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#InternationalYogaDay: How ancient yoga is going global…and taking to the water.

Move over hot, flying and spinning yoga.

Paddleboard yoga is the latest trend to stand the ancient practice of breath control, body postures and movement on its head – this time on a surfboard surrounded by water.

Fitness experts and enthusiasts in America say classes for waterborne yoga, which is also known as Stand Up Paddleboard (SUP) hone balance, focus concentration and lure exercisers who prefer open air to overheated studios.

“People tell me it’s like walking on water,” said paddleboard racer and yoga instructor Gillian Gibree, who has been teaching Paddleboard Yoga in San Diego since 2009.

The instructor and trained lifeguard said first timers begin with a water safety demonstration on dry land before going on to water, where even the simplest yoga postures can take on an added intensity.

“On the board, even plank (a foundational push-up pose) is a challenge,” she said. “Everything is slowed down because it takes much longer to keep your balance.”

Because the board is unstable, different muscle groups are fired, said Gibree, who has floated her practice on rivers, bays and even oceans, although she usually teaches on flat water.

“It works a lot on balance and you have to find your drishti (yoga’s focused gaze) on the board,” she said. “It’s a total body workout.”

SUP Yoga joins two ancient traditions.

The modern SUP sport originated in Hawaii in the 1950s and 1960s but stand up paddle boarding dates back thousands of years, to ancient fisherman from Polynesia to Peru.

And while the classical techniques of yoga date back more than 5,000 years, a worldwide survey of more than 3,000 fitness professionals published this month by the American College of Sports Medicine rated it number seven among the top 10 fitness trends for 2015.

Gibree, said her clients come from places as far-flung as Canada, Switzerland, South Africa and New Zealand.

“Anywhere there’s a pond, lake, marsh, or body of water,” she said.

Exercise physiologist and yoga instructor Jessica Matthews said the paddling technique intrinsic to SUP Yoga adds an upper body component to the practice.

“Some things work well on the board, some work more easily on land,” she said, noting that, while paddleboard yoga doesn’t replace a studio practice, it can complement it.

Matthews’ paddleboard yoga classes start with warm-up, breathing and stability exercises on land, much like a regular yoga class.

Once on the water she explores more of the basic postures.

“It’s always a trade-off,” said Matthews, who has lately seen classes pop up in indoor pools.

“The beauty of SUP yoga is that you can do it on any body of water.”

The popularity of “fusion yoga” like SUP yoga is gaining immense popularity just as the world comes to acknowledge the wide-ranging health benefits of yoga.

According to a new review of existing research, yoga could be as good for the heart as cycling or brisk walking, and easier to tolerate for older people and those with health challenges.

Based on 37 clinical trials, researchers found that doing yoga lowered blood pressure, cholesterol, heart rate and other cardiovascular risk factors in increments comparable to those seen with aerobic exercise.

“Taken together, these improvements could facilitate and complement a regimen toward better cardiovascular health,” said Paula Chu, a doctoral candidate in health policy at Harvard University in Cambridge, Massachusetts, who led the study.

She and her co-authors caution in the European Journal of Preventive Cardiology, however, that larger studies are needed to understand how yoga improves health, how much of it is ideal and if there are differences in benefits from various types of yoga before the practice becomes a standard prescription for heart disease.

Nonetheless, yoga’s benefits have been long suspected, said Dr. Larry Phillips, a cardiologist at NYU Langone Medical Center in New York.

“I think what we’ve seen is with yoga and the relaxation and behavior modification that goes along with it, there is a benefit to all patients, but especially those with heart disease,” said Phillips, who was not involved in the new analysis.

“Here we are able to see there are more measurable benefits than we’ve seen before,” he told Reuters Health.

Yoga’s breath control and body postures are believed to help nourish self-awareness, control stress and develop physical strength and balance.

The more traditional Hatha style of yoga is the most widely practiced in the U.S.

One study estimates that 15 million Americans have practiced yoga at least once, according to Chu and her co-authors.

They focused on yoga’s effects on cardiovascular disease, as well as risk factors including high blood pressure, high blood sugar, excess abdominal fat and abnormal cholesterol levels that make up a profile – known as metabolic syndrome – that often leads to heart disease and diabetes.

The study team analyzed 37 randomized, controlled trials involving 2,768 people through December 2013.

The trials either looked at yoga compared to no exercise or to aerobic exercises. Participants’ average age was 50 and they were followed for anywhere from 12 weeks to one year.

Those who did yoga had significant improvements in a range of risk factors. Systolic blood pressure (the top number) dropped by an average of 5.21 mm Hg, and diastolic pressure (the bottom number) dropped 4.9 mm HG. LDL “bad” cholesterol fell by an average 12.14 mg/dl and HDL “good” cholesterol rose by an average 3.20 mg/dl. Average heart rate was lower by a little over 5 beats per minute and weight loss averaged a bit over 5 pounds.

These changes were similar to the improvements seen among people who did aerobic exercise instead.

There were no changes, though, in fasting glucose levels or A1C, a measure of long-term blood sugar control in diabetics.

Chu and her colleagues note that one weakness of the results is that the analyzed trials included various types of yoga that were practiced for different amounts of time. These included Silver yoga (for seniors), Iyengar yoga (a form of Hatha that emphasizes correct postures), Viniyoga (which includes chanting) and Vinyasa (breath-synchronized movements.)

There were also a wide range of populations, from the young and healthy to older people with histories of heart disease, Chu told Reuters Health.

“We are not recommending anyone ditch their medicines or established medical or physical practices,” she said. “Individuals can talk to their doctors about whether yoga is a viable option for them.”

Phillips said he encourages his patients to develop a healthy lifestyle and exercise regimen, which could include yoga.

He urges people to find a class that is appropriate for their comfort level and ability.

“I think the effects of relaxation do decrease stress levels and have a benefit to the heart,” said Phillips, adding that he had found doing yoga boosted his own mood and energy level.

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