Keywords: Tibetan Buddhism; Ladakh; Nuns; Sowa-Rigpa; Yoga; Ayush

Abbreviations: LNA: Ladakh Nuns Association; CYP: Common Yoga Protocol; YCB:Yoga Certification Board; CIBS: Central Institute of Buddhist Studies; IYA: Indian Yoga Association

Background

Ladakh and Health Concerns

Since 2019, Ladakh (trans-Himalayan region of northern India) has been administered as a Union Territory of India. Leh (capital city), located 3,200 to 3,600 meters above sea level receives minimal annual precipitation, making it one of the driest inhabited regions in India. The demographic composition of Ladakh is ethnically and religiously diverse (Ladakhi people primarily follow Tibetan Buddhism but also include Tibetan migrants and Muslim communities from Kashmir) with around 302,000 inhabitants [1]. Recently, Ladakh has undergone significant infrastructural development, including improvements in road networks, electricity, telecommunications, and transport systems, resulting in an accelerated market economy. Concurrently, tourism has flourished, from within India and abroad. This rapid modernization and shift in lifestyle have raised concerns regarding public health [2]. Previous studies have identified prevalent health issues in the region, including hypertension, stroke, stomach cancer, and occupational lung diseases [3], and due to dietary transitions and sedentary behaviors associated with urbanization lifestyle-related diseases such as hypertension and diabetes have become increasingly common [2].

Ladakh Nuns Association (LNA)

The Ladakh Nuns Association (LNA), established in 1996 by venerable Dr. Tsering Palmo, a Ladakhi nun and Sowa-Rigpa doctor in Leh, is a non-profit foundation dedicated to empowerment, education, and spiritual upliftment of Buddhist nuns and community in Ladakh. Founded in response to the long-standing marginalization of nuns within Himalayan monastic traditions, who traditionally had limited access to education and spiritual training compared to monks. LNA seeks to improve the status of nuns by promoting access to both traditional Buddhist education and modern secular learning, building nunneries, conducting workshops, training nuns as doctors in Sowa-Rigpa, child conservation of spiritual studies, local herb collection, education support for children [4].

Tibetan Buddhism, Sowa-Rigpa, and Yoga

Tibetan Buddhism is fundamental to the spiritual and cultural life of Ladakh. Emphasizing ethical conduct, meditation, and the cultivation of compassion, its teachings support not only monastic discipline but also the broader well-being of local communities. In practice, daily religious activities commonly include the observance of monastic precepts, mantra chanting, meditation, pilgrimage, and ritual ceremonies, many of which share both conceptual and practical similarities with yogic traditions. Sowa-Rigpa, the traditional Tibetan system of medicine (Amchi medicine, officially recognized by the Ministry of Ayush, Government of India) [5], is another vital element of Ladakhi culture. Its emphasis on the interconnectedness of body, breath, mind, and environment aligning with the principles of Yoga and Ayurveda. Within this cultural context, integration of Yoga into Buddhist nunneries is not a foreign intervention, but rather as a complementary practice that resonates with existing traditions, offering new tools to support health, emotional balance, and mental focus within monastic life.

Need for the Study and Research Objectives

Studies have highlighted the mental health benefits of mindfulness and meditation in monastic communities globally [6-8]. But, empirical research on mental well-being of Buddhist nuns, especially in Ladakh is lacking. And, no study has examined the role of Yoga as a psychosocial intervention within Buddhist nunneries. This study aims to address that gap by introducing integrated Yoga practices into the daily lives of Buddhist nuns and local women at the LNA. Framed as a non-religious, culturally sensitive intervention, the program seeks to promote emotional well-being, foster social connection, and enhance spiritual focus without conflicting with existing monastic disciplines. The specific objectives of this study are to:

1. Assess psychosocial impact of integrated Yoga practices on Buddhist nuns living in a monastic environment
2. Explore compatibility of these practices with the ethical and contemplative frameworks of Tibetan Buddhism and Sowa- Rigpa
3. Evaluate feasibility and perceived value of Yoga as a sustainable, community-based health intervention in Ladakh.

Methodology

Research Design

A qualitative case study design was used and data collection was conducted through unstructured interviews and systematic field observations to ensure methodological triangulation. A theory-driven thematic analysis was employed, organizing the findings under four predefined dimensions: physical and physiological, psychological, social, and spiritual. Ethical clearance was obtained from the relevant institutional committee, and informed consent was secured from all participants (at LNA) prior to their involvement in the study.

Participants and Setting

The Yoga program comprised of 26 participants including 24 Buddhist nuns and two local women. The participants, residing in the LNA during the intervention period, ranged from around 7 to 55 years across different life stages: school-age children, adolescents, young adults, working adults, and elders.

Intervention: Integrated Yoga Practices

The intervention at LNA was conducted from 20^th August to 30^th September 2023, with daily sessions held across four different time slots:

• 5:00–6:00 a.m. (general morning session)
• 5:00–6:00 p.m. (therapy-focused session)
• 6:00–7:00 p.m. (children’s session)
• 9:30–10:30 p.m. (youth session)

Participants attended between one and three sessions per day. Integrated Yoga practices were based on Common Yoga Protocol (CYP) and supplemented by additional practices drawn from Yoga Certification Board (YCB) syllabus, traditional yogic texts, and publications from the Kaivalyadhama Yoga Institute and Bihar School of Yoga.

The program included:
• Sūkṣma-vyāyāma (loosening exercises/joint movements)
• Sūrya Namaskāra (sun salutations, with variations)
• Modern warm-ups and aerobic activities
• Āsanas (postures)
• Prāṇāyāma (yogic breathing techniques) and preparatory breathing techniques
• Śuddhi Kriyā-s, such as:
• Dhauti (cleansing of upper digestive tract)
• Jala Neti (nasal cleansing with water) and Sūtra Neti (nasal cleansing with rubber tube)
• Trāṭaka (a yogic gazing technique)
• Nauli (abdominal churning, taught at an introductory level)
• Kapālabhāti (frontal sinus cleansing)
• Dhyāna (meditation)
• Hasta Mudrā-s (hand gestures)
• Yama (social discipline) and Niyama (individual discipline)

In addition, a 32-hour YCB-compliant training module was delivered to four young adult nuns, providing more in-depth instruction aligned with national certification standards.

Two additional Yoga programs were also conducted for contextual comparison:

1. At Government Primary School Skara-Yokma, Yoga sessions were offered to 84 participants (including children from nursery to 5^th grade and nine teachers) from 5^th to 30^th September 2023, during morning assemblies three times a week.

2. At the Sowa-Rigpa Hospital at the Central Institute of Buddhist Studies (CIBS), Yoga was introduced to five healthcare professionals-including doctors, therapists, and chemists-over a period of three weeks from 31^st August to 20^th September 2023, with afternoon sessions held three times a week.

Data Collection

Data was collected through:
• Informal interviews and post-session discussions.
• Participant observation (documenting behavior, verbal expressions, and emotional responses during and after sessions).
• Field notes maintained by the instructor-researcher.
• Visual documentation (photos and session charts with permission).

Data Analysis

A theory-driven thematic analysis approach was utilized and followed Braun and Clarke’s [9] six-phase framework:
1) Familiarization with the data
2) Generation of initial codes
3) Search for themes
4) Review of themes
5) Definition and naming of themes
6) Production of the final report

Data from interviews and field observations were initially coded according to four predefined dimensions:
1) Physical and physiological
2) Psychological
3) Social
4) Spiritual

Within each dimension, sub-themes were identified inductively to capture the richness and complexity of participants’ experiences. This combination of deductive and inductive approaches ensured a balance between theoretical focus and openness to emergent meanings.

Results

The findings of the psychosocial case study were structured according to four analytical dimensions: physical and physiological, psychological, social, and spiritual. These four dimensions are explored in an integrated manner, acknowledging the interdependent relationship between body and mind (Figure 1).

Physical and Physiological Dimension

Yoga practices were tailored to address the unique challenges of Ladakh’s high-altitude and arid environment, focusing particularly on respiratory, digestive, and musculoskeletal health. The intervention incorporated cleansing techniques (Śuddhi Kriyā), therapeutic Āsanas, subtle joint movements (Sūkṣma vyāyāma), and breathing practices adapted to the monastic lifestyle. Participants reported a range of physical and physiological improvements

Enhanced Respiratory and Digestive Health

Cleansing techniques such as Jala Neti (nasal irrigation), Kapālabhāti (frontal sinus cleansing), Dhauti (upper gastrointestinal cleansing), Śaṅkha Prakṣālana (full intestinal wash), and Agnisāra (stimulation of digestive fire) were particularly effective in addressing region-specific health concerns. Several nuns, who initially reported chronic constipation, experienced notable improvements. Interest in Yoga for weight management was also expressed, with one participant achieving a 5-kg weight loss over two months, accompanied by increased physical lightness and mental clarity.

Musculoskeletal Benefits

Therapy-oriented sessions involving Sūkṣma-vyāyāma, stretching, and therapeutic Āsanas alleviated chronic lower back pain and enhanced joint mobility. Regular practice of dynamic Āsanas and Sūrya Namaskāra (Sun salutations) contributed to improved flexibility, postural correction, and reduced musculoskeletal tension, including relief from migraines and neck-shoulder stiffness.

Adaptability to Monastic Life and Climate

Given the extreme winter conditions and the demands of prolonged seated chanting, participants valued Yoga as an adaptable form of indoor exercise. In deference to the Buddhist context, Sūrya Namaskāra was practiced without the recitation of bīja mantras.

Psychological Dimension

Yoga practices were found to contribute meaningfully to the psychological well-being of participants, addressing emotional challenges commonly encountered in the monastic setting. Although no formal psychological assessment tools were employed, qualitative feedback consistently highlighted positive effects across multiple psychological domains.

Psychophysical Relaxation Through Āsanas

The practice of Āsanas was frequently associated with reduced muscular tension, which participants perceived as contributing to psychological relaxation and stress alleviation. Many described experiencing an enhanced sense of calmness and emotional balance following physical practice sessions.

Stress Reduction and Promotion of Emotional Openness Through Prāṇāyāma and Dhyāna

Among the Prāṇāyāma techniques introduced, Nāḍī Śodhana prāṇāyāma (alternate nostril breathing) and Bhrāmarī prāṇāyāma (humming bee breath) were particularly well received for promoting calmness and mental focus. Participants consistently described these practices, alongside Dhyāna (meditation), as effective in reducing stress and anxiety, promoting emotional openness, and improving concentration.

Improvements in Sleep Quality

Several participants reported improvements in sleep quality during the intervention period, suggesting broader psychophysiological benefits of the practices that may warrant further investigation.

Reduction of Visual Strain and Mental Fatigue

In response to participant requests, Trāṭaka (a yogic gazing technique) was incorporated twice during the intervention to alleviate symptoms of eye strain caused by prolonged scripture recitation, reading, and occasional smartphone use. Participants, already familiar with meditative practices, readily adopted Trāṭaka and reported subjective improvements in both visual comfort and mental relaxation.

Social Dimension

Building upon the foundation of Buddhist monastic discipline, the group-based structure of the Yoga sessions significantly contributed to strengthening participants’ sense of social connection, mutual support, and community belonging. Qualitative feedback further highlighted the emergence of cooperative behaviors, leadership development, and increased social participation among both adult and child participants. Key social outcomes observed included

Fostering of Leadership and Cooperative Behavior Among Children

In children’s sessions, rotational leadership roles were incorporated, promoting self-efficacy, teamwork, and communication skills. A notable example involved a group of elementary school-aged nuns who, after consistent practice at LNA, were invited to lead Yoga demonstrations during school assemblies. Their engagement extended beyond demonstration to active organization of mats, arrangement of rows, and peer instruction, reflecting enhanced confidence and proactive social behavior.

Increased Community Engagement and Social Initiative

Participants demonstrated a growing willingness to engage with their communities through Yoga-related activities. The leadership experiences of the young nuns suggest that early exposure to structured group practices can foster broader social initiative within monastic and educational contexts.

Recognition and Future Aspirations

The awarding of completion certificates was perceived as a meaningful recognition of effort and achievement. Several participants expressed the view that possessing a Yoga certificate could enhance their future employment prospects, particularly in sectors such as health, education, and community development, where Yoga skills are increasingly valued.

Spiritual Dimension

Integrated Yoga practices were perceived as functionally complementary to traditional Buddhist practices, enhancing participants’ contemplative experiences and physical resilience during spiritual activities. Qualitative feedback indicated a seamless integration of Yogic techniques with existing monastic disciplines. Participants reported several spiritual benefits

Support for Physical Stability During Monastic Activities

Āsana practices were particularly valued for their role in maintaining stable seated postures during prolonged scripture recitation. Participants noted improved postural endurance and reduced musculoskeletal discomfort, including mitigation of kyphotic tendencies associated with repetitive prostrations.

Enhancement of Concentration and Meditative Focus

Regular practice of Āsanas and breathing techniques was associated with improved concentration during scripture recitation and meditative practices. Participants described an increased capacity for sustained mental focus and physical stillness, contributing to deeper engagement in their contemplative routines.

Compatibility with Existing Meditative Traditions

Anecdotal reports from participants engaged in Vipassanā meditation highlighted the perceived compatibility between Yogic techniques and established Buddhist contemplative disciplines. Yoga was seen not as a disruptive addition, but as a supportive practice that enriched existing spiritual frameworks.

Discussion

Integrated Yoga practices effectively addressed the physical and physiological, psychological, and social needs of Buddhist nuns and women in Ladakh. These practices may enhance the depth and sustainability of traditional contemplative disciplines within the unique monastic and climatic context.

Psychosocial Relevance

The outcomes are particularly significant within the sociocultural context of LNA, where young nuns often experience limited opportunities for emotional expression and social interaction, potentially influenced by early ordination, formative childhood experiences, restrictive social environments, and individual personality traits [10,11]. In this context, the regular Yoga practice offered a structured method for self-regulation and mental composure. The group-based structure of the Yoga sessions provided a culturally appropriate space for physical practice, shared discipline, and peer interaction.

Cultural Compatibility: Intersections with Tibetan Buddhism and Sowa-Rigpa

Three systems-Yoga, Tibetan Buddhism, and Sowa-Rigpashare a fundamental orientation grounded in Indian philosophical thought, wherein the origin of suffering (duḥkha), the mechanism of karma, and the establishment of ethical discipline are all traced to the necessity of overcoming ignorance (avidyā). This shared metaphysical foundation offered a powerful point of connection that helped frame Yoga not as a foreign or conflicting practice, but as a complementary path aligned with the nun’s spiritual worldview. These intersections allowed for a seamless integration of Yoga into their spiritual routines, enhancing awareness, the regulation of breath, and the harmonization of body and mind as essential methods of personal transformation. Among the participants were nuns already established as Amchi (traditional physicians), who regarded Yogic techniques not merely as personally beneficial, but also as holding therapeutic potential within clinical settings. In this context, the adoption of Yoga in Ladakh’s monastic and healing institutions can be understood not as a novel imposition, but as a culturally resonant enrichment. The underlying philosophical commonality enables an integrated, respectful approach to health and well-being that bridges spiritual practice, ethical awareness, and therapeutic care.

Locally Rooted Sustainability: The Need for Instructor Development

While short-term interventions have demonstrated encouraging results, the long-term sustainability of Yoga programs in Ladakh will depend on reducing external dependency and fostering local capacity. Establishing a cadre of communitybased Yoga instructors-particularly among nuns themselves-can empower institutions like LNA to continue integrating Yoga in ways that are contextually relevant and culturally embedded. Training local instructors offers multiple benefits. It allows for regular and consistent programming tailored to the rhythms of monastic life and the health needs of the region. It also opens educational and vocational pathways for women, especially nuns, by equipping them with skills applicable beyond monastic settings. To support this transition, future training programs should be designed with both national standards and regional adaptations in mind. Aligning with the YCB guidelines ensures credibility and alignment with India’s national Yoga education framework. In this context, collaboration with the Indian Yoga Association (IYA) could play a crucial role in harmonizing local initiatives with national frameworks while ensuring the preservation of the region’s cultural and spiritual distinctiveness.

Conclusion

Conducted in a high-altitude, culturally distinctive, and spiritually rich environment, this study at LNA demonstrated that Yoga practices provided tangible benefits across physical, psychological, social, and spiritual domains. Integrated Yoga practices can be considered culturally compatible psychosocial support tools complementing spiritual and communal lives of Buddhist nuns. A need to transition from externally led interventions to sustainable, community-driven models, particularly through development of Yoga instructors from within the monastic community itself, is recommended. Young nuns expected to serve as future spiritual leaders within their communities, will need to proactively maintain and enhance their own physical and mental well-being, for which Yoga practices may serve as one of the best available options.

Limitation

Future longitudinal research to evaluate sustainability of these changes and validate predicted outcomes is necessary, as the study is limited by a small sample from a defined cultural context.

Acknowledgments

The author sincerely thanks the Ladakh Nuns Association (LNA) for their cooperation and participation, and Kaivalyadhama Yoga Institute for their support in facilitating the Common Yoga Protocol Appreciation Course, which guided the development of this study. Their contributions were essential to the successful completion of this work.

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