Leslie Kazadi, CYT, RYT 500, leads workshops on teaching seniors, mentors teachers, and teaches therapeutics in various settings in Santa Monica, California. She is honored to continue collaborating on yoga research with several prestigious universities.
Very mindful of our need to adhere to study standards, we dis- cussed how to conduct the measurement phase. This required precision and consistency. Although in the classes I gave adjustments and individual instructions just as I taught any class, during the data col- lection, I gave the same, very basic instructions to each participant. We needed cues so the staff knew when to start collecting data. If I did not give the proper cue at the proper time, or if participants did not precisely follow the cues, moved off their mark, got tangled up in the equipment, or equipment malfunctioned, we had to start over. Minimizing our mistakes was critical, because this process could take up to five hours from beginning to end, and we obviously got participant fatigue and distress as time wore on.
In the classroom, I had two set sequences to follow: beginning and intermediate poses. At that point, I had the benefit of much more information on the participants than I would have had they walked into a public yoga class. I knew their medical conditions and previous injuries. Although, just like a regular class, unreported injuries show up when students move in a way they have been unwittingly avoiding for years. So when someone complained of being sore after class and taking Advil the next day or moved deeper into a pose and felt pain, I did what any teacher would do and made modifications. What I couldn't do, because it was a set sequence, was give a participant an alternate pose. This restriction inspired my creativity. I might have someone doing cobra standing facing the wall, but it was still the elements of cobra. If it was a participant who was self-conscious about doing something different, I would have the whole class do the modified version. Any modifications tailored for an individual were documented as a protocol variation (a requirement of any research study). I also made detailed reports of all modifications to the sequence, any poses that were explored in more depth, and any poses that were omitted. I could omit up to three poses in a class in order to spend more time in others, with the constraint that no pose would be omit- ted more than three times in a row, in order to preserve protocol.
Preserving participants was also an important issue. I struggled with the pressure for evidence-based improvement versus the imperative for safety. In regular classes, my focus is solely safety and well- being. The participants also felt the pressure to improve and also to keep up with the other students much more than I have experienced in regular classes. A few participants got discouraged by this early on and wanted to quit, although they stayed because of the relationship we had formed.
The benefits of yoga and the benefits of studies are complementary. The participants get the usual benefits of yoga plus the bonus of participating in a project that contributes to scientific knowledge. Some who don’t immediately like yoga continue because of their commitment to the study. And they learn how they improved in tangible, measurable ways, which is more important than I realized, even to those who do love yoga. As a teacher, it's an amazing, albeit intimidating, opportunity to work with a team of researchers. With different areas of expertise, we all learn, collaborate, and compromise with the common goal of investigating what we think we know and sometimes arriving at new conclusions. Each conclusion invites more questions, new opportunities to delve more deeply into how and why this healing art may work, and how to extrapolate results from the lab back into the classroom.
The data collection process needed to be as smooth and efficient as possible so the participants would not get overly tired or over- whelmed, because they would go through this laborious process four times over the course of the 32-week study. (Despite our concerted efforts, two participants dropped out after the first measurements.) In the interests of time and efficiency, I was asked many questions, such as: Can we measure backbends first because it will save time adding/removing biomarkers? No. Can we omit the breathing and warmup at the beginning, which isn't being measured? No. Can we omit the wall for standing poses, which interferes with the cameras? No! Their job was to capture data. Mine, I quickly learned, was to serve as a bridge between lab science and yoga practice. In the beginning, we seemed to have very different, competing goals. I am honored to say we truly collaborated and compromised, realizing our goal was actually the same. It was an amazing team.
1. Participant wearing sensors/markers during data collection.
2. Markers are labeled to define body segments.
3. Biomechanical model is generated to calculate muscular demand and joint loading.
A new possibility came to me through relationships I developed with Dr. Gail Greendale of UCLA and Dr. George Salem at USC in the above-mentioned studies. They invited me to collaborate with them in an intervention-design study for healthy older adults to create a protocol for a safe yoga program for community-dwelling, ambulatory seniors. We would use high-tech equipment to determine the efficacy of yoga poses that are typically taught to seniors.
First, we created a sequence that we considered safe. We considered many modifications and props to accommodate seniors. We considered building props with the access of the lab to make poses more effective for seniors. But we realized this would not be available in most settings where seniors practice yoga. One question we consistently asked ourselves: is this realistic in a senior center? The grant was submitted. And denied. Twice. Two years elapsed between our first discussion and first yoga class.
Once the grant was approved, we had to determine how to collect data in the lab. The lab has sophisticated equipment, including ten cameras that record biomarkers that are placed on the participants at all the major joints to capture their movements and ROM; force plates that the participants stand on while doing poses that determine the force exerted on joints; and surface electromyography (EMG) to measure muscle activation. This biomechanical approach to collecting data presents an amazing opportunity to get clear, scientific results. It also presents some unique challenges.
The transition from yoga teacher to yoga researcher
My first door into yoga research opened in 2004, when I was asked to be the second teacher in a study designed to mitigate hyper- kyphosis in older adults. The study design called for two teachers instructing separate groups to determine the effectiveness of the protocol versus the effectiveness of a particular teacher. I was thrilled to be asked by my teacher to take on this role.
Through my connections in the kyphosis study and my experience in teaching students with Parkinson's disease (PD), I was invited to design and teach the yoga protocol for a pilot study for PD by a graduate student at USC. Designing a study protocol is a daunting responsibility. In a research study, a sequence is typically designed in advance based on the general characteristics of the intended study sample (for example, older persons with excess kyphosis). But the teacher does not know who the exact participants will be or have any specific knowledge of the intricacies of the individuals involved.
Careful attention and intention must be given in choosing each pose so that the sequence strikes a balance that is safe and challenging, effective, and appealing for all participants. One must also engage in a dialogue with the principal investigator, who in this case was not a yogi, about the interface between yoga traditions and scientific methods. For example, she was very concerned about the “woo-woo” factor of chanting om. I acknowledged that this might be off-putting for some and that it was also a concern of mine. But I explained how it is particularly useful for PD because it not only improves respiration but also addresses speech dysfunction, common in PD. We included om without any participant resistance.
As a teacher, I knew the yoga was successful when participants remarked on feeling more graceful, get- ting out of a chair without using their hands, and even skipping on the sidewalk! As a researcher, I knew the study was successful when the results showed that hip range of motion (ROM) and gait stride increased while walk time decreased. In a perfect world, all of these things are measured; in reality, many factors limit these possibilities.