Yoga in the NHS: The Importance of PRO’s and How Yoga Can Help by Sherezade Ruano-Santana

In honour of the UK's National Health Service (NHS) 70th birthday, we asked Sherezade Ruano-Santana, Arrhythmia Specialist for the NHS at Imperial College and Yoga Therapist specialising in Cardiovascular Disease and Cancer, to shed some light on the remarkable movement towards integrating hollistic practices with modern medicine, treating the patient as a whole - mind, body and soul.

"Modern science and medicine have made major and significant progress in managing life-threatening, contagious diseases. In the Western world, we suffer from diseases of excess triggered by unhealthy psychological behaviours, materialism, and ego-driven attitudes. Most of these 'new diseases' such as diabetes type II, high cholesterol, high blood pressure, anxiety, and some inflammatory diseases have their root cause in poor diet, lack of exercise, and most importantly maladaptive responses to stress and tension from modern day living.

I like to believe that most health practitioners nowadays know that healing truly requires a mind-body-spirit approach. Here is where yoga plays a significant role in merging modern medicine with holistic practices. The recent surge of yoga's popularity in Western culture has been mirrored by clinical and academic interest; this is reflected in the number of clinical studies investigating yoga's ability to aid mostly in chronic conditions such as cancer, cardiovascular disease, mental health, cardiorespiratory conditions, musculoskeletal, and neurological diseases.

The UK National Health Service (NHS) and US National Institute of health describe yoga as a safe and effective prevention for high blood pressure, heart disease, pain management, depression, and stress. Given the number of conditions that are exacerbated by these factors, it is likely that the positive effects of yoga may be beneficial for disease prevention, treatment, and rehabilitation in a broad population.

We are certainly and fortunately observing an urge in the number of research studies in areas such as preventative medicine, psychophysiology of the disease, neuroimmunology, neurocardiology, mental health, sleep disorders, and cancer where specific yoga practices have been successfully applied.

Most research studies are now prioritising the importance of the patient-reported outcome (PRO) in their data analysis. According to the BMJ (British Medical Journal), PRO are scores of tools to measure subjective outcomes that matter to patients. This has been developed over the past 30 years but few are used routinely at the point of care. PRO’s are used to measure change in general health status, acute and chronic pain, and depression while waiting for care and after surgical treatment.

According to TheKing'sFund, more than 100 years ago Florence Nightingale suggested a health-related outcome measure for her patients: relieved, unrelieved and dead. Despite the developments in medical technology since then, attempts to measure the positive outcomes of health care have been slow in coming. Nevertheless, in the nursing profession, PRO has always been an extremely important subjective outcome that needs to be translated, expressed and worded in a way that science and emotions can be combined and understood.

We are facing a new era in the health care system whereby these subjective outcomes are being considered as a remarkably relevant measurement in an increasing number of systematic reviews and meta-analyses trials. Evidence shows that the systematic use of information from PRO’s leads to better communication and decision making between doctors and patients and improves patient satisfaction with care. There is also evidence that patients report better outcomes such as improvement in depression, better emotional and psychological management of their condition and increased trust, confidence and positive attitudes thus leading to better management of their own health.

It is remarkably important to understand the value of the physical and physiological state of a patient, as well as the emotional, spiritual and psychological well-being in order to overcome or better manage any disease or illness.

While running my NHS practice, my primary focus is on my patient's symptoms and complaints, however, what they are unaware of is that while they are expressing how they feel, I am already planning a very different outcome to what they would normally expect. I listen carefully to the nature of their symptoms; such as where does the pain comes from, how do the palpitations or irregular heartbeats start, what is the duration and frequency of their symptoms, and of course I consider different pharmacological therapies and procedures that might be necessary to perform. Beyond their physical symptoms, I ask questions that lead to the expression of their worries, difficulties, emotional pain, and stressors. I listen carefully with an enormous sense of compassion. I observe their breathing pattern, the way they express themselves, and ultimately all non-verbal communication strategies they have learned to use in order to make their symptoms a priority. Most of my patients leave my clinic with a prescription to start practicing yoga and meditation. Most GP's and consultants are already aware that receiving my clinic letters will imply reading the word YOGA in it. 

The ancient science of yoga has studied and examined every aspect of human life from the physical -yoga postures-, to the mental, psychological, and spiritual. There is enough scientific evidence and research studies showing the positive effects of yoga in many chronic diseases. We might be facing an era where the use of yoga and the use of its ancient teachings can help with one of humanity's major problem: stress.

Lifestyle changes become more and more important in today's society, where our routines tend to be filled by unhealthy habits, busy schedules and hostile behaviors, all leading to states of anxiety and uncontrolled negative thoughts. Contrary to what modern medicine promise, yoga therapy seeks to move in the direction of health, without a diagnosis, and works with shifting the behaviors, intentions (Sankalpa), attitudes (Bhava) and beliefs related to anxiety.

To achieve balance we must consider the whole person and strive to establish health on all levels. Yoga used as a complementary -and not alternative- therapy to medicine is a practice that seeks to understand the individual's situation beyond the physical symptoms or presenting condition. It is important not to assume that every individual with similar symptoms will have the same underlying cause. It is also important to remember the burden our consultants, nurses and other specialists are facing at this moment in the NHS. Hence it is essential to broaden our views and open the door to new practitioners and therapists that can easily and effectively cover the gap between modern medicine and holistic practices that can certainly create a comprehensive approach to wellness and aid in the reduction of important high-risk factors that subsequently leads to chronic lifestyle diseases.  Yoga as a comprehensive approach can also save money spent on health care, ultimately changing the focus of the health care system itself.

Using yoga in the mainstream medicine can not only be a fantastic tool to reduce the economic burden of our National Health System but also make significant and historical changes in the way the United Kingdom practice modern medicine."

Join Sherezade on a 5 day intensive on Yoga for Cardiovascular Conditions and Cardiac Rehabilitation Training: An in Depth Exploration from 10th to 14th November 2018 at Yogacampus. Click here to find out more.