Table 2.

Recommendations for health care providers to consider for rheumatic disease patients prior to participating in yoga.

• Primum non nocere: Importance of principle of "non-harming" in medicine and yoga

• Evaluate general health and overall endurance

• Evaluate co-morbid cardiovascular and pulmonary disease (may require referral to other  specialists)

• Assess for severe osteoporosis (risk of fracture/fall)

• Clearly identify vulnerable joints to the patient (e.g., joints with instability, at particular  risk for injury, with limited mobility, active swelling or underlying damage, and any joints  that have been replaced.) In all of these cases, the patient should be aware of the need  for caution and to avoid positions that include movements contra-indicated after a hip or  other joint replacement. Patients should be advised to listen to their body throughout  class, avoiding movements that bring on pain. Patients should always review possible  problem areas and limitations with the instructor prior to starting the class.

• Review warning signs of injury and appropriate management of discomfort (e.g. rest,  cold, heat)

• Consider providing a letter for yoga instructor outlining general and specific medical and  musculoskeletal concerns. Care providers can also agree to speak directly with the yoga  instructor and provide a contact number.

• Engage in ongoing dialog with patient concerning their yoga experience and concerns

• Consider physical and/or occupational therapist assessment of limitations/modifications