Yoga and HIV Part II

by Jnani Chapman, R.N.

Waz Thomas was teaching yoga to people with cancer at Commonweal's week long residential retreat program along the northern California coast when he tested HIV Positive. Now, 13 years later, and still teaching yoga he says, "I feel that my health is better than most of my friends who are not dealing with AIDS." Yoga plays a part in keeping him relatively symptom-free. He has had one hospitalization for bacterial pneumonia and the occasional chronic sinus or ear infection, but overall he feels great.

While yoga has been observed and experienced for more than 3,000 years to help maintain and restore health, it has only been recently introduced in the West. Most people associate yoga with exercise and most yoga classes focus the entire time on physical movement. But yoga is in many ways opposite of exercise and some of the non-movement-oriented practices of yoga can have a profound effect on the physical body.

In exercise we engage in a rhythmic repetitive muscular movement. The brain responds by telling the muscle fibers to shorten and tighten. The muscle fatigue may bring us a satisfying feeling and tell us we got a good work-out.

In contrast, in yoga postures that fatigue the body are indications that we may be doing something wrong. The goal is to keep the muscles relaxed in movement so that the muscle fibers actually elongate, resulting in increased range-of-motion and flexibility.

The yoga practitioner engages the body in a stretch extending and elongating as much as comfortable into a pose, not as much as possible. This distinction is important because nowadays many yoga studios are teaching a more aerobic, almost aggressive style that is actually more like exercise than yoga. These classes are popular and provide a good workout, but they may better be thought of as a combination of yoga and exercise, rather than a classical yoga session. Such a class can substitute as exercise for people who want to cross train or expand their exercise options. They will improve strength, muscle tone, cardiovascular tone and provide some increase in flexibility. For people who are tying to maintain and restore health, however, this modified form of yoga exercise may actually perpetuate a depletion syndrome.

How is this so? Exercise stresses muscle and, while this can be useful and helpful, if one over-does it in exercise it can initiate a stress response in the body. The stress response shunts blood away from the digestive organs and creates a cascade of biochemical and neurological triggers which tax multiple systems including the immune system. Our skeletal muscles are well endowed with capillary beds--a rich intricate network of blood vessels which provide the oxygen needed for the muscles to work. Overdoing exercise may induce a competition for oxygen as the stress response increases metabolism, increasing the body's need for oxygen. The engaged muscles will continue to receive the oxygen they need, while other parts of the body like internal organs, the endocrine and immune systems, may suffer.

The physical postures and movements of yoga are collectively known as hatha yoga. In the Sanskrit language of ancient India tha means moon and ha means sun. The two together are indicating the balance of opposites (night and day, yin and yang). The spine is integral for physical balance and hatha yoga focuses at its core on flexibility of the spine; forward bends balance backward-bending poses, left twists balance twists to the right. There are even inverted positions to counter-balance gravity.

The attitude one practices hatha with is as important as the practice itself. One could say if exercise is yang, yoga is yin: Exercise is physical effort, but in yoga the effort is primarily mental. On a treadmill the mind can be a million miles away, but in yoga the mind must be present in the moment, noticing what is happening and how it feels.

TKV Desikachar, considered by many to be the father of yoga therapy, once said, "Awareness, breath and movement--that is yoga!" By this definition, without awareness, whatever the practice, it is not yoga As you stretch be aware of any competitive thoughts or judgments, but don't act them out. Stay relaxed in the stretch, breathing easy. That's yoga!

It is often said in yoga that awareness is the first step in change, our willingness to see and accept things as they are may be a key to successful yoga practice. We need a desire to explore and discover our limits vs. a desire to push them away or break through them.

The Extended Exhalation Breath
Here is a breathing practice that also will help develop awareness. The physiology of the breath and the benefits that conscious control of breathing can provide are topics for another article. For now, try this practice and let yourself experience what it can do. Begin by watching the natural breath without attempting to control it. Let the breath come and go (as it was doing before you started to think about it). As it flows notice what areas of the body are involved automatically with breathing. Does the abdomen expand and contract as the breath comes and goes? Do the sides of the rib cage move? What about the shoulders? What about the chest? Try to let the muscles of the trunk relax so that they can move easily and effortlessly. When you can achieve and maintain this relaxed state you are ready to begin consciously controlling the breath. The goal is to control the exhalation--to slow it down--to extend it until it is twice as long in duration as the in breath. Let the breath flow out evenly and steadily for four to six seconds and let the in breath take half that time, two-three seconds. In the beginning it may not even be possible to get to a 2:1 ratio. That's ok. Stay comfortable with the practice and it will build in time. How long you chose to exhale should be determined by how long it can be done easefully and comfortably. Pay attention to how each part of the body feels during the practice.

If it starts to tense up and tighten this is a signal that you are tying too hard. Some people begin the Extended Exhalation Breathing Practice able to exhale evenly for four-six seconds and even able to let the inhalation be full and efficient in two or three seconds. Others may find that inhaling for one or two seconds is okay but the exhale is gone in three or four seconds. Accept whatever ratio feels natural for you. Let the practice be rhythmic and steady. Let yourself relax in a comfortable position while practicing this technique. As the practice develops people find that the ratios gradually build in duration.

Try it initially for two or three minutes. Always stop if there is any lightheadedness or dizziness. This is a signal of fatigue in the body. In this situation it is better to engage in the practice of watching the natural breath. Some people do the extended exhalation breath for five or 10 minutes twice a day. Other people choose it as a focus for meditation and may practice from one-half to one hour each day.

Waz Thomas teaches yoga adapted to the needs of the students. Each hour long class usually includes hatha, breathing practices, a guided deep relaxation and a period of silent meditation. He claims that these# practices integrated as a life style can inform each moment, each circumstance and condition of life.

CAT/COW
A wonderful yoga stretch that has been used widely in physical therapy is commonly known as Cat/Cow. Cat/Cow is done as an awareness practice to experience the range of motion currently available as we move the spine forward and backward while on hands and knees. Remember to be gentle and easy and not to push or force the body. Try to relax into the movements, moving and breathing evenly and comfortably. Place each knee directly below the center of the hip joint so that the thigh is perpendicular to the floor and place wrists or fists directly below the center of the shoulder joint so that the arm is perpendicular to the floor without any bend in the elbow. Please be on a padded mat or rug to avoid hurting the knees. Have the back relaxed, keep the neck in line with the spine so that the head is not dropped. Slowly and evenly exhale as you curl up the back like a Halloween cat. You are pointing the waist up toward the ceiling b y tucking the tail bone under and and curling the chin in toward the chest. Then as you inhale flatten the back and lift the neck back in line with the spine. (This is the Cow part of the pose.) Coordinate moving the spine forward and back with the breath: Exhale as you curl in pointing the hips toward the head and inhale as you open back out, elongating the spine. Cat/Cow is a common stretch for back problems. Try this practice for three-five minutes twice a day. There are many variations that can be added to provide a 15-20 minute hatha session.N