Physical Exercise and Yoga in Prevention and Treatment of by taoyni



Physical Exercise and Yoga in Prevention and Treatment of Addictive
Karel NESPOR, M. D., Ph.D. and Borivoj PROKES, M. D.
The Czech version of this paper was published in Cas. Lek. ces. 2005 (144):53-55.

Prevention of addictive diseases should be complex and systematic and it should include training
of social skills, decision making skills, family intervention, etc. Similarly, effective treatment is
usually long-term, systematic and complex. Physical exercise and yoga can be useful components
of comprehensive prevention and treatment programs. On the other hand, competitive
professional sports rather increase the number of risk factors of substance-related problems
(injuries, stress, doping, one-sided strain, exhaustion, unbalanced life style, etc.). Practical
experience with the use of yoga in substance dependent patients and pathological gambles are
mentioned. The advantages of yoga include the integration of physical exercise and relaxation.
Beside this, yoga is not competitive, does not require expensive equipment and it can be used
even in patients with severe health problems.

Key words: Yoga - Sport – Exercise – Addictive diseases – Prevention – Treatment

Physical Exercise in Prevention
Best effective programs preventing alcohol and drug related problems, such as Life Skills
Training Program (Botvin et al., 1995), are complex and include the training of social skills
relaxation techniques, decision making, family involvement, etc. Beside this the availability of
alcohol and other drugs is also important (e.g. age limits for purchasing alcohol). We are not
aware of any effective preventive program based solely on physical exercise. On the other hand,
physical exercise can be an useful component of complex preventive and treatment programs. It is
necessary to distinguish between targeted rehabilitation exercises and recreational sports on one
hand and competitive professional sports on the other (Nespor, 1994). Recreational sports and
targeted physical rehabilitation seem useful whereas professional competitive sport is associated
with many risk factors (tables 1 and 2).

Table 1. Sports in the prevention of substance related problems - protective factors.
                                           Recreational          Professional sports
Compensation of one-sided or               Usually yes           Usually no
insufficient physical activity.
Healthy peer involvement                   It depends            It depends
Feeling „high“ in a healthy way.           Yes                   Yes
Non-pharmacological management of          Yes                   Yes, but tough competition is
anxiety and depression.                                          often associated with anxiety.
Prevention of many health problems         Usually yes           Usually no
including painful diseases which may
increase the risk of substance abuse.
Immunity                                   Improved              It can be weakened by
                                                                 excessive physical activity.
Spontaneous relaxation after exercises. Usually yes              Sometimes yes, sometimes
                                                                 rather exhaustion.

Table 2. Sports in the prevention of substance related problems - risk factors.
                                                           Recreation Competitive sport
                                                           al sport
Doping                                                     Seldom        Comparatively often
Excessive stress                                           Seldom        Comparatively often
Extreme exhaustion                                         Seldom        Comparatively often
One-sided strain, unbalanced life-style                    Seldom        Comparatively often
Injuries                                                   Seldom        Comparatively often
Excessive competition causing disregard to health          Seldom        Comparatively often
Related to the promotion of alcohol and unhealthy          Seldom        Comparatively often
Related to the promotion of gambling (bookmaking)          Seldom        Comparatively often
Alcoholic victory celebrations (sportsmen and their        Seldom        Comparatively often

Protective factors
Some protective factors deserve more detailed description.
Compensation of one-sided or insufficient physical activity: Targeted rehabilitation and
suitable recreational sports are crucially important in the prevention and treatment of many
diseases. Long-term sitting at school and in front of a computer or a TV leads to e. g. painful back
problems and they increase the risk of the abuse of analgesic drugs.
Healthy peer involvement: The influence of peers on substance related behavior is very
important especially in adolescence, but also in later stages of life. That is why the organizations
with healthy life style policy and with the members refusing alcohol, tobacco and other drugs are
beneficial. On the other hand, alcohol visits to pubs after trainings or matches are very risky.
Non-pharmacological management of anxiety and depression: Physical exercise my decrease
anxiety and depression (Leppamaki a spol., 2004, Lam a Kennedy, 2004, Cox a spol., 2004). The
obvious advantage is almost instant effect. (Severe depression requires more complex approach
such as the combination of pharmacotherapy, behavioral psychotherapy and life style changes.)
Spontaneous relaxation after exercises: Relaxation itself and even more so in the combination
with physical exercise can relieve anxiety and depression. Beside this, relaxation helps to
overcome exhaustion and excessive stress. Sometimes relaxation appears spontaneously after
exercise or it can be induced more easily after some kind of physical activity.

Table 3. Some changes during relaxation and stress
 STRESS                                                                        RELAXATION
                                 MUSCLE TONE                                      
                               RESPIRATION RATE                                   
                                  HEART RATE                                      
                                BLOOD PRESSURE                                    
                                  METABOLISM                                      
                SOME HORMONES (SUPRARENAL, THYROID)                               
                       GALVANIC SKIN CONDUCTANCE                                  
                           EEG WAVES FREQUENCY                                    

Yoga in the prevention and the treatment of substance-related problems
The reasons why we use yoga in substance dependent patients include:
 We often treat patients with severe physical and sometimes also mental problems. Easy and
non-competitive yogic practices can be used even in them (Nešpor, 2001). E. g. the substance
dependent patient with posttraumatic paraplegia took part in our sessions. At the beginning he
practiced only at his wheelchair but after some time he dared to move on a mat, and he was able
to practice with appropriate modifications most of the exercises.
 Non-competitive nature of yoga is useful in the prevention of injuries in substance dependent
patients. Many of them are injury prone because of psychological factors (lack of concentration,
self-aggression) or biological factors, such as osteoporosis associated with alcohol dependence
(Olszynski et al., 2004). From this point of view e. g. a football match can be rather risky affair.
 Non-competitive nature of yoga protects often poor self-esteem of these patients.
 Relaxation is an important part of yoga. It is general relaxation (it is interposed between more
demanding practices and usually also at the end of a session), and partial relaxation during

various practices (i. e. relaxation of the muscles which are not necessary to maintain certain
posture). Earlier we found out that yogic relaxation can improve psychological state of the in-
patients treated for substance dependence (Nespor and Frouzova, 1985). Relaxation decreases
anxiety and depression, and also alleviates various painful problems and sleeplessness and it can
thus often replace addictive medication.
 Most of out patients neglected physical exercise long before their treatment. Out treatment
program includes lot of psychotherapy, workshops and other activities during which patients sit
on chairs. It is demanding, strains their weakened cervical and lumbar spine and causes painful
problems. Yoga compensates well for this one-sided strain by suitable practices during which the
spine is more or less horizontal with the floor.
 Relaxation and other suitable yoga practices alleviate depression (Woolery et al., 2004).
Depressive symptoms are common in substance dependent patients especially at the beginning of
their treatment. Gupta and Narain (1992) compared physical exercise and yoga in patients with
dysthymia. Yoga was more effective, even if both intervention groups were improved. One of the
advantages of yoga is integration of physical exercise and relaxation.
 There are several studies describing lower substance consumption in subjects practicing
Transcendental Meditation (e g. Gelderloos et al., 1991). Unfortunately these studies have no
control group that is why it can be argued that these practices may attract more people who are
already ready to change their life-style. Shaffer et al. (1997) found that yoga practices are as
effective as psychotherapy in patients undergoing methadone maintenance treatment. It would be
interesting to know what would be the combined effect of yoga and psychotherapy. Apart from
the above mentioned mechanisms, it is possible that the effects of yoga may include also social
influence (the refusal of alcohol, tobacco and other drugs is common among yoga minded

Methodical remarks
 Our usual sessions last 30 or 45 minutes and they are divided in three approximately equal
parts: 1. At the beginning we use simple yogic physical practices. 2. After that full yoga breath,
possibly some other simple breathing practices, and some symbolic and positive story are
introduced. 3. We end with yogic relaxation.
 We use simple practices to protect the self-esteem of our patients.
 The practices should be rather pleasant and should compensate for long sitting.
 We often ask patients what they want to do. Their typical wishes are “something for the
spine”, “a story”, “yogic laughter” or “relaxation”). These “orders” are then taken into account.
 Modified yogic practices are often incorporated in other programs, such as workshops or
psychotherapy groups. E.g. the “Heavenly Stretch” can be practiced with the instruction to think
about the pleasures of sober life; “Chopping the Wood” may be associated with hammering down
the pillars of abstinence, and “The Wings” with leaving old habits behind. Such exercises
brighten the mood and enhance motivation.

Problems such us loud snoring during relaxation or small talk during practices are easily
manageable. Following issue is more important. Even if most patients quite like the practices
during their in-patient treatment, only the small fraction of them continues at home. It is a pity

because full advantage of yoga appears usually only after long-term and systematic practice. We
give to patients, if they wish the contacts to yoga clubs but it is clearly not enough.

We shall end with a slightly modified quotation by an American colleague: “Substance
dependence is a chronic problem, and its treatment is successful if it is treated as a chronic
problem.” Regular yoga practice can be the helpful part of long-term treatment and maintenance
of substance dependent patients but it may not be easy to convince them that it is.

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Dr. Karel Nespor, Psychiatricka lecebna Bohnice, 181 02 Praha 8, Czech Republic.

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