Health Psychology Home Page

Papers written by students providing scientific reviews of topics related to health and well being

bikram and rajashree in toe stand Bikram Yoga:

Its Claims, Benefits, Purpose, and Treatment

Sarah Lindsay Wood

•What is Bikram Yoga and what is its purpose?

Bikram Yoga, named for its creator, Bikram Choudhury, yogi to the stars, is the newest trend in Hatha Yoga. Often termed “hot yoga,” each class consists of a twenty-six asana (a stable posture or pose used in prolonged meditation) series completed in a recommended room temperature of 105 degrees Fahrenheit accompanied by a 60 percent humidity level (http://www.bikramyoga.com/sqa.htm). Like other forms of Hatha yoga, it focuses on the importance of meditation and breathing in completing each pose. However, unlike traditional forms, the Bikram method is said to be a “comprehensive, all-inclusive workout that entails all the components of fitness: muscular strength, muscular endurance, cardiovascular (strength), flexibility, and weight loss” (http://www.virajster.com/bikrmyoga.htm). According to Trisha Lamb Feuerstein, head of research for the Yoga Research and Education Center, Bikram holds extra appeal in American society because of its “no pain no gain” mentality. “It makes you sweat (and) makes you hurt;” thus, its appeal is magnified. Aside from its seemingly extreme aspects, its ultimate purpose is much the same as all other forms of yoga. Similar to traditional forms, its main purpose is to promote mind-body unity and relaxation while providing a source of spiritual, psychological, and physical rehabilitation through holistic healing. (http://content.health.msn.com/content/article/1668.51358).

•How does Bikram Yoga work?

Bikram’s method of yoga is said to work by the bikramlogo on red “tourniquet effect: stretching, balancing (using gravity), and creating pressure all at the same time” (http://www.bikramyoga.com/sqa.htm). The asana, when held in a steady and comfortable, yet firm and relaxed state, serves to “open the energy channels, chakras, and psychic centers of the body,” while simultaneously improving one’s muscular strength and maintaining “control of the mind” (http://www.yogabasics.com/asana/). Bikram’s most unusual aspect, the addition of extreme heat to treatment, is said to make the body more supple, providing protection of the muscles “to allow for deeper stretching” in each asana, while thinning the blood “to clear the circulatory system.” Moreover, perspiration, resulting from heat, opens the pores of the skin and therefore allows for complete detoxification of the body. The heart rate is increased for an effective cardiovascular workout, strength is improved “by putting muscle tissue in optimal state for reorganization,” and the lipids of the skin are reorganized in the muscular structure. The “80-20” breathing method, said to

build “energy and equipoise for the posture,” is used in each class for standing and back-bending poses. “Exhalation breathing” is also utilized in classes to complete forward-bending asanas, helping to “relax the body, compress the digestive organs, and promote proper forward rotation of the pelvis.” “Blood and calcium are brought to the bones” as opposing gravity strengthens them, and the body’s lymph nodes are “massaged,” providing for a more efficiently-working lymphatic system. A “compression and extension to the thymus, spleen, appendix, and intestines” occurs, the lungs are expanded and “flushed out by increased blood circulation,” and “communication” within the endocrine system is “perfected.” Finally, stimulation of the nerves occurs, “supplying fresh blood, oxygen, and nutrients throughout” (http://www.bikramyoga.com/sqa.htm).

•What claims are made about the effectiveness of this treatment?

bikram According to Bikram Choudhury’s web page, the benefits of his treatment are limitless. However, the amount of benefit is directly correlated with the amount of effort put into treatment. Bikram recommends that his students practice “no less that ten times a month to get minimum benefit” from his yoga. He personally claims that if students “come every day for the next three months,” then he will give them “new [bodies]” and “new life” (http://www.bikramyoga.com/sqa.htm). He does not promise to “cure” anyone of chronic diseases; he instead states that if students “faithfully follow” his regimen, then they will be relieved of the “symptoms of discomfort” present in these diseases (http://www.bikramyoga.com/benefits.htm). Among these ailments, curing capability has been claimed for everything from diabetes, anorexia/bulimia, eczema, multiple sclerosis, obesity, and autoimmune hepatitis, to Lyme’s disease (http://www.bikramyoga.com/testimonials.htm). On his web page, Bikram offers two guarantees through the practice of yoga: 1) “If you continue to perform Bikram’s Beginning Yoga Class regularly--all twenty-six poses—exactly as directed—the chronic symptoms will not return.” and 2) “If you don’t continue your yoga faithfully, fully, or as directed, your symptoms will return.” Choudhury’s only disclaimer is that to fully enjoy the extent of Bikram yoga’s curing capabilities, the series must be completed in its entirety. Simply performing several of the poses within the series guarantees nothing (http://www.bikramyoga.com/benefits.htm).

•What evidence is offered in support of these claims?

Much of the evidence offered in support of the aforementioned claims is simply anecdotal. Testimonials of the treatment’s effectiveness can be located on nearly every yoga website. However, these often unreliable sources cannot serve as actual evidentiary support for the previously stated claims. What few studies that have been conducted regarding yoga and the validity of its claims, do, however, offer some cause for hope. According to USA Today, extensive research has reported that Hatha Yoga in general can benefit people with asthma, arthritis, and high blood pressure (http://healing.about.com/gi/dynamic/offsite.htm?site=http://www.usatoday.com/life/health/exercise/lhexe020.htm). Cardiac surgeon at New York Presbyterian Hospital in Manhattan, Dr. Mehmet Oz, argues that genuine Hatha Yoga does in fact “massage the lymph system,” activating the flow of lymph throughout the body, speeding up its infection-fighting and waste-filtering process, and promoting “the draining of the lymph.” According to Oz, specific asanas “stretch muscles that from animal studies are known to stimulate the lymph system.” In conducting these studies, researchers have found that there is an “increase in lymph flow” when dogs stretch their paws in a manner similar to the asana positioning of “downward-facing dog.” Furthermore, an eight-week study completed by Dr. Ralph Schumacher of the University of Pennsylvania School of Medicine in 1998 determined that a “yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome.” Also in 1998, Dr. Dean Ornish, through experimenting with 194 patients of coronary heart disease, found that “80% of the patients were able to avoid bypass or angioplasty by adhering to lifestyle changes, including [Hatha] yoga.” To avoid the argument of confounding variables present in his experiment, Ornish noted that “adherence to the yoga and meditation program was as strongly correlated with the changes in the amount of blockage as was the adherence to diet” (http://www.time.com/time/health/article/0,8599,106356,00.html). An empirical study published in the Indian Journal of Personality and Clinical Studies compared the effectiveness of Hatha yoga with the effectiveness of a commonly prescribed drug, Diazepam, in alleviating symptoms of anxiety. To conduct the study, two subject groups were formed from a population of 91 adults diagnosed with anxiety neurosis. Group 1, consisting of 38 subjects, measured the effectiveness of yoga practiced five times per week for three months while Group 2 (53 subjects) measured the effectiveness of drug therapy for the allotted time period. All subjects were administered a “battery of tests pre- and post-treatment,” and upon completion of the study, “at least 6.7% of Group 1 subjects were reported to be completely asymptomatic as compared with none of the Group 2 subjects.” These findings, therefore, demonstrate a significant increase in effectiveness of Hatha yoga as opposed to the effectiveness of drug therapy in treatment of anxiety disorders (PsycINFO Database Record, 2002). Furthermore, a study conducted at the University of California at Davis sought to disclose the effects of Hatha yoga practice on the “health-related aspects of physical fitness,” including muscular strength and endurance, flexibility, body composition, and pulmonary function. In completing the study, researchers formed a subject group of ten “healthy, untrained volunteers (nine females and one male)” with ages ranging from 18 to 27 years. For the complete eight-week duration of the study, subjects were required to attend a minimum of two yoga classes per week. Through comparison of a pre- and post-treatment evaluations of each subject, researchers documented a 31% increase in isokinetic muscular strength for elbow extension, a 19% increase in strength for elbow flexion, a 28% increase in strength for knee extension, a 57% increase in isometric muscular endurance for knee flexion, a 13% increase in ankle flexibility, a 155% increase in shoulder elevation, a 188% increase in trunk extension, a 14% increase in trunk flexion, a 7% increase in absolute oxygen uptake, and a 6% increase in relative maximal oxygen uptake. The results, therefore, indicate that regular Hatha yoga practice contributes to wide-ranging improvement in aspects of physical fitness (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11832673&dopt=Abstract). Two studies published in the April 2000 issue of Indian Journal of Physiology and Pharmacology showed that “yoga may be as effective as drug therapy in controlling hypertension,” and similarly showed that a four-month Hatha yoga treatment “significantly increased feelings of good health,” as measured through the use of a standardized scale known as the “Subjective Well-Being Inventory.” Yoga, whatever type it may be, is proven to relax if done properly. This relaxation, in theory, is what initiates the healing process (http://my.webmd.com/content/article/1676.51324). However, the integration of heat into Bikram Yoga is the main aspect which sets this form clearly apart from all other forms of Hatha Yoga. By incorporating heat into his form of yoga, Bikram Choudhury has invoked much controversy. Some claim that the safety issues commonly presented by the integration of heat into treatment may often outweigh the actual benefit of Bikram’s method.

•What are its most common safety issues?

On his website, Choudhury claims that “nothing about Bikram’s Beginning Yoga Class is haphazard” (http://www.bikramyoga.com/yoga.htm). However, critics are quick to counter this claim. Exercise physiologist at the Orthopedic Specialty Hospital in Murray, Utah, warns that working out in hot temperatures comes with dangerous health risks. Warner states that “heat puts stress on the cardiovascular system,” and therefore, people with “any type of cardiovascular” disease should avoid Bikram Yoga. Moreover, he stresses that pregnant women, young children, and the elderly should avoid this type of yoga because overexposure of people in these categories to heat has been a proven health hazard (http://www.bikramyogaslc.com/sltrib5301.php). Lawrence Armstrong of the University of Connecticut further states that “110 degrees is not that severe, but prolonged time in a hot environment raises risks of fainting and may be dangerous to those susceptible to heatstroke.” According to a study completed by Samuel M. Keim, John A Guisto, and John B. Sullivan, Jr. on environmental thermal stress, “all training”(sports activity or moderate/intense exercise) should be stopped when temperature exceeds 90˚F. The study states that acclimatization will occur after training in a temperate environment, leading to an “improved ability to handle thermal stress” by making sweat glands more efficient, increasing plasma volume, and initiating the vasodilatation and sweating processes at lower temperatures. However, this natural adaptation to the temperate environment does not occur until 7-10 days after one’s initial exposure. Therefore, those who have not acclimated and still pursue heavy exertion in the temperate environment—especially those exposed to “very humid conditions,” as presented in Bikram—are at high susceptibility to heat stress. Moreover, according to the study, those at “extremes of age,” those with chronic disease, and those with stimulant drugs (i.e. cocaine, methamphetamines) present in the system may have an “increased risk of hyperthermia.” Finally, the study states that some prescription medications, specifically “anticholinergic medications and some cardiac drugs,” have been proven to “interfere with the body’s heat loss mechanisms,” making those who use them more susceptible to heat illness. Researchers argue that activity in a hot environment must be discontinued when symptoms of heat stress occur, including “a deep body temperature above 100˚F,” a feeling of “sudden and severe fatigue, nausea, dizziness, lightheadedness, or fainting,” a period of “inexplicable irritability, malaise, or flu-like symptoms,” and/or a cease of sweating accompanied by “dry, hot skin” (http://galen.imw.lublin.pl/users/gmf/aaem0201.pdf). Georg Feurstein of the Yoga Research and Education Center, fears that “yoga-related programs stressing fitness may push people who seek an aerobic workout into overstretching, causing injuries” (http://healing.about.com/gi/dynamic/offsite.htm?site=http://www.usatoday.com/life/health/exercise/lhexe020.htm). Lastly, dehydration is a commonly recurring health risk seen in the practice of Bikram Yoga. In the heated room, one’s body “needs adequate fund of water” (nearly twice the recommended daily amount) “to allow perspiration to release heat from the body” as this method of yoga is practiced (http://www.bikramyoga.com/sqa.htm). This guideline is often overlooked by students, leading to much injury within the classroom.

•Conclusion

Clearly the argument of Bikram’s effectiveness can be supported in some aspects while questioned in others. “Those sympathetic to yoga think the benefits are proved by millenniums of empirical evidence” as well as by personal experience. “Those who are suspicious” argue that its actual effectiveness cannot be proved (http://www.time.com/time/health/article/0,8599,106356,00.html). Ultimately, one must use his own rationale to determine if Bikram Yoga can be his cure for life’s ailments. The only true path to knowledge is gained through experience. Only by taking the knowledge that one has already gained, using it cautiously, and experiencing what the specific treatment can do for him, can a person ultimately see how effective treatment really is in his life.