Yoga

Yoga is a system of physical postures, breathing techniques, and sometimes meditation used to promote physical and emotional well-being, that originated in ancient India. Many variations of yoga exist, but the styles embraced as a potential treatment for myalgic encephalomyelitis/chronic fatigue syndrome patients tend to be more gentle and restorative in practice.

Types

Many different types of yoga exist. Some types of yoga investigated for ME/CFS include:

• seated or recumbent yoga, which is done while sitting in a chair and without standing, to avoid orthostatic intolerance symptoms
• recumbent isometric yoga, which was developed as a treatment for ME/CFS

Theory

Yoga is both a mind-body therapy and an exercise therapy. Yoga is normally viewed as an "adf-on" or secondary therapy for ME/CFS, typically aiming to reduce some symptoms like pain or fatigue, and improve overall quality of life.

Oka et al. (2014) state that there is evidence that yoga reduces cancer-related fatigue, and it is hoped that yoga may also reduce fatigue related to ME/CFS, but only if activity is kept to below the level that provokes post-exertional malaise since this would increase fatigue and other symptoms. Oka et al. state that ME/CFS patients are deconditioned and hypothesize that the exercise involved in yoga may reduce any deconditioning symptoms.

Yoga has also been explored for improving autonomic nervous system symptoms, e.g., orthostatic intolerance, which many ME/CFS patients have.

Risks and criticism

General reports of harms and adverse effects during yoga have been increasing in recent years, and include:

• Lower back pain and muscle pain
• Aggravating existing pain
• Musculoskeletal pain may occur even in healthy individuals
• Adverse effects from yoga may be serious rather than mild, including bone fractures, tendon or ligament injuries, muscle strain, myositis ossificans of the forearm, eye disorders, and breathing difficulties
• A group of 2508 patients with various chronic illnesses or taking medication found that close to 30% had experienced adverse effects of yoga taught by qualified instructors
• In the same group, 36% of adverse reactions were serious rather than mild
• People with long-term musculoskeletal conditions, chronic diseases, in poor physical condition on the survey day, people over 70, and people who found the yoga mentally or physically stressful were at increased risk of adverse events serious enough to prevent future yoga sessions

Risks to ME/CFS patients may also include:

• Post-exertional malaise since yoga is a form of exercise
• Yoga instructors often used background music, especially for relaxation, but this may instead provoke ME/CFS symptoms in patients with noise sensitivity
• Some patients may be housebound or bedbound and be unable to travel to yoga classes on the day
• Standing poses typically used in yoga may be unsafe since many patients with ME/CFS have orthostatic intolerance, risks including injury from fainting, post-exertional malaise and tachycardia
• Dizziness has been reported even during seated isometric yoga
• Short-term memory problems and cognitive dysfunction may prevent patients from understanding the instructions, and concentrating may cause fatigue in patients
• Patients may accidentally over-stretch, increasing pain
• Patients who need assistance weh everyday activities may be unable to participate, and patients with severe or very severe ME may be unable to sit for long enough to do seated yoga

Notable studies related to ME/CFS

• 2005, Prospective observational study of treatments for unexplained chronic fatigue - (Abstract)
• 2014, Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial - (Full Text)
• 2017, Development of a recumbent isometric yoga program for patients with severe chronic fatigue syndrome/myalgic encephalomyelitis: A pilot study to assess feasibility and efficacy - (Full Text)
• 2018, Changes in fatigue, autonomic functions, and blood biomarkers due to sitting isometric yoga in patients with chronic fatigue syndrome - (Full Text)
• 2019, The longitudinal effects of seated isometric yoga on blood biomarkers, autonomic functions, and psychological parameters of patients with chronic fatigue syndrome: a pilot study - (Full text)
• 2019, Changes in circulating microRNA after recumbent isometric yoga practice by patients with myalgic encephalomyelitis/chronic fatigue syndrome: an explorative pilot study (Full text)
• 2020, Changes in Heart Rate Variability after Yoga are Dependent on Heart Rate Variability at Baseline and during Yoga: A Study Showing Autonomic Normalization Effect in Yoga-Naïve and Experienced Subjects (Full text)
• 2021, Health-related benefits and adverse events associated with yoga classes among participants that are healthy, in poor health, or with chronic diseases (Full text)

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Seated isometric yoga program for ME CFS. Takakazu Oka, Oct 6, 2018.

• Recumbent Isometric Yoga - Bateman Horne Center Feb 28, 2021

Blog

• Aroga Yoga - a yoga and wellness blog by a yogini who has been living with ME/CFS since the age of 13 yrs.

Learn more

• Aug 28, 2007, "Relief for Chronic Fatigue Through Yoga" by Alice Lesch Kelly in Yoga Journal
• Mar 28, 2013, "How I yoga for ME/CFS" Blog post in My Journey thru M.E. by Jess Bruce
• Apr 15, 2015, "Breathe Deep: Dan Moricoli on Yoga and Recovering From Chronic Fatigue Syndrome" by Cort Johnson in Health Rising

See also

• Aroga Yoga
• Exercise
• Tai chi
• Post-exertional malaise

See myalgic encephalomyelitis.

See chronic fatigue syndrome.

a fibrous cord of tissue that connects muscle to bone.

tendon a fibrous cord of tissue that connects muscle to bone.

the tissue that connects two or more bones at a joint

ligament the tissue that connects two or more bones at a joint

muscle strain An injury involving a stretched or torn muscle or tendon (tendons are fibrous cords of tissue that connect muscle to bone).

chronic illness any long-term illness, regardless of the severity. Chronic illnesses are typically incurable, requiring long-term management.

adverse reaction Any unintended or unwanted response to a treatment, whether in a clinical trial or licensed treatment. May be minor or serious.

chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time. Chronic diseases are long-term (typically incurable and requiring long-term management) but are not necessarily severe.

An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

tachycardia An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

heart rate variability (HRV) - A measurement of the variability of the heart rate over time. When the heart rate is consistent, there will be a low heart rate variability. When the heart rate is constantly changing, there will be a high heart rate variability. Heart rate variability is often used by ME/CFS patients to monitor their autonomic nervous system, as high heart rate variability is associated with the sympathetic nervous system and low heart rate variability is associated with the parasympathetic nervous system.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

biopsychosocial model (BPS) - A school of thought, usually based in psychology, which claims illness and disease to be the result of the intermingling of biological, psychological and social causes. (Learn more: me-pedia.org)