so should be the approach to attain and maintain it. Rather than keeping different methods in silos from which we can determine ‘the best’ one, wouldn’t it be more effective to recognize, learn from and integrate the best of all possible methods with mutual respect and appreciation?

The European Congress for Integrative Medicine exemplifies this very idea. By annually bringing together experts from all walks of modern and complementary paths to health and healing, it seeks to advance integrative medicine. In doing so, it enables people from different health perspectives to learn from each other in an open and collaborative environment.

This year’s congress covered a wide variety of topics, including but not limited to Ayurveda, integrating complementary healthcare into medical education, integrative oncology, mind-body connections, nutrition and microbiome health, yoga, and planetary and environmental health.

Some key information and highlights from the conference will be shared below in order of the following topics:

1. Integrating complementary healthcare into medical education
2. Mind-body connections
3. Integrative oncology
4. Yoga
5. Ayurveda
6. Planetary and environmental health
7. Overall takeaways and where might we go from here…

We hope these reports will capture for you some of the enriching insights from this conference!

ECIM session article #1: Integrating complementary healthcare into medical education

Chair: Elizabeth Thompson – CEO, National Centre for Integrative Medicine (UK)

When thinking about conventional medical education, one might conjure up images of long hours spent memorizing parts of the human body and physiological process, and sleep-deprived hospital rounds as an intern, learning the standard ‘diagnosis, drug remedy/surgical intervention, fixed’ approach. I can’t say how reflective of reality this truly is, as I did not attend medical school. But this is certainly the type of images that flood my mind. Having spent many volunteer hours in hospitals during my university years, I would guess that, although exaggerated, this is not that far off the mark.

But regardless, this education certainly produces many competent professionals whose daily actions play a core role in saving, improving and extending lives – a fact that cannot be undervalued. At the same time, as with everything in life, there is always room for improvement, and the gaps and aspects that could be improved in medical education are increasingly being recognized. This knowledge was the unspoken starting point on which this session built; numerous inspiring speakers provided an overview of what they are doing to contribute to improving medical education, by seeking to integrate some key elements of complementary healthcare. These keynote speakers largely shared insight into their institutions and activities working towards this goal, which are outlined below.

Session speaker #1: Victoria Maizes – Executive director of the Andrew Weil Center for Integrative Medicine (US)

The key messages from this presentation highlighted that one of the Center’s numerous activities is to contribute to transforming healthcare through education.

They have programs, mainly online, which seek to train professionals ‘in the healing-oriented practice of integrative medicine…’ Their educational programs essentially cover points that medical education does not, such as learned compassion and self-care of health professionals. An example of one of their programs is the Integrative Medicines in Residency program, a 200-hour online integrative medicine curriculum designed for incorporation into primary care residency education. This stemmed from having tried integrating programs into the medical curriculum, and finding residency to be the best place.

Alongside such programs they also offer free courses for health professionals and the public (see The University of Arizona Andrew Weil Center for Integrative Medicine). They are an internationally recognized center, and are interested in collaboration to expand education of health practitioners around the world: What is Integrative Medicine?

Session speaker #2: Rupy Aujla – GP in emergency medicine in the UK, founder of Culinary medicine UK and The Doctor’s Kitchen

As a General Practice doctor in the UK working in emergency medicine, Rupy founded ‘Culinary medicine UK’ in 2017, which aims to integrate the medicinal effects of food and eating into the current healthcare model. It is based on the concept of learning about nutrition, the medicinal effects of food, and how to cook. They ran a pilot as part of the specialty choice modules at Bristol University to establish a gold standard of what undergraduate healthcare practitioners should learn. They have also worked with University College London to offer a compulsory culinary medicine course as part of its primary care program in year 5. The overall aim is to scale an undergraduate program across a number of different medical schools, tailored for a UK audience. Visit their website for further information: https://culinarymedicineuk.org/

Session speaker #3: Ally Jaffee – junior doctor and cofounder of Nutritank (UK)

Ally and her cofounder noticed during their medical education that diet or how to have conversations with patients about diet and lifestyle was not included. They became aware of the lip-service being given to the importance of diet and lifestyle in existing guidelines, but through their own research learned that many doctors are not actually comfortable having these conversations with patients. Nutritank’s ambition is to see this change in medical education. They thus founded Nutritank, a think tank and a network, and have involved as many medical students as possible across the UK. This movement aims to integrate aspects into medical education such as how to work with patients on lifestyle and nutrition, but also what practitioners can do for their own self-care to reduce burnout and increase resilience.

Their persistent and collaborative efforts have resulted in a clause being added to the 2019 National Health Service (NHS) long-term plan to further educate staff in nutrition. Furthermore, after 3.5 years of work, their UK undergraduate curriculum in nutrition has recently come out and been sent to universities across the UK. Visit their website for further information: Nutritank.

Session speaker #4: Trevor Thompson – Professor of Primary Care education and general practitioner (UK)

Professor Thompson structured his talk around the concept of ‘how to transform a medical school in eight minutes’ (since he only had eight minutes to speak), and asked the question ‘why is it needed?’ He answered that current medical schools are founded on a 19th century concept of health, which does not align with the new awareness of and interest in lifestyle-oriented approaches. He suggests that there is a need for better awareness of the necessity for student self-care and of external changes like climate change.

For successful healthcare transformation, he highlighted the importance of aligning with the current leaders in the field. They are, for instance, saying to support student self-care (e.g. guidelines from the National Institute for Health and Care Excellence (NICE) in the UK). There are guidelines on advice doctors should be giving, but in many cases, doctors never learned how to give that advice in the first place. He therefore advocates for an approach to enable doctors to give effective consulting, practice the art of medicine, self-care and resilience, while being aware of planetary health and sustainability, and account for disability, disadvantage and diversity.

In summary, to transform a medical school he suggests one needs to 1) follow the leaders, 2) build holism into the infrastructure, 3) have content that rocks, and 4) ensure holism is assessed.

Session speaker #5: Tabatha Parker – Executive Director of the Academy of Integrative Health and Medicine (US)

Tabatha provided an overview of the academy, which is focused on the question of how to reimagine healthcare and create a global movement. Their mission is to advance holistic and integrative health globally, and they want to bring collaborations together to do so. The original organization started in 1978 and has evolved significantly. They have a commitment to equity within the organization, but also within the larger integrative medicine community, consciously considering how they can bring this work into everything they do. They have a two year board-certified curriculum, and offer education on a global level. They feel that the integrative health community needs to strategically come together, and they invite organizations to join academy. More information can be found here: Academy of Integrative Health and Medicine.

Session speaker #6: Elizabeth Thompson – CEO of National Centre for Integrative Medicine (UK)

Dr. Thompson explained the aims and challenges of the NCIM. The Centre was inspired by the Weil Center. They have faced challenges in the UK, particularly because lifestyle and nutrition have really been taken up seriously, but the mind-body-spirit view has been harder to integrate into conventional structures, which do yet fully accept such approaches. They have been introducing such integrative health education to medical undergraduate students, but only a few students at a time. Their key aim is to break through into medical training so that integrative health becomes a standard part of what is done. For postgraduate training, they have a two year Master’s level integrative health program to create sound knowledge of integrative medicine, use a range of approaches, enhance holistic management, increase self-confidence and skills in integrative medicine, improve prevention of burnout and increase human connection. They teach not only doctors, medical students, and complementary health practitioners, but also have materials and resources to reach the public. More information can be found here: https://ncim.org.uk/

The session made it clear that there are numerous promising integrative health initiatives, which provide hope and opportunities for the future of medical education.

ECIM session article #2: Mind Body Connection

Chair: Michael Teut – Senior physician and clinical researcher, Institute for Social Medicine, Epidemiology and Health Economics, Charité (Germany)

How do we understand the mind body connection in health?

The crucial influence of the mind on the body and vice versa has gained increasing interest, stimulating a wide array of engagement and research. The presentations below capture some of the activities currently occurring in this field.

Sessions speaker #1: Hillary McClafferty – Medical doctor, FAAP. Academy of Pediatric Integrative Medicine (US)

Hillary spoke about the what, why, how and where of mind-body medicine in pediatrics. She has and continues to use many types of mind-body therapies with children, such as breath work, meditation, yoga and music therapy, to name a few. She suggests that these therapies are relevant for children because children can experience stress, pain, adverse childhood events and complex illness, which points to a need for expanded treatment options. Stress can affect children (like adults) at an emotional level and cellular level, and although things like stress can be positive or negative, children need tools to handle both.

Although there are challenges, such as the fact that such therapies have minimal coverage in the US, she further highlighted that mind-body therapies are powerful because they are non-invasive and non-pharmacological. But how can practitioners choose the best mind body modality? She uses a mind-body history in addition to the normal physical history. It includes looking at a child’s typical day, family stress patterns, family dynamics, obstacles, and strengths. Beyond treating the medical concern, mind-body therapies can improve other areas contributing to health, such as confidence, lifestyle, sleep, etc.

Resources: Book: Mind-body Medicine in Clinical Practice (2018). Hillary McClafferty

Session speaker #2: Holger Cramer – Research Director, Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen (Germany)

This presentation provided an overview of a study teaching mindfulness and compassion to primary school students. Many mindfulness-related activities in school-aged children have been extra-curricular, but the researchers wondered if mindfulness could instead be integrated directly into classes and training provided by teachers, for more long-term impact.

They conducted their study in Solingen, Germany, with 3rd and 4th grade students across 21 primary schools. There was a non-randomized, non-controlled pilot phase (phase 1) to benchmark workflows and understand the research tools, followed by the main, cluster randomized controlled study (phase 2). In phase 1, teachers participated in a 20-hour mindfulness and compassion based training and practiced mindfulness for themselves. In phase 2, teachers integrated their learning into their lessons and practiced with students regularly. Measurements included assessment of emotional and social school experiences of the children, as well as health-related quality of life, concentration and attention.

The study results showed a positive impact of the intervention, but also a surprising distinction: teachers learning mindfulness and compassion for themselves only already positively impacted students’ interaction and health. There was minimal additional benefit to the students practicing mindfulness themselves. The researchers did not interpret this, but perhaps it points to different ways to most effectively approach mindfulness in different age groups.

Session speaker #3: Maren Michaelsen – health researcher, Institute of Integrative Healthcare and Health Promotion, Witten/Herdecke University (Germany)

Maren presented a meta-analysis which synthesized the results of randomized controlled trials (RCTs) of mind-body interventions in various workplace settings. They examined mindfulness-based programs (i.e. formal mental exercises focused on increasing mindfulness) and mindfulness-informed approaches (i.e. more informal techniques that increase mindfulness indirectly). They propose that existing reviews have focused mostly on mindfulness-programs, but in the real world mindfulness-informed approaches may be utilized more often, so they wanted to know how effective these are. Their outcome measures covered six categories: self-reference, physical health, mental health, well-being, recovery and work-related factors. They found that mindfulness based stress reduction and meditation seemed to be more influential for some factors than other mind-body interventions. The results overall suggest that integrating mind-body interventions into the workplace is feasible and has the potential for sustained value. It is unclear as to the difference in effectiveness between mindfulness-based programs and mindfulness-informed approaches.

Session speak #4: Anna Rezo – Researcher, University of Potsdam (Germany)

Anna also presented a meta-analysis. Knowing that stress affects both physical and mental health, ad that university students experience high stress levels, her team examined the effects of mindfulness-based programs on stress in university students. They differentiated between formal practice (e.g. yoga, meditation), informal practice (e.g. mindfulness in daily life) and education (e.g. self-care, stress). Their outcome measures included self-reported stress (primary outcome), mental ill-being (e.g. anxiety, distress) and mental well-being (e.g. resilience) (secondary outcomes).

Prior to conducting their review, they determined three pathways through which mindfulness-based interventions may work: 1) changes in allostatic load or ‘wear and tear on the body’ (e.g. decreased cortisol, decreased blood pressure), 2) neuronal changes (e.g. decreased amygdala, increased hippocampus volume, or 3) change in mental processes (e.g. attention regulation, awareness, emotional control). From their review they found a small effect for their primary outcome. For the secondary outcomes, all had small effect sizes.

Awareness and research of the mind-body connection is growing. The next step that is unfolding is determining how to best integrate knowledge, skills and techniques into healthcare.

ECIM session article #3: Integrative oncology

Keynote speaker: Moshe Frenkel – MD, Director of the Complementary and Integrative Medicine Service, Division of Oncology, Rambam Medical Center (Israel), Clinical Associate Professor, University of Texas Medical Branch (US), Medical

Doctor Frenkel talked about the role of complementary and integrative medicine in cancer care. Oncology has continued to evolve over the last twenty years, bringing increasingly sophisticated technologies and approaches such as nanotechnology, gene therapy, genomics and patient-centered care. Some of the newest trends include functional genetics, immunotherapy, earlier detection and diagnosis, all of which have contributed to significantly improved survival for cancer patients.

With such success then, why is integrative medicine needed? Cancer brings up fear and uncertainty, stimulating patients to look for alternative options to deal with this. Moreover, most conventional treatments come with a slew of side-effects, such as diarrhea, nausea, vomiting, fatigue, etc., which patients seek options for managing.

In the past few years, there has been an increased emphasis on supportive care, psycho-oncology and providing health and quality of life for the whole person, not just curing or managing the illness. This is where complementary and integrative medicine provides added benefit. There has been a shift in perspective from a ‘war against cancer’, to building a ‘supportive terrain’ to stimulate growth and healing. This supportive terrain can be built through nutrition, lifestyle changes, complementary and integrative medicine and mind-body-spirit approaches.

A new field has thus emerged, ‘integrative oncology’, in which incorporation of integrative medicine into conventional oncology care is emphasized, and the key goal is to improve supportive care. This enhances the ability of the patient to manage multiple aspects of the disease. Since guidance for healthcare practitioners on how to do this did not yet exist, Dr Frenkel’s team developed five basic guiding principles:

• Know what patients are doing and provide reliable response to address their main concerns
• Reduce negative interactions with conventional treatments
• Provide psychological, social and spiritual support
• Empower people with cancer and their families to develop strategies for living with cancer and support them in the process
• Explore the main concerns that patients have

Through their clinic they found that patients were coming to address questions such as ‘what else can I do?’, ‘how can I cope with my situation?’, ‘how can I deal with stress, fear and anxiety?’

But a question remains: should integrative medicine be adjunctive, or an essential ingredient in supportive cancer care? He suggests that integrative medicine should be an essential ingredient (see source below) and play a significant role at each stage of the disease trajectory. Newly diagnosed patients are often confused, stressed, and unable to use complementary and integrative medicine at this stage. Weeks or months later, they may learn about options and often reflect that they wish they would have learned about these earlier. Patients undergoing treatment are those that most often look for integrative oncology, because it can decrease stress associated with treatment side effects, improve adherence to treatment, reduce the need for pharmacological supportive care and potentially improve survival. Patients finishing their treatments often still have unmet needs. Here, complementary and integrative medicine can facilitate improvement of quality of life, and there may even be survival benefit. For instance, in a 2008 study, breast cancer patients who received a stress reduction and health behaviour intervention showed reduced death from and recurrence of breast cancer (see source below).

Integrative oncology is being implemented in a number of countries around the world. In Israel alone there are 12 centers throughout the country. This movement is an encouraging step towards putting more emphasis on quality of life of cancer patients, and a more holistic, integrative approach to treatment.

Further resources

• Andersen, B. L., Yang, H. C., Farrar, W. B., Golden‐Kreutz, D. M., Emery, C. F., Thornton, L. M., ... & Carson III, W. E. (2008). Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer, 113(12), 3450-3458.
• Frenkel, M., Sapire, K., Lacey, J., & Sierpina, V. S. (2020). Integrative Medicine: Adjunctive Element or Essential Ingredient in Palliative and Supportive Cancer Care?. The Journal of Alternative and Complementary Medicine, 26(9), 781-785.

ECIM session article #5: Planetary and Environmental Health

Keynote speaker: Rob Verkerk – founder and director of the Alliance for Natural Health International (UK)

As a sustainability scientist, Rob spoke about the ecosystem required for the sustainability of life on our planet. He opened the discussion by pointing to some of the enormous global problems we’re currently facing, and suggesting they share common origins, depending on how far back one looks.

Rob commented on the human tendency to exceed our natural capacity for sustainability, and the fact that we’re seeing a capacity tipping point in terms of human health issues and environmental issues. Two examples were explored in further detail: climate change and the COVID-19 pandemic. When we look for solutions to such issues, those that become dominant in the public discourse tend to be quite limited. For instance, solving the problem of carbon emissions is perceived to be key to solving the climate change problem; high vaccination rates are often perceived to be key to solving the pandemic.

This prompts the question, do we really ‘know or agree what the problem is for each of these crises?’ In the case of climate change, we hear much more about reducing carbon emissions than how we can support ecosystems that sequester carbon efficiently. Such perspectives draw attention away from other considerable effects of the problem, including mass extinction and biodiversity loss, land use and pollution, and industrialized lifestyles, to name a few. As you move back to a broader perspective, some of these points overlapped with the issue of COVID-19, such as industrialized lifestyles; research found as many as 10 preventable chronic diseases resulting from industrialized lifestyles are associated with mortality risk from COVID-19. Rob’s team isolated 52 different factors that affect a severe COVID experience. They differentiated between modifiable, possibly modifiable and non-modifiable factors, suggesting that dealing with the landscape within which the disease occurs can help more effectively deal with the problem.

Returning to the capacity tipping point topic, at such a point, absorptive (persistence) and adaptive (incremental adjustment) capacity have been exceeded, and the level of transformative capacity (transformational response) has been reached, which requires much more significant transformation than working on comparatively small aspects and expecting them to bring the needed change.

Many of today’s problems are related to the fact that humanity is poorly adapted to modern lifestyles, and the planet is poorly adapted to a humanity that is not playing within the rules of nature. While processes are linear, such as the environmental and health continuums below, it is important to remember that these processes occur within very complex systems. If, for example, complex industrial systems expand without attention to impact on sustainability, the tipping point on the first continuum is reached (where we are now) and we need to look at transformative changes.

Environmental and health continuums

Sustainable human-ecosystem-planetary interactions	__________	Human ecosystem-planetary collapse
Wellbeing	__________	Severe pathological illness

So what do we do? In terms of climate change, Rob suggests that we need to be looking at ecosystems and interactions between systems, acting within and not outside of nature. In terms of health, we need to transition from reactive, disease-centric to proactive, eco-centric systems. When thinking about sustainability, we should not be looking at risk factors of problems, but causes, or causes of causes, or causes of causes of causes…to determine the true origin that we need to deal with.

Read more here: Alliance for Natural Health International.

ECIM session article #6: Ayurveda

Chair: Amit Bhargava – Council member & medical director, AYUSH collaboration projects, College of medicine (UK)

Ayurveda is a system of medicine from India that originates from the idea that disease results from an imbalance in a person’s consciousness. To bring back balance in body, mind, spirit and environment, Ayurveda uses lifestyle interventions and natural therapies. The session speakers provided an array of insights into Ayurveda, as outlined below.

Session speaker #1: Suhas Kumar Shetty – President, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital (India)

Suhas spoke about the Ayurvedic herb called Brahmi (Bacopa monnieri (L.) Pennell), and its effect on depression, anxiety and stress in the general population of the Hassan district in India during COVID-19. His team conducted a preliminary study that had two phases.

In phase 1, potential participants were screened for psychological distress during COVID-19. In phase 2, they evaluated the effectiveness of Brahmi to reduce depression, anxiety and stress in eligible participants (198 people).

They found that taking Brahmi (in capsule form) two times per day for 30 days significantly reduced depression, anxiety and stress, and could therefore have implications in clinical practice to support psychological health both during COVID-19 and in other situations.

Session speaker #2: Peter Kath – President, European Ayurveda Association (Germany)

Peter spoke about Ayurveda for crisis and trust, structuring his talk within three questions:

1. What does it mean to be in a crisis?

A definition of crisis from medicine is the decisive moment in the course of a disease when there is a beginning of a cure or a radical deterioration of the patient’s condition. Thus, the path out of crisis can lead to healing, if the danger is recognized and steady steps are taken to restore balance. In the current COVID-19 pandemic, fear and anger are playing large roles worldwide.

2. What are the threats of the current crisis?

Crises can trigger fear: fear of being alone, of infection and death, exclusion, and helplessness.

3. How can Ayurveda contribute to its management?

There are a number of therapies within Ayurveda that can help with crises like what we currently face. Peter introduced us to one for dealing with an imbalance triggered by fear: therapeutic music. Research on music and health has been conducted in numerous countries such as Denmark, Germany, and Norway. Such studies have found positive effects of practicing and listening to music on our health. An Ayurvedic therapeutic approach using music and carefully chosen Sanskrit lyrics can be very effective. Certain vibrations from singing such mantras can positively impact the body, mind and emotions.

Session speaker #3: Anupama Kizhakkeveettil, Professor and program director of Ayurvedic medicine (US)

Anupama introduced the Ayurvedic bio-cleansing method ‘Panchakarma’ for management of skin conditions. For a practitioner of Ayurveda, the skin reflects healthy or unhealthy states of the body’s inner organs and tissues. Causes of skin disease are often related to food, improper physical, mental and vocal activities, and harmful external substances/organisms.

Panchakarma is the first line of Ayurvedic treatment for many chronic disorders, which uses cleansing methods such as induced emesis, induced purgation, oil based enema, decoction based enema, herbal nasal drops and bloodletting.

As a whole, Ayurveda can support the management of skin diseases through a multifaceted approach including diet, lifestyle recommendations, herbs and various detox therapies.

Session speaker #4: Flora Stubbs – citizen advocate of Ayurveda and integration into the NHS (UK)

Flora spoke about integrating Ayurveda into the UK healthcare system. She identified current challenges to the healthcare system, including chronic diseases, mental health disorders, lifestyle disorders, antibiotic resistance and multi-morbidity. There is thus an increasing need for healthcare that is effective, preventative and affordable.

Flora suggests that integrating Ayurveda and tradition sciences into modern medicine can play a role in improving P5 medicine (predictive, preventative, personalized, participatory, precision), because they have large potential for improving chronic disease and lifestyle disorders, and have a holistic, patient-centered approach. At the same time, she acknowledge many barriers to such integration, including the lack of standardization of the therapies, the limited cross-cultural discourse, social norms and public perception, complex terminology and emphasis on products (modern medicine) over systems (Ayurveda).

Ayurveda has a wide breadth of techniques and approaches that can be very beneficial, particularly in our current times of lifestyle disease, environmental change and global challenges affecting our health.

ECIM session article #7: Yoga

Chair: Nina Fuller-Shavel – Integrative Medicine Doctor, Scientist and Educator, Director of Synthesis Clinic (UK)

‘Yoga is a mind and body practice. Various styles of yoga combine physical postures, breathing techniques, and meditation or relaxation’ (How does yoga work?).

This session covered an array of topics, including yoga’s impact on non-communicable disease, the role it can play in healthcare systems, yoga research, its impact on lower back pain, and how it can helper older individuals with multiple morbidities.

Session speaker #1: Sat Bir S. Khasala, Assistant Professor of Medicine, Harvard Medical School, Director of Yoga Research, Yoga Alliance, Director of Research, Kundalini Research Institute (US)

This session started by reminding us of two profound facts: that non-communicable diseases (NCDs) are a leading cause of death worldwide, and that most of these deaths could be avoided, since NCDs are largely influenced by lifestyle. Lifestyle risk factors that can lead to NCDs include, for instance, a lack of physical exercise, poor nutrition, chronic stress, and other unhealthy behaviors.

While in conventional care models prevention and health maintenance has often not been emphasized, yoga practice can facilitate such prevention and maintenance behaviours. Research shows that the practice of postures, breathing, relaxation and meditation can improve fitness, self-regulation, awareness and spirituality, all of which can have a positive impact on aspects such as physical and mental health, stress and emotional regulation.

In an effort to communicate how such benefits could be integrated more regularly into health care, Professor Khasala and colleagues have written a book: Bir, S. (Ed.). (2016). Principles and Practice of Yoga in Health Care. Handspring Publishing Limited.

Additional sources

• Bryan, S., Zipp, G. P., & Parasher, R. (2012). The effects of yoga on psychosocial variables and exercise adherence: a randomized, controlled pilot study. Alternative Therapies in Health & Medicine, 18(5).
• Cox, A. E., Ullrich-French, S., Tylka, T. L., & McMahon, A. K. (2019). The roles of self-compassion, body surveillance, and body appreciation in predicting intrinsic motivation for physical activity: Cross-sectional associations, and prospective changes within a yoga context. Body Image, 29, 110-117.
• Ross, A., Friedmann, E., Bevans, M., & Thomas, S. (2013). National survey of yoga practitioners: Mental and physical health benefits. Complementary therapies in medicine, 21(4), 313-323.

Session speaker #2: Heather Mason – Yoga in Healthcare Alliance (UK)

Heather talked about yoga in healthcare systems and what’s is currently happening internationally. She highlighted yoga therapy – a sub-therapy of yoga that involves additional training to enable practitioners to work with health conditions – as an important sub-set of yoga to integrate into healthcare.

Why would it be beneficial to integrate yoga into healthcare? First, for economic reasons. Studies have found a high potential cost-effectiveness of yoga, and a reduction in absenteeism due to musculoskeletal conditions. Because of this, yoga now exists in the NICE UK guidelines for non-specific back pain and sciatica as a primary conservative intervention.

The US was first place to integrate yoga into healthcare, starting with Dean Ornish in the 1980s. His four part program (of which one part included yoga) was found to reduce heart disease, which led to his program being covered by Medicare starting in 2010. Additionally, the US department of Veteran Affairs has been developing policy and guidance to implement complementary and integrative healthcare, using yoga as one of eight approaches.

In Sweden in 2010, yoga was integrated into the Swedish National Health Service following a trial at the Karolinska Institute on an intervention ‘Mediyoga’ by Goran Boll. Goran trained health professionals to offer yoga to patients, instead of bringing in outside professionals. In 2021, 20% of Swedish clinics and hospitals provide ‘Mediyoga’.

The Ministry of AYUSH (Ayurveda Yoga Naturopathy Unani Siddha Sowa-Rigpa Homeopathy) in India aims to expand traditional Indian Medicine throughout the country, and bring their efforts internationally through memorandums of understanding with numerous countries.

In Germany, yoga is recommended in many multi-modal treatments. It is entering health care as a form of therapy within the health care system, including health insurance coverage. Yoga therapy is a protected term for doctors and psychotherapists.

In the UK, yoga is entering healthcare through social prescribing, which includes referral of a patient to activity group. The Yoga in Health Care alliance was commissioned in West London to create a social prescribing programme for mild depression, mild anxiety, pre-diabetes, social isolation and risk of cardiovascular event in 10 years.

Session speaker #3: Susan Wieland – Assistant professor, Maryland School of Medicine (US)

Susan spoke about characteristics of systematic reviews of yoga: a bibliometric analysis of the research. The authors’ aim was to support yoga research by identifying systematic reviews of randomized controlled trials of yoga for health, describing the bibliographic characteristics, and identifying the topics covered by the systematic reviews. They found that: from 2004 – 2019 research in this field has increased substantially; most reviews focused on treatment, very few on prevention; the most common medical topics being addressed included (in order of descending frequency) psychiatric, cancer, musculoskeletal, cardiovascular, reproductive/sexual, neurological, metabolic, respiratory; reviews generally reported at least one promising finding, but also uncertainties.

Read the entire review here: Wieland, L. S., Cramer, H., Lauche, R., Verstappen, A., Parker, E. A., & Pilkington, K. (2021). Evidence on yoga for health: a bibliometric analysis of systematic reviews. Complementary Therapies in Medicine, 102746.

Session speaker #4: Holger Kramer – Research Director, Department of Internal and Integrative Medicine, Evang. Kliniken Essen-Mitte, University of Duisburg-Essen (Germany)

Holger presented an updated systematic review and meta-analysis on yoga for low back pain. Acknowledging the high prevalence of low back pain and the fact that yoga is among the most commonly use complementary treatments for it, the authors sought to explore randomized controlled trials of yoga interventions to manage low back pain. They found that: most trials were in the US; most addressed chronic low back pain; a variety of yoga styles were used, but Iyengar yoga was most common; yoga showed robust short and long-term effects for pain, disability, physical function and mental health, when compared to non-exercise controls; effects included clinically important changes to some degree; since yoga is comparable in effectiveness and safety to other exercise, it can be recommended for patients with low back pain.

Publication is in press.

Session speaker #5: Lesley Ward – Research Fellow, Department of Sports, Exercise and Rehabilitation, Northumbria University (UK)

Lesley reported on experiences of online yoga for older adults with multi-morbidities. Multi-morbidities are common in older adults, and yoga has been found to be a low-cost way to address multiple issues simultaneously. Gentle Years Yoga is a system of yoga that is chair based and appropriate for older adults with multiple chronic conditions. Her and her team ran a 12 week randomized controlled study of the program with older adults (65+) with two or more chronic conditions. While the trial was face-to-face, it moved online when COVID-19 started. A process evaluation of a sub-study explored the experiences of students with the online format. They found four main themes:

1. IT skills (participants were more computer savvy than expected and were ready for online delivery)
2. Improved accessibility (many found it easier to access/get to a meeting on Zoom instead of having to go somewhere)
3. Online classes may facilitate practice (some participants felt less external distractions when practicing with Zoom, and a greater sense of privacy)
4. Yoga teacher attributes (limitations of online medium required teachers to adapt their communication approach, e.g. simple descriptive explanations, physical demonstrations, closeness to screen for fine movements, use non-verbal feedback).

The wide array of research and practical applications of yoga for health show many promising avenues for integration of this practice in health care.