It’s been impossible to ignore; health services around the world have been facing immense pressures due to the pandemic. The unprecedented increase in demands placed upon the global health services—and the UK NHS in particular—raises important questions concerning approaches to health care in general.
Even before the pandemic, many health systems were crippling under the weight of chronic diseases, many of which are the result of lifestyle. In the UK alone, about one third of the population had been absorbing 70 percent of the health budget for such conditions.
The pandemic has expended untold resources, and as funds and health services were necessarily redirected to those with COVID, many with lifestyle conditions have been left without essential support. For example, a recent UK survey of adults with type 1 diabetes found that 50% of respondents felt unsupported during the COVID crisis, with 63% reporting that they were unable to access their normal level of healthcare support.
It is abundantly clear that as we attempt to rebalance health systems in the wake of the pandemic, we must empower those with lifestyle conditions towards better self-care and focus on prevention; only then can we avoid such crises in the future.
A Growing Backlog of Care
A recent report from the British Medical Association (BMA) based on data from November and December 2021 distinctly illustrates the disruptive impact of the pandemic on NHS care. The shutdown of many non-COVID health services during the first wave followed by drastic changes in patient behaviour has led to a tragic and unheard of backlog in both primary and secondary care services.
A particularly poignant example is seen in unmet cancer targets, with early data showing a significant association between delayed treatment and increased mortality. The proportion of patients seen by a specialist consultant within two weeks of an urgent GP referral for suspected cancer remains worryingly low at 78.6%, with the 93% target for patients to be seen within that time frame not met since May 2020.
The sheer volume of patients affected by the backlog is also significant; the BMA estimates that between April 2020 and November 2021, there were 4.22 million fewer elective procedures and 29.14 million fewer outpatient attendances. Moreover, these figures don’t take into account the inevitable hoards of patients who have not yet presented to their GP for fears of burdening the health service or being infected by COVID-19.
This backlog heralds future problems of which we are not yet fully aware, and may take more than a generation to correct. Mind-body interventions that require little equipment, are inexpensive, enhance positive health habits and build self-reliance have never been more essential. In particular, yoga therapy as an adaptive, multi-dimensional intervention that works with habits, thoughts processes, movement, breath, and attentional control is deserving of thorough investigation within this purview.
How Can Yoga Therapy Help?
One avenue through which yoga therapy can help support healthcare systems during this time is the direct improvement of health variables influenced by the pandemic. By improving well-being and reducing stress via yoga, there can be a stemming of increased pressure on health systems, affording the opportunity for faster recalibration.
A recent study investigating the benefits of yoga practice during the pandemic reported a wealth of positive outcomes, particularly correlating to the stress imposed by lockdowns and restrictions. Participants in the yoga group had healthier sleeping and eating habits than those in a non-yoga control, lower dependence on substance use as a means of coping with stress and lower levels of anxiety. Furthermore, the incidence of chronic disease was proportionately lower in the yoga group, thus reducing the probability they would utilise health services in the long-term.
Likewise, an ever-growing body of evidence shows that by tackling non-communicable diseases (NCDs)—conditions that are non-infectious and often the result of lifestyle—through the improvement of lifestyle choices, some of the burden placed on healthcare systems may be lifted. A corpus of research consistently demonstrates the positive impact of yoga therapy on a variety of mental and physical health conditions, with particularly profound effects on NCDs.
For such conditions, yoga therapy provides a non-invasive, cost-effective, easy to use solution that will reduce presentation to primary and secondary care settings. Backed by evidence that mind body interventions substantially reduce patient visits, there is a clear rationale that yoga therapy could help to ease the current burden on the NHS.
Counter Waiting Lists with Social Prescribing
A further challenge with the current backlog of care is the length of time patients are waiting for treatment. The BMA report showed that the number of patients waiting more than one year is 6 million, an alarmingly high record figure and 220-fold the number waiting in November 2019.
The profound stress caused by such long waits undoubtedly exacerbates health issues for many, with poor health proliferated by both the lack of care and the stress of feeling that support is not available. Studies have shown that people who are already unwell are more prone to stress-related immune changes, calling for greater emphasis on initiatives to support patients while they wait for access to care.
Social prescribing, a scheme that that allows health professionals to refer patients toward health and wellbeing interventions and activities in the local community, was developed to foster a sense of connectedness and support between people. By sharing in activities with like-minded people, social prescribing helps to reduce some of the stress patients feel and may improve health. Already a fundamental component of the NHS, social prescribing also reduces presentation to health services. Although clearly not a substitute for necessary medical care, social prescribing may help those whose primary issue is stress, depression, anxiety, or loneliness, all of which contribute to poor health behaviours.
One of the offerings within social prescribing is therapeutic yoga classes, such as the evidence-based course developed by the Yoga in Health Care Alliance (YIHA). With teachers across the country, patients can attend this 10-week Yoga4Health programme to reduce stress, increase strength, flexibility and self-reliance—all while connecting to a community. Since the sense of community that yoga provides has been found to reduce stress and depression, further social prescribing of group yoga therapy classes could be used to counter the negative impact of waiting lists on patients’ mental and physical wellbeing.
With millions of people having faced social isolation like never before during the pandemic, the social connection found in yoga is essential for improving mental health for the general population. This is of course one of its standout points as a social prescribing offering. Even in the absence of other people, yoga can enhance feelings of connectedness through the release of oxytocin, a hormone increased by yoga practice and associated with a sense of connection and bonding. Whether in group or individual practice, yoga may offer a powerful antidote to the damaging psychological impact of social distancing.
Yoga Therapy and Mental Health
In addition to the negative impact of social isolation on mental health, the ubiquitous feeling of threat posed by COVID has created the perfect conditions for depression and anxiety to thrive. This trend is clearly reflected in recent statistics showing record high patient numbers requiring NHS treatment for common mental illness.
Although anxiety disorders were already the most prevalent mental health issue before the pandemic began, one alarming statistic has revealed that over a one-year period, the global prevalence of anxiety disorders increased by 76.2 million. Since the full long-term effects of the COVID era on mental health are yet to be known, it is imperative that preventative measures are taken to reduce further strain on mental health services in the near future.
Arguably yoga therapy’s greatest benefit is for mental health, with particular efficacy when it comes to treating depression and anxiety. A growing body of research elucidates not only psychological benefits and improved mood, but also the powerful physiological effects of yoga in altering the same neurochemicals which are targeted by anti-depressant and anti-anxiety medication.
One possible mechanism behind the antidepressant effects of yoga is via the reduction of the stress hormone cortisol, which is found in higher levels in those with depression. In terms of anxiety, yoga has been found to reduce GABA, a chemical messenger in the brain which functions to inhibit the fear-based pathways associated with anxiety disorders.
Considering that chronic depression and anxiety affect almost every biological system in the body, yoga can take a pivotal role by positively influencing underlying biological processes while simultaneously supporting emotional needs. As such, yoga therapy offers a promising intervention to help support mental health systems under immense pressure.
Time to Act
With an enormous backlog of care in overstretched health services and skyrocketing mental health issues in the general population, the increased demand on the NHS due to COVID-19 paints a bleak picture. But it’s not all doom and gloom; evidence is encouraging that yoga therapy and other mind-body practices can help both healthcare staff and patients to live happier, healthier lives, while synchronously reducing healthcare costs and affording individuals greater autonomy over their health.
Healthcare organisations and practitioners worldwide are awakening to the evidence-based benefits of yoga therapy as a comprehensive and cost-effective intervention. The Minded Institute has spent the last 13 years building one of the most comprehensive yoga therapy training programmes in the world, and through our passion and dedication to raising the profile of yoga’s health benefits, we are committed to supporting the NHS in revolutionising its approach to healthcare.
References
- https://www.guidelines.co.uk/news/report-reveals-impact-of-covid-19-pandemic-in-uk-on-people-with-type-1-diabetes/456445.article
- https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis
- Hanna T P, King W D, Thibodeau S, Jalink M, Paulin G A, Harvey-Jones E et al. Mortality due to cancer treatment delay: systematic review and meta-analysis BMJ 2020; 371 https://doi.org/10.1136/bmj.m4087
- Nagarathna, R., Anand, A., Rain, M., Srivastava, V., Sivapuram, M. S., Kulkarni, R., Ilavarasu, J., Sharma, M., Singh, A., & Nagendra, H. R. (2021). Yoga Practice Is Beneficial for Maintaining Healthy Lifestyle and Endurance Under Restrictions and Stress Imposed by Lockdown During COVID-19 Pandemic. Frontiers in psychiatry, 12, 613762. https://doi.org/10.3389/fpsyt.2021.613762
- https://www.bravewell.org/content/IM_E_CE_Final.pdf
- Stahl JE, Dossett ML, LaJoie AS, Denninger JW, Mehta DH, Goldman R, et al. (2015) Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization. PLoS ONE 10(10): e0140212. https://doi.org/10.1371/journal.pone.0140212
- https://www.apa.org/research/action/immune
- https://themindedinstitute.com/yoga-for-depression/
- https://www.england.nhs.uk/2021/11/record-high-patient-numbers-completing-nhs-treatment-for-common-mental-illness/
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02143-7/fulltext
- Thirthalli, J., Naveen, G. H., Rao, M. G., Varambally, S., Christopher, R., & Gangadhar, B. N. (2013). Cortisol and antidepressant effects of yoga. Indian journal of psychiatry, 55(Suppl 3), S405–S408. https://doi.org/10.4103/0019-5545.116315
- Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., Yakhkind, A., Perlmutter, R., Prescot, A., Renshaw, P. F., Ciraulo, D. A., & Jensen, J. E. (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. Journal of alternative and complementary medicine (New York, N.Y.), 16(11), 1145–1152. https://doi.org/10.1089/acm.2010.0007
- https://www.youtube.com/watch?v=xvjU4vZkLj8
