As chronic obstructive pulmonary disease (COPD) advances, about 35% of patients experience severe weight loss called pulmonary cachexia, including diminished muscle mass.[31] Around 25% experience moderate to severe weight loss, and most others have some weight loss.[31] Greater weight loss is associated with poorer prognosis.[31] Theories about contributing factors include appetite loss related to reduced activity, additional energy required for breathing, and the difficulty of eating with dyspnea (labored breathing).[31]
Later developments in the various Buddhist traditions led to new innovations in yogic practices. The Theravada school, while remaining relatively conservative, still developed new ideas on meditation and yogic phenomenology in their later works, the most influential of which is the Visuddhimagga. The Indic meditation teachings of Mahayana Buddhism can be seen in influential texts like the Yogācārabhūmi-Śāstra (compiled c. 4th century). Mahayana meditation practices also developed and adopted new yogic methods, such as the use of mantra and dharani, pure land practices which aimed at rebirth in a pure land or buddhafield, and visualization methods. Chinese Buddhism developed its own methods, such as the Chan practice of Koan introspection and Hua Tou. Likewise, Tantric Buddhism (also Mantrayana, Vajrayana) developed and adopted tantric methods, which remain the basis of the Tibetan Buddhist yogic systems, including the Six yogas of Naropa, Kalacakra, Mahamudra and Dzogchen.[248]
The spiritual sense of the word yoga first arises in Epic Sanskrit, in the second half of the 1st millennium BCE, and is associated with the philosophical system presented in the Yoga Sutras of Patanjali, with the chief aim of "uniting" the human spirit with the Divine.[24] The term kriyāyoga has a technical meaning in the Yoga Sutras (2.1), designating the "practical" aspects of the philosophy, i.e. the "union with the supreme" due to performance of duties in everyday life.[25]