Yoga & the NHS

The Yoga4Health social prescribing protocol: an outline of a simple practice with big benefits. By Paul Fox

Hundreds of NHS patients all over the UK have benefited from a 10-week course of yoga designed to equip them with the skills and confidence to lead happier and healthier lives. The Yoga4Health protocol was commissioned by the NHS in west London five years ago and created by the Yoga In Healthcare Alliance (YIHA), a registered charity dedicated to integrating the benefits of evidence-based yoga into healthcare.

In next month’s issue of OM, we will explain how YIHA is fulfilling its charitable mission through the social prescribing movement and its network of nearly 400 yoga teachers – a community it is aiming to grow to over 1,000.

In this issue, we are focusing on some of the practices included in the protocol, to share the many benefits of the Yoga4Health programme.

Y4H Sun Sals chair

Who is this protocol for?

The Covid-19 pandemic has reminded us that infectious disease can still wreak havoc on human populations. However, it remains true that the biggest killers are non-communicable diseases (NCDs), such as cancer and cardio-vascular disease (heart attack, stroke). The risk of getting these NCDs is related to the way we lead our lives. Obesity, lack of physical activity, smoking, excessive alcohol consumption, social isolation, stress, anxiety, and depression all raise risks of becoming chronically ill.

The Yoga4Health protocol is an early intervention/prevention programme aimed at supporting people at risk of becoming chronically ill to make lifestyle change based on a daily yoga practice. The 10-week programme provides intensive support via weekly two-hour classes and daily home practice resources.

YIHA’s programme has a second purpose. Around one in five GP appointments involve patients who feel ill for reasons that would be better addressed via support and lifestyle change rather than drugs or a clinical procedure. That is why the NHS is so interested in programmes like Yoga4Health. It has the potential to make the NHS more sustainable by reducing the volume of appointments and lowering the drugs and treatment bill. It’s win-win: the patient feels better, and the NHS works more effectively and efficiently.

Yoga4Health teachers run classes for groups of up to 15 patients who meet the following referral criteria:
- At risk of cardio-vascular disease or Type 2 diabetes
- Suffering from stress or mild-moderate anxiety/depression
- Suffering from social isolation

Patients are either directly referred to the programme via their GP or Social Prescribing Link Worker or are signposted to the programme or self-refer.

Y4H Initial sequence

Practicing the Yoga4Health protocol

Here we present a small part of the protocol for you to enjoy. In a two-hour class patients receive a five-minute talk (psycho-education), followed by tuition on a breathing practice that is used throughout the session. There then follows 75 minutes of asana practice, a relaxation, a recap on the breathing practice and 20 minutes of group discussion to foster social connection and support lifestyle change. Those on the programme are supported with a rich range of resources to develop a daily yoga practice which follows the 10 themes of the 10-week protocol.

For the purposes of this article, you may practice the sequence using your own comfortable breath (preferably breathing in and out through the nose). Service users learn breath awareness and then techniques to slow their breath and extend the exhale using what we call ‘ocean breathing’. This is our non-Sanskrit term for ujjayi breathing, used because we offer a secular and inclusive programme in line with NHS requirements. We also teach equal breathing, or Coherent Breathing, in a 6:6 rhythm (inhale for si seconds and exhale for six seconds). These week-by-week progressive breathing practices promote autonomic regulation, parasympathetic response, and heart rate variability (HRV).

Yoga4Health classes are fully inclusive. They begin in a chair and service users can then choose to remain in a chair or move onto a yoga mat. Yoga4Health teachers are trained to give simultaneous instructions for chair or mat versions of each practice in the protocol. The classes are gentle, mindful, and therapeutic. Here we present the opening chair sequence, closing sequence, and the inclusive sun salutations developed by Heather Mason, the founder of YIHA and leading creator of the Yoga4Health protocol.

Y4H Final Sequence Standing

The evidence for the effectiveness of the Yoga4Health protocol is contained in two academic publications from Westminster University which evaluated the programme independently for the NHS. You can find the full evaluation by typing ‘Yoga4Health mixed methods evaluation’ into a search engine. In March, a second paper on patient experiences of Yoga4Health was published in BMC Complementary Medicine and Therapies. This is also freely available online.

For those interested in learning more about the work of YIHA and the Yoga4Health protocol, see the new book, Yoga on Prescription, published by Singing Dragon. YIHA also sells a full-colour wallchart o the chair and mat protocol practices via its website, where details about training to become a Yoga4Health teacher are also available. Visit:

Paul Fox is a former Chair of the British Wheel of Yoga, former Chair of British Wheel of Yoga Qualifications and current Chief Operating Officer for YIHA. He has trained over 200 yoga teachers.

Om Magazine

First published in November 2009, OM Yoga magazine has become the most popular yoga title in the UK. Available from all major supermarkets, independents and newsstands across the UK. Also available on all digital platforms.