This issue's topic is different from most of Topics in Geriatric Rehabilitation's in that it is not about a medical or functional condition, and it is not about patient assessment, nor even about a generally perceived medical problem. It is about a method of treatment. Yoga was not born in a technical laboratory or therapeutic setting, has only recently undergone anything like clinical trials, and is a technique, a practice, not a science. Its basic nature is introspective, not empirical. Yet, it has been refined and analyzed by teachers, such as Bellur Krishnamachar Sundararaja Iyengar, John Friend, and Alan Finger, to name just 3, and subjected to peer scrutiny that warrants at least the coverage that is humbly presented here.

Yoga offers special advantages in the prevention and treatment of illness. One of the most difficult problems in modern medicine is compliance. As the first article in this issue indicates, people like yoga and gravitate toward it with or without the exhortations of any clinical people. Saltonstall et al have culled through hundreds of comments by yoga practitioners for those that best represent the general response to yoga. Secondly, unlike medications, and many types of alternative medicine such as chiropractic and sometimes even physical therapy, there is no dependence in yoga on anyone. Wang and Feinstein's article highlights yoga's use by individuals as a means of assuaging pain. After it is learned and mastered, there is no need for anyone but oneself to obtain relief. Yoga fosters independence. Third, yoga brings about a legendary calm one sees caricatured in so many of its commercial renditions. Although featured in many of the articles in this issue, this aspect of yoga as a treatment option is particularly prominent in the cardiac work described by Trieger, the balance therapy reported by Tatum et al and Philbin's integrative approach to mourning.

But yoga also has special application to the older person. Aging may be defined as progressive acceleration in the mortality rate.1 As such, it is a statistical, rather than an individual characteristic: those who are 90 are less likely to celebrate their next birthday than their younger siblings are to celebrate theirs, but more likely to reach 95 than people that are 89! Yet many centenarians are in perfect health, and more outstanding yet, there is fairly strong evidence that in the very old, (in the 110-120+ group), mortality paradoxically decelerates ... the probability of expiring actually drops!

Nevertheless, aging individuals as a group are more vulnerable to many conditions, and less able to withstand the rigors of surgical and medical treatment on their way back to happiness and health. Balk and Bernardo's work on building bone without medications, Fishman et al in nonsurgical treatment of rotator cuff syndrome, and, again, Trieger's work with cardiac problems are examples of yoga's benefits that apply to anyone, but are particularly valuable to older adults.

Few experienced therapists of any type can have missed the uniquely intimate and trusting relationship that often develops with their clients or patients. Therapeutic sessions are a break from the rest of their challenging and usually painful day; they close the door, often doff some clothing, and lie down. How many times do they begin: "My husband is such a child," or "I'll never understand my daughter?" Here the fundamentally uplifting elan of yoga has a pervasive and irresistible aspect. One of the Ten Commandments of yoga (Yamas and Niyamas) may be translated as "Be content." This pervades yoga-related communication in a thoughtful rather than a superficial way. Zador's article addresses some of the pitfalls inherent in this dictum; Gage's historical contribution recounts the type of cooperation and will-to-help, the esprit-de-corps that characterized the groundbreaking work of Dean Ornish's group, and the Taylors go into revealing detail in working successfully with the dying.

There are few therapies that boast about their side-effects. Both medicine and surgery are undertaken because there is a favorable cost-benefit or risk-benefit ratio. The 2 are placed on opposite sides of the balance of good judgment. In yoga, the side-effects, irrelevant to the actual reasons for its initial adoption, may turn out to be more to the practitioner's advantage than the primary therapeutic effect! Almost any style of yoga brings with it reduced blood pressure, less obesity, and less back pain, improved range of motion, safe strengthening, reduced asthma and reduced anxiety, better recovery after surgery and chemotherapy and almost stunningly low cost. The main effect and the side-effects are on same side of the balance: the positive side. In contemporary society, the handwriting is on the wall: yoga has demonstrated its high value as a therapeutic modality. Sophocles wrote "For all catastrophes, [he then lists some such as flood and famine], save death itself, man [presumably he means humankind] has a remedy." Yoga has been shown to lend itself to this global cause, and also to add joy and rejuvenation to the lives of the healthy.

-Loren M. Fishman, MD, BPhil, (oxon)

1009 Park Avenue, New York, NY

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