Health Insurance Coverage of Yoga?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Mark T. Beratolini, Chairman and CEO of Aetna, Inc. – one of the largest health insurance companies in the U.S. – thinks outside the conventional health care box. He believes that, since yoga can significantly reduce stress, it can also help reduce health care costs for individuals and insurance companies alike (researchers have found that highly stressed people have a much higher risk of developing health conditions like cardiovascular disease, diabetes, cancer, obesity, musculoskeletal pain, depression, anxiety, and fatigue). In fact, Beratolini is such a big proponent of yoga that he even helped fund a study on mind-body programs, hoping to get the evidence-based research ball rolling so that insurance companies will start providing coverage for mind-body therapies.

Beratolini’s faith in the power of yoga stems, not merely from a desire to cut Aetna’s health care costs, but from a personal healing journey. Partially paralyzed and in constant pain after a skiing accident, the Aetna CEO used yoga (as well as cranial sacral therapy and acupuncture) to help him regain control over his life. Instead of taking any of the seven narcotic painkillers he “lived on” for a year after his accident, Beratolini now begins each day with asanas (physical postures of yoga), pranayama (breathing exercises) and yogic chanting.

The Aetna CEO has since been spearheading research efforts to show the efficacy of yoga and other mind-body programs through large-scale, evidence-based studies. He started by asking his yoga teacher – Gary Krafstow of the American Viniyoga Institute – to create a yoga program for Aetna workers. Beratolini then worked with researchers at the Duke University Medical School to conduct a rigorous pilot study (Wolever RQ, et. al, 2012) of the scientific effects of Krafstow’s program, called Viniyoga Stress Reduction, as well as a mindfulness meditation program called Mindfulness at Work.

Study Demonstrates Viability and Effectiveness of Mind-Body Programs

Of the 239 Aetna employees in Hartford, CT and Walnut Creek, CA who volunteered for the study, 90 were randomly assigned to therapeutic yoga classes, 96 to mindfulness based classes and 53 to a control group. Participants in the yoga program attended a one-hour weekly class for 12 weeks through which they learned yoga postures, breathing techniques, mental techniques for stress reduction, guided relaxation, and how to start a home practice. Those in the Mindfulness at Workprogram were taught mindfulness1practices to specifically help cope with work stress, also through a 12-week class held one hour per week.

At the study’s end, participants in each mind-body program had experienced “statistically significant reductions in perceived stress,” when compared with the control group. The mind-body program participants also showed improved heart rate coherence (a measure of autonomic balance) as well as better breathing rate. The researchers noted that:

The findings for heart rhythm coherence were so strong that they merit discussion themselves. It is consistent with mindfulness and yoga theory that these individuals would improve their autonomic tone. In fact, while it has yet to be demonstrated empirically, a major tenet of these practices is that they train individuals to be less reactive in terms of sympathetic reactivity as well as more psychologically and physiologically adaptable.

The convenience and flexibility of the yoga and mindfulness programs helped demonstrate their viability as workplace offerings. Researchers ensured easy access to the programs by scheduling classes around lunchtime. They also offered the Mindfulness at Workclasses both onsite and in a virtual classroom (accessed through employee computers) to encourage regular attendance. The results were positive enough that Aetna started making the mind-body programs available in 2010, when the study ended, to all of its employees nationwide.

More Evidence that Yoga is Good for the Heart

While I’ve known for a long time that the stretching and breath work of yoga benefit the heart, I’ve recently read up on other research that supports doing yoga for heart health. A recent study conducted, which I wrote about in my blog at, showed that just three yoga classes per week can help regulate heartbeat by cutting episodes of atrial fibrillation by 50 percent! The 49 participants also found that the program, which included meditation, breathing exercises and relaxation, helped improve their quality of life and reduce anxiety and depression.

Yoga Continues to Gain Clout as an Integrative Medical Therapy

Inspired by a year-long stay at the Kripalu Center for Yoga and Health in the Berkshires of western Massachusetts, Rob Saper, Director of Integrative Medicine at Boston University Medical School, co-created a new yoga elective course for medical students with yoga teacher Heather Mason. Through this course, students learn both the science and practice of yoga as a stress management tool.

Saper is also the lead author of a yoga study published in a 2009 issue of Alternative Therapies in Health and Medicine: a randomized controlled trial involving 30 participants through which researchers studied the effects of weekly hatha yoga classes on lower back pain. After 12 weeks of yoga classes, the yoga group demonstrated approximately 33 percent less back pain and an 80 percent decrease in pain medications than the control group, which received standard treatment including doctor’s visits and medication. Saper stated, “We hypothesize that yoga classes will be as effective as physical therapy, but more cost effective,” adding that research like his might also facilitate private, state and federal health insurance coverage of yoga and mind-body therapies.

Like Saper, I’m a big fan of the programs at the Kripalu Center for Yoga and Health, and have, in fact, been conducting a workshop there with my wife Jan Sinatra for the past two years. The workshop, called “New Frontiers in Cardiovascular Health and Healing,” involves both lectures and exercise sessions. During the lecture portion, I explore the effects of emotions on health, as well as metabolic cardiology and energy, or vibrational, medicine. Through the exercise segments, I guide participants through gentle exercises designed to help release emotional blocks.  My two favorite yoga teachers – Liza Dousson and Kristin Pancavage – also have provided invaluable assistance by leading the yoga sessions.

I applaud Beratolini and Saper for their pioneering research, and also hope that yoga and other mind-body therapies will one day become mainstream lifestyle practices, as well as preventative treatments that health insurers cover. I highly encourage other doctors and professionals in the medical sphere to give yoga a chance – for their own health, if nothing else!

1. Having described mindfulness as “nonjudgmental observation of the ongoing stream of internal and external stimuli as they arise,” the researchers explained that “being mindful… allows participants to more deeply understand how their thoughts, emotions, sensations and behavioral urges arise and impact health and quality of life.”

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