Yoga Therapy for the Heart: Interview with Sonja Rzepski, C-IAYT

Sonja Rzepski is an IAYT-certified yoga therapist and graduate of Prema Yoga Institute’s Yoga Therapy Program. Sonja received her initial yoga teacher certification in the inaugural teacher training of Samahita Centered Yoga Institute in 1999, and originally studied Ashtanga yoga under Eddie Stern. Sonja teaches the Yoga Therapy for Cardiac Care course for PYI; in addition, she was the lead yoga therapist for the Northwell Lenox Hill Cardiac Care Yoga program, whose work was chronicled in a recent study published in the Annals of Clinical Cardiology entitled The Yoga Meditation Heart Connection—A Pilot Study Looking to Improve Women’s Heart Health, which demonstrated a meaningful connection between yoga and meditation practices and improved well-being and decreased depression rates in female cardiac patients, as well as other benefits.

I recently had the opportunity to sit down with Sonja and ask her about her work with cardiac patients as well as about yoga and heart health in general.  What follows are excerpts from that conversation.

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Molly Goforth: Can you talk a bit about how you came to your specialization in cardiac care? 

Sonja Rzepski: It honestly goes way back, because of my mom's experience of having a heart attack, and also my family history of heart disease.  I hadn’t been seeing my parents on a regular basis because I was living in New York City, and they were living upstate when my mother got a job opportunity in the city and I started seeing her regularly.  I noticed that she was looking sort of grey, that she had gained a significant amount of weight, and that she got short of breath easily, just walking down the block. I knew my grandfather had had a heart attack, and that my mother had a significant history of heart disease in her immediate family, as I mentioned.  So I asked her if she had been to the doctor, and she quite casually told me that she had seen her doctor recently and he had said that women couldn’t have heart attacks before menopause.  I asked her if he had done any tests, and she said no. My mother is an extremely upbeat, positive person, but her energy was low, and even though she was having chest pains, her doctor didn’t run any tests and put her on anti-depressants. He just didn’t consider heart disease to be a possibility for a pre-menopausal woman.

MG: I would say that’s unbelievable, but sadly, it’s not.

SR:  No, it’s not.  There is so much information regarding women and cardiac health, and how to prevent heart disease in women.  But regarding my mother, she was told it was indigestion, it was depression, it was anything but her heart.  The only reason she ended up getting an accurate diagnosis is that she happened to go to lecture given by a specialist in heart disease in women at NYU, and she found that she was checking all the boxes, so to speak, regarding her symptoms.  After the lecture she spoke to the doctor, and she ended up becoming a patient, but it took her months to get an appointment. By the time she was finally seen, she actually had a heart attack in the hospital, on the table.

MG: Oh, my God.

SR: She had 92% blockage at that point, and of course the anxiety of it all likely contributed to the cardiac event.

MG: Of course.

SR: Thank goodness she was in the right place.  I was flabbergasted, because it was my own mother and she had been so misdiagnosed for so long.  It became very educational for me; I started to go with her to appointments and I started to become fascinated at the work her doctor, Dr. Steinfeld, was doing.  I wanted to learn more and more, and I started to get more in depth and to apply what I was learning to my yoga teaching.

MG: And how did that progress?

SR: I worked with Dr. Rachel Bond and Dr. DeJesus, and I started working with their support group. They had a women's support group for heart disease and I started basically mentoring with a cardiologist and working with their patients. And thank goodness the doctors were very open-minded and generous.  I mean, I was getting amazing training right there in the hospital. So then it just grew and grew and we started a formal outpatient cardiac class at the hospital.  Our patients had had cardiac events or suffered from heart disease and were seeing the cardiologists, but were not in the hospital at that time. They would return for classes, and that's how this study came about. And then, through Prema, we were able to bring in Yoga Therapy students as mentees, to support the work and even eventually to teach.

MG: What a compelling personal story about how you came to specialize in Cardiac Care. Is you mother doing better now? 

SR: She's doing much better now right. Not only does she lead her own women's support group, she does about 20 to 25 minutes of her own yoga practice every morning.

MG: That’s so great.  Shifting gears a bit, can you speak to working in a hospital setting as a yoga therapist?  What were some of the challenges? 

SR: I think there are actually two great extremes. The cardiologists and the cardiac nurses who saw the results our yoga therapy work was having on their patients were incredibly supportive and bent over backwards to make sure that we had a lovely space to practice in and even supplied water and healthy snacks…they couldn’t have been more supportive. And then the flipside of that is the bureaucracy. Unfortunately, in a hospital setting, even though we're certified yoga therapists, it’s such a new field and with regard to the administration, there's a lot of red tape. When administrative medical professionals don't see the word “licensed” in front of yoga therapy…I’ll just say that there’s still some doubt about the profession, and mistrust, and need for more proof of efficacy. So when studies like ours are done, it’s incredibly important, because anytime you can cite a study it actually brings you that much closer to legitimacy in the eyes of the medical establishment.  Honestly, even to get our study approved took months and months and months, even though we had a bevy of cardiologists supporting it.

MG: That must have been frustrating.

SR: There is a lot of red tape, unfortunately. But our personal experience was always wonderful. Seeing the actual interaction between patients and doctors and nurses and staff on the floor was always fantastic.

MG: Did any of the study’s findings surprise you?

SR: In the upcoming Yoga Therapy for Cardiac Care course at PYI, we will study the Ayurvedic perspective of heart disease and how yoga therapy can address it.  We don’t have the time now to get into a discussion of the complexities of the Ayurvedic concept of doshas and how that relates to cardiac care,  but I can say that the extremely high-functioning, high energy people who would come into the room as patients in our cardiac yoga therapy study…it was often very surprising to me that they were so ready to embrace the practice of yoga and mediation. So one thing that I learned as a yoga therapist working with this population was how important it was to create that safe, sacred space wherever we were.  We would sometimes be in a beautiful room with a fireplace, and other times we would be in the auditorium and they would have to practice… I realized how important was to make the space as consistent and warm as possible, to create that impetus to relax and alter their energy to match the environment.  We tried to incorporate a spiritual element as well, with a singing bowl and playing music before we started, because yes, there was always a lot of energy coming into the room.

I think it was also the weight loss that was actually a surprise to me, as well, because we were doing very, very gentle chair yoga and meditation primarily. But 37.5% of participants lost weight. What the study was really geared toward was dealing with anxiety and depression. And there was a very significant decrease in that, as well. So that was really affirming. It went from a rating of seven to 4.9. 

MG: That's incredible.

SR: Yeah it really is, over a relatively short few months. So that was great. But the weight loss is what really surprised me. And I think part of what made that possible was that the women started to really look forward to coming.  It really became a community, a place where they started to really enjoy talking together and sharing their stories, and the outlook shifted from coming in as a patient and really identifying with their disease to being a part of a support group in a community that was doing healthy, uplifting activity together.  So I really think that we may have had a lot to do with improving other elements of their lives, not simply depression and anxiety but also just their outlook on life: “Hey, I'm going to make more of an effort to get better, because my life matters.”

MG: Speaking of lifestyle changes, are there cultural factors in the U.S. that you feel contribute to heart disease?

SR: Unfortunately, (heart disease) is on the rise and it's the largest killer in the world. And there are quite a few factors cultural factors that contribute. We are becoming less active as a whole. More and more people are waking up, going from their car to work, sitting all day at their job, and going back home and sitting in front of a television. So in general we're becoming less and less active and we don't even realize it. Second, the quality of our food, especially in this country, is just getting worse. There's more and more fast food, but also, even when someone does try to make an effort eat more healthfully, the quality of our meat, the quality of our dairy…and that healthier food is more expensive, all of these factors are truly contributing to declining heart health.

And then there’s a really big one, and it’s stress.  It’s the fact that people are having to work longer and longer hours with worsening health care. And the attendant anxiety this causes, as in,  “Well, I don't want to even go to the doctor because it's going to cost (too much).” There are many contributing factors.

On the bright side, one thing I think is a wonderful value of yoga therapy is that it encourages the client or patient to look at the whole picture of their health, and the more mindful a person becomes, the more they start to care about what they're eating and realize that moving feels good and your life can be strong and healthy. Empowering the agency in their physical form and yet making choices to practice more loving kindness and towards others also highly affects the heart. And this is what I'm very excited about regarding yoga therapy for cardiac care: that we get to bring together all these categories for a healthy life.

MG: Sonja, in your opinion, who is this Yoga For Cardiac Care training for?

SR: First of all, whether you are a personal trainer, a fitness instructor, a yoga teacher or really anyone who is dealing with a population working on their own health, you’re going to obtain such a knowledge base of how not only to recognize the signs and risks of heart disease but also what is effective. Which breathing techniques. Which asana. What languaging is helpful that they can implement and put into their work, whoever they are: acupuncturists, anyone in the wellness field.  And I’d also say that anyone who is supporting a family member or friend with heart disease or anyone who is at risk for heart disease.

MG:
Are there any ways, having worked with women in the study at Lenox Hill, that you think about gender and women when you are thinking about cardiac care in yoga therapy, in addition to how important it is to raise awareness among women about paying attention to their heart health?

SR: You need to have support networks, that is really important to awareness. Because the way heart disease presents in women can be very different from how it presents in men.  So that is number one.
And then I think for women it is really wonderful and important to empower each other. Because very often, for women, it’s easier for them to help a friend rather than to help themselves. So getting them all together allows them to all help one another. And then there is a greater chance that change will happen.

MG: I love that observation: I think that’s a point that should really be amplified. Sonja, I am so looking forward to taking your training, and thank you so much for your time.

SR: You’re very welcome. 

Prema Yoga Institute’s Yoga Therapy For Cardiac Care course, taught by Sonja Rzepski, runs from March 27th-29th at Pure Yoga West. Registration opens February 27th.

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Molly Goforth is a yoga and meditation teacher and a student at Prema Yoga Institute. She specializes in accessibility and trauma-informed yoga teaching and practice.