Yoga’s dose-response effect

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My new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Also check out my new book, THE EXPLORER'S GENE: Why We Seek Big Challenges, New Flavors, and the Blank Spots on the Map, published in March 2025.

- Alex Hutchinson (@sweatscience)

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This week’s Jockology column in the Globe and Mail takes a closer look at a neat yoga study that I blogged about last month. I got in touch with Nina Moliver, the researcher responsible for the study, and looked at the data more closely:

When Nina Moliver decided to study the long-term health and wellness effects of yoga for her doctoral research in psychology, one of her professors offered some advice.

“The yoga world doesn’t need more testimonials,” the professor at Arizona’s Northcentral University told her. “The only way you’re going to communicate with the medical community is with numbers.”

Yoga science is a burgeoning discipline, with researchers probing yoga’s effects on everything from stress hormones to skin conditions. But how can a typical four- to six-week study capture the benefits of an ancient mind-body discipline that takes years, if not decades, to master? It can’t, Dr. Moliver concluded – so she decided to take a radically different approach that offers the first quantitative look at yoga’s long-term benefits. And the results of her study are promising for dedicated yoginis…. [READ ON]

One little online extra that I’ll post here is one of the graphs from the study, to give a sense of what the data looks like. Basically, you get data points filling the triangle on the upper left of the graph, while the lower right remains empty.

Here’s how I describe the data in the Globe article:

Interestingly, the most experienced yoginis weren’t necessarily happier or healthier than the happiest and healthiest non-yoginis, at least in the parameters Dr. Moliver was able to measure. “They didn’t find ‘enlightenment’ that others can’t reach,” she says. The biggest differences were at the other end of the scale, in the scarcity of unhealthy or unhappy long-time yoga practitioners.

 

When Nina Moliver decided to study the long-term health and wellness effects of yoga for her doctoral research in psychology, one of her professors offered some advice.

“The yoga world doesn’t need more testimonials,” the professor at Arizona’s Northcentral University told her. “The only way you’re going to communicate with the medical community is with numbers.”

Can yoga be studied with “conventional” clinical trials?

THANK YOU FOR VISITING SWEATSCIENCE.COM!

My new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Also check out my new book, THE EXPLORER'S GENE: Why We Seek Big Challenges, New Flavors, and the Blank Spots on the Map, published in March 2025.

- Alex Hutchinson (@sweatscience)

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I’m generally a pretty skeptical guy. If someone tells me that X really works, but it can’t be verified by science because science is just one way of understanding things, I roll my eyes. But bear with me here. A couple of years ago, I interviewed a guy named Timothy McCall, the author of Yoga as Medicine, for an article about yoga research. He was a smart guy with some very interesting things to say, and I still get occasional e-mail updates from his website. The latest includes a link to this article, from the Spring 2011 issue of Yoga Therapy Today, by Nina Moliver, called “Yoga Research: Yes, No, or How?”

The article is a pretty wide-ranging look at the current debate (in yoga circles) about how yoga and science fit together. A couple of points caught my attention. First, McCall and Moliver argue, yoga is a very slow healing technique:

[E]ven six months is a drop in the bucket for a Yoga practice. By privileging short-term studies and standardized protocols, we are forever studying beginners, [and] we are systematically underestimating the healing potential of Yoga in our research…

The bigger argument is that randomized, controlled trials — of any length — to study yoga don’t work, for various complex, holistic reasons that don’t sound very convincing to me. The alternative is observational studies. And as it happens, Moliver completed an award-winning PhD thesis at Northcentral University last year that used an observational design — an online survey — to study yoga in 211 female yoga practitioners plus 182 controls. Observational studies have a lot of problems, in particular the inability to distinguish between cause and effect, as Moliver acknowledges:

For example, if a researcher didn’t randomly assign the participants, it is not possible to know if Yoga practitioners are happier because they practiced Yoga, or if people who were happier were naturally attracted to starting a Yoga practice.

But there are still ways of extracting useful data. For example, if you see a dose-response effect — the longer people have been yoga-ing, the happier they are — that’s pretty suggestive. And as for those confounding variables:

For the Yoga practitioner, these so-called confounders — a healthier diet, a simpler lifestyle, more time outdoors, more kindness and compassion, more loving relationships, more bike-riding, a better path to right livelihood — are not confusing. They are mutually enhancing and reinforcing.

In other words, who cares if you end up happier and healthier because you’ve aligned energy flows in your body or simply because you’ve spent more time being physically active and mindful — the result is what matters. And indeed, Moliver’s study did see evidence of a dose-response relationship in her subjects, some of whom had been practicing yoga for as a long as 50 years. (I’m hoping the study will be published, as the abstract isn’t very revealing about the “range of intercorrelated wellness measures” that demonstrated the dose-response effect.)

This all sounds very reasonable to me — and in fact, it’s very reminiscent of Paul Williams’ National Runners’ Health Study, which takes a similar observational approach (albeit with more than 100,000 subjects) to tease out dose-response relationships that would be nearly impossible to detect with conventional short-term intervention studies.

One caveat: this approach tells us what works, but it doesn’t tell us how it works. You can’t take an observational study that finds health benefits from yoga and conclude that this proves that we can indeed control the circulation of energy flow in our bodies. To make claims about cause and effect, you really do need proper randomized trials. Notably, Moliver’s study didn’t see any difference between different types of yoga: just doing it, and keeping at it for long periods of time, correlated to better levels of psychological and physical well-being.

Yoga reduces cellular inflammation marker

THANK YOU FOR VISITING SWEATSCIENCE.COM!

My new Sweat Science columns are being published at www.outsideonline.com/sweatscience. Also check out my new book, THE EXPLORER'S GENE: Why We Seek Big Challenges, New Flavors, and the Blank Spots on the Map, published in March 2025.

- Alex Hutchinson (@sweatscience)

***

I get a lot of questions about the benefits of yoga, and they’re very difficult to answer for a number of reasons. One is that yoga is so diverse — different types of yoga (and different teachers and different classes) offer very different stimuli. Even within a given type of yoga, it’s a very “mixed” activity, working on flexibility, strength, as well as possibly cardio and mental state. Given these challenges, it’s not surprising that there’s a lack of solid research into the benefits of yoga, so I’m always happy to see a study that looks at something more quantifiable than “sense of wellness.”

With that preamble, here’s a press release about a new Ohio State study, which found that women who practiced yoga had lower amounts of a cell called interleukin-6 (IL-6) in their blood. IL-6 is a cytokine (a type of cell produced by the immune system) associated with inflammation, which has been implicated in heart disease, stroke, diabetes and other diseases. Great!

If you look more carefully at the study, though, it’s not quite the smoking gun we’re looking for. For one thing, it wasn’t a “prospective” study that observed changes over time. Instead, they took one group of yoga experts, and compared them to another group of yoga novices. The experts had lower levels of IL-6, but of course it’s hard to know whether the personality (or physical) traits that had led these people to become yoga masters also had other effects that put their bodies under lower stress. The study also looked at how the subjects’ IL-6 levels responded to stressful tests like cold-water immersion and hard math problems. Again, the yoga experts did better, but that doesn’t really tell us anything definitive.

Surprisingly, one test that showed no difference between the novices and the experts was in their physiological response to a yoga session. Here’s what Lisa Christian, one of the researchers, had to say about that:

“Part of the problem with sorting out exactly what makes yoga effective in reducing stress is that if you try to break it down into its components, like the movements or the breathing, it’s hard to say what particular thing is causing the effect,” said Christian, herself a yoga instructor. “That research simply hasn’t been done yet.”

Which is basically what I was saying at the top of this post. Yoga is complicated — and for now, the research looking for its “secret” remains pretty sketchy.