cyter report -sept2014

INNOVATIVE ASPECTS OF CYTER

THE INNOVATIVE ASPECTS OF CYTER

Joseph and Lilian le Page, the founders of Integrative Yoga Therapy, USA were recently in India on a mission to make a film on Yoga therapy and travelled across the county recording therapeutic activities of premier Yoga centers. After their visit to CYTER they commented,

“There are many centers where you can get a Yoga degree, attend a Yoga therapy session or find Yoga research being undertaken. However, to have all three happening in one place is surely innovative. This center is indeed a role-model that combines the best of the East with that of the West.”

That is what we have here at CYTER. An integrated set up where we are educating future Yoga therapists while simultaneously helping patients recover from their illnesses and at the same time working towards developing an understanding about the ‘Hows & Whys’ of Yoga through scientific research.

Whereas Yoga is usually found in the Physical Education and Sports Department of most universities, we at CYTER have it in a medical institution thus enhancing the learning curve of our trainees as also enabling us to offer holistic therapeutic benefits for all patients in our hospital. Yoga consultations are part and parcel of all the Master Health checkups offered by our Hospital services thus integrating the modern and the ancient even at the entry level itself. Such quality of life enhancing benefits for nearly 6000 patients at MGMCRI&RI are another truly innovative aspect of the work here at CYTER.

Our PG Diploma in Yoga Therapy (PGDYT) is one of the innovative courses in the world as it is offered through a medical institution and brings together the ancient wisdom of Yoga with the evidence based approach of modern medicine. We have two batches of students enrolled in the course and classes are going on regularly for first semester batch while the second semester batch completed their examinations in August 2014. During our Deputy Director’s recent lecture tour down under many medical, paramedical and Yoga professionals evidenced keen interest in attending such a course from the next academic year, making its truly international in participation.

We have also given training to nursing students, faculty members, senior citizens, special children and transgender participants and published 28 papers and 9 abstracts on the short and long term, health enhancing benefits of such training and therapeutic programmes. Current research studies are focusing on obesity, computer vision syndrome and depression in the transgender community. MBBS students have been exposed to Yoga through special sessions and we suggest that the CYTER model be adopted by all innovative

medical colleges when the new MCI regulations on inclusion of Yoga in MBBS curriculum are implemented.

The Govt of India, Ministry of Health &FW is currently promoting indigenous systems of health in a strong manner through AYUSH. The limitations of modern medicine in managing stress induced psychosomatic, chronic illnesses are the strength of Yoga and hence a holistic integration of both systems enables best quality of patient care. CYTER can be projected a nodal centre to train medical educators and administrators for setting up such integrative health centers in our country as we have the necessary infrastructure and man power.

A successful Workshop-cum-Seminar was organized on “Yoga for lifestyle disorders” and this was attended by more than 250 medical, paramedical, Yoga professionals and students from all over the country with 25 international delegates in November 2013. Regular awareness programmes are conducted in the community at various schools, colleges, medical and social associations and senior citizen welfare associations locally. CYTER also conducted a very well received Yoga Therapy workshop during the 20th International Yoga Festival organized by the Government of Pondicherry in January 2014.

It is imperative that Sri Balaji Vidyapeeth remain a Denovo University as it is only in such a supportive and innovative milieu that the holistic art and science of Yoga, our cultural heritage, has been able to reach both the classes and the masses of our society optimally, effectively and holistically.

REPORT ON CYTER ACTIVITIES

CYTER Report- September 2014 Page 1

Sri Balaji Vidyapeeth Mahatma Gandhi Medical College & Research Institute

Pillaiyarkuppam, Pondicherry - 607 402 CENTRE FOR YOGA THERAPY, EDUCATION AND RESEARCH (CYTER)

REPORT ON WORK DONE

Modern medical advancements provide the rationale for the integration of various traditional healing techniques like Yoga to promote healing, health, and longevity.

Thanks to the foresight of Chairman and management of SBVU and MGMCRI, CYTER was started on 1 November 2010 and was functioning adjacent to Blood bank in Hospital Block.

Currently functioning in 1st floor, I block, adjacent to the main Hospital block, MGMCRI since December 2013.

YOGA THERAPY (patient load): CYTER is conducting a scientifically sound Yoga therapy programme through its Yoga

Therapy OPD in I Block from 9 am to 1 pm, Monday-Saturday.

Consultations are offered by Dr. Ananda Balayogi Bhavanani, Deputy Director CYTER and Mrs Meena Ramanathan, Coordinator and Yoga Therapist. Qualified Yoga instructors are imparting the schedules daily from 9.30am to 12.30 pm.

Individualised and group Yoga therapy sessions are being conducted for various medical conditions such as diabetes, hypertension, musculoskeletal and psychiatric disorders with excellent feedback from participants.

Yoga therapy and lifestyle consultations are offered daily as part of Basic, Superior, Complete Cardiac and Deluxe Health Check packages of Master Heath Check-up in the Corporate Services Wing of the hospital since October 2013.

Year Male Female TG Total Grand total

2010 31 28 - 59

5881

2011 440 750 27 1217

2012 210 542 10 763

2013 553 817 2 1372

2014 (Jan-Aug)

1135 1319 16 2470


YOGA EDUCATION (courses): A small but significant step was taken on the 30th January 2014 with the inaugural of

the Post Graduate Diploma in Yoga Therapy (PGDYT) course at the CYTER in the Mahatma Gandhi Medical College. The course was officially inaugurated ceremonially by Dr Madanmohan, Director CYTER and then faculty members and the six students of PGDYT course received blessings of the Vice chancellor Prof KR Sethuraman, Dean (PG Studies &Research) Prof N Ananthakrishnan, Dean (Admin) Prof S Krishnan, and the Registrar Prof AR Srinivasan. Holistic health, integrative treatment and mind–body medicine are now buzz words. Integrating Yoga with modern medicine will enable us to produce holistic physicians for health delivery of tomorrow as integrative medicine becomes popular. This two semester (480 hr) part time course aims to produce qualified Yoga therapists competent to impart a scientifically sound Yoga therapy programme for patients of different conditions. The first batch of students completed their 1st semester exams in August 2014 and second batch of students joined PGDYT at CYTER on 10th September.

Yoga training has been given for nursing students of the Kasturba Gandhi Nursing College on a regular basis since 2011. Nursing recruits visit CYTER during their orientation programmes and are given special sessions highlighting benefits of Yoga.

Regular Yoga awareness programmes in MRD since September 2013.

Efforts to include Yoga in MBBS curriculum.

Regular talks as part of arthritis, obesity, back pain, diabetes awareness programmes organized by various departments.

Capsule talks and lecture-demonstrations in Scientific Academic Forum (SAF)

Outreach programmes in educational institutions and other social organizations to create awareness of Yoga and the functioning of CYTER at MGMCRI.

A CME-cum-Workshop on YOGA AND LIFESTYLE DISORDERS was organized by CYTER and Department of Physiology at MGMC&RI on 22 November 2013. More than 250 medical and paramedical professionals and students as well as Yoga practitioners and enthusiasts took part in the CME that gave participants an overview of the role Yoga can play in lifestyle disorders by inculcating a healthy lifestyle.

The CYTER team of Prof Madanmohan (Director), Dr Ananda Balayogi Bhavanani (Deputy Director) and Smt. Meena Ramanathan (Coordinator - cum- Yoga therapist) presented an invited Workshop on Yoga Therapy at the 20th International Yoga festival organized by Department of Tourism, Government of Puducherry at Gandhi Tidal - January 4-7th 2014.

Dr Ananda Balayogi Bhavanani (Deputy Director-CYTER) was invited to present workshops, seminars and talks at various venues in Australia and New Zealand from 24th March to 14th April 2014. He presented highly successful programmes organized by the Gitananda Yoga Association of Australia at IYTA-Wellington, Lotus Yoga Centre-Paraparaumu in New Zealand and Anand Yoga Academy at Adelaide. He also conducted intensive 3-day retreats at Tatum Park, NZ and Integral Yoga Academy of Australasia at Adelaide. He presented a special 2-day workshop at the International Yoga Teachers Association at Sydney, Australia and visited the Sivanna Integrative Health Centre, Sydney to discuss further collaboration in Yoga therapy. He had special personal meetings with Yogashri Dr Eric Dornekamp, the senior most Yoga authority of New Zealand and the world famous authority on Yantra-Tantra, Dr. Swami Anandakapila Saraswathi (Jonn Mumford) of Sydney, Australia.


Dr. Ananda was invited to attend Board of Studies meeting of GS College of Yoga and Cultural Synthesis, at Kaivalyadhama in Lonavla. He has been nominated as the chairperson for the subject, “Anatomy and Physiology of the Human Body in the Context of Yoga.” This appointment is prestigious as Kaivalyadhama is one of the oldest and premier Yoga institutions of India. He was also Chief Guest for the inauguration of the Foundation Course in Yoga & Ayurveda at Kaivalyadhama. He was an invited Resource Person for the National Seminar on "Dimensions of Yoga and its dynamics" at MoP Vaishnav College for Women, Chennai. He delivered an invited lecture on “Diverse Dimensions of Yoga for the youth" in the event organized jointly by the Krishnamacharya Yoga Mandiram and MoP Vaishnav College.

Smt. Meena Ramanthan, Coordinator and Yoga Therapist CYTER submitted her PhD dissertation to the Tamil Nadu Physical Education and Sports University, Chennai. The title of her 250 page dissertation is “Effect of selected yogasanas and pranayama on selected cardiorespiratory, psychological and psychomotor variables among low and highly depressed geriatric women.” She was invited to present an interactive session at the CNE for nurses, staff and faculty of Indira Gandhi Government General Hospital and Post Graduate Institute (IGGGH&PGI) Pondicherry. Mrs Meena Ramanathan gave an interactive talk cum practical session on “Stress–a Curse; Yoga- a Boon; Yogic Integration for Healthcare Givers” with a demo by Sangeeta and Danush Apnadesh.

CYTER inaugurated a special Silver Citizens Yoga and Health Programme for Senior Citizens of the Serene Pelican Belfort Township. More than 25 senior citizens attended the sessions at CYTER. Dr Ananda gave an introduction and then the practice session was led by Meena Ramanathan and supported by Latha and Dhanush, the Yoga instructors. A special “Silver Citizens Clinic” is being organized from 11am to 12.30pm every Thursday at CYTER to benefit those who are above 60years of age.

YOGA RESEARCH (publications): A. Published papers (28) :

1. Bhavanani AB. Yoga in health care. Annals of SBV 2012; 1 (2): 15-24.

2. Bhavanani AB, Ramanathan M, Balaji R and Pushpa D. Immediate effect of suryanamaskar on reaction time and heart rate in female volunteers. Indian J Physiol Pharmacol 2013; 57 (2): 199–204.

3. Bhavanani AB. Modern Medicine, Meet Yoga. Integral Yoga Magazine USA. Fall 2013. pg 21-23.

4. Dinesh T, Sharma V K, Raja Jeyakumar M, Syam Sunder A, Gopinath M, Bhavanani AB. Effect of 8 weeks of pranav pranayama training on pulmonary function test parameters in young healthy, volunteers of JIPMER population. Int Res J Pharm App Sci 2013; 3 (4):116-18.

5. Dinesh T, Gaur G S, Sharma V K, Velkumary S, Bhavanani AB. Effect of 12 weeks of kapalabhati pranayama training on cardio-respiratory parameters in young, healthy volunteers of JIPMER population. International Journal of Medical & Pharmaceutical Sciences Research and Review 2013; 1 (4): 53-61.

6. Bhavanani AB, Ramanathan M, Madanmohan. Immediate cardiovascular effects of a single yoga session in different conditions. Altern Integ Med 2013; 2: 144.


7. Bhavanani AB, Ramanathan M, Madanmohan, Srinivasan AR. Hematological, biochemical and psychological effects of a yoga training programme in nursing students. Int Res J Pharm App Sci 2013; 3(6):17-23

8. Madanmohan. Integrating yoga and modern medicine. Annals of SBV 2013; 2 (2): 7.

9. Madanmohan. Yog for healthy lifestyle. Annals of SBV 2013; 2 (2): 20-23.

10. Bhavanani AB. Psychosomatic mechanisms of yoga. Annals of SBV 2013; 2 (2): 27-31.

11. Bhavanani AB. Yoga practices for prevention and management of lifestyle disorders. Annals of SBV 2013; 2 (2): 32-40.

12. Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time. Int J Yoga 2014; 7: 60-65.

13. Sharma VK, Raja Jeyakumar M, Velkumary S, Subramanian SK, Bhavanani AB, Madanmohan, Sahai A, Dinesh T. Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers. Journal of Clinical and Diagnostic Research 2014; 8 (1) : 10-13.

14. Bhavanani AB, Ramanathan M, Madanmohan. Immediate effect of alternate nostril breathing on cardiovascular parameters and reaction time. Online International Interdisciplinary Research Journal 2014; 4; (Special Issue): 297-302.

15. Bhavanani AB. Yogic perspectives on mental health. International Light 2014. Jan-March: 14-17.

16. Bhavanani AB. Yoga. Clinical Roundup: Selected Treatment Options for Depression. Alternative and Complementary Therapies 2014; 20: 54-55.

17. Madanmohan. Yoga for youth. Souvenir of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 52.

18. Bhavanani AB, Madanmohan, Meena Ramanathan, Srinivasan AR. Yoga improves psychophysical health of nursing students. Souvenir of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 65-70.

19. Bhavanani AB. Introducing integral yoga education for the youth. Souvenir of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 84.

20. Meena Ramanathan, Bhavanani AB. Immediate effect of chandra and suryanadi pranayamas on cardiovascular parameters and reaction time in a geriatric population. International Journal of Physiology 2014; 2 (1): 59-63.

21. Rajajeyakumar M, Amudharaj D, Bandi harikrishna, Madanmohan T, Jeyasettiseloune, Bhavanani AB. Immediate effect of different pranayam on short term heart rate variability in health care students. A preliminary study. International Journal of Physiology 2014; 2 (1): 39-43.

22. Bhavanani AB. Yoga: A novel integrative therapy. Nisargopachar Varta 2014; 6 (5): 13-15.

23. Bhavanani AB, Jayasettiaseelon E, Sanjay Z, Madanmohan. Immediate effect of chandranadi pranayam on heart rate variability and cardiovascular parameters in patients of diabetes mellitus and hypertension. Yoga Mimamsa 2013; 45 (1&2): 1-13.


24. Dinesh T, Gaur GS, Sharma VK, Bhavanani AB, Rajajeyakumar M, Sunder AS. Effect of slow and fast pranayama training on handgrip strength and endurance in healthy volunteers. Journal of Clinical and Diagnostic Research 2014; 8 (5): BC01-03.

25. Bhavanani AB, Meena Ramanathan, Madanmohan. Yoga and mind body therapies in health and disease: a brief review. Annals of SBV 2014; 3 (1): 29-41.

26. Bhavanani AB. Yogic perspectives on mental health. Annals of SBV 2014; 3 (1): 47-52.

27. Bhavanani AB. The yoga of interpersonal relationships. Annals of SBV 2014; 3 (1): 53-60.

28. Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers. International Journal of Yoga 2014; 7: 89-95.

In press:

1. Lee Majewski, Ananda Balayogi Bhavanani . A novel rejuvenation program for cancer patients at Kaivalyadhama, India. Yoga Mimamsa (Ahead of print).

2. Ananda Balayogi Bhavanani. Diverse dimensions of Yoga. Yoga Mimamsa (Ahead of print).

3. Ananda Balayogi Bhavanani. Role of yoga in health and disease. Journal of Symptoms and Signs.

B. Published abstracts (9):

1. Health, rejuvenation and longevity: an ayurvedic perspective. Madanmohan, Bhavanani AB. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 48.

2. Yoga and modern medicine: need for integration. Madanmohan, Bhavanani AB. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 48-49.

3. Effect of yoga training on cardiorespiratory health in obese subjects. Madanmohan, Bhavanani AB, AR Srinivasan, S Balanehru. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 49.

4. Yoga works, but how? Bhavanani AB, Meena Ramanathan, Madanmohan. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 49-50.

5. Immediate cardiovascular effects of pranayamas in patients of hypertension. Bhavanani AB, Madanmohan. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on


‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 50.

6. Effect of 12 weeks of pranayama training on basal physiological parameters in young, healthy volunteers. Dinesh T, Gaur G S, Sharma V K, Bhavanani AB, Harichandra Kumar KT. Poster No. A74. APPICON 2013.

7. Yoga for youth. Madanmohan. Abstracts of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 6.

8. Yoga improves psychophysical health of nursing students. Bhavanani AB, Madanmohan, Meena Ramanathan, Srinivasan AR. Abstracts of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 21.

9. Introducing integral yoga education for the youth. Bhavanani AB. Abstracts of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 22.

C. Ongoing research projects (5):

1. Effect of 12-weeks of yoga training on cardiorespiratory, neurological and psychological parameters in a geriatric population. Pre and test recordings have been completed and 12 weeks Yoga training sessions conducted twice weekly in the Hospice of St. Cluny, Pondicherry.

2. Intra ocular pressure variations in forward bending yoga postures. Collaborative project with Department of Ophthalmology, MGMCRI. Proposal approved by IHEC in April 2014 and subjects are being recruited.

3. Effects of tratak and bhramari pranayama (yogic eye care module) on ocular muscle balance and accommodation in computer vision syndrome. Collaborative project with Department of Ophthalmology, MGMCRI. Proposal approved by IHEC in April 2014 and subjects are being recruited.

4. A study to assess the effectiveness of pranayama on level of depression among the transgender. Collaborative project with KGMC. Proposal approved by IHEC, KGNC in March 2014 and subjects are being recruited.

5. Effect of yoga training on cardiorespiratory health in obese subjects. Proposal submitted to CCRYN, Deptt of AYUSH, Ministry of Health & FW, Govt of India after clearance from IHEC.

PG DIPLOMA IN YOGA THERAPY

UNIQUE FEATURES OF PGDYT

“There are many centers where you can get a Yoga degree, attend a Yoga therapy session or find Yoga research being undertaken. However, to have all three happening in one place is surely innovative. This center is indeed a role-model that combines the best of the East with that of the West.”

- Joseph le Page, founder- Integrative Yoga Therapy, USA

At CYTER we have an integrated set up where we are educating future Yoga therapists, simultaneously helping patients recover from illnesses and at the same time developing an understanding through scientific research.

Whereas Yoga is usually found in departments of Physical Education & Sports in most universities, we at CYTER have it in a medical institution thus enhancing the learning curve of our trainees as also enabling us to offer holistic therapeutic benefits for all patients in our hospital.

Our PG Diploma in Yoga Therapy (PGDYT) is one of the innovative courses in the country as it is offered through a medical institution and combines the ancient wisdom with evidence based approach of modern medicine. The course is conducted by experienced faculties who have Yoga and modern medical training as well as a wealth of therapeutic and research experience with more than 200 publications to their credit.

The syllabus includes topics dealing with teachings drawn from ancient texts combined with modern medical advancements thus exposing students to various clinical applications of Yoga as a therapy in a medical institution.

Internal assessment is given based on seminars and assignments and the student’s participation in regular patient care and research activities of CYTER in the hospital. A total 600 marks is allotted for theory including:

• Foundations of yoga

• Foundations of modern medicine

• Foundations of yoga chikitsa (application of yoga as a therapy)

• Application of yoga in different fields of human endeavor

• Role of yoga in cardiovascular, respiratory, musculoskeletal and digestive disorders

• Yoga as a therapy for neurological, endocrine, metabolic, psychiatric and other disorders

There is an extensive Practicum in both semesters (400 marks) that provides training in extensive Yogic techniques that are then applied in different conditions. Hands-on training in conducting sessions for healthy participants as well as clinical experience in dealing with patients of various conditions is provided.

We have two batches of students enrolled in the course and classes are going on regularly. The first batch had a medical doctor attending while the second has two nursing professionals amongst the students.

CYTER- SYLLABUS FOR PGDYT Page 1

Sri Balaji Vidyapeeth

Mahatma Gandhi Medical College & Research Institute

Pillaiyarkuppam, Pondicherry - 607 402

CENTRE FOR YOGA THERAPY, EDUCATION AND RESEARCH (CYTER)

POST GRADUATE DIPLOMA IN YOGA THERAPY (PGDYT)

1. NAME OF COURSE: PG DIPLOMA IN YOGA THERAPY (PGDYT)

2. DURATION OF COURSE: 12 months. The course will have two semesters of 6 months each.

Each semester will have 240 hours of teaching (theory: 80 hours, practicum: 120 hours,

assignment: 40 hours).

3. NUMBER OF SEATS & MANNER OF SELECTION: 25. Selection by entrance test and interview.

ELIGIBILITY: Modern medical and AYUSH doctors, dental surgeons, nursing professionals,

bachelor in physiotherapy, occupational therapy, PGDY, MSc Yoga.

4. ADVANTAGES OF THE COURSE, INNOVATIVE ASPECTS AND EMPLOYMENT OPPORTUNITIES:

Holistic health, integrative treatment and mind–body medicine are now buzz words.

Integrating Yoga with modern medicine will enable us to produce holistic physicians for

health delivery of tomorrow as integrative medicine becomes popular.

5. QUANTUM OF FEES: Rs 5,000/-

6. DETAILS OF TIMINGS FOR THE COURSE (EACH SEMESTER) :

i) Contact classes --------------------------------------------------------------- 200 hours (2 hours / day, 5 days / week, 20 week/ semester = 200 hours) ii) Assignment -------------------------------------------------------------------- 40 hours

Total 240 hours/sem

7. DETAILS OF SYLLABUS:


SEMESTER I

1. FOUNDATIONS OF YOGA

UNIT 1: Meaning and definition of the term Yoga. Yoga as “goal” as well as the “means”.

Different connotations and meanings of Yoga. Misconceptions about Yoga. Comprehensive nature

and scope of Yoga. Aims and objectives of Yoga. A brief outline of the history of Yoga from

ancient to modern times. Modern developments and trends in Yoga. A brief introduction to the

vast literature on Yoga. Yoga as a lifestyle.

UNIT 2: Patanjali’s Ashtanga Yoga. Ethical basis of Yoga. Different traditions and schools of Yoga.

Yogic concepts of pancha kosha, prana vayu, tattva, triguna, tridosha, klesha and antaraya.

Application of Yoga in various human activities like therapeutics, physical culture, education and

sports.

UNIT 3: Introduction to and scientific perspective of important Yogic techniques like asana,

pranayama, kriya, mudra, bandha, jathis and surya namaskar.

UNIT 4: Spanda-nishpanda concept of relaxation in Yoga. Dharana-dhyana (concentration and

meditation) in the yogic context. A scientific perspective of these techniques.

UNIT 5: Similarities and dissimilarities between Yogic practices and physical exercises. Asanas vs.

muscular exercises. Pranayama vs. deep breathing exercises. Role of various yogic techniques in

purification and fortification of the body-mind-spirit complex. Role of Yoga in management of

stress and maintenance of homeostasis.

2. FOUNDATIONS OF MODERN MEDICINE

UNIT 1: Human body as an integrated whole. Homeostasis and milieu interieur. Cells, tissues,

organs and systems of human body. Their mutually supportive and harmonious working

relationships in health and breakdown of these natural mechanisms in disease.

UNIT 2: Introduction to of anatomy and physiology of cardiovascular and respiratory systems.

Regulation of CVS, RS and body temperature. Bridging the autonomic and conscious activities

through Yoga and other mind-body therapies.

UNIT 3: Introduction to anatomy and physiology of musculo-skeletal and nervous systems.

Biomechanics of movement and important muscles used in Yoga practices. Introduction to the

functional areas of cerebral cortex. Neurophysiology of sleep-wakefulness and EEG. Limbic system,

pre-frontal lobe and physiology of emotions. Positive emotions.

UNIT 4: Introduction to anatomy and physiology of the endocrine, digestive and excretory systems.

Important aspects related to the shat kriyas (cleaning practices of Yoga).

UNIT 5: Homeostasis and stress: Psycho-neuro-endocrine and psycho- neuro-immune correlates.

Autonomic nervous system and its role in health and disease. Balancing the opposites (right and

left) energies through loma-viloma, ha-tha and surya-chandra. Balancing the right & left brain by

Yoga.

UNIT 6: Integrative physiology. Physiological responses to muscular exercise, gravity and

acceleration, high altitude hot and cold environment. Physiological effects of yogic practices.


3. FOUNDATIONS OF YOGA CHIKITSA (APPLICATION OF YOGA AS A THERAPY)

UNIT 1: Yoga defined as samatvam (integration and harmony). Different aspects and meanings of

Yoga as related to health. Meaning of the term “positive health”. Yoga as a system that fosters

positive health. Cultivation of desirable psychological attitudes and reconditioning of the psycho-

physiological apparatus for positive health. Concepts of pancha-kosha and tri-sharira and their

special relationship to health and disease (adi-vyadhi). Yogic perspective of health and disease:

integration vs disintegration, sukha vs duhkha.

UNIT 2: Yoga as a therapy: its need and application in modern health care. Principles, mechanisms

and modalities of Yoga chikitsa. Vyuha model (heya-hetu,hana-upaya). Relationship of Yoga with

the AYUSH and CAM systems of medicine with emphasis on ayurveda, siddha and naturopathy. Yoga

chikitsa vs yogopathy: tracing the root cause of disease and applying the remedy, rather than

symptomatic management.

UNIT 3: Yoga as the original body mind medicine and ideal lifestyle. Concepts of ahar, vihar, achar

and vichar. Yogic principles of diet in relation to the dosha and guna concepts. Role and

importance attached to the mind in Yoga. Importance of right attitude (pratipaksha bhavanam) in

tackling common conflicts and frustrations. Role of yama-niyama (restraints and regulations) and

correct psychological attitudes (maitri-karuna et al) for psycho-somatic health.

UNIT 4: Importance of various techniques of hatha and jnana Yoga in the promotion of physical

health, mental clarity and emotional wellbeing. Role of mantra, japa, bhajan, chanting, yantra

and yatra in healing. Importance of faith and prayer in healing. Karma and its role in health and

disease. Role of music (nada yoga) and other alternative therapies.

UNIT 5: Research as the “central feeder” aspect of modern, evidence- based Yoga therapy. Modern

research findings and their applications in Yoga therapy. Need for modern methods of research in

understanding and evaluation of Yogic phenomena.

PRACTICUM

UNIT 1: Jathis and vyayama, surya namaskar, talasana, trikonasana, ardha kati chakrasana, ardha

utkat and utkatasana, sukhasana, vajrasana, padmasana, baddhakonasana, vakrasana, ardha

matsyendrasana, paschimottanasana.

UNIT 2: Shavasana, navasana, uttanpadasana, pavanmuktasana, sarvangasana, halasana,

matsyasana, shalabhasana, bhujangasana, dhanurasana, makarasana.

UNIT 3: Kriyas and Mudras: Jala neti, vamana dhauti, brahma mudra. Moola, uddiyana and

jalandhara bandha. Sethu, kaya and marmanasthanam kriyas.

UNIT 4: Vyagraha, vibhaga pranayama, pranava pranayama, nadishuddhi, surya and chandra nadi

and bhedana, ujjai and bhramari pranayama.

UNIT 5: Submission of 10 lesson plans as per assignments by each student that will consist of

lessons on one mudra, one bandha, two kriyas, four asanas and two pranayamas. Each student to

conduct 10 Yoga sessions in the classroom environment on the basis of their Lesson Plans.


SEMESTER II

1. APPLICATION OF YOGA IN DIFFERENT FIELDS OF HUMAN ENDEAVOR

UNIT 1: “Spiritual Yoga” (adhyatmayoga) and “applied Yoga” (loukika Yoga). Scope and limitations

of applied Yoga. Introduction to the application of Yoga in different fields of human activity.

Empowering the individual through Yoga.

UNIT 2: Role of Yoga in enhancing quality of life of senior citizens and in the management of

various degenerative aspects of aging. Yoga for people with special needs, especially in children

with mental and physical disabilities.

UNIT 3: Yoga in rehabilitation. Role of Yoga in various addictions and in tackling social problems

(interpersonal and intrapersonal). Psycho-physiological improvements through Yoga in sporting

activities, both recreational and professional. Yoga sport competitions: benefits and drawbacks.

UNIT 4: Role of Yoga in enhancing productivity in the corporate sector. Stresses and strains of

executive jobs and their Yogic remedy. Yoga for self development, self motivation, to reduce

monotony and stress and enhance capacity of the individual as well as the corporate.

UNIT 5: Personality development through Yoga and its role in enhancing personal efficiency.

Managing the hectic lifestyle of medical and paramedical professionals. Regaining the “art of

medicine”, a healthy interpersonal doctor-patient relationship through Yoga. Code of conduct for

Yoga therapists.

2. ROLE OF YOGA IN CARDIOVASCULAR, RESPIRATORY, MUSCULOSKELETAL AND

DIGESTIVE DISORDERS

UNIT 1: Cardiovascular disorders: hypertension, atherosclerosis, CAD, stroke, heart failure,

arrhythmias. Yoga in a cardiac rehabilitation programme.

UNIT 2: Respiratory disorders: chronic obstructive airway diseases with emphasis on bronchial

asthma and bronchitis. Hathenas and shat kriyas in the managements of breathing disorders.

UNIT 3: Musculoskeletal conditions: lumbago, cervical spondylitis, arthritis, repetitive strain

injuries.

UNIT 4: Digestive disorders: peptic ulcer, IBS, liver disease, chronic constipation, hemorrhoids.

UNIT 5: Role of Yoga in management of cancer: adjunct and palliative role of Yoga. Pain and

fatigue relief. Improvement in QoL. Dealing with end life crisis. Care of the caregiver.

3. YOGA AS A THERAPY FOR NEUROLOGICAL, ENDOCRINE, METABOLIC,

PSYCHIATRIC AND OTHER DISORDERS

UNIT 1: Neurological: central, autonomic and peripheral neuropathies, Parkinsons disease,

dementia. Management of chronic pain.

UNIT 2: Endocrine: growth disorders, thyroid, reproductive disorders


UNIT 3: Metabolic: obesity, diabetes mellitus, and metabolic syndrome

UNIT 4: Health issues in women and children, menarche, antenatal and postnatal care, menopause.

UNIT 5: Psychiatric disorders: BPAD, anxiety, depression. immune disorders.

PRACTICUM

UNIT 1: Ushtrasana, balasana, maha mudra 1&2, gomukhasana, mandukasana,

pashchimottanasana, purvottanasana. Trataka, kapalabhati, agnisara, nauli, viparitakarani,

ashwini mudra. Sitkari, sheetali, savitri and bhastrika pranayama.

UNIT 2 : Yoga schedules for musculoskeletal and digestive disorders.

UNIT 3 : Yoga schedules for cardiovascular and respiratory disorders.

UNIT 4: Yoga schedules for neurological, endocrine, metabolic, and other disorders.

UNIT 5: Submission of 10 complete Yoga therapy patient records of 5 different conditions. “Hands

on” evaluation in the class room of simulated “mock” Yoga therapy situations.


8. SCHEME OF EXAMINATION: Both semesters will have 3 theory papers and 1 practicum.

Theory papers: Duration: 2 1/2 hours Max marks 80

Structured essay (8 x 10) = 80 marks

Internal assessment = 20 marks

Total = 100 marks

Practicum:

4 practicums based on unit 1-4 = 80 marks

Lesson plan based on unit 5 = 20 marks

Micro teaching/therapy session = 20 marks

Viva & evaluation of project work = 40 marks

Total = 160 marks

Internal assessment = 40 marks

Grand Total = 200 marks

SEMESTER I

Max marks

Paper 1: Foundations of yoga 80

Paper 2: Foundations of modern medicine 80

Paper 3: Foundations of yoga chikitsa (application of yoga as a therapy) 80

Practicum 160

SEMESTER II

Max marks

Paper 1: Application of yoga in different fields of human endeavor 80

Paper 2: Yoga as a therapy for cardio-vascular, respiratory, musculo-skeletal and

digestive disorders 80

Paper 3: Yoga as a therapy for neurological, endocrine, metabolic and psychiatric

and others Disorders 80

Practicum 160

Eligibility for appearing for the examination: Attendance : 80 %; internal assessment: 50%.

Project to be submitted 2 months before the 2nd semester examination.

Passing minimum: 50% of internal assessment + marks obtained (theory and practicum).


Reference books and websites:

1. Understanding Medical Physiology. Bijlani RL & Manjunatha S. Jaypee Brothers. 2011

2. A Primer of Yoga Theory. Ananda Balayogi Bhavanani. Dhivyananda Creations, Pondicherry.

3. A Yogic Approach to Stress. Ananda Balayogi Bhavanani. Dhivyananda Creations,

Pondicherry.

4. Anatomy and Physiology of Yogic Practices. MM Gore, Lonavla

5. Applied Yoga. Meena Ramanathan. Arogya Yogalayam, Pondicherry.

6. Asana, Pranayama, Mudra and Bandha. Swami Satyananda, Bihar School of Yoga, Munger,

Bihar.

7. Asanas. Swami Kuvalayananda. Kaivalyadhama, Lonavla.

8. Asanas : Why? and How? O.P. Tiwari, Kaivalyadhama, Lonavla

9. Ashtanga Yoga of Patanjali . Swami Gitananda. Ananda Ashram, Pondicherry

10. Frankly Speaking. Swami Gitananda. Ananda Ashram, Pondicherry

11. Glimpses of The Human Body. Shirley Telles. VK Yogas, Bangalore

12. Hatha Yoga Practices of Gitananda Yoga. Ananda Balayogi Bhavanani. ICYER, Pondicherry.

13. History of Yoga from Ancient to Modern Times. Meenakshi Devi Bhavanani. ICYER at

Ananda Ashram, Pondicherry.

14. Notes for Yoga Practicals I & II. Ananda Balayogi Bhavanani. Dhivyananda Creations,

Pondicherry.

15. Principles and Methods of Yoga Practices. Ananda Balayogi Bhavanani. Dhivyananda

Creations, Pondicherry.

16. Scientific Basis of Yoga Education. Ananda Balayogi Bhavanani. Dhivyananda Creations,

Pondicherry.

17. Scientific Survey of Yoga Poses. Swami Kuvalayananda. Lonavla

18. The Yoga Tradition. George Feuerstein. Shambala Pub, USA

19. www.iayt.org

20. www.icyer.com

21. www.svyasa.org

22. www.kdham.org

23. Yoga and Sports. Swami Gitananda & Meenakshi Devi. Ananda Ashram, Pondicherry

24. Yoga: Asana, Pranayama, Mudra, Kriya. Vivekananda Kendra Prakashan, Chennai.

25. Yoga and Wellness. Ananda Balayogi Bhavanani. MDNIY, New Delhi.

26. Yoga Chikitsa: Application of Yoga as a Therapy. Ananda Balayogi Bhavanani. Dhivyananda

Creations, Pondicherry.

27. Yoga for a Wholistic Personality. Ananda Balayogi Bhavanani. MDNIY, New Delhi.

28. Yoga for Breathing Disorders. Swami Gitananda Giri and Ananda Balayogi Bhavanani.

Dhivyananda creations, Pondicherry.

http://www.iayt.org/

http://www.icyer.com/

http://www.svyasa.org/

http://www.kdham.org/


29. Yoga for Health and Healing. Ananda Balayogi Bhavanani. Dhivyananda creations,

Pondicherry.

30. Yoga for Weight Loss. Ananda Balayogi Bhavanani. Dhivyananda Creations, Pondicherry.

31. Yoga Life. Monthly Journal of Ananda Ashram, Pondicherry (Back issues)

32. Yoga Mimamsa. Quarterly Journal of Kaivalyadhama, Lonavla (Back issues)

33. Yoga: by Vivekananda Kendra Prakashan, Chennai.

34. Yogic Therapy. Swami Kuvalayananda and Dr. S.L. Vinekar. Kaivalyadhama, Lonavla.

PAPER PUBLICATIONS

PUBLICATIONS BY CYTER STAFF

A. Published papers (28) :

1. Bhavanani AB. Yoga in health care. Annals of SBV 2012; 1 (2): 15-24.

2. Bhavanani AB, Ramanathan M, Balaji R and Pushpa D. Immediate effect of suryanamaskar on reaction time and heart rate in female volunteers. Indian J Physiol Pharmacol 2013; 57 (2): 199–204.

3. Bhavanani AB. Modern Medicine, Meet Yoga. Integral Yoga Magazine USA. Fall 2013. pg 21-23.

4. Dinesh T, Sharma V K, Raja Jeyakumar M, Syam Sunder A, Gopinath M, Bhavanani AB. Effect of 8 weeks of pranav pranayama training on pulmonary function test parameters in young healthy, volunteers of JIPMER population. Int Res J Pharm App Sci 2013; 3 (4):116-18.

5. Dinesh T, Gaur G S, Sharma V K, Velkumary S, Bhavanani AB. Effect of 12 weeks of kapalabhati pranayama training on cardio-respiratory parameters in young, healthy volunteers of JIPMER population. International Journal of Medical & Pharmaceutical Sciences Research and Review 2013; 1 (4): 53-61.

6. Bhavanani AB, Ramanathan M, Madanmohan. Immediate cardiovascular effects of a single yoga session in different conditions. Altern Integ Med 2013; 2: 144.

7. Bhavanani AB, Ramanathan M, Madanmohan, Srinivasan AR. Hematological, biochemical and psychological effects of a yoga training programme in nursing students. Int Res J Pharm App Sci 2013; 3(6):17-23

8. Madanmohan. Integrating yoga and modern medicine. Annals of SBV 2013; 2 (2): 7.

9. Madanmohan. Yog for healthy lifestyle. Annals of SBV 2013; 2 (2): 20-23.

10. Bhavanani AB. Psychosomatic mechanisms of yoga. Annals of SBV 2013; 2 (2): 27-31.

11. Bhavanani AB. Yoga practices for prevention and management of lifestyle disorders. Annals of SBV 2013; 2 (2): 32-40.


13. Sharma VK, Raja Jeyakumar M, Velkumary S, Subramanian SK, Bhavanani AB, Madanmohan, Sahai A, Dinesh T. Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers. Journal of Clinical and Diagnostic Research 2014; 8 (1) : 10-13.

14. Bhavanani AB, Ramanathan M, Madanmohan. Immediate effect of alternate nostril breathing on cardiovascular parameters and reaction time. Online International Interdisciplinary Research Journal 2014; 4; (Special Issue): 297-302.

15. Bhavanani AB. Yogic perspectives on mental health. International Light 2014. Jan-March: 14-17.

16. Bhavanani AB. Yoga. Clinical Roundup: Selected Treatment Options for Depression. Alternative and Complementary Therapies 2014; 20: 54-55.

17. Madanmohan. Yoga for youth. Souvenir of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 52.

18. Bhavanani AB, Madanmohan, Meena Ramanathan, Srinivasan AR. Yoga improves psychophysical health of nursing students. Souvenir of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 65-70.

19. Bhavanani AB. Introducing integral yoga education for the youth. Souvenir of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 84.

20. Meena Ramanathan, Bhavanani AB. Immediate effect of chandra and suryanadi pranayamas on cardiovascular parameters and reaction time in a geriatric population. International Journal of Physiology 2014; 2 (1): 59-63.

21. Rajajeyakumar M, Amudharaj D, Bandi harikrishna, Madanmohan T, Jeyasettiseloune, Bhavanani AB. Immediate effect of different pranayam on short term heart rate variability in health care students. A preliminary study. International Journal of Physiology 2014; 2 (1): 39-43.

22. Bhavanani AB. Yoga: A novel integrative therapy. Nisargopachar Varta 2014; 6 (5): 13-15.

23. Bhavanani AB, Jayasettiaseelon E, Sanjay Z, Madanmohan. Immediate effect of chandranadi pranayam on heart rate variability and cardiovascular parameters in patients of diabetes mellitus and hypertension. Yoga Mimamsa 2013; 45 (1&2): 1-13.

24. Dinesh T, Gaur GS, Sharma VK, Bhavanani AB, Rajajeyakumar M, Sunder AS. Effect of slow and fast pranayama training on handgrip strength and endurance in healthy volunteers. Journal of Clinical and Diagnostic Research 2014; 8 (5): BC01-03.

25. Bhavanani AB, Meena Ramanathan, Madanmohan. Yoga and mind body therapies in health and disease: a brief review. Annals of SBV 2014; 3 (1): 29-41.

26. Bhavanani AB. Yogic perspectives on mental health. Annals of SBV 2014; 3 (1): 47-52.

27. Bhavanani AB. The yoga of interpersonal relationships. Annals of SBV 2014; 3 (1): 53-60.

28. Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers. International Journal of Yoga 2014; 7: 89-95.

In press:

1. Lee Majewski, Ananda Balayogi Bhavanani . A novel rejuvenation program for cancer patients at Kaivalyadhama, India. Yoga Mimamsa (Ahead of print).

2. Ananda Balayogi Bhavanani. Diverse dimensions of Yoga. Yoga Mimamsa (Ahead of print).

3. Ananda Balayogi Bhavanani. Role of yoga in health and disease. Journal of Symptoms and Signs.

B. Published abstracts (9):

1. Health, rejuvenation and longevity: an ayurvedic perspective. Madanmohan, Bhavanani AB. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 48.

2. Yoga and modern medicine: need for integration. Madanmohan, Bhavanani AB. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 48-49.

3. Effect of yoga training on cardiorespiratory health in obese subjects. Madanmohan, Bhavanani AB, AR Srinivasan, S Balanehru. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 49.

4. Yoga works, but how? Bhavanani AB, Meena Ramanathan, Madanmohan. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 49-50.

5. Immediate cardiovascular effects of pranayamas in patients of hypertension. Bhavanani AB, Madanmohan. Abstracts of ‘Sanjeevita 2013′, the First Annual Summit on ‘Current Concepts in Integrative Medicine’ organized by the Central Inter-Disciplinary Research Facility (CIDRF) in collaboration with Sri Balaji Vidyapeeth, Puducherry. September 6th 2013, MGMC&RI, Pondicherry. Pg. 50.

6. Effect of 12 weeks of pranayama training on basal physiological parameters in young, healthy volunteers. Dinesh T, Gaur G S, Sharma V K, Bhavanani AB, Harichandra Kumar KT. Poster No. A74. APPICON 2013.

7. Yoga for youth. Madanmohan. Abstracts of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 6.

8. Yoga improves psychophysical health of nursing students. Bhavanani AB, Madanmohan, Meena Ramanathan, Srinivasan AR. Abstracts of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 21.

9. Introducing integral yoga education for the youth. Bhavanani AB. Abstracts of the National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 22.

Ann. SBV, July - Dec, 2012 1(2)

Annals of SBV

ABSTRACT: We are today faced with numerous debilitating chronic illnesses related to aging, environment, and hedonistic lifestyle, such as cancer, diabetes, osteoporosis, and cardiovascular diseases as well as many incurable diseases such as AIDS. Modern medical advancements provide the rationale for the integration of various traditional healing techniques including Yoga to promote healing, health, and longevity. It is imperative that advances in medicine include the wholistic approach of Yoga to face the current challenges in health care. The antiquity of Yoga must be united with the innovations of modern medicine to improve quality of life throughout the world. While modern medicine has a lot to offer humankind in its treatment and management of acute illness, accidents and communicable diseases, Yoga has a lot to offer in terms of preventive, promotive and rehabilitative methods in addition to many management methods to tackle modern illnesses. While modern science looks outward for the cause of all ills, the Yogi searches the depth of his own self. This two way search can lead us to many answers for the troubles that plague modern man. It is suggested that a two way integration of the experimentally tempered modern science with the experientially modelled science of Yoga can lead us to many answers for challenges plaguing modern humankind such as debilitating chronic illnesses related to aging, environment, and hedonistic lifestyle. Modern medical advancements provide the rationale for the integration of various traditional healing techniques including Yoga to promote healing, health, and longevity. It is imperative that advances in medicine include the wholistic approach of Yoga to face the current challenges in health care. The antiquity of Yoga must be united with the innovations of modern medicine to improve quality of life throughout the world.

INTRODUCTION: Yoga is the original mind-body medicine that has enabled individuals to attain and maintain sukha sthanam, a

dynamic sense of physical, mental and spiritual well being. Bhagavad-Gita defines Yoga as samatvam meaning thereby that Yoga is equanimity at all levels, a state wherein physical homeostasis and mental equanimity occur in a balanced and healthy harmony. Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj, the visionary founder of Ananda Ashram at the International Centre for Yoga Education and Research (ICYER) in Pondicherry and one of the foremost authorities on Yoga in the past century, has explained the concept of Yoga Chikitsa (Yoga as a therapy) in the following lucid manner. “Yoga Chikitsa is virtually as old as Yoga itself, indeed, the ‘return of mind that feels separated from the Universe in which it exists’ represents the first Yoga therapy. Yoga Chikitsa could be termed as “man’s first attempt at unitive understanding of mind-emotions-physical distress and is the oldest wholistic concept and therapy in the world.”

To achieve this Yogic integration at all levels of our being, it is essential that we take into consideration the all encompassing multi dimensional aspects of Yoga that include the following: a healthy life nourishing diet, a healthy and natural environment, a wholistic lifestyle, adequate bodywork through Asanas, Mudras and Kriyas, invigorating breath work through the use of Pranayama and the production of a healthy thought process through the higher practices of Jnana Yoga and Raja Yoga.

PSYCHOSOMATIC DISORDERS: From the Yogic viewpoint of disease it can be seen that psychosomatic, stress related disorders appear to progress

through four distinct phases. These can be understood as follows:1. Psychic Phase: This phase is marked by mild but persistent psychological and behavioural symptoms of stress like

irritability, disturbed sleep and other minor symptoms. This phase can be correlated with vijnanamaya and manomaya koshas. Yoga as a mind body therapy is very effective in this phase.

2. Psychosomatic Phase: If the stress continues there is an increase in symptoms, along with the appearance of generalized physiological symptoms such as occasional hypertension and tremors. This phase can be correlated with manomaya and pranamaya koshas. Yoga as a mind body therapy is very effective in this phase.

3. Somatic Phase: This phase is marked by disturbed function of organs, particularly the target, or involved organ.

yogA in heAlTh cAre

Ananda Balayogi Bhavanani *

* * Yogacharya Dr.Ananda Balayogi Bhavanani , Hon Advisor CYTER, MGMCRI


Page 16 Annals of SBV

At this stage one begins to identify the diseased state. This phase can be correlated with pranamaya and annamaya koshas. Yoga as a therapy is less effective in this phase and may need to be used in conjunction with other methods of treatment.

4. Organic Phase: This phase is marked by full manifestation of the diseased state, with pathological changes such as an ulcerated stomach or chronic hypertension, becoming manifest in their totality with their resultant complications. This phase can be correlated with the annamaya kosha as the disease has become fixed in the physical body. Yoga as a therapy has a palliative and quality of life improving effect in this phase. It also has positive emotional and psychological effects even in terminal and end of life situations.

POTENTIALITIES OF YOGA: Extensive research on Yoga being done all over the world has shown promise with regard to various disorders

and diseases that seem to be amiable to Yoga therapy (www.iayt.org, www.icyer.com, www.svyasa.org ). These include psychosomatic, stress disorders such as bronchial asthma, diabetes mellitus, hypertension, irritable bowel syndrome, gastro intestinal ulcer diseases, atherosclerosis, seizure disorder and headache. It also includes physical disorders such as heart disease, lung disease, and mental retardation. Psychiatric disorders such as anxiety disorders, obsessive-compulsive disorder, depression and substance abuse can also be managed along with other therapies. Musculoskeletal disorders such as lumbago, spondylosis, sciatica and carpel tunnel syndrome can be tackled effectively with Yoga practices that offer a lot of hope in metabolic disorders such as thyroid and other endocrine disorders, immune disorders, obesity and the modern metabolic syndrome.

According to Dr B Ramamurthy, eminent neurosurgeon, Yoga practice re-orients the functional hierarchy of the entire nervous system. He has noted that Yoga not only benefits the nervous system but also the cardiovascular, respiratory, digestive, endocrine systems in addition to bringing about general biochemistry changes in the yoga practitioners. Dr. Dean Ornish, the eminent American doctor who has shown that Yogic lifestyle can reverse heart isease says, “Yoga is a system of perfect tools for achieving union as well as healing”. Dr Swami Gitananda Giri says, “Yoga is scientific and many of it practices can be measured by existing scientific methods. As a science of mind it offers a safe method of concentration and meditation educing a practical application of the power of the human mind. Its entire process is centered in awareness that is why I call it the science of awareness.”

It is well established that stress weakens our immune system. Scientific research in recent times has showed that the physiological, psychological and biochemical effects of Yoga are of an anti-stress nature. Mechanisms postulated included the restoration of autonomic balance as well as an improvement in restorative, regenerative and rehabilitative capacities of the individual. A healthy inner sense of wellbeing produced by a life of Yoga percolates down through the different levels of our existence from the higher to the lower producing health and wellbeing of a holistic nature. Streeter


Annals of SBV

et al (Med Hypotheses 2012;78: 571-9) recently proposed a theory to explain the benefits of Yoga practices in diverse, frequently comorbid medical conditions based on the concept that Yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored. According to the theory proposed by Streeter and colleagues, the de-creased parasympathetic nervous system and GABAergic activity that underlies stress-related disorders can be corrected by Yoga practices resulting in amelioration of disease symptoms. HRV testing has a great role to play in our understand-ing intrinsic mechanisms behind such potential effects of Yoga.

Innes et al had earlier (J Am Board Fam Pract 2005; 18: 491-519) also postulated two interconnected pathways (given below) by which Yoga reduces the risk of cardiovascular diseases through parasympathetic (vagal) activation coupled with reductions in per4ceived stress and decreased reactivity of sympathoadrenal system and HPA axis. Innes andVincent(eCAM2007;4:469-86)alsopostulatedsimilarmechanismstobeoperatinginreducingriskforType2Diabetes mellitus (DM 2) and for complications related to DM 2.

PSYCHOSOMATIC MECHANISMS OF YOGA:

Yoga understands the influence of the mind on the body as well as that of the body on the mind. This is the principle of adhi-vyadhi elucidated in the Yoga Vasishta more than 5000 years ago! It is interesting that modern medicine has only realised this connection in the last hundred years whereas Yogic of India were teaching and practising it for thousands of years. No wonder Yoga may be considered as the original mind-body medicine.

We are what we think, yet we also start to think that which we do. Yogic concepts and techniques enable the development of right attitudes towards life and enable us to correct the numerous internal and external imbalances we suffer due to our wrong lifestyle/ genetic potential. Yoga enables us to take responsibility for our own health and happiness and as Swami Gitananda Giri would say, “If you want to be healthy do healthy things, if you want to be happy do happy things”.

The following are just a few of the mechanisms through which Yoga can be said to work as an integrated mind-body medicine:

1. Cleanses the accumulated toxins through various shuddi kriyas and generates a sense of relaxed lightness through jathis and vyayama type activities. Free flow in all bodily passages prevents the many infections that may occur when pathogens stagnate therein.

2. Adoption of a Yogic lifestyle with proper nourishing diet, creates positive antioxidant enhancement thus neutralizing free radicals while enabling a rejuvenative storehouse of nutrients packed with life energy to work on anabolic, reparative and healing processes .

3. Steadies the entire body through different physical postures held in a steady and comfortable manner without strain. Physical balance and a sense of ease with oneself enhance mental / emotional balance and enable all physiological processes to occur in a healthy manner.

4. Improves control over autonomic respiratory mechanisms though breathing patterns that generate energy and enhance emotional stability. The mind and emotions are related to our breathing pattern and rate and hence the slowing down of the breathing process influences autonomic functioning, metabolic processes as well as emotional responses.

5. Integrates body movements with the breath thus creating psychosomatic harmony. In Yoga the physical body is related to annamaya kosha (our anatomical existence) and the mind to manomaya kosha (our psychological existence). As the pranayama kosha (our physiological existence sustained by the energy of the breath) lies in between them, the breath is the key to psychosomatic harmony.

6. Focusesthemindpositivelyonactivitiesbeingdone,thusenhancingenergyflowandresultanthealthycirculationto the different body parts and internal organs. Where the mind goes, there the prana flows!

7. Creates a calm internal environment through contemplative practices that in turn enable normalization of homeostatic mechanisms. Yoga is all about balance or samatvam at all levels of being. Mental balance produces physical balance and vice versa too.

8. Relaxes the body-emotion-mind complex through physical and mental techniques that enhance our pain threshold and coping ability in responding to external and internal stressors. This enhances the quality of life as seen in so many terminal cases where other therapies are not able to offer any solace.

9. Enhances self confidence and internal healing capacities through the cultivation of right attitudes towards life and moral-ethical living through yama-niyama and various Yogic psychological principles. Faith, self confidence and



inner strength are most essential if at all we wish for healing, repair, rejuvenation and re-invigoration.10. Yoga works towards restoration of normalcy in all systems of the human body with special emphasis on the

psycho-neuro-immuno-endocrine axis. In addition to its preventive and restorative capabilities, Yoga also aims at promoting positive health that will help us to tide over health challenges that occur during our lifetime. This concept of positive health is one of Yoga’s unique contributions to modern healthcare as Yoga has both a preventive as well as promotive role in the healthcare of our masses. It is also inexpensive and can be used in tandem with other systems of medicine in an integrated manner to benefit patients.

INTEGRATING YOGA AND MODERN MEDICINE: At first glance, allopathic medicine and Yoga may seem to be totally incompatible and in some ways even antagonistic

to each other. Practitioners of either system are often found at loggerheads with one another in typical modern one-upmanship. However it is my humble endeavor as a student of both these life giving, life changing and life saving sciences, to find the similarities that exist between them and build a bridge between these two great sciences of today’s world. It would of course be much easier to build a bridge between Yoga and Ayurveda as both share many similarities of concepts such as the Trigunas, Tridoshas, Chakras and Nadis. They also understand that a healthy balance between body, mind and soul leads to total health. Diet and behavior are given importance in both systems and the ultimate goal of both is the attainment of Moksha. Though modern medicine may not share all of these concepts with Yoga, it is to be seen that there are a great many ‘meeting points’ for the construction of a healthy bridge between them. Both modern medicine and Yoga understand the need for total health and even the Word Health Organization has recently added a new dimension to the modern understanding of health by including spiritual health in its definition of the “state of health’. Spiritual health is an important element of Yoga and now that even the WHO has come around to understanding this point of view, there is hope for a true unification of these two systems. Modern medicine has the ultimate aim and goal of producing a state of optimum physical and mental health thus ultimately leadings to the optimum well being of the individual. Yoga also aims at the attainment of mental and physical well being though the methodology does differ. While modern medicine has a lot to offer humankind in its treatment and management of acute illness, accidents and communicable diseases, Yoga has a lot to offer in terms of preventive, promotive and rehabilitative methods in addition to many management methods to tackle modern illnesses. While modern science looks outward for the cause of all ills, the Yogi searches the depth of his own self. This two way search can lead us to many answers for the troubles that plague modern man.

The potential and manifest integration of Yoga and modern medical science can be discussed under different sub headings as follows:

PROMOTION OF POSITIVE HEALTH: Yoga is an excellent tool of promotive health that can enrich modern medicine. The practice of Yoga leads to the efficient functioning of the body with homeostasis through improved functioning of the psycho-immuno-neuro-endocrine system. A balanced equilibrium between the sympathetic and parasympathetic wings of the autonomic nervous system leads to a dynamic state of health. Yogi Swatmarama in the Hathayoga Pradipika, one of the classical Yoga texts gives us the assurance, “One who tirelessly practises Yoga attains success irrespective of whether they are young, old decrepit, diseased or weak”. He gives us the guarantee that Yoga improves health of all alike and wards off disease, provided we properly abide by the proper rules and regulations (yuvaa vrddho ativriddho vaa vyaadhito durbalo pi vaa abhyaasaat siddhimaapnotisarvayogeshvatandritah-HathayogaPradipikaI:64).TheWorldHealthOrganization(WHO)defineshealth as a state of complete physical, mental, and social well being and not merely absence of disease or infirmity. WHO has also in recent times suggested a fourth dimension of spiritual health but has fallen short of defining it without confusing it with religion. From a Yogic perspective it is heartening that the WHO definition gives importance to ‘well being’ that is a vital aspect of ‘being’ healthy as well as ‘feeling’ healthy. There is no use in a doctor telling patients that all their investigations are ‘normal’ when the patients themselves are not feeling ‘well’. This qualitative aspect of health is something that Yoga and Indian systems of medicine have considered important for thousands of years. The definition of asana given in the Yoga Sutra as sthira sukham implies this state of steady well being at all levels of existence (sthira sukhamasanam-YogaDarshanII:46).Patanjalialsotellsusthatthroughthepracticeofasanawecanattainastatethatis beyond dualities leading to a calm and serene state of well being (tato dvandva anabhighata- Yoga Darshan II: 48). Yoga aims at enabling the individual to attain and maintain a dynamic sukha sthanam that may be defined as a dynamic sense of physical, mental and spiritual well being. The Bhagavad Gita defines Yoga as samatvam meaning thereby that Yoga is equanimity at all levels. (yogasthah kurukarmani sangam tyaktva dhananjaya siddiyasidhyoh samobutva samatvam yoga uchyate – Bhagavad Gita II: 48) This may be also understood as a perfect state of health wherein physical


Annals of SBV

homeostasis and mental equanimity occur in a balanced and healthy harmony. One of the main lacunae of the WHO definition lies in the use of the term ‘state’ that implies health is something

to be achieved ‘once and for all’ with no need for care about it thereafter! It is definitely not so. We need to keep working on our health with great vigour and dynamic enthusiasm for the entire span of our life. If health is to be understood as a ‘state’, then it must be understood as a dynamic state that varies from day-to-day and often from minute-to-minute! It is often actually more challenging to maintain this dynamic state of health than to even attain it in the first place. Ask any World No.1 sports champion and they will testify to this inherent truth that applies to sports as well as to life itself.

MANAGEMENT OF DISEASES AND DISORDERS: Yoga doesn’t negate the use of drugs and other methods of modern medicine. Maharishi Patanjali in his Avatar as

Charaka didn’t shy away from the need to use medicinal herbs as well as surgical methods when necessary for the benefit of the patient. The system of Ayurveda is more in tune with the Yogic views of healing in this regard but definitely the modern antibiotic treatment of infectious diseases as well as the emergency medical and trauma management techniques of modern medicine must be understood to be life-savers in times of need. No Yoga therapist in his or her right mind should try to treat an acute myocardial infarction or an unconscious accident victim by Yoga alone. A symbiotic relationship between the techniques of modern medicine and Yoga can help the patient more than a dogmatic refusal to see the ‘other side’. Yoga has a lot to offer in terms of psychosomatic disorders and in stress related disorders such as diabetes, asthma, irritable bowel syndrome, epilepsy, hypertension, back pain and other functional disorders. Yoga can help reduce and in some cases eliminate drug dosage and dependence in patients suffering from diabetes mellitus, hypertension, epilepsy, anxiety, bronchial asthma, constipation, dyspepsia, insomnia, arthritis, sinusitis and dermatological disorders.

To quote Dr Steven F Brena, “Yoga is probably the most effective way to deal with various psychosomatic disabilities along the same, time-honored, lines of treatment that contemporary medicine has just rediscovered and tested. Asanas are probably the best tool to disrupt any learned patterns of wrong muscular efforts. Pranayama and Pratyahara are extremely efficient techniques to divert the individual’s attention from the objects of the outer environment, to increase every person’s energy potentials and ‘interiorize’ them, to achieve control of one’s inner functioning. Moreover, in restoring human unity, the Yoga discipline is always increasing awareness and understanding of ourselves, adjusting our emotions, expanding our intellect, and enabling us not only to function better in any given situation, but to perform as spiritual beings with universal values.” Yoga therapists must work in tandem with medical doctors when they are treating patients who have been on allopathic treatment. There are many instances where the patient stops medical treatment thinking that it no more necessary as they have started Yoga. This leads to many catastrophes that could be easily avoided by tandem consultations with a medical specialist. Similarly many modern doctors tend to tell the patient to take up Yoga or relaxation and forget to mention to the therapist what they actually want the patients to do. Most allopathic medications need to be tapered off in a progressive manner rather than being stopped suddenly. We often find this mistake in regard to corticosteroids as well as cardiac medications where sudden stoppage can be harmful. We must remember Plato’s words when he said, “The treatment of the part shouldn’t be attempted without a treatment of the entirety,” meaning that the treatment of the body without treating the mind and soul would be a useless waste of time.

REHABILITATION: Yoga as a physical therapy has a lot to offer patients of physical and mental handicaps. Many of the practices of

physiotherapy and other physical therapies have a lot in common with Yoga practices. Mentally challenged individuals can benefit by an improvement in their IQ as well as in learning to relate to themselves and others better. As their physiological functions improve with Yoga, the combination of Yoga and physical therapies can benefit such patients as well as those with learning disabilities. Musculoskeletal problems can be treated by the combination to improve function as well as range of movement, strength and endurance abilities. Balance and dexterity can also be improved by the combination therapy. The use of Yoga can help those recovering from accidents and physical traumas to get back on their feet faster and with better functional ability. An example of this was Dr Swami Gitananda Giri who managed to get back on his feet and function normally after a debilitating stay in a full body cast for more than six months. Swamiji used to say, “Modern medicine kept me alive, but Yoga gave me back my life as otherwise I may have been a cripple for life”. Yoga also has a lot to offer those suffering from drug and substance abuse in assisting them to get back to a normal life. Yoga helps develop their self-control and will power and also gives them a new philosophy of living. This is vital as otherwise they will lapse into their old negative habits.



HEALTHY DIET: This is a place that modern medicine and Yoga can help give a patient as well as normal person the proper wholistic

values of a proper diet. Modern research shows us the benefits of the ‘break-down’ study of foods on the basis of their physical and chemical properties. This is important for the person to know how much of each constituent of food is to be taken in the proper quantity. Yoga can help a person to learn the right attitude towards food as well as understand concepts based on the Trigunas and Tridoshas for better health. Yoga teaches us that the cause of most disease is through under (Ajjeranatvam), over (Atijeeranatvam) or wrong (Kujeeranatvam) digestion. Yoga also teaches us about the approach to food, the types of food as well as the importance of timings and moderation in diet. A combination of the modern aspects of diet with a dose of Yogic thought can help us eat not only the right things but also in the right way and at the right time thus ensuing our good health and longevity. Yoga emphasizes the importance of not only eating the right type of food but also the right amount and with the right attitude. Importance of not eating alone, as well as preparation and serving of food with love are brought out in the Yogic scheme of right living. Guna (inherent nature) of food is taken into consideration to attain and maintain good health. Modern dietary science of diet can learn a lot from this ancient concept of classification of food according to inherent nature as it is a totally neglected aspect of modern diet. We are what we eat! The great Tamil poet-saint Tiruvalluvar offers sane advice on right eating when he says, “He who eats after the previous meal has been digested, needs not any medicine.” (marunthuena vaendaavaam yaakkaikku arundiyathu atrathu poatri unnin-Tirukkural 942). He also says that life in the body becomes a pleasure if we eat food to digestive measure (attraal alavuarinthu unga aghduudambu pettraan nedithu uikkum aaruTirukkural 943). He also invokes the Yogic concept of Mitahara by advising that “eating medium quantity of agreeable foods produces health and wellbeing” (maarupaaduillaatha undi marutthuunnin oorupaadu illai uyirkku -Tirukkural 943).

PSYCHOSOMATIC RELAXATION: Most medical doctors understand that it is important to relax in order to get better. The problem is that, though

the doctor tells the patient to relax, they don’t tell them how to do so and maybe in fact they don’t know the answer themselves in the first place. Hatha Yoga and Jnana Yoga Relaxation practices help relax the body, emotions and mind. Relaxation is a key element of any Yoga therapy regimen and must not be forgotten at any cost. Shavasana has been reported to help a lot in hypertensive patients and practices such as Savitri Pranayama, Chandra Pranayama, Kaya Kriya, Yoga Nidra, Anuloma Viloma Prakriyas and Marmanasthanam Kriya are also available to the person requiring this state of complete relaxation. It is important to remember that relaxation on its own is less effective than relaxation that follows active physical exertion.

COPING SKILLS: Yoga has a lot to offer those who unable to cope with death and dying as well as those suffering from incurable

diseases. The Yoga philosophy of living sees death as an inevitable aspect of life that cannot be wished away. Swami Gitananda Giri used to tell us that the whole of life is, but a preparation for the moment of death, so that we can leave the body in the right way. Those who are taking care of the dying as well as those taking care of patients of incurable diseases and major disabilities are under an extreme amount of stress and Yoga practice as well as its philosophy helps them gain the inner strength necessary to do their duty. Yoga can help break the vicious spiral of pain-drug dosage-pain and by doing so help reduce the drug dosage in patients suffering chronic pain. It has been reported that Yoga helps improve the quality of life in patients suffering from cancer and also helps them cope better with the effects of treatment. It relaxes them and helps them sleep better. As someone rightly said, “Yoga may not be able to always cure but it can surely help us to endure”.

REDUCING EXPENDITURE: Modern medicine is often criticized for the cost involved in its methods of treatment. Yoga offers an inexpensive

method of health that can be added to the medical armory when required. Yoga only requires the patient’s own effort and really doesn’t need any paraphernalia. Of course the modern Yoga industry would rather have us believe that we need tons of Yoga equipment to start Yoga, but they are awfully of the mark in this case. Reduction in drug dosage and avoidance of unnecessary surgeries in many cases can also help reduce the spiraling cost of Medicare.

HEALTHY AGING: Aging is inevitable and Yoga can help us to age gracefully. Modern medicine tries to help retard aging and help


Annals of SBV

people look better by costly surgical methods that are only an external covering over the underlying aging process. Healthy diet, regular exercise, avoidance of negative habits and cultivation of the positive habits and a healthy lifestyle can help us to age with dignity. Yoga can also help our ‘silver citizens’ retain their mental ability and prevent degenerative disorders such as Parkinson’s disease, Alzheimer’s and various other dementias. Physical accidents such as falls can be minimized and many an artificial hip, knee or shoulder replacement surgery can be avoided. My own revered father-Guru Swami Gitananda Giri, Yogashri T Krishnamacharya, Sri Kannaiah Yogi, Swami Suddananda Bharathi, Sri Yogeshwarji, Sri Yogendraji, Sri pattabi Jois and Padma Bhushan BKS Iyengarji are but a few of the Yogis who have shown us that its is possible to grow old without losing any of the physical or mental faculties of youth.

PSYCHOTHERAPY: In the field of psychotherapy and psychoanalysis we can find a lot of ancient Yogic concepts being reiterated time

and again. Many modern psychotherapeutic concepts such as identification, projection, and transference are similar to concepts in Yoga psychology. Yoga psychology integrates diverse principles within a single body. CG Jung had a great interest in Yoga and the eastern thought and said, “Chakras represent a real effort to give a symbolic theory of the psyche”. His ‘Centre of Personality’ concept based on dream analysis is very similar to the Yogic concept of a central psychic or spiritual personality. He also correlated Chakras to the archetypes that abound in the collective unconscious. Yoga helps the psychotherapist in training self awareness, and in the self regulation of body, diet, breath, emotions, habit patterns, values, will unconscious pressures and drives. It also helps in relating to the archetypal processes and to a transient being. It offers an integrated method rather than one that is found in isolation in many different therapies. The theory of Kleshas is an excellent model for psychotherapy while emotional therapies of Yoga include Swadhyaya, Pranayama, Pratyahara, Dharana, Dhyana and Bhajans. Development of proper psychological attitudes is inculcated via the concepts of Vairagya, Chitta Prasadanam as well as Patanjali’s advise on adopting the attitudes of Maitri, Karuna, Mudita and Upekshanam towards the happy, the suffering, the good and the evil minded persons. Yoga also has a lot to offer in terms of spiritual therapies such as Swadhyaya, Satsangha, Bhajans and Yogic counseling. It is also interesting to note that both Yoga and psychoanalysis share common ground in understanding that symptoms of the disease are often willed by the patients. While all psycho analysists must undergo psychoanalysis themselves, it is taught in Yoga that one must first undergo a deep Sadhana, before attempting to guide others on the path. However while psychoanalysis searches the unconscious, Yoga attempts to understand and explore the super conscious.

LIFESTYLE CHANGES: Yoga helps patients take their health in their own hands. They learn to make an effort and change their life style for

the better so that their health can improve. Life style modification is the buzzword in modern medical circles and Yoga can play a vital role in this regard. Yogic diet, Asanas, Pranayamas, Mudras, Kriyas and relaxation are an important aspect of lifestyle modification. To live a healthy life it is important to do healthy things and follow a healthy lifestyle. The modern world is facing a pandemic of lifestyle disorders that require changes to be made consciously by individuals themselves. Yoga places great importance on a proper and healthy lifestyle whose main components are Achar (healthy activities on a regular basis), Vichar (right thoughts and attitude towards life), Ahar (healthy, nourishing diet) and Vihar (proper recreational activities to relax body and mind)

WOMEN’S HEALTH: Women are the chosen ones blessed with the responsibility of the future of our human race. Healthy mothers give

birth to healthy babies and a healthy start has a great future ahead. Yoga has a lot to contribute in combination with modern medicine to the health status of womankind. Puberty and menopause become easier transitions with the help of Yoga and many eminent Yoginis have said that they were not even aware of a single menopausal symptom as they went through this difficult period in a woman’s life. Similarly our young girls can vouch for the fact that their pubertal changes and menarche has been relatively smoother than their counterparts who don’t practice Yoga. The benefits of Yoga in terms of family planning are also an important aspect that needs further study, as they can be an effective part of the contraceptive armory. The risk of side effects is negated and the entire control restored to the individuals themselves. The Oli Mudras as practiced in the Gitananda Yoga tradition have great potential in this regard and also the Swara Yoga theories of conception have a lot of exciting possibilities. Once conception occurs, Yoga helps the young mother to be, to prepare herself physically and mentally for the upcoming childbirth. Yoga helps open the joints of the pelvis and hip as well as strengthen the abdominal muscles for childbirth. Later, simple Pranayamas and relaxation techniques help the new mother relax and enjoy the new experience of her life. Post partum introduction of simple practices along with



breathing, relaxation and a lot of crawling helps her come back to normal earlier and this can be used in all maternity hospitals along with allopathic management. Yoga practices can also help reduce the drug dosage in medical problems that often complicate a normal pregnancy such as diabetes, asthma and hypertension.

RESEARCH: The positive benefits of Yoga research are of vital significance and an understanding of how the various practices

work in different conditions and in normal situations are of great value for both the science of Yoga as well as for the world of medicine. Yoga therapists can benefit a lot by a scientific understanding of Yoga postures and other techniques. This will bring about a rational approach to Yoga therapy rather than a haphazard application of individualistic knowledge. Under the department of AYUSH, Morarji Desai National Institute of Yoga has created advanced centers for Yoga in JIPMER, NIMHANS, AIIMS and DIPAS to promote all aspects of Yoga in these premier medical institutions of India. Various private institutions are running in our country and doing their best to propagate Yoga-Vidya. Yoga therapy is being used both in conjunction with modern medicine or alternative systems of medicine as well as on its own in various centers. Various conditions such as diabetes, hypertension, arthritis, mental depression, bronchial asthma etc have been found to be relieved by Yoga Therapy and centers such as ICYER at Ananda Ashram, sVYASA, Kaivalyadhama, The Yoga Institute and Krishnamacharya Yoga Mandiram are doing a great deal of work in this field. Though there is a lot of research on Yoga being done by medical doctors these days but it is important to remember Swami Gitananda Giri’s words when he said, “We must research Yoga and not the lack of Yoga”. Many studies are badly constructed and manya-time we find that the Yoga practices performed by the patients have no real relation to Yoga at all. The higher aspects of Yoga are still not in the ‘researchable’ realm of modern science.

NEED FOR COORDINATION: The need of the modern age is to have an integrated approach towards therapy and to utilize Yoga therapy in

coordination and collaboration with other systems of medicine such as Allopathy, Ayurveda, Siddha and Naturopathy. Physiotherapy and Chiropractic practices may be used with the Yoga if needed. Advice on diet and lifestyle is very important irrespective of the mode of therapy that is employed for a particular patient.

PRESENT SCENARIO:The therapeutic potential of yoga has been recognized world over and studies have shown its beneficial effects in

numerous psychosomatic disorders like diabetes, hypertension, asthma, arthritis and other chronic diseases that are a great burden on our health care delivery system. The International Association of Yoga Therapists in the USA (www.iayt.org) is doing a lot of work to make Yoga Therapy acceptable to the medical community worldwide. They have given details of hundreds of research studies done all of over the world with regard to yoga as a novel and adjunct therapy to be used along with modern medicine.

In India Yoga Therapy is under Dept of AYUSH in Ministry of Health and Family Welfare and through its Morarji Desai National Institute of Yoga (www.yogamdniy.nic.in) five Advanced Centers for Yoga have been set up in our country. The Advanced Centre for Yoga Therapy, Education and Research (ACYTER), a collaborative venture between JIPMER and MDNIY is functioning since June 2008 and focusing primarily on the role of Yoga in the prevention and management of cardiovascular disorders and diabetes mellitus. More than 30,000 patients have benefited from the Yoga therapy consultations and practical sessions till date. The centre also aims to popularize the science of yoga among medical professionals (Yoga Vijnana 2008; 2: 71-78) and general public and has conducted workshops and awareness programmes to this effect.

Central Council for Research in Yoga and Naturopathy in the Ministry of Health and Family Welfare (www.ccryn.org) funds research studies in Yoga and ran a National Programme on Yoga and Naturopathy in 2010-2011. Yoga therapists have been appointed under the NRHM programmes in government hospitals all over the country and most major private medical hospitals have established Yoga and Healthy Living Centers.

Though there are many private hospitals hosting Healthy Lifestyle Centers for their patients, it is only in recent times that the Public Sector Hospitals have started such centers. AIIMS was one of the first centers to have such a unit (Indian J Physiol Pharmacol 2008; 52: 123-31) but today numerous units are functioning all over the country under the


Annals of SBV

patronage of the Ministry of Health and Family Welfare, Government of India. The Centre for Yoga Therapy, Education and Research (CYTER) is running at MGMC&RI under the patronage of

Sri Balaji Vidyapeeth and a scientifically sound Yoga therapy programme is running since 2010. Awareness programmes have been conducted for medical and paramedical personnel and more than 5000 patients have benefited till date and many studies under publication.

A WORD OF CAUTION: A word of caution is also required. Though Yoga and Yoga therapy are very useful in bringing about a state of total

health it is not a miracle cure for all problems. It needs a lot of discrimination on the part of both the therapist as well as the patient. It may not be useful in emergency conditions and there is a strong need to consult a qualified medical doctor where in doubt. Each patient is different and so the therapy has to be molded to suit the individual needs rather than relying on a specific therapy plan for patients suffering the same medical condition. A very true problem is that there is a different approach of the different schools of Yoga to the same condition. It is better to follow any one system that one is conversant with, rather than trying to mix systems in a “Yogic Cocktail’. One must also be vigilant as there is a strong presence of numerous quacks pretending to be Yoga therapists and this leads to a bad name for Yoga therapy as well as Yoga in general.

CONCLUSION: The art and science of Yoga has infinite possibilities for providing answers to most health problems troubling

modern humankind. However we often misunderstand this science and want it to be a miracle pill. A pill that we take only once, and want all the problems to vanish into thin air! Yoga is a wholistic science and must be learnt and practiced with a holistic view. The dedicated practice of Yoga as a way of life is no doubt a panacea for problems related to psychosomatic, stress related physical, emotional and mental disorders and helps us regain our birthright of health and happiness. It is only when we are healthy and happy that we can fulfill our destiny. With the adoption of a proper attitude and lifestyle through the Yogic way of life, we can rise above our own circumstances and our life can blossom as a time of variety, creativity, and fulfillment. Yoga helps us regain the ease we had lost through dis-ease (as implied by sthira sukham asanam-PYS). It also produces mental equanimity (samatvam yoga uchyate-BG) where the opposites cease to affect (tato dwandwa anabhigatha-PYS). This enables us to move from a state of illness and disease to one of health and wellbeing that ultimate allows us to move from the lower animal nature to the higher human nature and finally the highest Divine Nature that is our birthright.

REFERENCES AND RECOMMENDED READING: 1.Ajaya Swami. Psychotherapy East and West. Himalayan institute, Pennsylvania, USA 1983. 2.Anand BK. Yoga and Medical Sciences. Souvenir: Seminar on Yoga, science and man. Central council for re searchinIndianMedicineandHomeopathy.NewDelhi.1976.3.Anantharaman TR. Ancient Yoga and Modern Science. Mushiram Manoharlal Publishers Pvt Ltd, New Delhi. 19964.Anantharaman TR. Yoga as Science. Souvenir: Seminar on Yoga, science and man. Central council for research inIndianMedicineandHomeopathy.NewDelhi.1976.5.Back issues of International Journal of Yoga Therapy. Journal of the International Association of Yoga Therapists, USA. www.iayt.org 6.BackissuesofYogaLife,MonthlyJournalofICYERatAnandaAshram,Pondicherry.www.icyer.com7.Back issues of Yoga Mimamsa. Journal of Kaivalyadhama, Lonavla, Maharashtra. 8.Bhatt GP. The Forceful Yoga (being the translation of the Hathayoga Pradipika, Gheranda Samhita and Siva Samhita). Translated into English by Pancham Sinh, Rai Bahadur Srisa Chandra Vasu. Mothilal Banarsidas Publishers Pvt Ltd, Delhi. 2004.9.Bhavanani AB, Ramanathan M, Harichandrakumar K T. Immediate effect of mukha bhastrika (a bellows type pranayama)onreactiontimeinmentallychallengedadolescents.IndianJPhysiolPharmacol2012;56:174–18010.Bhavanani AB. Concepts of Health in Dravidian Yogic Treatises. Open Access Scientific Reports 2012; 1: 123. doi:10.4172/scientificreports.123 11.Bhavanani AB. Don’t Put Yoga in a Small Box: The Challenges of Scientifically Studying Yoga. International Journal Of Yoga Therapy 2011; 21 ; 21. 12.Bhavanani AB. Understanding the Science of Yoga. SENSE, 2011, Vol. 1 (1), 334-344 13.Bhavanani AB. Yoga as a therapy: A perspective. Yoga Mimamsa Vol. XLII (January 2011) No. 4 pp 235-241. 14.Bhavanani AB. A primer of Yoga theory. Dhivyananda Creations. Puducherry-13. (2008) 15.Bhavanani AB. A Yogic Approach to Stress. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. (2ndedition) 2008.



16.BhavananiAB.Yogaforhealthandhealing.DhivyanandaCreations.Puducherry-13.(2008)17.Bhavanani AB. Yoga Therapy Notes. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2007 18.Brena Steven F. Yoga and medicine. Penguin Books Inc. USA. 1972. 19.Carlson LE et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immuneparametersinbreastandprostatecanceroutpatients.PsychosomMed.2003Jul-Aug;65(4):571-81.20.Chidbhavananda Swami. The Bhagavad Gita. Ramakrishna Tapovanam, Trichy, 198421.Datey KK, Deshmukh SN, Dalvi CP, Vinekar SL. “Shavasana”: A yogic exercise in the management of hypertension’.Angiology1969;20:325-333.22.Feuerstein Georg. The Shambala Guide to Yoga. Shambala Publications Inc, Boston, Massachusetts, and USA.1996.23.Gitananda Giri Swami and Meenakshi Devi Bhavanani (Ed). Bridging the gap between Yoga and science. Souvenir of the international conference on biomedical, literary and practical research in Yoga. ICYER, Pondicherry, India. July 25-28, 1991. 24.GitanandaGiriSwami.Yogatheartandscienceofawareness.Souvenir1996;4thInternationalYogaFestival, Govt of Pondicherry. 25.GitanandaGiriSwami.Yoga:Step-by-Step,SatyaPress,Pondicherry,1976.26.GoVLandChampaneriaMC.Thenewworldofmedicine:prospectingforhealth.NipponNaikaGakkai Zasshi.2002Sep20;91Suppl:159-63.27.Innes KE, Vincent HK. The Influence of Yoga-based programs on risk profiles in adults with type 2 diabetes mellitus:Asystematicreview.eCAM2007;4:469-86.28.Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease,

and possible protection with Yoga: a systematic review. J Am Board Fam Pract 2005; 18: 491-51929.Khalsa SBS. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J PhysiolPharmacol2004;48:269-85.30.Madanmohan, Rai UC, Balavittal V, Thombre DP, Swami Gitananda. Cardiorespiratory changes during savitri pranayama and shavasan. The Yoga Review 1983; 3: 25-34.31.Madanmohan. Introducing Yoga to medical students: the JIPMER experience. Yoga Vijnana 2008; 2: 71-78.32.Nagarathna R and Nagendra HR. Integrated approach of Yoga therapy for positive health. Swami Vivekananda Yoga Prakashana, Bangalore, India. 2001.33.Ramamurthi B. Uphill all the way. Guardian press, Chennai. 2000. 34.Ramanathan Meena. Thiruvalluvar on Yogic Concepts. Aarogya Yogalayam, Venkateswara Nagar, Saram, Pondicherry-13.2007 35.Selvamurthy W, Sridharan K, Ray US, Tiwary RS, Hegde KS, Radhakrishan U et al. A new physical approach to control essential

hypertension. Indian J Physiol Pharmacol 1998; 42: 205-13.36.SharmaR,GuptaN,BijlaniRL.EffectofYogabasedlifestyleinterventiononsubjectivewell-being.IndianJPhysiolPharmacol2008;

52: 123-31.37.Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB et al. Yoga asana sessions increase brain GABA levels: a pilot

study.JAlternComplementMed2007;13:419-26.38.Swami Satyananda Saraswathi. Four Chapters on Freedom. Bihar School of Yoga, Munger, India. 1999 39.Vijayalakshmi P, danmohan,

Bhavanani AB, Patil A, Kumar Babu P. Modulation of stress induced by iso metric handgrip test in hypertensive patients following yogic relaxationtraining.IndianJPhysiolPharmacol2004;48:59-64

40.Yoga the Science of Holistic Living. Vivekananda Kendra Patrika. Vol. 17- 2. 1988.

Indian J Physiol Pharmacol 2013; 57(2) Suryanamaskar on Reaction Time and Heart Rate 199

SHORT COMMUNICATION

IMMEDIATE EFFECTS OF SURYANAMASKAR ON REACTION TIMEAND HEART RATE IN FEMALE VOLUNTEERS

ANANDA BALAYOGI BHAVANANI*, MEENA RAMANATHAN,R. BALAJI AND D. PUSHPA

Centre for Yoga Therapy, Education and Research (CYTER),MGMCRI, Pondicherry – 607 402

( Received on November 5, 2012 )

Abstract : Suryanamaskar (SN), a yogic technique is composed of dynamicmuscular movements synchronised with deep rhythmic breathing. As itmay have influence on CNS, this study planned to investigate immediateeffects of SN on reaction time (RT) and heart rate (HR). 21 female volunteersattending yoga classes were recruited for study group and 19 femalevolunteers not participating in yoga were recruited as external-controls.HR, auditory reaction time (ART) and visual reaction time (VRT) wererecorded before and after three rounds of SN in study group as well as 5minutes of quiet sitting in both groups. Performance of SN producedimmediate decrease in both VRT and ART (P<0.001). This was significantwhen compared to self-control period (P<0.001) and compared to external-control group, it decreased significantly in ART (p=0.02). This waspronounced when Δ% was compared between groups (P<0.001). HRincreased significantly following SN compared with both self-control(p=0.025) and external-control group (p=0.032). Faster reactivity may bedue to intermediate level of arousal by conscious synchronisation of dynamicmovements with breathing. Rise in HR is attributed to sympathetic arousaland muscular exertion. We suggest that SN may be used as an effectivetraining means to improve neuro-muscular abilities.

Key words : yoga suryanamaskar reaction time heart rate

INTRODUCTION

Beneficial effects of Yoga have beenreported in peripheral and central neuronalprocessing (1, 2, 3, 4). Reaction time (RT) issimple and effective method of studyingcentral neuronal processing and is a simple

means o f determining sensory-motorassociation, performance and cortical arousal(3).

It has been reported that changes inbreathing period produced by voluntarycontrol of inspiration are significantly

Indian J Physiol Pharmacol 2013; 57(2) : 199–204

*Corresponding author : Dr. Ananda Balayogi Bhavanani, Honorary Advisor, Centre for Yoga Therapy,Education and Research (CYTER), MGMCRI, Pondicherry – 607 402

200 Bhavanani et al Indian J Physiol Pharmacol 2013; 57(2)

correlated to changes in RT (5). Some studieson yoga have shown that regular practice ofyoga over a period of few weeks to a fewmonths can significantly decrease both visualreaction time (VRT) and auditory reactiontime (ART) (2, 3, 6). Previous studies byBhavanani et al have reported a significantand immediate decrease in RT following thepractice of nine rounds of mukha bhastrika,a bellows type of pranayama in normalschool chi ldren as wel l as mental lychallenged adolescents (7, 8).

Suryanamaskar (SN) is a sequentialcombination of yogic postures performeddynamically in synchrony with the breath.Energy cost and physiological changes duringthe practice as well as after training havebeen reported (9, 10, 11, 12).

Keeping the above in mind, this studywas planned to investigate the acute effectsof SN on RT and heart rate (HR) in trainedfemale volunteers.

METHODS

Twenty-one female volunteers (mean age28.29±1.71 years) were recruited from thoseattending regular yoga classes at CYTER inMahatma Gandhi Medical College andResearch Institute, Puducherry. Anothergroup of 19 female volunteers (mean age32.11±1.41 years) not attending yoga classeswere recruited as external-controls. Informedconsent was obtained from all participantsand ethical clearance was obtained fromInstitutional Human Ethics Committee.

Numerous variations of the SN aretaught and the one used in the present studyis known as Aruna SN. This is an integral

part of the Gitananda Tradition and involvesdynamic per formance o f a sequent ia lcombination of yogic postures in synchronywith breathing (13). The speciality of thisvariation is the usage of nasarga mukhabhastrika, a bellows type of yogic breathingdone with internal ized awareness o fdiaphragmatic actions.

The keywords for SN are “stretch” and“breathe” and the breathing must be deepand regular with the movements flowing withthe breath. From a standing posit ion(samasthiti asana) both arms are stretchedup breathing in, and the palms broughttogether in anjali mudra. While exhaling,stretch down with palms flat to the groundand forehead to knees in pada hastha asana.Lift the head while breathing in and thenblast out with a “whoosh” jumping back withthe whole body parallel to the ground inchatur danda asana. On the next in-breath,lift the head and bend back as much aspossible (kokila asana). Come into meruasana by lifting the buttocks up, keeping theknees tight and straight while pushing downon the heels. In this position, inhale throughthe nose and “whoosh” out forcefully throughthe mouth (nasarga mukha bhastrika).Breathe in and jump forward bringing bothfeet between the hands placed firmly on theground. Stretch the head up and feel astretch through the entire back. Breathe outand lower the head down to knees. Breathein and lift back up to anjali mudra and finallyreturn and relax in samasthiti asana.

RT apparatus manufactured by AnandAgencies, Pune was used with built in 4 digitchronoscope and display accuracy of 1ms.Simple ART was recorded for auditory beepsound and simple VRT for red light. Subjects


were instructed to release response key withdominant hand as soon as they perceivedthe stimulus given from the front to avoideffect of lateralised stimulus (14). All subjectswere g iven adequate exposure to theequipment on 2 dif ferent occasions tofamiliarize them with the procedure. Toensure objectivity, HR was recorded usingnon-invasive semi-automatic BP monitor (CH– 432, Citizen Systems, Tokyo, Japan) havingrange from 40 to 180 beats/min and accuracy± 5%.

For SN group, RT measurements and HRrecordings were done twice; before and aftera control period of 5 minutes of quiet sittingand then before and after practice of SN.Control period was 5 minutes, equivalent toduration taken to perform SN. To avoidinfluence of recording on different days andorder of recording, half subjects performedsel f - contro l recordings on day-1 andothers did SN recordings. This was reversedon day-2. For external-control group, RTmeasurements and HR recordings were donebefore and after 5 minutes of quiet sittingwith half recording on day-1 and others onday-2. Ten trials were recorded and averageof lowest three similar observations weretaken as single value (14).

Statistical analysis

Data are expressed as mean±SEM.Statistical analysis was done using GraphPadInStat version 3.06 and all data passednormality testing by Kolmogorov-SmirnovTest and hence analyzed using Students ttest for paired data for intra-groupcomparisons and Students t test for unpaireddata between groups. P values less than 0.05were accepted as indicating significantdifferences.

RESULTS

Mean age of subjects in the SN groupwas 28.29±1.71 and in external-control groupwas 32.11±1.41 years and difference betweengroups was not significant.

Comparison of self-control HR, ART andVRT recordings in SN group showed nos igni f i cant d i f ferences (P>0.05) whencompared with external -contro l grouprecordings both at baseline and after 5minutes of quiet sitting.

The mean±SEM values of HR, ART andVRT recordings and their s tat ist ica lcomparison between SN, self-control and

TABLE I : Immediate effect of suryanamaskar on heart rate (HR), auditory reaction time (ART) andvisual reaction time (VRT) in 21 female volunteers before (B) and immediately after (A)three rounds of suryanamaskar and a self-control period of 5 minutes of quiet sitting.

Suryanamaskar (n=21) Self-Control period (n=19) Comparison (P value)

B A Δ % B A Δ % B A Δ %

HR 76.71±2.04 80.52±2.47** 5.00±1.67 76.67±1.67 75.29±1.66 –1.44±1.95 0.982 0.025 0.072

ART 225.04±8.23 193.44±8.66*** –14.28±1.75 236.63±9.06 234.14±8.78 –0.94±0.68 0.012 < 0.001 < 0.001

VRT 245.80±6.93 213.72±6.80*** –13.08±1.03 249.52±5.49 244.69±5.83 –1.88±1.13 0.359 < 0.001 < 0.001

Values are given as mean±SEM. **P<0.01 by paired t test, ***P<0.001 by paired t test.


compared to both self-control period (p=0.025)and external-control group (p=0.032). The Δ%difference in HR between SN and external-control group was statistically significant(p=0.004) and just missed significance withself-control period (p=0.072). This rise in HRcan be attributed to sympathetic arousal aswell as muscular exertion and this is inagreement with another report that averageintensity during SN was 80% HRmax,sufficient to elicit a cardio-respiratorytraining effect (12). It has been previouslyreported that SN produces an increase inVO2 max indicat ing improved aerobiccapacity and that it exerts only moderatestress on cardio-respiratory system as itkeeps the practitioner within their lactateand anaerobic threshold (9, 10).

Performance of SN produced immediateand statistically significant decreases in VRTand ART. The faster reactivity is in agreementwith previous studies on immediate effectsof mukha bhastrika and three weeks ofslow and fast pranayama training (7, 8, 14).Decrease in RT signifies improvement incentral neuronal processing ability and thismay be attributed to greater arousal andfaster rate of information processing alongwith improved concentration. RT is fastest

external-control groups are given in TablesI and II.

The changes were significant with regardsto a rise in HR and fall in ART and VRTfollowing SN as compared with both self-control and external-control group data. Thiswas more pronounced (P<0.001) in ART andVRT data when the basel ine adjustedpercentage changes (Δ%) were comparedbetween groups.

DISCUSSION

To the best of our knowledge, this is thefirst report on the immediate effects of SNon RT. Previous studies on immediate/acuteeffects of SN have focussed on energy costand cardio-respiratory changes during thepractice or cardiorespiratory and metabolicresponses to four rounds of the practice(9, 12). Both these studies lacked controlgroups whereas our present study analysesimmediate effects of RT with reference toboth self-control data as well as data from aseparate external-control group.

HR increased significantly followingperformance of three rounds of SN (P<0.01).This was statistically significant when

TABLE II : Immediate effect of suryanamaskar on heart rate (HR), auditory reaction time (ART)and visual reaction time (VRT) in 21 female volunteers before (B) and immediatelyafter (A) three rounds of suryanamaskar and in an external- control group of 19female volunteers performing 5 minutes of quiet sitting.

Suryanamaskar (n=21) External-Control period (n=19) Comparison (P value)

B A Δ % B A Δ % B A Δ %

HR 76.71±2.04 80.52±2.47** 5.00±1.67 76.16±1.53 74.37±0.99 –1.89±1.69 0.831 0.032 0.004ART 225.04±8.23 193.44±8.66*** –14.28±1.75 223.89±10.42 223.21±9.51 –0.10±1.32 0.931 0.026 < 0.001VRT 245.80±6.93 213.72±6.80*** –13.08±1.03 242.90±7.61 234.08±8.71* –3.74±1.38 0.779 0.070 < 0.001

Values are given as mean±SEM. **P<0.01 by paired t test, ***P<0.001 by paired t test.


with an intermediate level of arousal anddeteriorates when subjects are either toorelaxed or too tensed. Exercise improves RTand moderate muscular tension shortens pre-contraction RT while isometric contractional lows the brain to work faster (15) .Alternate forward and backward bendingmovements as well as the jumping back andforth movements in SN may have influencedRT in a manner s imi lar to i sometr icmuscular exercise. Though RT shorteningeffect of exercise is normally lost in postexercise period as arousal diminishes (16),in our subjects shortening of RT was carriedover into post SN period too. With the abovein mind, we attribute faster reactivity of oursubjects following SN to an intermediatelevel of arousal brought about by conscioussynchronisat ion o f dynamic muscularmovements with slow, regular and deepbreathing.

Previous studies have demonstrated EEGchanges around somato-sensory and parietalareas of cerebral cortex suggesting affectivearousal fo l lowing agnisara, naul i andbhastrika and suggested such changes occurthrough strong stimulation of somatic andsplanchnic receptors (17). The nasargamukha bhastrika in meru asana, involvingmultiple forceful expirations done rapidly andconsecutively may have prolonged andresidual neuro-muscular effect influencingRT. It has been suggested that such forceful

expirations may alter afferent inputs fromabdominal and thoracic regions, in turnmodulating activity at ascending reticularactivating system and thalamo-cortical levels(7, 8).

On the basis of the present study, it isconcluded that three rounds of SN producesignificant shortening of RT in femalesubjects as part of a generalised sympatheticarousal as evidenced by significant rise inHR. We suggest that SN may be used as aneffective training means to improve neuro-muscular abilities. As our study is limitedby a small sample size, further studies withlarger sample sizes may help to understandbetter underlying mechanisms involved inbringing about such an immediate benefit.

ACKNOWLEDGMENTS

The authors thank management andauthor i t ies o f Sr i Bala j i VidyapeethUniversity for setting up the Centre for YogaTherapy, Education and Research (CYTER)in Mahatma Gandhi Medical College andResearch Institute (MGMCRI).

The authors are grateful to YogachariniMeenakshi Devi Bhavanani, Director ICYERfor her constant motivation, encouragementand supportive guidance. We thank MissSubashana, ANM for assistance duringrecording sessions and data entry.

REFERENCES

1. Malhotra V, Singh S, Tandon OP, Madhu SV,Prasad A, Sharma SB. Effect of yoga asanas onnerve conduction in type 2 diabetes. Indian JPhysiol Pharmacol 2002; 46: 298–306.

2. Madanmohan, Thombre DP, Balakumar B,Nambinarayanan TK, Thakur S, Krishnamurthy

N, et al. Effect of yoga training on reactiontime, respiratory endurance and muscle strength.Indian J Physiol Pharmacol 1992; 36: 229–233.

3. Malathi A, Parulkar VG. Effect of yogasanas onthe visual and auditory reaction time. Indian JPhysiol Pharmacol 1989; 33: 110–112.


4. Telles S, Joseph C, Venkatesh S, Desiraju T.Alterations of auditory middle latency evokedpotentials during yogic consciously regulatedbreathing and attentive states of the mind. IntJ Psychophysiol 1993; 14: 189–198.

5. Gallego J, Perruchet P. The effect of voluntarybreathing on reaction time. J Psychosom Res1993; 37: 63–70.

6. Borker AS, Pednekar JR. Effect of pranayamon visual and auditory reaction time. Indian JPhysiol Pharmacol 2003; 47: 229-230.

7. Bhavanani AB, Madanmohan, Udupa K. Acuteeffect of mukh bhastrika (a yogic bellows typebreathing) on reaction time. Indian J PhysiolPharmacol 2003; 47: 297-300.

8. Bhavanani AB, Ramanathan M, HarichandrakumarKT. Immediate effect of mukha bhastrika (abellows type pranayama) on reaction time inmentally challenged adolescents. Indian J PhysiolPharmacol 2012; 56: 174–180.

9. Sinha B, Ray US, Pathak A, Selvamurthy W.Energy cost and cardiorespiratory changesduring the practice of surya namaskar. Indian JPhysiol Pharmacol 2004; 48: 184–190.

10. Bhutkar PM, Bhutkar MV, Taware GB, DoijadV, Doddamani BR. Effect of suryanamaskar practiceon cardio-respiratory fitness parameters: A PilotStudy. Al Ameen J Med Sci 2008; 1: 126–129.

11. Bhavanani AB, Udupa K, Madanmohan,Ravindra P. A comparative study of slow andfast suryanamaskar on physiological function.Int J Yoga 2011; 4: 71-76.

12. Mody BS. Acute effects of surya namaskar onthe cardiovascular and metabol ic system. JBodyw Mov Ther 2011; 15: 343-347.

13. Bhavanani AB. Suryanamaskar: An expressionof our gratitude to l i fe . Puducherry, India:Dhivyananda Creations; 2011. P 54–58.

14. Madanmohan, Udupa K, Bhavanani AB,Vijayalakshmi P, Surendiran A. Effect of slowand fast pranayams on react ion t ime andcardiorespiratory variables. Indian J PhysiolPharmacol 2005; 49: 313–318.

15. Etnyre B, Kinugasa T. Postcontraction influenceson reaction time (motor control and learning).Research Quarterly for Exercise and Sport 2002;73: 271–282.

16. Collardeau M, Brisswalter J, Audiffren M. Effectsof a prolonged run on simple reaction time ofwell -trained runners. Perceptual and MotorSkills 2001; 93: 679–689.

17. Roldan E, Dostalek C. EEG patterns suggestiveof shi f ted leve ls o f exc i tat ion e f fected byhathayogic exercises. Act Nerv Super (Praha)1985; 27: 81–88.

Int. Res J Pharm. App Sci., 2013; 3(4):116-118 ISSN: 2277-4149

Dinesh T et al., 2013 116

International Research Journal of Pharmaceutical and Applied

Sciences (IRJPAS) Available online at www.irjpas.com

Int. Res J Pharm. App Sci., 2013; 3(4):116-118

EFFECT OF 8 WEEKS OF PRANAV PRANAYAMA TRAINING ON PULMONARY FUNCTION

TEST PARAMETERS IN YOUNG HEALTHY, VOLUNTEERS OF JIPMER POPULATION Dinesh T

1, Sharma V K

2, Raja Jeyakumar M

3, Syam Sunder A

4, Gopinath M

5 Ananda Balayogi Bhavanani

6

1Assistant Professor, Department of Physiology, Vinayaka Missions medical college, Karaikal- 609605, 2Sharam V K Assistant Professor, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research,

Puducherry- 605006 3Assistant Professor, Department of Physiology, Chennai Medical college hospital and research centre, Irungalur, Trichirappalli-

621105 4PhD Scholar, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry-

605006 5Assistant Professor, Department of Physiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research,

Melmaruvathur- 603319 6Deputy Director, CYTER, Mahatma Gandhi Medical College and Research Institute, Puducherry - 607 402

Corresponding Author: Dinesh T, Email: [email protected]

Abstract: Background: Yoga is an ancient Indian science it has been practiced as a healthy way of life. Yoga consists of five principles that include proper exercise, proper relaxation, proper breathing, proper diet, positive thinking and meditation.

Pranayama is a method of breathing and chest expansion exercise has been reported to improve respiratory function in healthy

individuals as well as in patients with respiratory diseases... The aim of the study is to find out the positive beneficial effects of

pranav pranayama training on pulmonary function parameters in young healthy, volunteers of both the genders. Materials and

methods: The present study was conducted on 12 healthy volunteers of both genders. Among them 6 were males subjects and 6

were females subjects. The mean age group of the subjects was 18.58+0.66 years. Pre and post pulmonary function parameters such as FEV1, FVC, FEV1/ FVC, FEF25-75, MVV were taken using the spirometer at the end of 8 weeks pranayama training.

Results: Our results showed a significant difference in pulmonary function parameters. Before paranayma training FVC was

around 2.29+ 0.58, after it was 2.35+0.63, FEV1 was around 2.22+0.59 after it was 2.285+0.63, FEV1/FVC was around

97.11+3.83 after it was 97.45+3.36, FEF was around 3.35+1.01,after it was around 5.85+8.15, PEFR was around

266.83+72,after it was around 290.91+82.56, MVV was around 84.2+23.16 after it was around 85.90+ 23.59, from the above

results we concluded that PEFR was not statically significant P< 0.05. Other parameters showed a significantly high value in pre

and post data which is statistically significant P> 0.05.Conclusion: From our study we found that 8 weeks of pranav pranayama

training in the young, healthy volunteers showed increase in the commonly measured pulmonary function parameters, but the

increase was not statistically significant probably because of short duration of training. By increasing the duration of time the

reliable goal can be achieved by obtained maximal values of pulmonary function parameters which reflect directly on lung health

status.

Keywords: Pranav Pranayama, pulmonary function, healthy lungs, dead space, ventilatory function.

Introduction

Yoga, an ancient Indian science has been practiced as a healthy way of life. Yoga emphasizes on controlled

breathing (pranayama), body posture (asana), relaxation of

mind (meditation) keeps a person energetic & healthy for

maintaining health and fitness and for treating diseases.

Pranayama is a method of yogic type of breathing and chest

expansion exercise, has been reported in previous studies as

it is known to improve respiratory function in healthy

individuals as well as in respiratory diseases. Pranayama,

the fourth step of ash tang yoga is an important component

of yoga training. „Prana‟ the vital life force that acts as a

catalyst in all our activities and „Ayama‟ is the expansion of

Pranayama can be defined as the science of controlled, conscious expansion of Prana in our energy body sheath. As

a deep breathing technique, Pranayama reduces ventilation

and decreases work of breathing. It also refreshes air

throughout the lungs, in contrast with shallow breathing that

refreshes air only at the base of the lungs(3). Spirometry is the most commonly used technique to screen the respiratory

diseases. It includes the assessment of lung volumes and

flow-volume curves (1, 2). Among the previous Studies

conducted at pranayama in several institutions in India have

reported impressive success in improving the lung functions

and has a positive effect and permanent relief from asthma.

It has also been proved that asthma attacks can usually be

prevented by Yoga methods without resorting to drugs.

Physicians have found that the addition of improved

concentration ability and yogic meditation together with the

practice of simple postures and pranayama makes treatment

more effective in patients who practice. Yoga has a better chance of gaining the ability to control their breathing

problems. With the help of yogic breathing exercises, it is

possible to control an attack of severe shortness of breath

Research Article

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without having to seek medical help. Various studies have

confirmed the beneficial effects of pranayama for patients

with respiratory problems (2, 3) .The ultimate goal of

traditional yogis was “self realization” or “enlightenment”, a

concept, which perhaps is quite esoteric to you and me. The

first step on this path is to reduce peripheral mental activity

through bringing awareness into the body, and then later

through relaxation and meditation to simply observe the

breath. This helps to quiet the mind and take us to a place of

peace. The reduction, and ultimately cessation of mental

activity is the goal or aim of meditation. On experiencing this state we become aware of our unity with all things and

our essential nature of peace (3).

Materials and methods

The present study was conducted on 12 young

healthy, volunteers of both the genders. Mean age was

18.58+0.66 years. After obtaining clearance from the

Institute Ethics Committee, subjects were motivated and

recruited for the study. Subjects with the history of active

sports training, previous experience of yoga, history of

chronic respiratory illness, history of major surgery in the

recent past, smoking, alcohol consumption were excluded from the study. The subjects were familiarized with the aims

and objectives of the study as well as laboratory

environment. After giving detailed information about the

study, written consent was obtained from the volunteer

subjects.

Analysis of Parameters:

Baseline parameters (pre values) were recorded at

the beginning of the study. Height and weight were

measured using height scale and weighing scale

respectively. Using spirometer (Micro lab Version 1.32) pulmonary function parameters were recorded. Pulmonary

Function Tests parameters analyzed are studied were

Forced Vital Capacity (FVC), Forced Expiratory Volume in

first second (FEV1), Ratio between FEV1 and FVC (FEV1/

FVC), Peak Expiratory Flow Rate (PEFR), and Forced

Expiratory Flow at 25-75 (FEF25-75) and Maximum

Voluntary Ventilation (MVV). The values of all tests were

taken as % predicted as per age, sex and height of each

subject according to standard equation .The subjects were

instructed to do the procedure in the sitting posture, with the

erect spine, without forward bending. The subject is asked to

keep the mouth piece inside the mouth with the lips closed so as to make a seal, to avoid air leak while blowing; nose

was closed with the nose clips. They performed slow

expiratory vital capacity and forced vital capacity

maneuvers. These procedures were repeated for two more

times with of 3-5 minutes of interval in-between. The

subjects are instructed to give their maximal effort. The

above said PFT parameters such as FVC, FEV1, FEV1 /

FVC, FEF25-75, PEFR and MVV were noted. Three readings

were taken and the best value out of them was recorded. The

same procure was followed while recording the post values

at the end of 8 weeks of pranayama training.

Pranayama training: The subjects were given pranav pranayama training

and practiced the same under the guidance of a trained,

certified yoga instructor at Advanced Centre for Yoga

Therapy Education and Research (ACYTER), JIPMER,

Pondicherry. Practice sessions were conducted three days

per week (Monday, Wednesday and Friday) during the

evening time for 20-30 minutes for a total duration of eight

weeks. On rest of the days subjects were motivated to

practice at their home. Pranav pranayama is slow, deep and

rhythmic breathing in co ordination with A, U; M sounds

which were pronounced during expiration. They were asked

to assume „Sukhasana‟ (the comfortable posture). Deep

inhalation for 6 counts in co ordination with turning the

head to right side. This is followed by chanting „ah‟ in coordination with the movement of head towards centre.

Deep inhalation for 6 counts in co ordination with turning

the head to left side. This is followed by chanting „vu‟ in

coordination with the movement of head towards centre.

Deep inhalation for 6 counts in co ordination with turning

the head and chin up. This is followed by chanting „ma‟ in

coordination with the movement of head towards

centre.Pranav pranayama was given for 3 cycles. At the end

subjects were made to lie down in Shavasana for 10

minutes.

Statistical analysis: Graph pad software was used to analyze the data.

The values obtained from pre and post training period were

analyzed using Student‟s paired t - t e s t. Data were

expressed as Mean ± SD.„P‟ value of less than 0.05 was

considered as significant.

Results:

Our results showed a significant difference in

pulmonary function parameters. Before paranayma training

FVC was around 2.29+ 0.58, after it was 2.35+0.63, FEV1

was around 2.22+0.59 after it was 2.285+0.63, FEV1/FVC was around 97.11+3.83 after it was 97.45+3.36, FEF was

around 3.35+1.01,after it was around 5.85+8.15, PEFR was

around 266.83+72,after it was around 290.91+82.56, MVV

was around 84.2+23.16 after it was around 85.90+ 23.59,

from the above results we concluded that PEFR was not

statically significant P< 0.05. Other parameters showed a

significantly high value in pre and post data which is

statistically significant P> 0.05. The above values are coded

in table 1 as the pre and post data of our study which was

conducted on 12 healthy volunteers of both the genders of

age group around18.58+0.66 years. A positive result was

analyzed among the pulmonary function parameters from our study.

Table 1: Effect of savitri pranayama training on

pulmonary function parameters before and after 8 weeks

of study period. Values are expressed as Mean±SD

PFT Parameters BeforePranayama

training (n=12)

After pranayama

training (n=12)

FVC (L) 2.29+ 0.58 2.35+0.63

FEV1 (L) 2.22+0.59 2.285+0.63

FEV1/FVC (%) 97.12+3.83 97.45+3.36

PEFR (L/m) 266.83+72 290.91+82.56 *

FEF25-75 (L/s) 3.35+1.01 5.85±1.15**

MVV (L) 84.2+23.16 85.90+23.59

LEGEND -1 the values obtained before and after the

training period were compared using Student‟s paired t - t e



s t *P< 0.05, **P < 0.01. Forced Vital Capacity (FVC),

Forced Expiratory Volume in first second (FEV1), Ratio

between FEV1 and FVC (FEV1/ FVC), Peak Expiratory

Flow Rate (PEFR), Forced Expiratory Flow at 25-75 (FEF25-

75) and Maximum Voluntary Ventilation (MVV).

Discussion

Yoga consists of different type of practices, most

common of which is pranayama. Different pranayama

produce different physiological effects. Madan Mohan et al

conducted a study on effect of slow and fast pranayama on cardiorespiratory changes they concluded that pranayama

has a positive effect by improving the cardio respiratory

performance by minimizing the sympathetic effect on

circulatory pool (1, 4). Another study conducted by Joshi et al

in which they found that yogic Asanas and pranayama

reduce the resting respiratory rate and increase vital

capacity, timed vital capacity, maximum voluntary

ventilation, breath holding time and maximal inspiratory and

expiratory pressures (2) . They concluded pranayama

sessions in young male volunteers. The results of the study

showed that there was a decrease in both expiratory and

inspiratory muscle strength, alveolar hypoventilation due to depression of hypoxic and hypercapnoeic ventilatory drives

and decrease in maximal breathing and diffusing capacity(5)

The decrease of oxygen uptake due to meditative practice

influenced the reduction of the total caloric expenditures

that, as a variable derived from VO2, also had a statistically

significant reduction of 35% which proves that oxygen

consumption increases with pranayama practice (6, 7) Results

of our study indicate that there was trend towards increase in

the ventilatory function parameters including FEV1, FVC,

FEV1/FVC, FEF 25-75 and MVV between time points,

although none of the parameters were statistically significant. However PEFR parameter showed statistically

significant improvement. Improvement in the study subjects

may have occurred due to strength and endurance of

respiratory muscles and improvement in cardio, respiratory

parameters. Our findings are in congruence with the

previous studies of Udupa et al… A in1975. In our study

the changes did not reach statistical significance probably

due to differences in the protocols, study design and lesser

number of subjects in our study (9, 10). Our study further

substantiates the claim that yoga practice is beneficial on the

pulmonary function in normal subjects. In future we are

planning to extend this study further with more number of subjects and duration of yoga training on healthy subjects as

well as patients (11).

CONCLUSION

12 healthy volunteers between age group of

18.58+0.66 years years participated in this study. They were

given training of pranav pranayama. Pulmonary function

test parameters were recorded as pre and post sessions. Our

results showed significant increase in pulmonary function

parameters after regular practice of pranav pranayama .The

present study has shown that adding comprehensive yoga-based breathing exercises (pranayama) to the daily life to

improve the lung function.

Acknowledgement

We acknowledge Mr. Dayanidy yoga instructor, ACYTER,

JIPMER. Dr.Velkumary, Assistant Professor, Mr. Shyam

Sundar Kiran PhD scholar, Department of Physiology,

JIPMER who helped us for the conduct of this project.

And a warm thanks to the volunteers who participated in our

study.

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1. Madanmohan, Udupa K, Bhavanani AB,

Vijayalakshmi P, Surendiran A. Effect of slow and fast pranayamas on reaction time and

cardiorespiratory variables. Indian J Physiol

Pharmacol 2005; 49: 313–318.

2. Joshi LN, Joshi VD, Gokhale LV. Effect of short

term „pranayamaa‟ practice on breathing rate and

ventilatory functions of lung. Indian J Physiol

Pharmacol 1992; 36: 105-108.

3. Bijilani RL. The Yogic Practices: Asanas,

Pranayamas and Kriyas. Bijilani RL, editor,

Understanding medical physiology, Third edition.

New Delhi, India: Jaypee Brothers Medical

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perform and interpret spirometry in primary care.

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5. Khaidjapho K, Jaree P, and Pongnaratorn P,Yoga

exercise increases chest wall expansion and lung

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6. N.k. Subbalakshmi1, s.k. Saxena, urmimala, and

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shodhana pranayamaa‟On some selected

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7. Madanmohan, Rai UC, Balavittal V, Thombre

DP,Swami Gitananda. Cardiorespiratory changes

during savitri pranayama and shavasan. The Yoga

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8. Ganong WF. Review of Medical Physiology.

Boston: McGraw-Hill, 2003.

9. Udupa KN, Singh RH, and Settiwar RM. Studies

on the effect of some yogic breathing exercises

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10. Anjum Sayyed1, Jyotsna Patil, Vilas Chavan,

Shrirang Patil,Sujeet Charugulla , Ajit Sontakke

and Neelima Kantak, Study of lipid profile and

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International Journal of Medical & Pharmaceutical Sciences Research and Review Vol. 1 (4)

INTERNATIONAL JOURNAL OF MEDICAL & PHARMACEUTICAL SCIENCES RESEARCH & REVIEW

Research Article…..!

Received: 20-10-2013; Accepted: 11-11-2013

EFFECT OF 12 WEEKS OF KAPALABHATI PRANAYAMA TRAINING ON CARDIO-RESPIRATORY PARAMETERS IN YOUNG, HEALTHY

VOLUNTEERS OF JIPMER POPULATION

Dinesh T1,Gaur G S2, Sharma V K3,Velkumary S4, Ananda Balayogi Bhavanani 5

1 Department of Physiology, Vinayaka Mission’s Medical College, Karaikal – 609605. 2Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry – 605006. 3Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry – 605006. 4Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry – 605006 5Deputy Director, CYTER, Mahatma Gandhi Medical College and Research Institute, Puducherry - 607 402.

Corresponding Author: Dr. Dinesh T, Assistant Professor.

ABSTRACT

BACKGROUND

In the recent decades, interest has been increasing all over the world in the

applications of yogic techniques in the field of therapeutics and research.

Pranayama are breathing techniques that exert profound physiological effects on

pulmonary, cardiovascular and mental functions.



OBJECTIVE

To study the effect of 12 weeks of Kapalabhati pranayama training on cardio-

respiratory parametersin healthy, young subjects.

KEYWORDS: Kapalabhati pranayama, Heart Rate, Blood Pressure, Respiratory

rate.

INTRODUCTION

Yogic system was developed by the sages of India which has been practiced

down the ages. In the recent decades, interest has been increasing all over the

world in the applications of yogic techniques in the field of therapeutics and

research. With increased awareness and interest in alternative and complementary

remedies, yogic techniques including pranayama are gaining importance and

becoming acceptable to the public as well as scientific community(1). Pranayama

are breathing techniques that exert profound physiological effects on pulmonary,

cardiovascular and mental functions. The science of pranayama deals with the

knowledge, control and enrichment of this vital force which results in rhythmic

respiration, calm and alert state of mind. Pranayama has variable effect on cardio-

respiratory system (2). Regular practice of pranayama improves cardio-vascular

and respiratory functions, improves autonomic tone towards parasympathetic

system, decreases the effect of stress and strain on the body and improves

physical and mental health (1, 3, 5). The word kapalbhati is made up of two words:

kapal meaning 'skull' (here skull includes all the organs under the skull too) and

bhati meaning 'shining, illuminating'. The technique of Kapalabhati involves

short and strong forceful exhalations and inhalation happens automatically. The

aim of the study is to find out the beneficial effects of Kapalabhati pranayama

training on cardio-respiratory parameters in young, healthy, volunteers of both

genders.



MATERIALS AND METHODS

The Present study was conducted in Department of Physiology, JIPMER on 62

healthy volunteers. The distribution was n=32 Pranayama training group and

control groups n=30. Kapalabhati pranayama started with 30 times for 1 min and

increased to 5 minutes/day, twice daily, thrice/ week for 12 weeks. Cardio-

respiratory parameters including resting heart rate (HR), systolic blood pressure

(SBP) and diastolic blood pressure (DBP) measured after 10 minutes of supine

rest.Respiratory rate (RR) was recorded before and after 12 weeks of study

period.

The Present study was conducted in Department of Physiology, JIPMER on 62

healthy volunteers of both genders, after obtaining clearance from the Institute

Ethics Committee. Subjects were randomized into pranayama (n=32) and control

groups (n=30), after getting informed, written consent. Mean age of the

volunteers was 18.54 + 1.65 yrs. The subjects were familiarized with the aim and

objective of the study as well as laboratory environment.

PARAMETERS ANALYZED

Cardio-respiratory parameters including resting HR, SBP and DBP were

measured after 10 minutes of supine rest using digital BP monitor (Citizen- CH

432B, Japan) and respiratory rate (RR) was recorded passively by observing the

abdominal movements while recording the HR and BP. The same procedure was

followed while recording post values at the end of 12 weeks of pranayama

training.



PRANAYAMA TRAINING

Supervised pranayama training was given to the study group by a certified yoga

instructor at Advanced Centre for Yoga Therapy Education and Research

(ACYTER), JIPMER, Puducherry according to the guidelines of Morarji Desai

National Institute of Yoga, New Delhi and they practiced Kapalabhati pranayama

started with 30 times or one minute and increased to 5 minutes/day, twice daily,

thrice/week for 12 weeks. Rests of the days, subjects were motivated to practice

at their home. Control group did not involve in any pranayama training during

this 12 weeks study period.

STATISTICAL ANALYSIS

Data for all parameters at baseline and post test were collected according to the

study protocol and computerized in Microsoft Excel database. Data were

summarized by using descriptive statistics such as percentage, mean and SD for

different parameters. Longitudinal changes in each group were compared by

using Student’s paired t-test. P<0.05 was considered statistical significant.

RESULTS

Pranayama training resulted in marginal decrease (P>0.05) in all basal

cardiovascular parameters while RR decreased significantly (P<0.01). On the

other hand, there was a significant (P<0.05) increase in RR.

Mean age of the volunteers was (18.54 + 1.65). The analysis on the effect of 12

Weeks of Kapalbhati pranayama on cardio-respiratory parameters has been given

in Table No.1 that shows a significant decrease in RR from 17.34 ± 2.09 to 16.41

± 0.61(P=0.03) and Marginaldecrease in other parameters (P>0.05) such as SBP,

DBP and HR.



Table. 1 Effect of 12 weeks of Kapalabhati pranayama training (n=32) on cardio-

respiratory parameters: heart rate (HR), systolic blood pressure (SBP), diastolic

blood pressure (DBP) and respiratory rate (RR). Values are expressed as mean ±

SD.

Parameters Before pranayama training After pranayama training

HR(beats/min) 85.47 ± 10.47 83.75 ± 8.91**

SBP (mmHg) 112 ± 11.71 110.68 ± 10.74*

DBP (mmHg) 72.44 ± 10.92 72.16 ± 9.52*

RR(beats/min) 17.34 ± 2.09 16.41 ± 0.61***

Analysis done by Student’s paired t-test. *P<0.05, **P<0.01, ***P<0.001.

Table. 2 Changes in control group (n=30) after 12 weeks of study period

oncardio-respiratory parameters: heart rate (HR), systolic blood pressure (SBP),

diastolic blood pressure (DBP) and respiratory rate (RR). Values are expressed as

mean ± SD.

Parameters Before 12 weeks study period After 12 weeks study period

HR (beats/min) 86.33 ± 9.65 87.47 ± 7.78*

SBP (mmHg) 107.23 ± 13.55 111.4 ± 11.24**

DBP (mmHg) 71.45 ± 6.791 73.73 ± 9.239*

RR(beats/min) 17.23 ± 1.22 18.33 ± 1.81*

Analysis done by Student’s paired t-test. *P<0.05, **P<0.01, ***P<0.001.



DISCUSSION

Pranayama involves manipulation of breath movement and the breath is a

dynamic bridge between the body and mind. The psychosomatic effects of

different pranayama are believed to derive from differences in duration of the

phases of the breathing cycle, tidal volume and other factors including the use of

mouth, nostrils, and constriction of the laryngeal muscles and position of the

glottis (6). Resting HR is determined mainly by parasympathetic tone and

decrease in HR and BP indicates a decrease in sympathetic activity and / or

increase in parasympathetic activity (7,8). Our results demonstrate that there was a

significant reduction in RR in pranayama group. On the contrary, there was a

significant increase in RR in the control group. There was statistically

insignificant, but definite trend towards decrease in HR, SBP and DBP in the

pranayama group. According to the traditional wisdom of yoga, pranayama is the

key for bringing about psychosomatic integration and harmony. By voluntarily

controlling breathing pattern, it is possible to influence ANS functions (9). Very

few references are available on the effect of fast pranayama training on cardio-

respiratory parameters in individuals. Our results are in agreement with that of

Raghu raj et al in 1998 found practicing fast pranayama like Kapalabhati for 12

weeks lead to decrease in sympathetic activity and are not in agreement with

observations of few other studies. Madanmohan et al in 2005 evaluated short-

term effect of three weeks of fast pranayama (bhastrika) practice on cardio-

respiratory variables and reported an increase in sympathetic activity whereas Pal

et al in 2004 found no change in autonomic activity by the practice of 12 weeks

of Kapalabhati pranayama (10,11). Another study conducted by Kullok et al in

1990 explained changes in autonomic activity by breathing exercises on the basis

of known anatomical asymmetries in the respiratory, cardiovascular and nervous

system and that the coupling mechanisms between each of these systems: lung-

heart, heart-brain and lungs-brain are also asymmetrical (13). We propose that



these changes may have occurred by pranayama practice due to improved

autonomic tone towards parasympathodominance resulting in hypo metabolic

state, relaxed state of mind and improved cardiac vagal tone. When the mind is

relaxed and resting, parasympathetic activity increases and RR decreases.

Increase in parasympathetic activity decreases resting HR and decrease in

sympathetic tone in skeletal muscle, blood vessels, decreases peripheral vascular

resistance and hence, decrease in DBP and improved tissue perfusion. Further our

study substantiates the claim that Kapalabhati pranayama practice is beneficial on

cardio-respiratory function in healthy, volunteers.

CONCLUSION

12 weeks of Kapalabhati pranayama training showed improvement in the cardio-

respiratory parameters with significant decrease in RR may be attributed to a

calm and stable mind-emotion complex in our subjects. Hence we conclude that

pranayama training is useful in reducing RR through psycho-somatic

mechanisms and that this enhances the health and well being of young subjects.

ACKNOWLEDGEMENT

we acknowledge programme director, coordinator, yoga instructors of ACYTER,

JIPMER. Author would like to thank Professors, Assistant Professors, Ph. D,

scholars of Department of Physiology, JIPMER who helped us for the conduct of

this project.



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3. Udupa KN, Singh RH. (1972) The scientific basis of yoga. JAMA; volume 220(10): PP1365

4. Wallace RK, Benson H, Wilson AF. A wakeful hypo metabolic physiologic state.( 1971) American J Physiology; volume 221(3): 795-99.

5. Bhargava R, Gogate MG, Mascarenhas JF. (1988 )Autonomic responses to breath holding and its variations following pranayama. Indian J Physiology Pharmacol; volume 32(4): PP 257-64.

6. Telles, Desiraju T. Heart rate alterations in different types of pranayama. (1992) Indian J PhysiologyPharmacology; volume 36(4): PP 287-88.

7. Gopal KS, Bhatnagar OP, Subramanian N, Nishith SD. (1973); Effect of yogasanas and pranayama on BP,pulse rate and some respiratory functions. IndianJ Physiology Pharmacology volume17: PP 273–76.

8. Upadhyay DK, Malhotra V, Sarkar D, (2008) Prajapati R. Effect of alternate nostril breathing exercise on cardio respiratory functions. Nepal Med Coll J; volume10(1): PP 25-27.

9. Jerath R, Edry JW, Branes VA, Jerath V. (2006) Physiology of long pranayama breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses PP 67:56–71.

10. Raghu raj P, Ramakrishna AG, Nagendra HR. (1998 )Effect of two related yogic breathing techniques on heart rate variability. Indian J Physiology Pharmacology volume; 42(4): PP 467-72.

11. Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. (2005) Effect of slow and fast pranayamas on reaction time and cardiorespiratory variables. Indian J PhysiologyPharmacology volume; 49: PP 313–18.



12. Pal GK, Velkumary S, Madanmohan(2004). Effect of short- term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Research; volume 120:PP115–21.

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Volume 2 • Issue 9 • 1000144Altern Integ MedISSN: 2327-5162 AIM, an open access journal

Open AccessResearch Article

Alternative & Integrative MedicineBhavanani et al., Altern Integ Med 2013, 2:9

http://dx.doi.org/10.4172/2327-5162.1000144

Keywords: Yoga therapy; Cardiovascular effects; Psycho-somatic harmony

IntroductionHumanity is today faced with numerous debilitating chronic

illnesses related to aging, environment and an increasingly hedonistic lifestyle. These illnesses include cancer, diabetes, osteoporosis, and cardiovascular disease, as well as incurable diseases such as AIDS. While modern medicine has much to offer in its treatment of acute illness, accidents and communicable diseases, it cannot provide all the solutions for the many ills that plague 21st century (woman). Yoga, as a complement to modern medicine, can be especially useful in helping to fill in the gaps in the fields of disease prevention, management and rehabilitation. When combined, modern medicine and yoga turn out to be more than the sum of their parts. What is the source of this synergy between modern and ancient science? While modern science looks outward for the cause of all ills, the yogi searches the depths of their own self, finding therein many of the answers he needs to maintain a vital equilibrium. The combination of the outward and inward search proves to be more effective than either alone.

Dr. Dean Ornish, the renowned American physician and author who has shown that a yogic lifestyle can reverse heart disease, says, “Yoga is a system of perfect tools for achieving union as well as healing” [1]. Dr. B. Ramamurthy, the eminent neurosurgeon, has observed that yoga practice reorients the functional hierarchy of the entire nervous system [1]. He has also noted that yoga benefits the cardiovascular, respiratory, digestive, and endocrine systems, in addition to bringing about other positive biochemical changes. For humanity to take full

advantage of its birthright of health and happiness, it is imperative that modern, science-based medicine integrate the holistic approach of traditional healing techniques like yoga. Only in this way can medical practitioners provide true health care, as opposed to merely caring for the sick. The result will be an improvement in the quality of health, and life, around the world.

Numerous studies have been done in the past few decades on psycho-physiological and biochemical changes occurring following practice of yoga [2-9]. A few clinical trials have also shown promise despite yoga not being ideally suited for the scientific gold standard of ‘double-blind’ clinical trials [10,11] and though we are truly yet to research and understand subtler effects of yoga [12]. Evidence is also growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health and wellbeing [13]. It has been rightly pointed out that yoga is qualitatively different from any other mode of physical activity in that it consists of a unique combination of isometric

*Corresponding author: Ananda Balayogi Bhavanani, CYTER, Mahatma Gandhi Medical College & Research Institute, Pillayarkuppam, Pondicherry 607402, India, Tel: 91-413-2622902; E-mail: [email protected]

Received September 28, 2013; Accepted November 11, 2013; Published November 13, 2013

Citation: Bhavanani AB, Ramanathan M, Madanmohan (2013) Immediate Cardiovascular Effects of a Single Yoga Session in Different Conditions. Altern Integ Med 2: 144. doi:10.4172/2327-5162.1000144

Copyright: © 2013 Bhavanani AB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Immediate Cardiovascular Effects of a Single Yoga Session in Different ConditionsAnanda Balayogi Bhavanani1*, Meena Ramanathan1 and Madanmohan2

1Centre for Yoga Therapy, Education and Research, Mahatma Gandhi Medical College & Research Institute, Pillayarkuppam, Pondicherry, India 2Department of Physiology, Mahatma Gandhi Medical College & Research Institute, Pondicherry, India

AbstractAim and objective: This retrospective review of clinical data was done to determine cardiovascular effects of a

single yoga session in normal subjects as well as patients of different medical conditions.

Methods: Data of 1896 patients (1229 female, 633 male and 34 transgender) with mean age of 36.28 ± 12.64 y who attended yoga therapy sessions at CYTER between November 2010 and September 2012 was used for analysis. Heart rate (HR), systolic (SP) and diastolic pressure (DP) had been recorded using non-invasive blood pressure (NIBP) apparatus before and after 60 minute yoga sessions at CYTER and indices like pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and double product (DoP) were derived from recorded parameters. Participants were undergoing appropriate yoga therapy protocols as per their individual condition while normal subjects had a general schedule of practice. Typical yoga sessions included simple warm ups (jathis and surya namaskar), breath body movement coordination practices (kriyas), static stretching postures (asana), breathing techniques (pranayama), relaxation and chanting.

Results: There were statistically significant (p<0.001) reductions in all the studied cardiovascular parameters following the yoga session. The magnitude of reductions differed in the groups, it being more significant in those having hypertension (n=505) and less significant in those having endocrine/skin (n=230) and musculoskeletal (n=120) conditions. It was moderately significant in the normal subjects (n=582) as well as patients having psychiatric (n=302) and respiratory (n=157) conditions.

Conclusion: There is a healthy reduction in HR, BP and derived cardiovascular indices following a single yoga session. The magnitude of this reduction depends on the pre-existing medical condition as well as the yoga therapy protocol adopted. These changes may be attributed to enhanced harmony of cardiac autonomic function as a result of coordinated breath-body work and mind-body relaxation due to yoga.

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muscular contractions, stretching exercises, relaxation techniques, and breathing exercises [14].

There are only a few studies that have focused on the immediate effects of a single yoga session and these include one that investigated the effectiveness of a single 90-minute hatha yoga class and concluded that it can significantly reduce perceived stress [15]. Another recent study showed that cognitive performance after a yoga session was significantly superior as compared with an aerobic session [16]. A recent report on the acute effects of one session of hatha yoga practice on blood pressure and other cardiovascular responses in healthy volunteers has showed that systolic (SP), mean (MP), and diastolic (DP) blood pressures increased significantly during the yoga practice [14]. However they have not compared the pre-post effects of the entire session and only focused on the individual techniques during the session.

With the above in mind, this retrospective review of data was done to determine cardiovascular effects of a single 60-minute yoga session in normal subjects as well as patients of different medical conditions.

Materials and MethodsThis retrospective review of clinical data was conducted at the Center

for Yoga Therapy Education and Research (CYTER) functioning in Mahatma Gandhi Medical College and Research Institute, Puducherry,

India. CYTER is conducting regular yoga therapy sessions daily for patients of different conditions as well as normal subjects. Data of 1896 patients (1229 female, 633 male and 34 transgender) with mean age of 36.28 ± 12.64 y who attended yoga therapy sessions at CYTER between November 2010 and September 2012 was used for analysis. These sessions were carried out in CYTER Yoga hall between 10 AM and 12 noon on weekdays in a quiet environment, with a comfortable temperature and subdued lighting. The participants had been advised to finish their breakfast at least 2 hours earlier and come after emptying bowel and bladder.

Heart rate (HR), SP and DP had been recorded before and after the 60 minute yoga sessions at CYTER. To ensure objectivity, all recordings were performed using non-invasive semi-automatic BP monitor (CH-432, Citizen Systems, Tokyo, Japan) with an instrumental accuracy of ± 5% for HR and ± 3 mm Hg for BP. Pre intervention HR and BP was recorded after 5 min of supine rest while the post-intervention recordings were taken at the end of the session in supine position. Cardiovascular indices like pulse pressure (PP), MP, rate-pressure product (RPP) and double product (DoP) were derived from the recorded parameters.

The participants were undergoing appropriate yoga therapy protocols as per their individual condition (Table 1) while normal

Yogic technique Normal subjects

Endocrine and skin disorders

Respiratory disorders

Hypertension & CV disorders

Musculo-skeletal disorders

Psychiatric disorders

Jathis & kriyas (loosening techniques) √ √ √ √ √ √Aruna surya namaskar (slow, breath coordinated) √ √ √Standing asanasTrikona asana √ √ √ √Veera asana 1 & 2 √ √ √Tada asana √ √ √ √Ardhakati & kati chakra asana √ √ √Mehru asana & nasarga mukha bhastrika √ √Ardha utkat asana √ √Sitting asanasVakra asana √ √ √ √ √Paschimottana/purvottana asana √ √ √ √ √Matsya asana √ √ √ √Chatuspada kriya/vyagraha pranayama √ √ √Danda kriya √ √Ashwini mudra/moola bandha √Face prone asanasBhujanga asana/ bhujangini mudra √ √ √ √ √Ardha shalaba asana √ √ √Makara asana √ √ √ √ √Supine asanasPawanamukta series √ √ √ √ √Pada uttana series √ √ √ √ √Sethu kriya √RelaxationSavitri pranayama in shava asana √ √ √ √ √ √Marmanasthanam/kaya kriya √ √ √ √ √ √PranayamasMukha bhastrika √ √ √Chandra nadi/bhedana √ √ √ √Surya nadi/bhedana √Pranava √ √ √ √ √ √Bhramari √ √ √ √ √ √Nadi shuddhi √ √ √ √ √ √

Table 1: Yoga therapy protocols adopted for different groups with minor individual variations as per their psycho-physical condition and abilities.

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subjects had a general schedule of practice. Typical yoga sessions included simple warm ups (jathis and surya namaskar), breath body movement coordination practices (kriyas), static stretching postures (asana), breathing techniques (pranayama), relaxation and chanting. At our centre, we are using the yoga therapy methods and schedules as elucidated in Yoga Chikitsa: The Application of Yoga as a Therapy authored by Yogacharya Dr. Ananda Balayogi Bhavanani, published by Dhivyananda Creations, Pondicherry, India 2013.

Data were assessed for normality using GraphPad InStat version 3.06 for Windows 95, (GraphPad Software, San Diego California USA, www.graphpad.com). As all data passed normality testing by Kolmogorov-Smirnov Test, statistical analysis was carried out using Student’s paired t test and ‘p’ values less than 0.05 were accepted as indicating significant differences for pre-post comparisons (Tables 1 and 2).

ResultsThe results are given in Tables 2 and 3. There were statistically

significant (p<0.001) reductions in all the studied cardiovascular parameters following the yoga session in the overall analysis. The magnitude of reductions differed in the groups, it being more significant in those having hypertension (n=505) and less significant

in those having endocrine/skin (n=230) and musculoskeletal (n=120) conditions. It was moderately significant in the normal subjects (n=582) as well as patients having psychiatric (n=302) and respiratory (n=157) conditions.

Discussion There is a healthy reduction in HR, BP and derived cardiovascular

indices following a single yoga therapy session. The magnitude of this reduction appears to depend on the pre-existing medical condition as well as the yoga therapy protocol adopted.

Reductions in various cardiovascular parameters following a single session of yoga implies better autonomic regulation of the heart in our subjects. This can be attributed to either an overall increase of parasympathetic tone and/or a reduction in sympathetic tone. RPP and Do P are indirect indicators of myocardial O2 consumption and load on the heart, thereby signifying a lowering of strain on the heart [17,18]. Sympathetic activation is known to increase HR and RPP and decrease overall heart rate variability (HRV). RPP provides a simple measure of HRV in hypertensive patients and is a surrogate marker in situations where HRV analysis is not available [19]. It has also been shown that SDNN and total power of HRV are inversely correlated with mean HR and RPP [17].

Groups HR SP DPB A B A B A

Normal subjects (n=582)

79.93 ± 8.33 77.14 ± 7.40*** 115.35 ± 10.42 114.45 ± 9.36* 74.37 ± 9.46 73.48 ± 7.11*

Endocrine/skin (n=230)

80.05 ± 9.46 78.06 ± 8.54*** 111.65 ± 10.64 112.51 ± 10.04 70.77 ± 9.00 71.88 ± 7.40 *

Respiratory (n=157)

78.55 ± 7.76 76.36 ± 6.35 ** 112.32 ± 6.75 111.18 ± 5.57* 72.94 ± 6.52 72.79 ± 5.97

Hypertension (n=505)

78.50 ± 7.38 75.84 ± 6.71*** 129.04 ± 14.65 124.98 ± 11.35*** 80.59 ± 9.96 79.10 ± 8.39***

Musculo-skeletal (n=120)

77.78 ± 7.25 75.80 ± 6.49 * 112.98 ± 12.14 112.03 ± 9.13 72.59 ± 9.12 73.30 ± 7.31

Psychiatry (n=302)

81.53 ± 9.81 78.66 ± 9.06 *** 115.06 ± 11.54 112.86 ± 10.56 *** 74.01 ± 9.18 73.50 ± 8.02

Total (n=1896)

79.55 ± 8.44 77.00 ± 7.61*** 118.13 ± 13.58 116.39 ± 11.29 *** 75.3 ± 9.85 74.76 ± 8.04 ***

*p<0.05 **p<0.01 ***p<0.001 by Student’s paired t test of pre-post comparisons.

Table 2: Heart rate (HR), systolic pressure (SP) and diastolic pressure (DP) before (B) and after (A) a single session of yoga therapy in different groups.

Groups PP MP RPP DoPB A B A B A B A

Normal subjects (n=582)

40.98 ± 9.70 40.97 ± 8.03 88.03 ± 8.66 87.14± 6.97** 92.23 ± 13.11 88.37 ± 11.84*** 70.43 ± 10.77 67.32 ± 9.18***

Endocrine/skin (n=230)

40.88 ± 7.94 40.63 ± 8.16 84.39 ± 8.82 85.42 ± 7.44 * 89.25 ± 12.98 87.90 ± 13.04 67.47 ± 10.22 66.74 ± 9.77

Respiratory (n=157)

39.38 ± 7.32 38.39 ± 5.84 86.07 ± 5.62 85.59 ± 5.15 88.33 ± 11.12 84.91 ± 8.46** 67.67 ± 8.46 65.33 ± 6.49**

Hypertension (n=505)

48.45 ± 12.46 45.88 ± 10.59*** 96.74 ± 10.6 94.39 ± 8.06*** 101.59 ± 17.08 94.91 ± 12.99*** 76.19 ± 12.55 71.71 ± 9.80***

Musculo-skeletal (n=120)

40.39 ± 9.77 38.73 ± 6.28* 86.06 ± 9.13 86.21 ± 7.39 87.99 ± 13.34 85.00 ± 10.76* 67.08 ± 10.18 65.43 ± 8.57*

Psychiatry (n=302)

41.05 ± 7.70 39.36 ± 8.65** 87.69 ± 9.35 86.62 ± 7.96** 93.90 ± 15.33 88.82 ± 13.53*** 71.55 ± 11.92 68.16 ± 10.22***

Total (n=1896)

42.83 ± 10.50 41.63 ± 9.08*** 89.58 ± 10.8 88.63 ± 8.20*** 94.03 ± 15.28 89.66 ± 12.76*** 71.33 ± 11.64 68.30 ± 9.63***

*p<0.05 **p<0.01 ***p<0.001 by Student’s paired t test of pre-post comparisons. Table 3: Pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and double product (DoP) before (B) and after (A) a single session of yoga therapy in different groups.

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A previous report on the acute effects of one session of hatha yoga practice on blood pressure and other cardiovascular responses in healthy volunteers showed that SP, MP and DP increased significantly during the yoga practice [14]. The elevation in blood pressure due to yoga practice was associated with increases in cardiac output and HR, which are responses similar to those observed in isometric exercise. However it is to be noted that for each posture during the yoga practice, that study continuously measured HR, SP, DP, MP, stroke volume, and cardiac output. On the other hand we have only evaluated the pre-post effects and hence are commenting on the overall effects of the yoga sessions rather than individual practices. The conscious self-effort made in asana practice may be understood as the spanda (tension) component whereas the relaxation of effort (prayatna shaithilya) may be understood as the nishpanda (relaxation) component. Even Maharishi Patanjali tells us that the pair of opposites (dwandwa) is transcended (dwandanabigata) when one perfects the state of asana. Hence, it is essential to physiologically evaluate not only the actual performance of an asana, but also the period of recovery following it.

A study by Telles et al. [20] studied O2 consumption and respiration following four yoga postures interspersed with relaxation and supine relaxation alone, and concluded that the combination of stimulating and relaxing techniques reduced physiological arousal better than the mere practice of relaxation techniques alone [20]. They also pointed out that though the practical performance of yoga techniques seem to be stimulatory in nature, their physiological effects are in fact more relaxatory. This is corroborated by a previous study reporting that shavasana relaxation is enhanced with the addition of savitri pranayama thus decreasing O2 consumption by 26% [21].

All the yoga therapy protocols adopted at CYTER have a major component of pranayama and yogic relaxation. We hypothesize that this may be the main factor that is producing cardiac autonomic balance in most of our subjects irrespective of their initial condition. We also noticed that the reductions were greater in those who had abnormal readings in the initial testing as opposed to those in whom the initial readings were within normal range. It is traditionally taught that yoga is the state of balance (samatvam yoga uchyate-Bhagavad Gita) and this restoration of physical, mental, emotional and spiritual balance may be the prime factor behind the changes seen across groups.

The above findings of our retrospective data analysis are in agreement with a previous suggestion that yoga appears to modulate stress response systems by reducing perceived stress and anxiety, which in turn, decreases physiological arousal with decreases in HR and BP and respiration [13].

ConclusionThere is a healthy reduction in HR, BP and derived cardiovascular

indices following a single yoga session. The magnitude of this reduction depends on the pre-existing medical condition as well as the yoga therapy protocol adopted. These changes may be attributed to enhanced harmony of cardiac autonomic function as a result of coordinated breath-body work and mind-body relaxation due to yoga.

Acknowledgments

The authors thank the management and authorities of Sri Balaji Vidyapeeth University for setting up the Centre for Yoga Therapy, Education and Research (CYTER) in Mahatma Gandhi Medical College and Research Institute (MGMCRI). We are grateful to Yogacharini Meenakshi Devi Bhavanani, Director ICYER for her constant motivation and supportive guidance. Thanks are due to Yoga instructors Mrs D Pushpa and Dr. R Balaji for conducting the therapy sessions and for their valuable assistance during recording sessions and data entry.

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1. Bhavanani AB (2012) Understanding the science of yoga. Yoga Mimamsa 44: 228-245.

2. Khalsa SB (2004) Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol 48: 269-285.

3. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Babu K (2004) Modulation of stress induced by isometric handgrip test in hypertensive patients following yogic relaxation training. Indian J Physiol Pharmacol 48: 59-64.

4. Manjunatha S, Vempati RP, Ghosh D, Bijlani RL (2005) An investigation into the acute and long-term effects of selected yogic postures on fasting and postprandial glycemia and insulinemia in healthy young subjects. Indian J Physiol Pharmacol 49: 319-324.

5. Yang K (2007) A review of yoga programs for four leading risk factors of chronic diseases. Evid Based Complement Alternat Med 4: 487-491.

6. Sengupta P (2012) Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. Int J Prev Med 3: 444-458.

7. Madanmohan, Bhavanani AB, Dayanidy G, Sanjay Z, Basavaraddi IV (2012) Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients. Int J Yoga 5: 10-15.

8. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP (2012) Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 78: 571-579.

9. Madanmohan, Bhavanani AB, Zeena S, Vithiyalakshmi L, Dayanidy G (2013) Effects of a comprehensive eight week yoga therapy programme on cardiovascular health in patients of essential hypertension. IJTK 12: 535-554.

10. Innes KE, Bourguignon C, Taylor AG (2005) Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract 18: 491-519.

11. Innes KE, Vincent HK (2007) The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review. Evid Based Complement Alternat Med 4: 469-486.

12. Bhavanani AB (2011) Don’t put yoga in a small box: the challenges of scientifically studying yoga. Int J Yoga Therap: 21.

13. (2009) Yoga for anxiety and depression. Studies suggest that this practice modulates the stress response. Harv Ment Health Lett 25: 4-5.

14. Miles SC, Chun-Chung C, Hsin-Fu L, Hunter SD, Dhindsa M, et al. (2013) Arterial blood pressure and cardiovascular responses to yoga practice. Altern Ther Health Med 19: 38-45.

15. Huang FJ, Chien DK, Chung UL (2013) Effects of Hatha yoga on stress in middle-aged women. J Nurs Res 21: 59-66.

16. Gothe N, Pontifex MB, Hillman C, McAuley E (2013) The acute effects of yoga on executive function. J Phys Act Health 10: 488-495.

17. Madanmohan, Prakash ES, Bhavanani AB (2005) Correlation between short-term heart rate variability indices and heart rate, blood pressure indices, pressor reactivity to isometric handgrip in healthy young male subjects. Indian J Physiol Pharmacol 49: 132-138.

18. Bhavanani AB, Sanjay Z, Madanmohan (2011) Immediate effect of sukha pranayama on cardiovascular variables in patients of hypertension. Int J Yoga Therap: 73-76.

19. Prakash ES, Madanmohan, Sethuraman KR, Narayan SK (2005) Cardiovascular autonomic regulation in subjects with normal blood pressure, high-normal blood pressure and recent-onset hypertension. Clin Exp Pharmacol Physiol 32: 488-494.

20. Telles S, Reddy SK, Nagendra HR (2000) Oxygen consumption and respiration following two yoga relaxation techniques. Appl Psychophysiol Biofeedback 25: 221-227.

21. Madanmohan S, Rai UC, Balavittal V, Thombre DP, Gitananda S (1983) Cardiorespiratory changes during savitri pranayama and shavasan. The Yoga Review 3: 25-34.


http://dx.doi.org/10.4172/2327-5162.1000144

http://dx.doi.org/10.4172/2327-5162.1000144

http://www.ncbi.nlm.nih.gov/pubmed/15648399







http://nopr.niscair.res.in/handle/123456789/19447










https://www.ncbi.nlm.nih.gov/m/pubmed/15854164/?i=5&from=/8899250/related



Bhavanani AB et al., 2013 17

International Research Journal of Pharmaceutical and Applied

Sciences (IRJPAS) Available online at www.irjpas.com

Int. Res J Pharm. App Sci., 2013; 3(6):17-23

HEMATOLOGICAL, BIOCHEMICAL AND PSYCHOLOGICAL EFFECTS OF A YOGA

TRAINING PROGRAMME IN NURSING STUDENTS Ananda Balayogi Bhavanani

1*, Meena Ramanathan

2, Madanmohan

3, Srinivasan Ar

4

1 Deputy Director, CYTER, MGMCRI, Pillayarkuppam, Pondicherry 607402. 2 Co-ordinator and Yoga therapist, CYTER, MGMCRI, Pondicherry.

3 Professor and Head, Department of Physiology, MGMCRI, Pondicherry. 4 Professor, Department of Biochemistry, MGMCRI and Registrar, Sri Balaji Vidyapeeth University, Pondicherry.

Corresponding Author: Ananda Balayogi Bhavanani; Email: [email protected]

Abstract: Background: We were granted the opportunity to impart a 6 month comprehensive course of yoga training for nursing students. The aim of this study was to analyse the effects of the training on the participants´ health and quality of life

(QoL) Materials and Methods: 60 healthy nursing students (12 M, 48 F) aged 18.60 ± 0.67 (SD) y were recruited, and 60 min of

yoga training was given twice weekly, for 6 months. Selected biochemical and hematological parameters were recorded along

with Ferrans and Powers QoL index before and after the training period. QoL was also tested at mid term. Because we were not

able to establish a separate control group, we correlated changes with the subjects´ frequency of attendance.Results: Post-

intervention statistical analysis (repeated measures of ANOVA) revealed highly significant and beneficial changes in most hematological and biochemical parameters. Major findings are enhanced bone marrow function, reduced allergic tendency,

alkalization of urine, metabolic reconditioning (with special emphasis on liver function) and improvement in all QoL indices.

These changes correlated positively with the subjects´ frequency of attendance, as evidenced by Pearson‟s linear correlation

testing. There were also significant improvements in QoL index and its subscales, both at mid training and post training. These

improvements also correlated positively with attendance. Conclusion: The present study provides evidence of the beneficial

psychological and physical effects of yoga training amongst graduate nursing course students . We suggest that yoga be made an

integral part of medical and paramedical collegiate education.

Key words: psycho-physical health, quality of life, yoga

INTRODUCTION

Holistic health, integrative treatment and mind–

body medicine are some of the current buzz words in health

care. Integrative medicine is gaining in popularity and, here,

yoga has the potential to make a significant contribution.

The art and science of yoga has been practised for thousands of years. Recently, numerous scientists have studied its

effects and reported consistent, beneficial physiological and

psychological changes. (1-10) Yoga may be considered the

original mind-body medicine; its philosophy and practice

are highly effective in producing psycho-somatic and

somato-psychic re-integration. Yoga improves mood and

reduces stress by emphasizing every-moment body

awareness involving attentional focus on one‟s breathing,

emotions, thoughts or specific parts of the body. (11) These

responses may be mediated by frontal lobe structures, whose

physiological markers, such as reaction time, have shown improvement in short-term and long-term yoga training

programmes. (1,5,10)

Practitioners of yoga claim that it provides one of

the best means for self-improvement and enables the

manifestation of one‟s highest physical, mental, emotional

and spiritual potential. Such improvements in mental and

emotional well-being enhance one‟s ability to manage

stress. This has been documented in normal volunteers and

patients suffering from lifestyle disorders. (12,13) It has been

suggested that yoga enhances mood, balances emotions and

modulates activity of hypothalomo-pituitary-adrenal (HPA)

axis. (3,4,14) )It reduces allostatic load in stress response

systems, restoring optimal homeostasis by normalizing

parasympathetic nervous system and GABA under-activity.(15) Another recent study detailed the

psychophysiological benefits of Yoga training in a

paramedical student population, reporting improvements in

anthropometric, cardiovascular and neurological parameters,

coupled with positive changes in heart rate variability

(HRV) and Quality of Life (QoL) indices, signifying a

healthier state of body and mind. (16)

Authorities of Kasturba Gandhi Nursing College

requested the authors to impart yoga training to students

enrolled in their Bachelor of Nursing course. This opportunity was used to study hematological, biochemical

and QoL indices, in order to help students understand the

effects of their yoga training and to scientifically validate

those effects.


Sixty apparently healthy nursing students (12 M, 48 F),

aged 18.60 ± 0.67 (SD) years, who were novices to yoga

took part in the present study after granting informed

Research Article

http://www.irjpas.com/




consent. Because yoga training was part of their co-

curricular activity, we devised a 6-month comprehensive

training programme. The programme was delivered in

twice-weekly, 60 min sessions and included the following

components:

1. Brief theory of yoga and its practices and their

benefits.

2. Jathis (loosening practices) and kriyas (breath-

body coordination practices).

3. Surya namaskar (sun salutation) with breath

awareness. 4. Yogasanas (postures): trikona (triangle), nataraja

(cosmic dancer), veera–I, II & III (warrior), vriksha

(tree), pashchimottana (posterior stretch),

purvottana (anterior stretch), chatushpada (four

footed), ushtra (camel), matsya (fish), janushirasa

(head to knee), vakra (twist), ardhamatsyendra

(half twist), makara (crocodile), bhujanga (cobra),

shalabha (locust), dhanura (bow), pada-uttana (leg

lift), pavana mukta (wind releasing), viparitakarani

(topsy-turvy), hala (plough), sarvanga (pan limb)

and shava (corpse) asanas.

5. Pranayamas (breathing techniques): mukha bhastrika (oral bellows), vyagraha (tiger), surya

nadi (sun channel), chandra nadi (moon channel),

pranava (AUM chanting breath), nadishuddhi

(alternate nostril-I), aloma viloma (alternate nostril-

II) and sadanta pranayamas (cooling breath).

6. Relaxation: shavasana with savitri pranayama (2:1

ratio breathing in corpse posture), kayakriya

(dynamic body relaxation), marmanasthanam kriya

(sequential relaxation) and yoga nidra (yogic

sleep).

The following hematological and biochemical

parameters were tested by qualified technicians in the

Central Laboratory of the hospital before and after the 6

month training period:

1. Total and differential leucocyte (WBC) counts,

ESR at ½ and 1hr, erythrocyte (RBC) count,

platelet count, hemoglobin (Hb) and hematological

indices.

2. Urine pH.

3. Random blood sugar, urea, creatinine, total

cholesterol (TC), triacylglycerols (TG), high

density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL ) and

ratios calculated for TC / HDL, TC / LDL, HDL /

LDL, LDL / HDL.

4. Blood electrolytes: sodium, potassium and

chloride.

5. Liver function test (LFT): total protein, albumin,

globulin, AG ratio, bilurubin (direct), SGOT,

SGPT and alkaline phosphatase.

The Ferrans and Powers QoL Index: Generic III version

was used to evaluate total QoL Score. (16) The QoL was tested before training, at mid-term (3 months) and after

completion of training (6 months). Part I (33 questions)

evaluated the subject‟s satisfaction with different aspects of

life and Part II (33 questions) evaluated the importance of

those aspects in the subject‟s life.

1. The health and functioning subscale was evaluated

by 13 questions dealing with health, pain, worries

etc

2. The social and economic subscale was evaluated by

8 questions dealing with friends, neighborhood,

education etc.

3. The psychological and spiritual subscale was

evaluated by 7 questions dealing with peace of

mind, faith in god, happiness etc.

4. The family subscale was evaluated by 5 questions

dealing with family health, family happiness and emotional support from family etc.

Statistical analysis of pre and post intervention data was

done using GraphPad InStat version 3.06 for Windows 95

(GraphPad Software, San Diego California USA,

www.graphpad.com). All data passed normality testing by

Kolmogorov-Smirnov Test and, hence, was analyzed using

Students t test for paired data. Repeated measures ANOVA

with Tukey-Kramer Multiple Comparisons testing was

applied for QoL indices comparing pre, mid and post

changes. Percent changes (∆%) were tested for correlation

with attendance in training sessions using Pearson‟s correlation coefficient. P values less than 0.05 were

accepted as indicating significant differences between pre

and post intervention data.

RESULTS

The results are given in Tables 1-5. Post-

intervention statistical analysis revealed a highly significant

and beneficial change in all parameters that correlated

positively with attendance of the subjects.

There was a highly significant (p< 0.001) increase

in total WBC, RBC and platelet count, urine pH, TC, HDL,

HDL/LDL and chloride levels and a decrease in eosinophils,

monocytes, creatinine, LDL, TC/HDL and LDL/HDL. The

Neutrophils and AG ratio increased significantly (p<0.01)

with a concurrent significant increase (p<0.05) in basophils,

urea, sodium, albumin and bilurubin.

There was a significant improvement in QoL for

both mid-training (3 months) and post-training (6 months)

comparisons, and this correlated positively (p< 0.001 to p<

0.05) with the attendance of the subjects. The improvements of QoL were highly significant (p <0.001) for pre-mid and

pre-post comparisons. It was highly significant (p< 0.001)

for pre-mid comparisons of health function and psycho-

spiritual as well as for pre-post of socio-economic subscales.

The improvement was significant (p< 0.01) for pre-post of

health function, psycho-spiritual and family subscales and

for pre-mid comparison of family subscale. It was p< 0.05

for pre-mid comparisons in socio-economic subscale.

There were insignificant changes in the other

parameters like random blood sugar, potassium, total protein, globulin, SGOT, SGPT, alkaline phosphatase,

basophils, monocytes, urea, keratinize, ESR and RBC

indices like PCV, MCV, MCH and MCHC.

DISCUSSION



The improvement in the hematological,

biochemical and psychological profiles of our subjects may

be attributed primarily to yoga training, since these changes

were significantly correlated to the frequency of their

attendance. Since yoga training was part of the curriculum

of our host institute, it was not possible to establish a

separate control group. To overcome this limitation, we

correlated changes in all parameters with attendance, and a

majority of them were significantly positive. This

strengthens the direct correlation between the observed

changes and yoga training, and, rules out the possibility that these were due to other normal, extraneous or growth-

related factors such as nutrition or other forms of physical

activity training.

Hematological and biochemical parameters: Hb

and blood components (WBC, RBC and platelets) showed

significant increases that were positively correlated to the

student‟s frequency of attendance in classes (Table 1). We

hypothesize that this may be attributed to either asanas

exercising limbs or pranayamas stimulating erythropoiesis,

or both. Our hypothesis is based on the fact that a natural

response to hypoxia (which can occur during aerobic exercise or changes in altitude) is endogenous erythropoietin

(eEpo) synthesis, which stimulates erythropoiesis. (17) An

earlier report by Malshe has suggested that benefits of

pranayama may be due to daily self-administered brief,

intermittent hypoxia causing release of eEpo and Vascular

Endothelial Growth Factor (VEGF), thus offering a

multitude of benefits in health and a variety of disease

conditions. (18 ) Our hypothesis is also supported by another

recent study that reported rapid gene expression changes in

peripheral blood lymphocytes upon practice of a

comprehensive yoga program. (19 ) They speculated that the increased expression of Nuclear Factor Erythroid 2 (NFE2)

induced by the yoga program may have favorable effects on

megakaryocyte maturation and platelet production.

The increase in leukocyte count signifies an

improvement in immune function, since these cells play a

crucial role in inflammatory processes and in defending

against pathogens. In this context, the insignificant rise of

ESR in our subjects does not indicate an inflammatory

event, but suggests that ESR is playing the role of

modulator, as proposed by Carranquea. (20) Carranquea also

proposed that this rise is due to the metabolic activity of blood cells and is a consequence of a reduction in oxidation

processes due to yoga‟s anti-stress effect and the release of

free radicals at the erythrocyte level. As oxidative activity

has a complex duality in terms of benefit, this facet needs to

be explored further before definite conclusions can be made.

The decrease in eosinophils is evidence of a

reduction in allergic tendencies. This provides a scientific

basis for using yoga in allergic conditions where

eosinophilia is implicated. Erythrocytes contain hemoglobin,

which is involved in the transport of oxygen from the lungs to the tissues and in the buffering of hydrogen ions. Hence,

the increase in RBC and Hb is evidence of the health-

promoting aspects of yoga even at the cellular level. Such

changes are further seen in the significant rise of platelets or

thrombocytes, which provide the first hemostatic plug

following tissue injury. The biochemical changes in urea

and bilurubin levels indicate increased cellular metabolism

with a resultant increase in cellular waste products for

excretion (Tables 2 and 3). The alkalization of urine (Table

2) is a positive sign, as medical management of urinary tract

infections and calculi usually aims to promote alkalization

of urine. The post yoga decreases in the number of pus cells

and epithelial cells in the urine also indicates a healthier

urinary tract and excretory system.

The lipid profile showed a healthy response, with an increase in HDL and decreases in LDL and VLDL (Table

2). All cholesterol ratios also showed positive changes

including total cholesterol whose increase (within normal

levels) may be attributed to the significant increase in HDL.

Normally, the „safe‟ TC/HDL ratio is less than 4. It was

initially 4.57 ± 0.83 in our subjects, but decreased to a safe

level of 3.88 ± 0.87 following the training programme.

Similarly, a healthy LDL/HDL ratio is less than 3. Although

the initial pre-training level in our subjects was a higher

normal value (2.95 ± 0.86), it also fell to a lower normal

value (2.25 ± 0.80). The HDL/LDL ratio should normally be

more than 0.3, but it is preferable to maintain it above 0.4. This ratio also increased from a lower normal value of 0.37

± 0.15 to a higher normal value of 0.49 ± 0.19, implying a

better prognosis for cardiovascular health. HDL, or good

cholesterol, is involved in transporting cholesterol from

tissues to the liver. Its increased presence, along with

positive changes in all cholesterol ratios, is a sign of the

anti-atherogenic effects of yoga. A similar conclusion is also

found in the review by Innes (7,8) and in recent reports on

healthy volunteers and patients of hypertension and diabetes

mellitus. (21, 22, 23).

The TG/HDL ratio decreased significantly from

2.60 ±0.53 to 2.05±0.60, a healthy fall of more than 20%.

This finding has positive prognosis as the TG/HDL ratio is

an indicator of insulin resistance and a ratio > or =3.5 has

been reported to provide a simple means of identifying

insulin-resistant, dyslipidemic patients, likely to be at

increased risk of cardiovascular disease. (24) Five of our

subjects had initial values more than 3.5 and 6 had values

more than 3. All of them except for one had reductions in

the ratio on post training analysis. This implies a possible

breakdown of insulin resistance that is of great health

enhancing value in the prevention and management of metabolic conditions such as diabetes and the syndrome X.

The increase in bilurubin in our subjects correlates

positively with their attendance. Bilurubin is a major

intravascular product of heme catabolism and is a potent

antioxidant. A preliminary meta-analytic study

demonstrated an unambiguous, inverse relationship between

serum bilurubin levels and atherosclerosis, thus indicating

its preventive potential in oxidative, stress-mediated

diseases. (25) In fact it was recently stated in the editorial of a research topic forum that bilurubin is now recognized as an

endogenous cytoprotective compound at low

(“physiological”) concentrations. (26) Hence, its increase

within normal limits in the present study may be interpreted



as a physiological change that indicates the health-

promoting effects of yoga.

These health-promoting changes in our subjects

may be attributed to improved metabolic activity due to the

regular practice of yoga techniques. These techniques have

been reported to help yoga practitioners attain ideal body

weight and improve their cardiovascular endurance and

anaerobic power. (27) Innes and Vincent have suggested that

Yoga reduces the cardiovascular risk profile by decreasing

activation of the sympatho-adrenal system and hypothalamic-pituitary-adrenal axis and by promoting a

feeling of well-being, along with direct enhancement of

parasympathetic activity via the vagus nerve. (8)

Quality of life index scores: There was a significant

improvement in QoL both at mid training (3 months) and

post training (6 months), and this correlated positively with

attendance in the yoga sessions (Tables 4 and 5).

Improvements appeared in all subscales, including the

health function, psycho-spiritual, family and socio-economic

categories. Our findings are in line with those of Sharma and

Michelson, who reported that a short lifestyle modification and stress management educational programme leads to

remarkable improvement in subjective well-being scores.

Such interventions can therefore make an appreciable

contribution to both primary prevention and management of

lifestyle diseases. (13, 28) This is supported by Innes and

Vincent, who suggest that yoga-based training programmes

provide a source of social support that may be a factor in

reducing risk for cardiovascular diseases. (8) According to

Madanmohan, 60 hour, comprehensive yoga training

programme for medical students at JIPMER showed

improvements in psychological well-being, as well as in the subscales of anxiety, depressive mood, positive well-being,

self control, general health and vitality.(29) Another recent

study on yoga for paramedical students used the Ferrans and

Powers QoL index and reported improvements in total QoL

and positive changes in all subscales. (16) Although there

were 8-12% changes in ∆% scores, these changes did not

reach statistical significance due to the smaller sample size

and shorter duration of training (3 months). Nevertheless,

our present study confirms those findings.

Our findings are similar to those of Malathi and

Damodaran, who reported decreased anxiety levels in

MBBS students following yoga training. (12) The authors also

reported improvements in their subjects´ sense of well-

being, their feeling of relaxation, and the quality of their

interpersonal relationships, as well as improved

concentration, efficiency, self-confidence and, attentiveness,

along with lowered irritability levels and a more optimistic

outlook on life. They concluded that yoga had reduced basal

anxiety levels and attenuated the increase in anxiety scores

in stressful states. They postulated that the decrease in

anxiety led to better adjustment adaptability towards

environmental and internal stressors, which thus enabled

participants to better and more calmly perform their routine

duties.

Harinath et al reported improvements in both

cardiorespiratory performance and psychological profile

after three months of yoga. These changes were

accompanied by increases in plasma melatonin. (30) A recent

review by Sengupta et al suggested that yoga triggers

neurohormonal mechanisms that reduce stress and anxiety

and acts as a psychophysiological stimulus to increase

endogenous secretion of melatonin. This, in turn, improves

the sense of well-being. (4) Another large-scale study in the USA reported that mind-body interventions showed

significantly greater improvements on perceived stress,

sleep quality, and the heart rhythm coherence ratio of HRV.

(31) Here, the authors concluded that both mindfulness-based

and therapeutic yoga programs may provide effective

interventions to target high stress levels, sleep disturbances,

and autonomic imbalances in employees. These results are

applicable to our study population, a group of nursing

students exposed to numerous stressors.

The potential benefits of the various practices in our study may be hypothesized as follows: suryanamaskar

improves metabolic function and tones up the

musculoskeletal system; trikona, nataraja and veera asanas

evoke a sense of stability and balance both physically and

mentally; vakra, ardhamatsyendra, paschimottana,

pavanamukta, bhujanga and dhanura asanas, by virtue of

their twisting and compression-relaxation actions, may be

stimulating intra-abdominal organs such as the liver and

pancreas, resulting in improvements in hematological,

biochemical and lipid profiles; sarvangasana, halasana and

viparitakarani may be harmonizing psycho-neuro-endocrine

function, as reflected in the biochemical parameters; aloma viloma, suryanadi and chandranadi pranayamas may be

normalizing emotional and autonomic balance; pranava and

savitri pranayama in shavasana may contribute toward a

sense of inner calmness, thus enhancing inherent

homeostatic mechanisms; and kaya kriya, marmanasthanam

kriya and yoga nidra create a sense of mind-body harmony

that facilitates psycho-somatic re-integration.

CONCLUSION

The present study substantiates the psychological

and physical benefits of yoga training. All the tested parameters showed desirable changes and most were

statistically significant. The major findings are enhanced

bone marrow function, reduced allergic tendency,

alkalization of urine, metabolic reconditioning with special

emphasis on liver function and improved QoL indices. This

may be attributed to an improved functioning of the body-

mind complex, which is facilitated by breath-body

coordination in the yoga practices. On the basis of the

present study, we recommend that yoga be made an integral

part of medical and paramedical collegiate education.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Malathi%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus



Table 1. Hematological parameters before and after 6 months of yoga training.

Parameters are given as Mean ± SD for „n‟ subjects. * p < 0.05, ** p < 0.01 and *** p < 0.001 by paired t test between pre and

post training values. Correlation coefficient (r) and p values are given after applying Pearson linear correlation between pre-post

∆% with the respective attendance in the classes.

Table 2. Biochemical parameters before and after 6 months of yoga training.


post training values. Correlation coefficient (r) and p values are given after applying Pearson linear correlation between pre-post ∆% with the respective attendance in the classes.

n Before After ∆% r p

Total Count

(/ mm3)

58 6570.69

±1478.38

7591.38

±1395.01 ***

18.24

±22.10 0.2853 0.03

Neutrophils

(%)

58 54.88

±7.24

57.71

±6.08 **

6.21

±12.80 0.1362 0.3081

Lymphocytes

(%)

58 39.71 ± 7.51

39.66 ± 5.54

3.47 ± 24.91

0.1011 0.4502

Eosinophils

(%)

57 4.61 ± 2.63

2.26 ± 1.84 ***

-47.53 ± 36.65

0.401 0.0018

ESR -1/2hr

(mm)

57 6.79

± 4.33

7.56

± 2.92

33.05

± 60.16 0.01026 0.9391

ESR-1hr

(mm)

57 15.26

± 8.75

15.30

± 6.73

14.70

± 50.14 0.1089 0.4201

Erythrocytes( RBC)

(million/ mm3)

56 4.33

± 0.43

4.58

± 0.52***

5.83

± 7.64 0.2743 0.0372

Hemoglobin (Hb)

(gm %)

11.82

±1.90

12.19

±1.73***

3.58

±5.75 0.3048 0.0200

Platelet

(lakhs/ mm3)

57 2.38

± 0.43

2.72

± 0.47***

16.41

± 21.62 0.3514 0.0068


Urine pH 57 6.18

± 0.24

6.42

± 0.35***

3.95

± 6.34 0.429 0.0008

Total cholesterol (TC)

(mg/dL)

53 147.96

± 28.08

154.87

± 31.27***

4.69

± 7.98 0.2846 0.0303

Triacylglycerols (TG)

(mg/dL)

53 83.87

± 21.02

80.94

± 22.52

-2.54

± 15.56 0.2376 0.0725

High density lipoprotein (HDL)

(mg/dL)

53 32.25

± 4.01

40.04

± 5.45***

24.91

± 16.50 0.5096 0.0001

Low density lipoprotein (LDL)

(mg/dL)

53 93.68

± 25.05

88.11

± 25.56***

-5.60

± 11.83 0.2652 0.0443

Very low density lipoprotein (VLDL)

(mg/dL)

53 17.68

± 4.52

16.55

± 4.54

-3.44

± 24.40 0.3396 0.0091

TG / HDL 53 2.60

± 0.53

2.05

± 0.60***

-20.84

± 15.83 0.4362 0.0011

TC / HDL 53 4.57

± 0.83

3.88

± 0.87***

-15.04

±10.99 0.3801 0.0033

TC / LDL 53 1.64

±0.56

1.84

±0.68***

12.23

±14.48 0.4385 0.0006

HDL / LDL 53 0.37

± 0.15

0.49

± 0.19***

34.85

± 27.88 0.4876 0.0001



Table 3. Liver function parameters before and after 6 months of yoga training.


post training values. Correlation coefficient (r) and p values are given after applying Pearson linear correlation between pre-post

∆% with the respective attendance in the classes.

Table 4: Ferrans and Powers Quality of Life Index scores: pre, mid and post six months of yoga training.

pre mid post p value

Overall QoL 18.37 ± 3.07 20.35 ± 2.49 *** 20.13 ± 2.30 ¥ ¥ ¥ < 0.0001

Health and function 18.54 ± 3.60 21.17 ± 2.96 *** 20.46 ± 3.14 ¥ ¥ <0.0001

Socio-economic 19.29 ± 3.71 20.65 ± 3.47 * 21.54 ± 2.90 ¥ ¥ ¥ 0.0001

Psycho-spiritual 19.26 ± 4.70 21.93 ± 3.91 *** 21.51 ± 3.12 ¥ ¥ <0.0001

Family subscale 19.29 ± 5.87 21.66 ± 4.34 ** 21.56 ± 4.80 ¥ ¥ 0.0024

Values given as mean ± SD for 60 subjects. P values are given for intergroup compassions done by repeated measures of ANOVA

with Tukey-Kramer Multiple Comparisons Test.

* = p < 0.05, ** = p < 0.01 and *** = p < 0.001 between pre and mid values. ¥ ¥ = p < 0.01 and ¥ ¥ ¥ = p < 0.001 between pre and post values.

Table 5: Correlation of various parameters of Ferrans and Powers QoL Index, with attendance of the subjects during pre-

post, pre-mid and mid-post periods of the six months yoga training.

Values given as mean ± SD for 60 subjects. Correlation coefficient (r) and p values are given after applying Pearson linear

correlation between pre-post, pre-mid and mid-post ∆% with the respective attendance in the classes.

ACKNOWLEDGMENTS:

The authors thank the management of Sri Balaji

Vidyapeeth University for setting up the Centre for Yoga

Therapy, Education and Research (CYTER) in Mahatma

Gandhi Medical College and Research Institute (MGMCRI).

We are grateful to Yogacharini Meenakshi Devi Bhavanani,


Total Protein

(g/dL)

23 7.36

± 0.44

7.37

± 0.33

0.38

± 5.38 0.1906 0.1518

Albumin

(g/dL)

25 4.29

± 0.51

4.52

± 0.34*

6.51

± 14.76 0.4312 0.0007

Globulin

(g/dL)

22 3.08 ± 0.43

2.90 ± 0.38

-5.06 ± 13.92

0.1058 0.4293

AG ratio 22 1.40 ± 0.29

1.60 ± 0.38**

16.73 ± 30.40

0.3868 0.0027

Bilurubin total

(mg/dL)

24 0.82

± 0.42

0.91

± 0.43*

22.78

± 40.40 0.3371 0.0097

Parameter Comparison Attendance ∆ % r value p value

Overall QoL

pre-post 19.48 ± 8.27 12.11±19.87 0.4868 < 0.0001

pre-mid 11.90 ± 5.59 13.53 ± 22.18 0.5273 < 0.0001

mid-post 7.58 ± 5.03 0.10±15.29 0.5617 < 0.0001

Health and function

pre-post 19.48 ± 8.27 14.74±30.02 0.3936 0.0019

pre-mid 11.90 ± 5.59 18.58 ± 29.42 0.4019 0.0015

mid-post 7.58 ± 5.03 -1.69±20.02 0.5668 < 0.0001

Socio-economic

pre-post 19.48 ± 8.27 15.40±25.46 0.3778 0.0029

pre-mid 11.90 ± 5.59 10.39 ± 25.97 0.5143 < 0.0001

mid-post 7.58 ± 5.03 6.65±20.54 0.3312 0.0098

Psycho-spiritual

pre-post 19.48 ± 8.27 17.99±32.92 0.2582 0.0464

pre-mid 11.90 ± 5.59 20.12 ± 36.06 0.3992 0.0016

mid-post 7.58 ± 5.03 1.62±26.50 0.3935 0.0019

Family subscale

pre-post 19.48 ± 8.27 27.96±71.22 0.3149 0.0143

pre-mid 11.90 ± 5.59 32.07 ± 83.28 0.3998 0.0016

mid-post 7.58 ± 5.03 1.35±21.89 0.3412 0.0076

Int. Res J Pharm. App Sci., 2013; 3(6):17-23 ISSN: 2277-4149 Director ICYER for her constant motivation and supportive guidance. Thanks are due to Yoga instructors Miss D Pushpa and Dr. R Balaji for conducting the training programme and for their valuable assistance during recording sessions and data entry. For help in improving the language of this paper, our thanks go to Billy Uber of Baden-Baden, Germany. REFERENCES: 1. Madanmohan, Thombre DP, Balakumar B, Nambinarayanan

TK, Thakur S, Krishnamurthy N et al. Effect of yoga training on reaction time, respiratory endurance and muscle strength. Indian J Physiol Pharmacol 1992; 36: 229-33.

2. Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishnamurthy N. Effect of pranayama training on cardiac and autonomic function in normal young adults. Indian J Physiol Pharmacol 2003; 47: 27-33.

3. Sengupta P. Health Impacts of Yoga and Pranayama: An art-of-the-state review. Int J Prev Med 2012; 3: 444-58.

4. Sengupta P, Chaudhuri P, Bhattacharya K. Male reproductive health and yoga. Int J Yoga 2013; 6: 87-95.

5. Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. Effect of slow and fast pranayams on reaction time and cardio respiratory variables. Indian J Physiol Pharmacol 2005; 49: 313-18.

6. Khalsa SBS. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol 2004; 48: 269-85.

7. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract 2005; 18: 491-519

8. Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. eCAM 2007; 4: 469-86.

9. Bhavanani AB, Udupa K, Madanmohan, Ravindra PN. A comparative study of slow and fast suryanamaskar on physiological functions. International J Yoga 2011; 4: 72-77.

10. Bhavanani AB, Ramanathan M, Harichandrakumar KT. Immediate effect of mukha bhastrika (a bellows type pranayama) on reaction time in mentally challenged adolescents. Indian J Physiol Pharmacol 2012; 56 : 174–180

11. Oken BS, Zajdel D, Kishiyama S, Flegal K, Dehen C, Haas M et al. Randomized controlled six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Altern Ther Health Med 2006; 12: 40–47.

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14. Arora S, Bhattacharjee J. Modulation of immune response in stress by yoga. Int J Yoga. 2008;1: 45–55.

15. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression and post-traumatic stress disorder. Med Hypotheses 2012; 78: 571-79.

16. Bhavanani AB, Zeena S, Jayasettiaseelon E, Dayanidy G, Vithiyalakshmi L, Madanmohan. Physiological and

psychological effects of a yoga training programme in paramedical students. Yoga Mimamsa 2013; 44: 246-64.

17. Elliott S. Erythropoiesis-stimulating agents and other methods to enhance oxygen transport. British Journal of Pharmacology 2008; 154: 529–41

18. Malshe PC. Nisshesha rechaka pranayama offers benefits through brief intermittent hypoxia. Ayu 2011; 32: 451–57.

19. Qu S, Olafsrud SM, Meza-Zepeda LA, Saatcioglu F. Rapid Gene Expression Changes in Peripheral Blood Lymphocytes upon Practice of a Comprehensive Yoga Program. PLoS ONE 2013; 8 (4): e61910

20. Carranquea GA, Maldonadob EF, Verab FM, Manzanequeb JM, Blancab MJ, Sorianoc G et al. Hematological and biochemical modulation in regular yoga practitioners. Biomedical Research 2012; 23 : 176-82.

21. Tundwala V, Gupta RP, Kumar S, Singh VB, Sandeep BR, Dayal P, Prakash P. A study on effect of yoga and various asanas on obesity, hypertension and dyslipidemia. International Journal of Basic and Applied Medical Sciences 2012 ; 2: 93-98

22. Madanmohan, Bhavanani AB, Dayanidy G, Zeena S, Basavaraddi IV. Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post menopausal diabetic patients. International J Yoga 2012; 5: 10-15.

23. Madanmohan, Bhavanani AB, Zeena S, Vithiyalakshmi L, Dayanidy G. Effects of a comprehensive eight week yoga therapy programme on cardiovascular health in patients of essential hypertension. Indian J Traditional Knowledge 2013; 12: 535-54

24. McLaughlin T, Reaven T, Abbasi F, Lamendola C, Saad M, Waters D, Simon J, Krauss RM. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005; 96: 399–404.

25. Novotný L, Vítek L. Inverse relationship between serum bilirubin and atherosclerosis in men: a meta-analysis of published studies. Exp Biol Med (Maywood) 2003; 228: 568-71.

26. Kapitulnik J, Maines MD. The Role of Bile Pigments in Health and Disease: Effects on Cell Signaling, Cytotoxicity, and Cytoprotection. Front Pharmacol 2012; 3: 136.

27. Bera TK, Rajapurkar MV. Body composition, cardiovascular endurance and anaerobic power of yogic practitioner. Indian J Physiol Pharmacol 1993; 37: 225-28.

28. Michalsen A, Grossman P, Acil A, Langhorst J, Lüdtke R, Esch T et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit 2005; 11: CR555-61.

29. Madanmohan. Introducing yoga to medical students: the JIPMER experience. Yoga Vijnana 2008; 2: 71-78.

30. Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC et al. Effects of hatha yoga and omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med 2004; 10: 261-68.

31. Wolever RQ, Bobinet KJ, McCabe K, Mackenzie ER, Fekete E, Kusnick CA et al. Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. J Occup Health Psychol 2012; 17: 246-58.




“Health for all by 2000 AD” has remained a pipedream. And can we achieve health for all even by 3000 AD? Unlikely. Unless we adopt an effective and integrative approach to the problem. The present health scenario is dismal. With increasing elderly population, the incidence of already prevalent chronic lifestyle disorders is on a steady rise. Antibiotic resistance is staring us in the face. Expensive high-tech modern medicine is beyond the reach of even the upper middle class. Public hospitals are over-crowded, under-staffed and fund-starved. Millions die of chronic diseases while they are on life-long drug treatment. It is clear that allopathy does not have all the answers and there is an urgent need to adopt an integrative and holistic approach to the problem. There are gems in “alternative” treatment modalities which are simple, bio-eco-friendly and inexpensive. We need to shed our ego and get rid of “holier-than-thou” attitude.

Yoga can effectively augment modern medicine. Being holistic, it is ideal for integrated development of our body, mind as well as soul. Mind, body and soul are intricately inter-related and mind-body dichotomy is at the root of our problems and disease. Health as well as ill health have physical, mental-emotional as well as spiritual dimensions. Elderly persons are more happy and healthy if spiritually active. However, spiritual domain has been outside the scope of modern medicine. Yoga can effectively fill this lacuna. Yoga has promotive and preventive potential and can play an important role before the disease manifests itself. Yoga has many advantages. Being non-pharmacological, it is free from negative, harmful side effects of drugs. In contrast, it has positive, “side benefits” in terms of improvement of psychosomatic health of the patient. Even if drugs have to be given along with yoga therapy, decrease in drug dosage will bring down the cost of medicare & limit the side effects of drugs. Another advantage of yoga therapy is that treatment of one disease is associated with simultaneous benefit in other diseases as well as improvement in quality of life. Yogic relaxation and breathing techniques can be of immense value in pre-operative relaxation and post-operative recovery. It is clear that inexpensive and holistic yoga therapy can be great boost to our health care delivery system.

Great ventures are bound to face great challenges. The principle of duality (dvand) is inherent in our world. Change is always resisted due to uncertainty, even fear of unknown. We have to deal with status quo-ists who lack motivation and love laziness. Who has time? Well meaning professionals are busy in administrative work or private practice. The curriculum is already loaded, how to add new content? Another challenge is to identify and exclude unscientific, untested and potentially harmful methods. Powerful drug companies have vested interest in tutoring and pleasing physicians. They are quite smart in modulating even the research findings! The task is stupendous, but worthy and achievable. We need to rope in competent, authentic and well meaning persons. We need visionaries who are scientists by training and action-oriented karmayogis. Use of internet will make the effort more effective, open and respectable. And Divine Grace will make the whole effort fruitful and enjoyable.

inTegrATing yogA And modern medicine : opporTuniTies And chAllenges

Madan Mohan *

* * Prof. Madan Mohan ,Director, Center for Yoga Therapy, Education and Research, Puducherry


Annals of SBV

Healthy lifestyle: a holistic view: Who does not want good health and long life ? However, there is no free lunch and one has to earn it by living a disciplined and healthy lifestyle. Health is the best wealth, so says the samskrit verse “Labhanam shreshtham arogyam”. If you possess good health, feel blessed, give thanks and preserve it at all costs. If not, do your best to achieve it, at any cost since our body is a temple of the Divine (Deho devalayah) and the means for performing all righteous deeds (Sharir madyam khalu dharm sadhanam). Vedic rishis have prayed for a full, enjoyable and independent life not just for 100 years, but even beyond (AUM tachchakshur devahitam …… bhooyashch sharadah shatat. Yajurved, 36: 14). Many warriors of Mahabharat war ( 3000 BC ) were of venerable age and the great warrior Bhishma Pitamah was absolutely healthy and strong at 186 years. The secret of their long and healthy life was disciplined lifestyle in tune with the laws of Mother Nature. These universal Divine laws of nature are called as “Rit” in Vedic language. Yog and ayurved which belong to the Vedic tradition are rooted in nature. In spite of spectacular advances in medical science, “modern” man is a victim of a host of chronic health problems like hypertension, diabetes, chronic pains and insomnia. The primary cause of these problems is our artificial lifestyle that is away from and against the laws of nature.

What does being healthy mean? Health is difficult to define, easy to appreciate and a joy to enjoy. Positive health means perfect functioning of body and mind and ability to enjoy healthy life in its various dimensions. WHO definition of health is “A state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity”. It is a condition or quality expressing adequate functioning of the organism in a given situation. To this definition, WHO has added “spiritual wellbeing” also. However, it is not clear what spirituality means. Spirituality should not be confused with religion and this point has been discussed in the section on Spiritual Health and Healing: a Yogic Perspective. Physiological approach to the question of health is in terms of measurable, objective values. A person is healthy if his blood pressure, heart rate, body temperature, blood glucose and other parameters are within normal physiological range. A healthy person is able to meet adequately the demands of his profession / work, i.e. as a teacher, a soldier or a farm hand. In a healthy person, dynamically interacting homeostatic (regulatory) mechanisms of unimaginable complexity maintain various body functions and parameters within normal physiological range. These mechanisms are less developed and easily taxed in newborn (especially premature) babies and the elderly. In ayurved, the term for health is “swasth”, i.e. one who is established and comfortable in his own being, a state of being whole and feeling whole. Acharya Sushrut (~ 600 BC) has given poetically beautiful and philosophically holistic definition of health thus: “Health is a state of balance of elements, optimum digestion and elimination and happy senses, mind and soul” (Samadoshah samagnishcha. Sushrut Samhita, Sutrasthanam, 15:41).

Lifestyle is the way people live and this has immense influence on the status of health or disease. Since one’s lifestyle is developed early in life, it is advisable to cultivate healthy lifestyle in early childhood. Many factors determine one’s lifestyle. Economic status determines incidence of under-nutrition in poor and obesity in the rich. Cultural values of the society dictate the incidence of vegetarianism in the population. Sedentary life is a major factor for coronary artery disease while personal habits like smoking and alcoholism determine the incidence of heart disease and cirrhosis of liver. Exercise, healthy diet and rest and relaxation are important components of lifestyle. From the yogic point of view, proper posture and brahmacharya are very important components of one’s lifestyle. Yog is the most perfect lifestyle module as it is comprehensive and holistic in its nature.

Yog for healthy lifestyle: Yog is a scientific–spiritual discipline and conscious evolution of our physical, mental and spiritual aspects. Its ultimate aim is to become divine by achieving unity with the all- pervading Divine Consciousness. According to Sri Aurobindo, “All life is yog” because yog is a philosophy that can be applied to everyday activities of our daily life. The ancient marvel of yog which is the most precious gem of our cultural heritage has been preserved despite centuries of stagnation and suppression due to brutal foreign invasions. And now it is our duty to promote and propagate

yog for heAlThy lifesTyle

Madanmohan *

* * Prof Madanmohan MBBS, MD (Physiology), PG Diploma in Yoga, MSc Yoga, DSc (Yoga), FIAYCYTER, MGMCRI, Puducherry



it for the benefit of entire humanity. Yog is holistic and its relevance is universal. It is the best means for improving our health as well as preventing and managing stress and stress disorders which are unmanageable by our health care delivery system.

According to materialistic view, we are essentially a body that has a mind. On the other hand, from the spiritual and yogic point of view, we are spiritual beings having human experience. In other words, we are an individual soul that has two beautiful instruments, body and mind. These three entities, i.e. soul, body and mind continuously and dynamically interact with, and influence each other. Yog has profound influence on our total health and personality because it has desirable effect on all the three aspects of our being. Yog is holistic in nature since it is science, philosophy as well as art. It has promotive, preventive as well as curative potential. Its effect is augmentative as it improves our physical, mental as well as spiritual health. Yog is a time-tested and safe tradition. Compared to other modes of health intervention, it has many advantages. It is economical in terms of time, energy and resources. Being holistic, it is ideal for our horizontal, in-depth as well as vertical development. For prevention as well as management of stress and stress disorders, there is no method as effective and as far-reaching as yog. That is why Yogeshwar Krishn describes the superiority of a yogi in unambiguous terms (Tapasvibhyo adhiko yogi. Bhagavadgita, 6:46).

Proper posture: From yogic point of view, proper posture and movement are important components of healthy lifestyle. Posture is a manifestation of physical and mental balance and has powerful influence on physical aging and mental mood. Good posture is very important for energetic and active life. When you are stooped, you look old and feel old. Do not think that slumped posture is natural to old age. So, lift yourself against the physical weight of gravity and mental weight of aging. Whether sitting or standing, maintain a good, firmly upright but comfortable and relaxed posture as asan should be firm but comfortable (Sthir sukham asanam. Yog Darshan). Stand and move with grace and vigor and do not tighten your muscles stiff in unwanted and awkward position. Of the 700 muscles that we have, good posture needs only 5 key muscles. Yogic posture is ergonomically appropriate and physiologically sound. Therefore, avoid poor posture and slouching in a chair as it:

i) Distorts alignment of bones and creates more pressure on lower back. ii) Tenses muscles resulting in muscle pain and stiffness of joints. iii) Interferes with breathing and decreases vital capacity. iv) Interferes with circulation and oxygen delivery to brain resulting in poor concentration and drowsiness. v) Results in poor digestion and constipation. vi) Decreases productivity and accelerates aging.

Yog improves physiological functions: Human body is a beautifully robust mechanism capable of taking care of itself. Yog assists this process and improves our physiological functions and health. Scientific research has shown that yogic techniques produce consistent and beneficial physiological changes and have sound scientific basis (Wallace RK. Science, 167: 1751, 1970; Madanmohan et al. Indian J Physiol Pharmacol, 36: 229, 1992). Even a few weeks of yog training can improve physiological and psychological functions. Practice of asans and pranayams results in overall improvement in physical fitness and cardio-respiratory functions. We have reported that yog training for 3 months produces a significant increase in respiratory pressures, breath holding times and hand-grip strength (Madanmohan et al. Indian J Physiol Pharmacol, 36: 229, 1992). This indicates an improved physical strength and cardio-respiratory function. In the same study, we also found a significant decrease in visual and auditory reaction times after the yog training. This indicates a faster and more efficient information processing by the brain. We have also reported that after yog training, exercise-induced stress to cardiovascular system in less severe (Madanmohan et al. Indian J Physiol Pharmacol, 48:461,2004 ). This means that yog training can enable one to tolerate more severe exercise load. Other workers have found that yog training produces a significant improvement in dexterity scores and motor speed (Manjunath & Telles, Indian J Physiol Pharmacol, 43: 225, 1999; Dash & Telles, Ibid, 43: 458, 1999). Yogis are capable of remarkable feats of endurance (Vakil RJ. The Lancet, 2: 871, 1950) and control of their autonomic functions (Chhina GS, Proc International Union Physiol Sci, 10: 103, 1974).

Yog for mental health: Just as our body requires physical exercise, balanced diet and bathing for good health, our mind requires inner discipline for mental health. Ordinary mind is a clutter of uncontrolled thoughts. Meditation (dhyan) is the ideal way to calm the mind. Meditation is the inner (antarang) yogic discipline in which there is a continuous flow of thought towards a higher spiritual ideal in a higher spiritual center of our consciousness. It makes the mind one-pointed and produces psychosomatic relaxation. Meditation is not an ordinary concentration. It is a special kind of concentration based on the first two steps of ashtang yog. Thess two steps are i) yam or five moral virtues and


Annals of SBV

ii) niyam or five spiritual discipline. Jap or repetition of holy name is very effective in achieving success in meditation. Jap should be done in a spirit of love and adoration as mystic worship and not in a mechanical way. Thus performed, jap and dyan are higher forms of worship to which our body, mind and soul, the whole being respond with better health and healing power. That is the secret of the power of yog. For success in dyan and to get attached to the universal Divine Consciousness, we have to create proper mood and loosen our worldly attachments. This attainment of unity and realization of identity is the goal of yog. In this state, our inner soul is freed from the thralldom of ego, mind and senses. Then problems of the world do not disturb our inner harmony. This is the basis of sound mental health, a distinguishing characteristic of a yog sadhak. Yog is equanimity (Samatvam yog uchyate. Bhagavadgita, 2: 48) and evenness of temper is the essential feature of mental health.

Spiritual health and healing: a yogic perspective: Human body is the highest and best creation of the Divine and an instrument for performing noble deeds (Sharir madyam khalu dharm sadhanam). That is why Vedic Rishis have called this body has Devapuri and Ayodhya (Asht chakra navadwara devanam poorvayodhya. Atharvaved, 10: 2: 31). Our body-mind-soul complex is the real temple of the Divine. By yog sadhana, we should keep it fit, clean and pure and seek the Divine within. Spiritual healing is curing a disease by non-physical means, i.e. through powers outside medical intervention. By prayer, meditation and therapeutic touch, the healer channels Divine healing energy that improves patient’s life force (pran shakti). There are claims that spiritual healing hastens recovery and even hopelessly ill patients can recover miraculously.

Faith, i.e. belief in a higher universal Divine power is the basis of the spirituality. Faith is what your heart tells you is true when you intellect cannot prove it. One can have faith in a religion or in eternal universal Truth called as Rit in Vedic language. It may be noted that spirituality is distinct from religion. Religion is a particular belief system and mode of worship. Religions are many, but spirituality is one. Religion may nurture spirituality, but spirituality does not depend on it. Prayer is another important component of spiritual life. Prayer can lift the mind and soothe the soul. Prayer enhances health and promotes healing of self and others. It is a medical secret - prayer heals. Performing actions and one’s duty with a spirit of selfless service (Nishkam karmyog of Bhagavadgita) is an important component of spiritual life. A person who believes in all-pervading universal Divine power feels connected not only to everyone, but to all forms of life and the whole creation. This promotes universal love which is distinct from selfish romantic love. A person who has these spiritual qualities is an asset to the whole society.

Health benefits of spirituality are significant. Faith in higher Spiritual power relieves one of cares, anxieties and stress and promotes calmness and tranquility. Consequently, his heart rate, blood pressure, muscle tone, oxygen consumption and carbon dioxide production decrease. Even his cholesterol decreases over a period of time. Spiritually-oriented people get sick less often. They recover faster in case they fall sick. It is claimed that patients recover better if family and friends pray for them. Spirituality also decreases the incidence of stroke and death from heart disease and increases survival after surgery. Spirituality helps to prevent / overcome bad habits because spirituality is considered to be bigger than these. As a result, there is increase in longevity and quality of life. Here it is interesting to note that Benson (New England Journal of Medicine, 281: 1133, 1969) has reported that transcendental meditation (TM) can help one to kick off drug addiction, which is a serious problem among the “modern” youth.

Power of pranayam: It needs to be emphasized that slow and deep pranayam breathing has a powerful influence on our wellbeing. A simple exercise to relieve stress and promote wellbeing is to straighten and mildly arch your spine as you inhale (purak) slowly and sequentially and then exhale (rechak) as you bend forward and round your back. It is claimed that pranayam reduces obesity and purifies the body. According to Patanjali, pranayam destroys the covering of inner light and the mind gains the power concentration (Yog Darshan, 2: 52-53). Manusmriti (6: 71) says that pranayam purifies the impurities of senses and the mind.

From the physiological point of view, slow and deep breathing (as in mahat yog pranayam) has the following advantages:

i) It is economical as it reduces dead space ventilation. ii) All the muscles of respiration are strengthened. iii) Different parts of the chest and lungs are stretched, improving their flexibility. iv) Abdominal viscera are gently massaged by the descending diaphragm. v) Venous return (blood flow) to heart is improved. vi) Mind-body coordination (thereby health) is improved.



There is evidence that pranayam has therapeutic potential. In an interesting work from our laboratories, we have demonstrated that subjects trained in yog can achieve a state of deep psychosomatic relaxation and significant decrease in oxygen consumption within 5 minutes of practicing savitri pranayam (Madanmohan et al. The Yoga Review, 3: 25,1983). Savitri pranayam is a slow, deep and rhythmic breathing in which the ratio between purak, kumbhak, rechak and shunyak (bahya kumbhak) is 2:1:2:1. Telles and Desiraju ( Indian Journal of Medical Research, 94: 357, 1991) also have demonstrated that pranayam can decrease oxygen consumption significantly. More recently, we have demonstrated the beneficial effect of pranayam in patients having premature ventricular complexes and palpitation (Prakash et al. International Journal of Cardiology, 111: 450, 2006; Ravindra et al. Ibid, 108: 124, 2006). It is clear that the power of pranayam is available to us freely. Let us use it for the benefit of the humanity.

Yog for prevention and management of stress: The all- pervasive stress and stress disorders are the bane of modern society. The main cause of stress among the affluent sections is material progress without a parallel development of inner, spiritual resources and this results in deep rooted conflicts and disharmony. Healthy balance between worldly enjoyment (bhog) and detachment (tyag) is good for mental health. This point is beautifully taught in a Vedic verse thus: “This whole universe is pervaded by Ishwar. Enjoy this world with a sense of detachment and do not covet the wealth of others” (Ishavasyam idam sarvam. Yajurved, 40: 1). Chronic stress results in disturbance of mental and physical equilibrium. The consequence is a host of chronic disorders like hypertension, angina, diabetes mellitus, peptic ulcer, irritable bowel, chronic pains, insomnia and cancers. It is alarming that the incidence of these lifestyle diseases is increasing in India. The problem is more marked in urban areas where people are living a routine of daily rat race. Over-ambitious, ever-struggling and restless persons (type “A” personality) are more prone to stress disorders. They can be screened in their early life by psychophysiological tests and taught yog relaxation techniques as a preventive measure.

Yog has a comprehensive and holistic approach to health and is the best treatment for stress and stress disorders. A judicious combination of simple stretching asans, slow rhythmic pranayams, yog nidra and dhyan is most effective and ideal for prevention and management of stress. Mantr (e.g. AUM) chanting, jap and bhajan singing, especially in a dedicated group (satsang) are very effective for managing stress and improving mental health. Yogeshwar Krishn gives a very high place to jap and bhajan singing when he says “Among the offerings, I am the offering of jap (Yajnanam jap yajnosmi, Bhagavadgita, 10: 25) and “He is the best yogi who worships Me by bhajan singing (Shraddhavan bhajate yo maam, Bhagavadgita, 6: 47).

Many workers have demonstrated the effectiveness of yogic techniques in the control of blood pressure and hypertension ( Selvamurthy et al. Ind J Physiol Pharmacol, 42: 205, 1998: Datey et al. Angiology, 20: 325, 1969). Yog lays great stress on proper diet, a distinctive feature of which is emphasis on purity (satvik ahar) and moderation (mitahar). Overeating is a form of malnutrition that results in conditions like obesity, diabetes mellitus, and arthritis. Yogeshwar Krishn emphasizes the importance of regulation in diet, recreation, sleep-wakefulness and other activities for the yog sadhak (Yuktahar viharasya. Bhagavadgita, 6: 17). Chhandogya Upanishd emphasizes the importance of purity of diet for our inner purity (Ahar shuddhou satva shuddhi. 7: 26: 2). Purity of mind results in improved mental health and freedom from psycho-somatic disorders. It is clear that yogic lifestyle is very effective for prevention as well as management of stress and stress disorders.



Yoga is the original mind-body medicine that has enabled individuals to attain and maintain sukha sthanam, a dynamic sense of physical, mental and spiritual well being. Bhagavad-Gita defines Yoga as samatvam meaning thereby that Yoga is equanimity at all levels, a state wherein physical homeostasis and mental equanimity occur in a balanced and healthy harmony.

Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj, the visionary founder of Ananda Ashram at the International Centre for Yoga Education and Research (ICYER) in Pondicherry and one of the foremost authorities on Yoga in the past century, has explained the concept of Yoga Chikitsa (Yoga as a therapy) in the following lucid manner.

To achieve this Yogic integration at all levels of our being, it is essential that we take into consideration the all encompassing multi dimensional aspects of Yoga that include the following: a healthy life nourishing diet, a healthy and natural environment, a wholistic lifestyle, adequate bodywork through Asanas, Mudras and Kriyas, invigorating breath work through the use of Pranayama and the production of a healthy thought process through the higher practices of Jnana Yoga and Raja Yoga.

Psychosomatic Disorders: The Nirvana Prakarana of the Laghu Yoga Vashishta, one of the ancient Yoga Texts describes in detail the origin

and destruction of mental and bodily diseases. Sage Vashishta teaches Lord Rama that there are two major classifications of disease. Those that are caused by the mind are primary (adhija vyadhi, the psychosomatic, stress disorders) while those that afflict the body directly are secondary (anadhija vyadhi, infectious disease, accidents etc). The primary disease has two sub divisions. These are the samanya (ordinary physical diseases) and the Sara (the essential disorder of rebirth that may only be destroyed by atma jnana or knowledge of the Divine Self). Samanya diseases are the ones that affect us physically and may be destroyed by the correction of the mind-body disharmony. It is in these psychosomatic disorders that the actual practical application of Yoga practices as a mode of therapy can be very useful.

From the Yogic viewpoint of disease it can be seen that psychosomatic, stress related disorders appear to progress through four distinct phases. These can be understood as follows:

1. Psychic Phase: This phase is marked by mild but persistent psychological and behavioural symptoms of stress like irritability, disturbed sleep and other minor symptoms. This phase can be correlated with vijnanamaya and manomaya koshas. Yoga as a mind body therapy is very effective in this phase.

2. Psychosomatic Phase: If the stress continues there is an increase in symptoms, along with the appearance of generalized physiological symptoms such as occasional hypertension and tremors. This phase can be correlated with manomaya and pranamaya koshas. Yoga as a mind body therapy is very effective in this phase.

3. Somatic Phase: This phase is marked by disturbed function of organs, particularly the target, or involved organ. At this stage one begins to identify the diseased state. This phase can be correlated with pranamaya and annamaya koshas. Yoga as a therapy is less effective in this phase and may need to be used in conjunction with other methods of treatment.

psychosomATic mechAnisms of yogA


“Yoga Chikitsa is virtually as old as Yoga itself, indeed, the ‘return of mind that feels separated from the Universe in which it exists’ represents the first Yoga therapy. Yoga Chikitsa could be termed as “man’s first attempt at unitive understanding of mind-emotions-physical distress and is the oldest wholistic concept and therapy in the world.”

*

* Yogacharya Dr. Ananda Balayogi Bhavanani, MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY, MD (Alt.Med)Deputy Director, CYTER, MGMCRI, SBVU and Chairman ICYER at Ananda Ashram, Pondicherry. Email: [email protected] and [email protected]


Annals of SBV

4. Organic Phase: This phase is marked by full manifestation of the diseased state, with pathological changes such as an ulcerated stomach or chronic hypertension, becoming manifest in their totality with their resultant complications. This phase can be correlated with the annamaya kosha as the disease has become fixed in the physical body. Yoga as a therapy has a palliative and ‘quality of life improving’ effect in this phase. It also has positive emotional and psychological effects even in terminal and end of life situations.

Potentialities: Extensive research on Yoga being done all over the world has shown promise with regard to various disorders

and diseases that seem to be amiable to Yoga therapy (www.iayt.org, www.icyer.com, www.svyasa.org ). These include psychosomatic, stress disorders such as bronchial asthma, diabetes mellitus, hypertension, irritable bowel syndrome, gastro intestinal ulcer diseases, atherosclerosis, seizure disorder and headache. It also includes physical disorders such as heart disease, lung disease, and mental retardation. Psychiatric disorders such as anxiety disorders, obsessive-compulsive disorder, depression and substance abuse can also be managed along with other therapies. Musculoskeletal disorders such as lumbago, spondylosis, sciatica and carpel tunnel syndrome can be tackled effectively with Yoga practices that offer a lot of hope in metabolic disorders such as thyroid and other endocrine disorders, immune disorders, obesity and the modern metabolic syndrome.



It is well established that stress weakens our immune system. Scientific research in recent times has showed that the physiological, psychological and biochemical effects of Yoga are of an anti-stress nature. Mechanisms postulated included the restoration of autonomic balance as well as an improvement in restorative, regenerative and rehabilitative capacities of the individual. A healthy inner sense of wellbeing produced by a life of Yoga percolates down through the different levels of our existence from the higher to the lower producing health and wellbeing of a holistic nature.

Streeter et al (2012) recently proposed a theory to explain the benefits of Yoga practices in diverse, frequently comorbid medical conditions based on the concept that Yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored.

They hypothesized that stress induces an: 1. Imbalance of the ANS with decreased parasympathetic and increased sympathetic activity, 2. Under activity of the gamma amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter

system, and 3. Increased allostatic load. They further hypothesized that Yoga-based practices 1. Correct underactivity of the parasympathetic nervous system and GABA systems in part through stimulation

of the vagus nerves, the main peripheral pathway of the parasympathetic nervous system, and2. Reduce allostatic load. According to the theory proposed by Streeter and colleagues, the decreased parasympathetic nervous system and

GABAergic activity that underlies stress-related disorders can be corrected by Yoga practices resulting in amelioration of disease symptoms. HRV testing has a great role to play in our understanding intrinsic mechanisms behind such potential effects of Yoga.

Innes et al had earlier (2005) also postulated two interconnected pathways (given below) by which Yoga reduces the risk of cardiovascular diseases through mechanisms of parasympathetic activation coupled with decreased reactivity of sympathoadrenal system and HPA axis. Psychosomatic Mechanisms Of Yoga:

Yoga understands the influence of the mind on the body as well as that of the body on the mind. This is the principle of adhi-vyadhi elucidated in the Yoga Vasishta more than 5000 years ago! It is interesting that modern medicine has only realised this connection in the last hundred years whereas Yogic of India were teaching and practising it for thousands of years. No wonder Yoga may be considered as the original mind-body medicine.

We are what we think, yet we also start to think that which we do. Yogic concepts and techniques enable the development of right attitudes towards life and enable us to correct the numerous internal and external imbalances we suffer due to our wrong lifestyle/ genetic potential. Yoga enables us to take responsibility for our own health and happiness and as Swami Gitananda Giri would say, “If you want to be healthy do healthy things, if you want to be happy


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do happy things”.The following are just a few of the mechanisms through which Yoga can be said to work as an integrated mind-body

medicine:1. Cleanses the accumulated toxins through various shuddi kriyas and generates a sense of relaxed lightness through

jathis and vyayama type activities. Free flow in all bodily passages prevents the many infections that may occur when pathogens stagnate therein.

2. Adoption of a Yogic lifestyle with proper nourishing diet, creates positive antioxidant enhancement thus neutralizing free radicals while enabling a rejuvenative storehouse of nutrients packed with life energy to work on anabolic, reparative and healing processes .

3. Steadies the entire body through different physical postures held in a steady and comfortable manner without strain. Physical balance and a sense of ease with oneself enhance mental / emotional balance and enable all physiological processes to occur in a healthy manner.

4. Improves control over autonomic respiratory mechanisms though breathing patterns that generate energy and enhance emotional stability. The mind and emotions are related to our breathing pattern and rate and hence the slowing down of the breathing process influences autonomic functioning, metabolic processes as well as emotional responses.

5. Integrates body movements with the breath thus creating psychosomatic harmony. In Yoga the physical body is related to annamaya kosha (our anatomical existence) and the mind to manomaya kosha (our psychological existence). As the pranayama kosha (our physiological existence sustained by the energy of the breath) lies in between them, the breath is the key to psychosomatic harmony.

6. Focuses the mind positively on activities being done, thus enhancing energy flow and resultant healthy circulation to the different body parts and internal organs. Where the mind goes, there the prana flows!

7. Creates a calm internal environment through contemplative practices that in turn enable normalization of homeostatic mechanisms. Yoga is all about balance or samatvam at all levels of being. Mental balance produces physical balance and vice versa too.

8. Relaxes the body-emotion-mind complex through physical and mental techniques that enhance our pain threshold and coping ability in responding to external and internal stressors. This enhances the quality of life as seen in so many terminal cases where other therapies are not able to offer any solace.

9. Enhances self confidence and internal healing capacities through the cultivation of right attitudes towards life and moral-ethical living through yama-niyama and various Yogic psychological principles. Faith, self confidence and inner strength are most essential if at all we wish for healing, repair, rejuvenation and re-invigoration.

10. Yoga works towards restoration of normalcy in all systems of the human body with special emphasis on the psycho-neuro-immuno-endocrine axis. In addition to its preventive and restorative capabilities, Yoga also aims at promoting positive health that will help us to tide over health challenges that occur during our lifetime. This concept of positive health is one of Yoga’s unique contributions to modern healthcare as Yoga has both a preventive as well as promotive role in the healthcare of our masses. It is also inexpensive and can be used in tandem with other systems of medicine in an integrated manner to benefit patients.

Need For Coordination: The need of the modern age is to have an integrated approach towards therapy and to utilize Yoga therapy in

coordination and collaboration with other systems of medicine such as Allopathy, Ayurveda, Siddha and Naturopathy. Physiotherapy and Chiropractic practices may be used with the Yoga if needed. Advice on diet and lifestyle is very important irrespective of the mode of therapy that is employed for a particular patient.

A Word Of Caution: A word of caution is also required. Though Yoga and Yoga therapy are very useful in bringing about a state of total

health it is not a miracle cure for all problems. It needs a lot of discrimination on the part of both the therapist as well as the patient. It may not be useful in emergency conditions and there is a strong need to consult a qualified medical doctor where in doubt. Each patient is different and so the therapy has to be molded to suit the individual needs rather than relying on a specific therapy plan for patients suffering the same medical condition.

A very true problem is that there is a different approach of the different schools of Yoga to the same condition. It is better to follow any one system that one is conversant with, rather than trying to mix systems in a “Yogic Cocktail’. One must also be vigilant as there is a strong presence of numerous quacks pretending to be Yoga therapists and this leads to a bad name for Yoga therapy as well as Yoga in general.



Conclusion: The dedicated practice of Yoga as a way of life is no doubt a panacea for problems related to psychosomatic, stress

related physical, emotional and mental disorders and helps us regain our birthright of health and happiness. It is only when we are healthy and happy that we can fulfill our destiny. With the adoption of a proper attitude and lifestyle through the Yogic way of life, we can rise above our own circumstances and our life can blossom as a time of variety, creativity, and fulfillment.

Yoga helps us regain the ease we had lost through dis-ease (as implied by sthira sukham asanam-PYS). It also produces mental equanimity (samatvam yoga uchyate-BG) where the opposites cease to affect (tato dwandwa anabhigatha-PYS). This enables us to move from a state of illness and disease to one of health and well being that ultimate allows us to move from the lower animal nature to the higher human nature and finally the highest Divine Nature that is our birthright.

References And Recommended Reading:

1.Ananda Balayogi Bhavanani. A Primer of Yoga Theory. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2008. www.rishiculture.org 2.Back issues of International Journal of Yoga Therapy. Journal of the International Association of Yoga Therapists, USA. www.iayt.org 3.Back issues of Yoga Life, Monthly Journal of ICYER at Ananda Ashram, Pondicherry. www.icyer.com 4.Back issues of Yoga Mimamsa. Journal of Kaivalyadhama, Lonavla, Maharashtra, USA. www.kdham.com 5. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible

protection with yoga: a systematic review. J Am Board Fam Pract 2005;18: 491-519. 6. Srimad Bhagavad Gita by Swami Swarupananda. Advaita Ashrama, Kolkata. 20077.Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid,

and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 2012; 78:571-9. 8.The Supreme Yoga: Yoga Vashista. Swami Venkatesananda. Motilal Banarsidass Publishers Pvt Ltd.Delhi. 20079.Ananda Balayogi Bhavanani. Yoga for health and healing. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2008. 10.Anantharaman TR. Ancient Yoga and Modern Science. Mushiram Manoharlal Publishers Pvt Ltd, New Delhi. 199611. Ananda Balayogi Bhavanani. Yoga Chikitsa-Application of Yoga as a Therapy Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2013.

www.rishiculture.org 12. Yoga: Step-by-Step. A 52 lesson Correspondence Course by Yogamaharishi Dr. Swami Gitananda Giri. Ananda Ashram at ICYER,

Pondicherry. www.icyer.com 13. The Forceful Yoga (being the translation of the Hathayoga Pradipika, Gheranda Samhita and Siva Samhita). Translated into English by

Pancham Sinh, Rai Bahadur Srisa Chandra Vasu and Romanized and edited by Dr GP Bhatt. Mothilal Banarsidas Publishers Private Limited, Delhi. 2004.

14. Yoga the Science of Holistic Living. Vivekananda Kendra Patrika. Vol. 17- 2. 1988.15. Taimni IK. The Science of Yoga. The Theosophical Publishing House, Chennai.196116. Meena Ramanathan. Thiruvalluvar on Yogic Concepts. Aarogya Yogalayam, Venkateswara Nagar, Saram, Pondicherry-13.200717. Swami Satyananda Saraswathi. Four Chapters on Freedom. Bihar School of Yoga, Munger, India. 199918. Nagarathna R and Nagendra HR. Integrated approach of Yoga therapy for positive health. Swami Vivekananda Yoga Prakashana,

Bangalore, India. 2001.19. Healthy mind, healthy body. Sri Ramakrishna Math, Chennai, India.1997.20. Feuerstein Georg. The Shambala Guide to Yoga. Shambala Publications Inc, Boston, Massachusetts, and USA.1996.


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Stress is inevitable in the modern world because of the imbalance between the demands of one’s environment and one’s capabilities. In fact, it is the distress, which causes the problem and can be defined as every physical and mental tension that we experience as unpleasant. The environment today is more demanding. From childhood onwards, the development of capacities and capabilities of the individual is not able to keep pace with the increase of demands on them. This gap in most cases goes on widening. The huge crowds at Temples, churches and mosques in some way or the other are related to this imbalance. Everyone seems to be going there in order to beg or bribe the almighty to perform the balancing act.

When we talk of stress we must also remember that some amount of stress is necessary in order to bring out the best in us. However it is vital to learn how to manage stress and keep it under our control. It is important to also remember the words of Epictetus in 60 A.D. who said, “Men are not disturbed by things, but the views, they take of them”. As Swamiji Gitananda Giri Guru Maharaj jocularly used to say’ “You don’t have problems—you are the problem!” A positive frame of mind will help us to be cheerful and unstressed. Maharishi Patanjali’s advise in this regard to cultivate Pratipaksha Bhavanam (The Opposite View) is vital to achieve balance of the emotions and mind. It is also worth trying to follow his advice of Maitri-Sukha (Friendliness towards the happy), Karuna-Dukha (Compassion towards the suffering), Mudhita-Punya (Cheerfulness towards the virtuous) and Upekshanam-Apunya (Indifference towards the wicked).

The most common causes of stress are the Shat Ripus or the six enemies of the spirit. These are Kama (Uncontrolled passion), Krodha (Senseless Anger), Lobha (Greed), Moha (Blind infatuation), Mada (Massive Ego) and Matsarya (Malice / envy). Corruption of character, conduct, thought and interpersonal dealing is another cause of stress.

An environment where sadistic pleasure gives satisfaction, where ethics have little or scant regard, where self-interest is more important and where under cutting and backbiting are a common feature, will surely lead to the development of extreme stress. It is important to realise these facts and be aware of them in our life. Unless we develop awareness and consciousness of what we think, feel and do, there cannot be a lasting solution to stress. We must strive to become persons of “Equal mindedness in all situations” that is described as Stitha Prajna or Samabhava in the Srimad Bhagavad Gita.

Though stress probably cannot be avoided, it can, however, be managed. The following actions may help reduce/eliminate the stress.

1. Awareness: It is important that we first become aware of the stress and then try to let it go. Sharing your tension with a friend and/or a family member may solve the problem to a great extent. You cannot wish away problems by non-acknowledgement of them.

2. Movement: Movement helps in reducing tension. This can mean walking, jumping, making noise, swimming and playing. Stress tends to accumulates in the joints and movement helps to dissipate it. Rotation of the neck and shoulders in many cases helps a lot. Some corporates have even established stress-relieving chambers where employees may shout, screams or hit a hanging pillow to relieve the pent up tension.

3. Yoga techniques: The regular practice of various Yoga techniques and inculcating the Yogic values in daily life will go a long way towards not only reducing the stress levels bit also in giving us that elusive “Peace of Mind”. Yogic relaxation practices such as Shavasana and Yoga Nidra help to create a sense of awareness and relaxation in the whole body as well as the mind.

4. Hobby: A hobby can help to relieve tension because it helps us to divert our mind from an unpleasant occurrence. Music, dance, painting, cooking and gardening are effective ways to take our mind to a different “Zone”. Playing with your pet can also help relieve tension and many people have ‘Thera-pets” or pets that help them therapeutically!

5. Breathing: Breathing is one of the easiest ways of relieving stress. Whenever you feel tension rising, take a few

yogA prAcTices for preVenTion And mAnAgemenT of lifesTyle disorders


*

* Yogacharya Dr. Ananda Balayogi Bhavanani, MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY, MD (Alt.Med)Deputy Director, CYTER, MGMCRI, SBVU and Chairman ICYER at Ananda Ashram, Pondicherry. Email: [email protected] and [email protected]



deep breaths and you will immediately feel the difference. 6. Attitude: It is important to “Let things lie” for sometime when facing problems and many situations resolve on

their own. Other situations may appear smaller and less stressful after some time. Development of a detached attitude can also help us to have a better perception of situations and this in turn helps us to face them better.

7. Visualization: Visualization of a pleasant solution to the problems can also help a lot. This is quite different from daydreaming. This is widely adopted by players and athletes for improving their performance. After a stressful encounter, coolly sit in your chair, close your eyes and visualize the episode as an act of an ignorant person and excuse him for the incident.

8. Auto-Suggestion: Another mental technique is Positive self-suggestion. The negative thoughts are to be replaced with positive ones and an attitude of ‘I can and I will ‘ is to be developed.

9. Self effort: Stress is related to the individual’s environment and their tolerance capacity. As both of these are different in different people, each individual has to settle for their own method for managing their day-to-day problems. It must be clearly understood that we are responsible for our health and happiness and have a duty to take care of these Divine gifts. Swami Gitananda Giri used to often say, “Health and happiness are your birthright”. It is through our own efforts and will power that we can ultimately solve the problem of stress and achieve our birthrights.

Yoga is an integrated way of life in which awareness and consciousness play a great part in guiding our spiritual evolution through life in the social system itself by understanding that “Yoga is the science and art of right-use-ness of body, emotions and mind”.

Basic Warming Up PracticesJattis are basic movements of the body parts that help to release pent up tensions in those parts. They increase

circulation to the part and also the flow of Pranic energy is increased due to the movements. A few of these practices will be described now.

Take up a comfortable standing position such as the Samasthiti Asana. Stand on one leg and shake the other leg. Repeat on the other side and then alternate a few times between right and left. Stand on both legs and start to shake your hands one at a time. Alternate between the right and left a few times and then start to shake both hands at the same time.

Shake your hands and move them up, down, to the left and to the right. Shake your hands all around you in a circular movement. This helps to energize the Pranamaya Kosha, our energy sheath or subtle body. Come back to the standing position.

Open the legs two feet apart and keep the hands on the hip. Move the torso in all four directions clock-wise and anti clock-wise in a grinding action. Then do it in a continuous manner. Bend forward and perform some toe touching with a bouncing action. Bounce to the front, and then move to your left. Move to your right and then come back to the front. Come back to the standing position.

Spread your feet a bit and lift both your arms to the side. Start to twist your torso from side to side a few times. Feel the stretch in your hip region and back. Come back to the standing position and relax with deep breathing for some time.

Sit down with both legs stretched out in front of you. Draw your right knee up to your chest and then kick out with a whooshing sound. Perform the same action on the left side. Continue to alternate legs for some time. Draw up both your knees and do the same action with a whooshing sound as you release the feet. Relax with your feet stretched out in front.

Surya NamaskarRishikesh Surya Namaskar, the Yogic sun salutation is a series of twelve physical postures. These alternating

backward and forward bending postures flex and stretch the spinal column through their maximum range giving a profound stretch to the whole body. The basic breathing principle is to inhale during upward and backward bending postures and exhale during forward bending postures.

Stand erect with your feet close together. Perform Namaskar Mudra by joining your palms together in front of your chest.

Breathe in and stretch your arms over your head into the Anjali Mudra and then arch your back. Feel the healthy stretch in your whole body.

Breathe out and bend forward while keeping your arms and back in one line and as straight as possible. Perform the Pada Hasta Asana by bringing your head to your knees while keeping your hands on either side of your feet.

Breathe in and extend your right leg back until it is straight as possible and you are balanced on your toes and hands. Your left leg should be bent with the sole flat on the ground. Lift your head and bend back and open up your chest. This


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is the Ashwa Sanchalana Asana, the equestrian posture.While breathing out bring your left leg back towards the right and keep the feet just a foot apart with your heels

flat to the ground. Simultaneously raise your buttocks and lower your head between your arms, so that your body forms a triangle with the ground. This is the Mehru Asana or mountain posture. While maintaining the posture, take a deep inhalation.

While breathing out drop both knees to the ground and slowly slide the body down at an angle and bring your chest and chin to the ground. Eight parts of your body namely your toes, knees, chest, hands and chin should touch the ground while the buttocks are kept up. You’re your breath while performing this Ashtanga Bhumi Sparsha, the eight limbed prostration.

Breathe out and come into Bhujanga Asana, the Cobra posture. Focus your awareness at the base of your spine and feel a healthy stretch in your back and neck.

Exhale and come back to the Mehru Asana, the mountain posture. This strengthens the arms and legs as well as the spinal column. Inhale and bring your right leg forward in-between your hands while keeping your left leg in its original

position to perform the Ashwa Sanchalana Asana. Breathe out and bring your left foot forward to come into the Pada Hasta Asana. Breathe in and come up and perform the Anjali Mudra and bend backward. Breathe out and come back to the standing while bringing your hands back to the chest in Namaskar Mudra.

To perform the Rishikesh Surya Namaskar on the opposite side perform the practice again with a slight modification. To complete the other half the same movements are repeated except that the left leg is brought back while performing the Ashwa Sanchalana the first time. The other postures such as Mehru Asana, Ashtanga Bhumi Sparsha and Bhujanga Asana are done in the same manner. When coming back to the Ashwa Sanchalana the left foot is brought forward and then the Pada Hasta is performed by joining right foot to the left before completing the practice with the Anjali Mudra and finally relaxing in the Sama Sthithi with deep breathing.

One full round consists of the 12 poses done twice in sequence. Practice 3 to 9 rounds of the Surya Namaskar daily for maximum benefit. When the exercises are done little quickly the gain is more physical and when they are done slowly with breath awareness the gain is more mental and spiritual.Yoga AsanasTALA KRIYA

The term, “Tala” refers to a Palmyra tree and you should try to stretch yourself as tall as that tree while performing this practice. Take up a comfortable and stable Samasthiti Asana. Breathe in and lift both arms up over your head until they are parallel to each other. Let the palms of both hands face inward and then go up onto your toes and stretch up as high as possible. Hold the breath and feel the healthy stretch along your whole body from toes to finger tips. Breathe out and relax your arms back to your sides while coming back to the flat foot posture. Repeat the practice two more times at each session for maximum benefit. With practice the posture can be held for a longer time and normal breathing done while holding the posture for 30 to 45 seconds.

HASTHA KONA KRIYAStand in a steady Samastiti Asana with your arms by your side. Breathe in and lift your right arm over your head.

Try to extend the arm over your head towards the left as far as possible without bending it. This gives a good stretch to



the entire right side of the body. Slowly start to breathe out and lower your arm slowly back to the side. Repeat the practice a few more times.

Make sure that you lift your arm on the in breath and lower it on the out breath. Perform the practice on the opposite side by lifting your left arm over your head while breathing in. Extend it as far towards the right as possible without bending it. Feel the excellent stretch on the entire left side of your body. Lower your arm back to your side while breathing out. Repeat the practice a few more times.

The Hastha Kona Kriya helps to stretch and tone up the musculature of the arms, shoulders and the Para-spinal area in a way not done in day-to-day life. This helps trigger the relaxation response in these tissues that are normally tensed due to disuse, misuse and abuse. A sense of profound relaxation is obtained after the practice of this activity that is

also known as the Ardha Kati Chakrasana.

TRIKONA ASANAStand in Samasthiti Asana. Place your feet two to three feet apart facing forwards.

Stretch your arms to the sides so that they are pulling the chest in opposite directions. Turn your head and right foot to the right side and slowly bring your right hand down to the right foot and place the palm of the right hand on the ground in front of the right foot. Look up at the middle finger of the left hand. Let the entire torso get a good twist and stretch. Hold the position for 30 seconds while performing deep breathing. Release and come back up to the open arm position and then do the opposite side by placing your left hand down in front of the left foot. Hold the position for 30 seconds while performing deep breathing. When ready come back up to the Samasthiti Asana and relax with a few rounds of deep breathing.

VAKRA ASANASit erect with your legs stretched out in the Uttana Asana. Bend your right knee

and place the right foot by the side of the left knee. Turn to your right and place your right hand on the ground behind you to support your erect position. Bring your left arm round the outer side of the right knee and catch hold of the right big toe. Turn your head and look back over your right shoulder. The erect knee acts as a fulcrum for getting maximum twist of the spine. Keep your torso as straight as possible. Hold the posture for 30 seconds with soft breathing.

Release the posture and come back to the Uttana Asana. This posture gives an excellent massage to the abdominal organs and is very useful for those suffering from diabetes as well as digestive disorders. It is also useful for neck and back problems. Repeat the practice on the opposite side in a similar manner. Hold the posture for 30 seconds with soft breathing. Release the posture and come back to the Uttana Asana and relax with deep breathing for some time.

ARDHA MATSYENDRA ASANASit erect with both legs stretched out in front and your palms gently pressing on the ground by your sides in Uttana

Asana. Fold your right knee and place the heel tight in against the perineum. Place your left foot by the side of your right thigh by crossing it over the knee. Bring your right hand round the outer side of the left knee passing between the chest and the knee and catch hold of the left big toe. Your right shoulder blade rests on the outer side of your left knee.

Take your left hand round your back and try to get a grip on your right thigh. Look back over your left shoulder. The erect knee acts as a fulcrum for getting maximum twist of the spine. Keep your trunk vertical. Hold the posture for 30 seconds with soft breathing. This posture gives an excellent massage to all the abdominal organs and is very useful for those suffering from diabetes as well as digestive disorders.

Release and come back to the Uttana Asana.Repeat on the opposite side by folding your left knee with the heel tight in against the

perineum. Place your right foot by the side of your left thigh by crossing it over the knee. Bring your left hand round the outer side of the right knee passing between the chest and the


Annals of SBV

knee and catch hold of the right big toe. Your left shoulder blade rests on the outer side of your right knee.Take your right hand round your back and try to get a grip on your left thigh. Look back over your right shoulder.

The erect knee acts as a fulcrum for getting maximum twist of the spine. Keep your trunk vertical. Hold the posture for 30 seconds with soft breathing. When you are ready slowly release the posture and come back to the Uttana Asana.

CHATUS PADA ASANA AND VYAGRAHA PRANAYAMATake up the Chatus Pada Asana with your weight evenly

distributed between your hands and knees. Start breathing in and out for an equal count of six. While breathing in slowly lift your head and arch your back downwards. Then breathe out slowly and lower your head while arching your back upwards. Breathe in while lifting your head and arch your back down.

Breathe out while lowering your head and arching your back up. Repeat this excellent practice at least nine times at each session. Vyagraha Pranayama helps us to utilize all sections of our lungs in a balanced and controlled manner thus energizing the whole body with healing Pranic energy.

When ready slowly relax back to the Vajrasana for a period of quiet contemplation.

BHUJANGINI MUDRATo perform the Cobra gesture, take up the Unmukha Asana

which is a prone position with your entire body in a straight line. In this technique the emphasis is on the breathing pattern and

the production of a mighty hissing sound through the clenched teeth. Slowly bring your arms forward and keep your palms on the ground alongside your shoulders. Take in a deep breath. While making a mighty hissing sound, flare back into the Bhujanga Asana. Slowly relax back onto the floor while breathing in and then again flare back with a mighty hiss. Repeat this Mudra at least three to six times at each session. This technique helps release the pent up stress that accumulates in our system from our daily life and provides great emotional and mental relief.

It is an excellent stress-buster and is a must for all in this day and age. After completing the practice come back down to the face prone pose. Place your arms alongside your body and turn your head to the side. Relax for a few minutes and let the benefit of this Mudra seep into each and every cell of your body.

PAWAN MUKTA ASANALie down in a comfortable Shavasana and start to breathe in and

out for an equal count of six or eight. To perform the single legged Eka Pada Pawan Mukta Asana bend and lift your right knee while breathing in and simultaneously also lift your head off the ground. Catch hold of your knee with your arms and try to touch your knee to your forehead. Hold the position a few seconds and then while breathing out slowly release the position and lower your head while at the same time bringing your foot back to the ground.

Repeat this at least two more times to complete a set of three rounds of the practice. Relax a few seconds in the Shavasana and then perform the practice on the left side. Relax in Shavasana for a few minutes with deep and rhythmic breathing while concentrating on your abdominal area that will help to relax you further.

To perform the double legged Dwi Pada Pawan Mukta Asana bend and lift both your knees while breathing in. Bring them as close to your forehead as possible while simultaneously raising your head to meet the knees. Hold a few seconds and then while breathing out, lower your



head and simultaneously bring your feet back to the ground. Repeat this two more times to complete a set of three rounds at each session.

Relax in Shavasana for a few minutes with deep and rhythmic breathing while concentrating on your abdominal area. This will help you to relax even further as the emotional tensions tend to tighten up the abdominal area leading to a feeling of “butterflies in the stomach”.

EKA PADA UTTANPADA ASANAFrom Shava Asana lift your right leg up towards the sky on the in breath.

Try not to bend the knee if possible. On the out breath lower the leg back to the ground. Use a breath cycle of in and out for a count of six or eight.

Repeat this two more times. Perform the same practice on the left side. Lift your left leg up towards the sky on the in breath. Try not to bend the knee if possible. On the out breath lower the leg back to the ground. Use a breath cycle of in and out for a count of six or eight. Repeat this two more times. After performing the practice at least three times on each side relax in Shava Asana with deep breathing.

DWI PADA UTTANPADA ASANAFrom Shava Asana lift both legs up towards the sky on the in breath. Try not to

bend the knees if possible. On the out breath lower the legs back to the ground. Use a breath cycle of in and out for a count of six or eight. Repeat this two more times and then relax in Shava Asana with deep breathing. Those who have back problems should not do straight leg lifting and should do it with bent knees instead to avoid increasing the strain on the back.

SARVANGA ASANALie down in Shava Asana. Breathe in and lift both legs at a time until you are in the Dwi

Pada Uttanpada Asana. Continue the upward motion and lift your back off the ground using both arms to support the lower back. Keep your trunk and legs in a straight line by supporting the entire trunk on the shoulders. Breathe in a shallow manner while concentrating on the healthy pressure at the throat region.

Release the posture after 10 to 15 seconds and while breathing out slowly come back to the Shava Asana. Roll your head from side to side to ease away any pressure that may have accumulated in the neck. After a short relaxation, repeat the practice two more times.

VIPARITA KARANI Viparita Karani is the shoulder stand-like Mudra where the weight of the body

is supported by the elbows while the hands are placed against the pelvic girdle. From the supine Shavasana slowly lift both your legs up as if performing the Sarvangasana. However the weight of your body should be balanced on your elbows and arms and not on your shoulders.

Hold the posture in a comfortable manner and then start to perform the incomplete and complete actions of this Mudra.

Perform the incomplete action by taking a deep inhalation and bringing your straightened legs towards your head so that your body makes an acute angle. Then perform the completed action by pushing your legs away while exhaling the breath. Make sure that your feet are extended in a rigid position making an obtuse angle.

Breathe in bringing your feet towards your head 1-2-3-4-5-6. Breathe out pushing your feet away 1, 2, 3,4,5,6. Continue the practice for a minimum of three to nine rounds of this alternation between the incomplete and

complete postures with the breath cycle at every session. This Mudra promotes a healthy metabolic function by stimulating the pancreas and the uptake of insulin by cells of

the body. It is highly recommended for the prevention, control and possible cure of conditions such as Diabetes Mellitus


Annals of SBV

and imbalances of the thyroid gland. When ready slowly bring your legs down to the ground in a phased manner and enjoy a quiet period of relaxation in the Shavasana.

SHAVASANA WITH SAVITRI PRANAYAMALie supine on the ground with your head preferably to the north enabling your body to be in alignment with the

earth’s electromagnetic field. Make sure that your head and body are in a straight line while hands are kept relaxed by side with palms facing upwards. Bring your feet together and let forefeet fall away into a ‘v’ shape with heels as close together as possible.

Start to consciously watch your breath by letting your awareness settle in the abdominal area. Feel the abdominal movements as your abdomen rises as you breathe in and falls as you breathe out. After a few rounds of this practice, slowly let your awareness settle at the tip of your nose. Feel the cool inspired air flowing into your nostrils as you breathe in and become aware of the warm expired air flowing out of the nostrils when you breathe out.

Consciously regulate your breath so that the duration of the incoming and outgoing breathes are equal. The inspiration and expiration can be for a count of 4 or 6 initially and then with practice elongated to a count of 8 or 10. Perform at least nine rounds of this conscious deep breathing and enjoy the relaxed sensation that spreads throughout your body.

Relaxation in Shavasana can be further deepened by utilizing Savitri Pranayama to relax and rejuvenate your body, emotions and mind. Breathe in through your nose for a count of 6. Hold in the breath for a count of 3. Breathe out through your nose for a count of 6. Finally hold the breath out for a count of 3. Make sure that you are breathing in and out through both nostrils and that you are using the complete Yogic breathing. Perform at least 9 rounds of this combination practice that heightens the relaxation to a very deep level.

After performing 10 to 15 minutes of the Shavasana slowly start to move your fingers and toes. Perform conscious stretching and make a smooth transition from the relaxed to the active state. Lift your left arm over your head and turn over onto your left side. Continue the turning action until you come into the face-prone posture. Perform Makara Asana by placing your right hand on the left while the left is placed palm down on the ground in front of you. Keep your forehead or chin on your right hand while keeping your legs a foot apart. Bring your hands forward near your shoulders and push yourself back into the Bhujanga Asana. Continue the back bending movement and go into the four footed Chatus Pada Asana. Relax into the Shashanga Asana with your arms stretched out in front and then finally come back to the Vajrasana. With your palms on your thighs sit quietly for some time and enjoy the effects of the deep relaxation that has spread to every part of your body.

SPANDA – NISHPANDA KRIYA This practice is done from Shavasana using the yogic concept of Shpanda Nishpanda, which means the coupling of

tension and relaxation. We consciously tense different parts of our body as much as possible and then relax them to the maximum in a step-by-step manner. This produces a better relaxation response than the mere attempt to relax without putting in the initial effort of tension.

Lie down in a comfortable supine Shavasana with your entire body in a singe straight line. After a few seconds of relaxation in this position, start to tense your entire body part-by-part from your toes up to the top of your head until every part of your body is as tense as possible. Hold this 100% tension state of Spandha for a few seconds. Let all the muscles of your entire body be as tense as possible. At the peak of the tension, just ‘let go’ and immediately relax your entire body 100%. This is the state of Nishpanda. Enjoy this relaxed state and with conscious awareness continue to watch your breath as it comes in and goes out of your nose.

Repeat this practice again by tensing up your entire musculoskeletal system to the state of Spandha and hold it for a few seconds. When ready let go completely and enjoy the Nishpanda state for a few minutes.

To complete the practice repeat the Spandha – Nishpanda Kriya a third time by tensing up your entire musculoskeletal system from your toes to the top of your head. Hold the complete tension for a few seconds. When ready let go completely and enjoy the complete relaxation that ensures. Be aware of how all your muscles relax in this practice because the relaxation is deepened when it is contrasted with tension.

This practice is a boon for those suffering psychosomatic, stress induced and stress aggravated life disorders such as hypertension, diabetes, asthma, insomnia, peptic ulcers and bowel disorders.



MARMANASTHANAM KRIYAThe twenty-two sensitive parts of the body are known by the collective Sanskrit

term Marmanasthanam. To concentrate upon these parts in a particular order or to command these areas to relax in a particular way while concentrating, gives a very satisfactory, deep relaxation that has been found by tested experiments to give relief even to compulsive dreaming. This is an excellent Kriya to do at the end of a strenuous session of Asanas and Pranayamas. The relaxation should be preceded by at least nine rounds of Savitri Pranayama, the Rhythmic Breath, to create the proper atmosphere. This technique (Kriya) can be done in two ways, one for relaxation the other for deep concentration. For relaxation the technique is done from “feet to the head.” For deep concentration from “head to feet.” While concentrating upon twenty-two body parts, each part is commanded (by mind) “to relax” or a thought of peace or serenity” directed to the areas.

For relaxation, concentrate upon the (1) toes and command the toes to relax (2) feet (3) lower legs to knees (4) upper legs to hips (5) buttocks (6) base of spine (7) pelvic area (8) abdomen (9) chest and (10) shoulders. Now take your concentration down to the (11) fingers, and command the fingers to relax then (12) hands (13) lower arms to elbows (14) upper arms to shoulders where your concentration joins with body concentration (15) throat (neck) (16) around the mouth and chin (17) around the nose and cheeks (18) eyes (19) back around the ears (20) back of the head (21) top of the head (22) Cavernous Plexus in the middle of the forehead. All the while you should command “relaxation.” Perform Jyoti Dharana and Jyoti Dhyana (concentration and meditation on the Divine light) at the Bhrumadhya Bindu (Midpoint between the eyebrows). Visualize the Divine Jyoti to be having the brilliance equal to 1000 suns but without the glare. Absorb yourself into this Divine Jyoti.

PRANAYAMA PRACTICESPRANAVAPRANAYAMA‘Tasya vachakah pranavaha’, the sacred sound of the Divine is the Pranava says

Maharishi Patanjali. This develops abdominal, thoracic and clavicular regions of the lungs to their maximum capacity. This Pranayama has unlimited healing potential and brings about harmony of body, emotions and mind. It is an important part of Rishiculture Ashtanga Yoga tradition as taught by Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj.

Adham Pranayama, the abdominal or lower chest breathing. Put the fingers into the Chin Mudra with the index and thumb fingers touching each other at the tips. Keep the other three fingers straight and united. Take a deep breath into the lower chest and abdominal regions and then let it out with the sound aaa…….

To perform thoracic or mid-chest breathing, the Madhyam Pranayama, curl your fingers inward to form Chinmaya Mudra. Take a deep breath into the mid chest and thoracic regions and then breathe out with the sound ooo…….

Adyam Pranayama is the clavicular or upper chest breathing and utilises Adhi Mudra. Clench your fists with your thumb in the centre. Keep the Adhi Mudra on your thighs and breathe deeply into the upper chest and clavicular regions and then exhale with the sound mmm…….

Joining the earlier three parts of the breath in a complete Yogic breath is the fourth stage, known was Mahat Yoga Pranayama. Put the Adhi Mudra with knuckles of your right and left hands touching in front of the navel. This is now known as the Brahma Mudra. Take a deep breath into the low, mid and upper chest regions. Now let the breath out with the sounds of aaa…ooo…mmm…. Relax and enjoy the feeling of potent healing energy flow through the entire body.

NASARGAMUKHABHASTRIKANasarga Mukha Bhastrika is a forceful expulsion of the breath through the mouth that can accompany different

movements to relieve our pent up stress.Take up a comfortable standing position and then start to shake your hands as vigorously as possible to help loosen

up the accumulated tensions of your daily life. Visualize all the tensions that have accumulated in your wrist and elbow joints getting a good ‘shake up’ by this action. When you have got the tensions loosened up, take in a deep breath through your nose and clench your fist as if catching hold of all your tensions and stress. Now with a powerful blast through your


Annals of SBV

mouth “whoosh” away all your accumulated tensions and stress as forcibly as possible. Again shake your hands as fast as possible. Breathe in and catch hold of the tension in

your fist. Throw it all away with a blast. Make sure that you are using your diaphragm muscle vigorously while blasting out the breath in this practice.

Perform this practice 3, 6 or 9 times as necessary. After performing 3 to 9 rounds of this practice, relax in the standing position and enjoy the feeling of relief that sweeps through your arms as you relax with some deep breathing.

CHANDRAPRANAYAMASit in Vajrasana and perform Nasarga Mudra with your right hand. Close your right nostril with your thumb.

Inhale slowly through your left nostril for a count of four. Now exhale through the same left nostril for a count of eight. Keep your right nostril closed throughout the duration of the practice. Repeat the Chandra Pranayama for a

minimum of nine rounds at each session. Patients of lifestyle disorders such as anxiety, hypertension, insomnia, diabetes and other stressful conditions can

benefit by practising this Pranayama 27 times before breakfast, lunch, dinner and before going to bed at night.

BHRAMARIPRANAYAMASit on the heels in the Vajrasana with the spine erect. Perform the Shanmuki Mudra with the thumbs of the hands

closing the external auditory canal. The first two fingers are then placed over the closed eyelids while the ring fingers regulate the flow of air through the nostrils. The little fingers are placed over the closed lips. This Mudra helps in joining together the nerves of the hands with the facial and trigeminal nerves on the face.

Take a slow and deep breath in for six counts. Let out the breath very slowly while making a sound in the nasal passages like the high-pitched sound of a female bee. This buzzing sound is very much like the Anuswarah sound of “mmm” of the Pranava AUM. Repeat this at least nine times.

Bhramari is one of the Swara Pranayamas and stimulates the secretions and tones up nerve centres. This helps relive Pitta conditions and rejuvenates the skin. It also creates a beautiful voice. It is a contemplative prelude to Nada Yoga.

CONTEMPLATIVE PRACTICESPRANADHARANA-BREATHAWARENESS: Sit in Vajrasana or lie down in Shava Asana. Begin to be

aware of your breathing and how the air passes down from the nostrils into the lungs and then back out the nostrils. Feel the abdominal movements as the abdomen rises with the in breath and falls with the out breath. Let your awareness settle in the abdomen. Feel the cool inspired air flowing into the nostrils and the warm expired air flowing out of the nostrils. Let your awareness settle at the tip of the nose. Consciously regulate the breath so that the ratio of insp: exp is equal. It can be a 4,6,8 or 10 count. Perform nine rounds of this practice.

MINDFULNESSBASEDMEDITATION: One of the most productive of the many forms of “quiet sitting”, popularly grouped under the heading of meditation is the mindfulness based awareness of one’s thoughts. This is to be done without identifying with the thoughts and without either justifying or condemning them. Take up a straight back sitting position and sit facing to the North or East in the early morning. Keep your mind as placid as possible, as this is the important feature of the early morning meditation. Breathe slowly and rhythmically, but very quietly. Do not upset the peace. Hold your mind concentrated inside your head at a point in line with the eyebrows. Relax. Don’t attempt to force visualization, simply be alert and expectant. Presently, you will have the sensation of movement within the head, as though watching a “ticker tape” of your thoughts. The thoughts will be in extreme slow motion. Observe the thoughts. Don’t get emotionally involved with them, just watch them. You will actually be able to see your thoughts, as well as hear them. Usually, the thoughts are quite mundane, but benign. Simply observe them, passively and dispassionately.

OMJAPA: Take up any meditative posture and start to perform the Savitri Pranayama in a 6 by 3 or 8 by 4 rhythm. Make an audible Pranava OM in the Bindu Nadi. With Japa-Ajapa, make silent intonation of the Pranava OM concentrating at this same point. Do not let the mind waver away from either a conscious repetition of the Mantra OM, as Japa, or as the silent Ajapa.

AJAPAJAPA: Take up any meditative posture and start to perform the Savitri Pranayama in a 6 by 3 or 8 by 4 rhythm. As you breathe in listen to the sound of SAH made as the breath enters your respiratory passages. As you breathe out listen to the sound of HUM that is made as the breath leaves your respiratory passages. Concentrate on this Ajapa Japa of HAMSA SOHAM in tune with the breath.

International Journal of Yoga • Vol. 7 • Jan-Jun-201460

Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time

Ananda Balayogi Bhavanani, Meena Ramanathan1, Balaji R2, Pushpa D2

Deputy Director, 1Co‑ordinator and Yoga Therapist, 2Yoga Instructor, Centre for Yoga Therapy, Education, and Research, Mahatma Gandhi Medical College and Research Institute, Puducherry, India

Address for correspondence: Dr. Ananda Balayogi Bhavanani, Deputy Director, Centre for Yoga Therapy, Education, and Research,

Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry India. E‑mail: [email protected]

human life and one such example is swarodaya vigyan, the ultradian nasal cycle as codified in the Shiva swarodaya, wherein differential effects of different phases of the nasal cycle are given in great detail.[2]

A group of pranayama, namely chandra and surya nadi (CN and SN, respectively) and chandra bhedana and surya bhedana (CB and SB, respectively) have uninostril breathing (UNB) and alternate nostril breathing (ANB) patterns using left and/or right nostrils, respectively. This type of yogic nostril manipulation is also furthered in nadi shuddhi (NS), a specific technique involving alternate use of both nostrils in a specific pattern.

These yogic UNB and ANB techniques have captured the imagination of researchers worldwide and recent studies have reported their differential physiological and

INTRODUCTION

Pranayama, the fourth limb of classical ashtanga yoga is an essential part of yogabhyasa and is increasingly being used as a tool of yoga chikitsa or the application of yoga as a therapy. There are a multitude of pranayama techniques and it is traditionally taught that each of them has different psycho‑physiological benefits.[1] The ancient rishis, the seers of India have intuitively analyzed all aspects of

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Website: www.ijoy.org.in

Quick Response Code

DOI: 10.4103/0973-6131.123489

Background: Recent studies have reported the differential physiological and psychological effects of yogic uninostril breathing (UNB) and alternate nostril breathing (ANB) techniques. This study aims to determine differential effects of these techniques on reaction time (RT), heart rate (HR), and blood pressure (BP).

Materials and Methods: Twenty yoga‑trained subjects came to the lab on six different days and RT, HR, and BP were recorded randomly before and after nine rounds of right UNB (surya nadi [SN]), left UNB (chandra nadi [CN]), right initiated ANB (surya bhedana [SB]), left initiated ANB (chandra bhedana [CB]), nadi shuddhi (NS), and normal breathing (NB).

Results: Overall comparison of ∆ % changes showed statistically significant differences between groups for all parameters. There was an overall reduction in HR‑ and BP‑based parameters following CB, CN, and NS with concurrent increases following SB and SN. The differential effects of right nostril initiated (SB and SN) and left nostril initiated (CB, CN, and NS) UNB and ANB techniques were clearly evidenced. Changes following NB were insignificant in all respects. The overall comparison of ∆ % changes for RT showed statistically significant differences between groups that were significantly lowered following both SB and SN.

Discussion and Conclusion: Our study provides evidence of sympathomimetic effects of right nostril initiated pranayamas with sympatholytic/parasympathomimetic effect following left nostril initiated pranayamas. We suggest that the main effect of UNB and ANB techniques is determined by the nostril used for inspiration rather than that used for expiration. We conclude that right and left yogic UNB and ANB techniques have differential physiological effects that are in tune with the traditional swara yoga concept that air flow through right nostril (SN and pingala swara) is activatory in nature, whereas the flow through left nostril (CN and ida swara) is relaxatory.

Key words: Blood pressure; heart rate; pranayama; reaction time.

ABSTRACT

Short Communication

Bhavanani, et al.: Immediate differential effects of pranayamas

61International Journal of Yoga • Vol. 7 • Jan-Jun-2014

psychological effects including effects on O2 consumption, metabolism and body weight,[3] blood glucose,[4] involuntary blink rates[4] and intraocular pressure,[5] heart rate (HR), stroke volume and end diastolic volume[6] as well as skin resistance, digit pulse volume, and blood pressure (BP).[7] ANB (as done in NS pattern) has been reported to rapidly alter cardiopulmonary responses and improve simple problem solving.[8] Raghuraj and Telles have suggested that yogic breathing through the right, left, or through both nostrils alternately produces distinct autonomic changes.[9] They reported that right UNB increased systolic pressure (SP) and diastolic pressure (DP), whereas left UNB resulted in significant reduction in SP and mean pressure (MP).

However, none have studied the immediate effect of these UNB and ANB techniques on reaction time (RT), a sensitive and simple indicator of central neuronal processing. RT is the interval between the onset of a signal (stimulus) and the initiation of a movement response and is an indirect index of central neuronal processing as well as a simple means of determining sensory‑motor association, performance, and cortical arousal. Though RT shortening effects of pranayama as well as comprehensive yoga training of different durations have been reported,[10‑12] earlier none have studied the immediate effects. Previous studies by Bhavanani et al. have reported significant and immediate decrease in auditory reaction time and visual reaction time (ART and VRT, respectively) following nine rounds of mukha bhastrika, a bellows type of pranayama in normal school children as well as mentally challenged adolescents.[13,14]

With the above in mind, we have studied the immediate effects of UNB and ANB on cardiovascular (CV) parameters and RT. The aim of the study is to determine the differential effects of these techniques if any and understand the mechanisms behind their physiological effects. It is hypothesized that right/left UNB, ANB performed by right in and left out/left in and right out methods as well as NS will have different effects. Keeping all of this in mind, this study was planned to investigate the acute effects of different UNB and ANB pranayamas on resting CV parameters and RT.


Twenty subjects (13 females and 7 males) regularly attending yoga sessions at the Centre for Yoga Therapy, Education, and Research (CYTER) thrice weekly for more than 3 months were recruited for the study by convenience sampling. Their mean age and Body mass index (BMI) were 34.10 ± 13.62 standard deviation (SD) and 25.28 ± 7.65 (SD), respectively. All of them were right handed. Eight of them reported normal health status, whereas the other 12 reported that they

were undergoing regular treatment for one or more medical conditions such as hypertension,[6] hypothyroidism,[3] type 2 diabetes mellitus,[2] polycystic ovary syndrome,[2] bipolar affective disorder,[1] sinusitis,[1] psoriasis,[1] and uterine prolapse.[1] None were receiving autonomic modifying agents like α‑ or β‑blocking drugs.

Each subject came to the CYTER lab on six different days. They were instructed to have a light breakfast before 8 a.m. and report for the study between 10 a.m. and 12 noon. On each of the 6 days, they performed nine rounds of any one of the six techniques selected by random selection of both subject and technique so as to avoid any bias or influence of different days on the group.

The subjects were instructed to sit in any comfortable posture and relax for 5 min before the pre‑intervention recordings of resting HR, BP, and RT were taken. They then performed nine rounds of the following techniques after which the post‑recordings of HR, BP, and RT were repeated.• Right UNB (SN) using nasika mudra wherein the ring

finger was used to occlude left nostril by pressing on the outside of the nostril

• Left UNB (CN) using nasika mudra wherein the thumb was used to occlude right nostril by pressing on the outside of the nostril

• Breathing in through right nostril and out through the left (SB) using nasika mudra to regulate flow through respective nostrils

• Breathing in through left nostril and out through the right (CB) using nasika mudra to regulate flow through respective nostrils

• Breathing in through left nostril and out through right followed by breathing in through right and out through left (NS) using nasika mudra to regulate flow through respective nostrils

• Performance of normal breathing (NB) through both nostrils with nasika mudra (just performed as a placebo but not closing either nostril).

Participants were instructed to focus their mind on their breath and ensure it was slow, deep, and regular while attempting to utilize all sections of their lungs. Respiratory rate for all techniques was maintained at 5‑6 breaths per min (BPM) and this was regulated by one of the investigators providing an audible count of six for both inspiration and expiration. As they were all attending regular yoga sessions, none reported any difficulty in doing the techniques in this manner.

To ensure objectivity in measuring HR and BP, the recordings were done using non‑invasive semi‑automatic BP monitor (CH – 432, Citizen Systems, Tokyo, Japan) with an instrumental accuracy of ± 5% for HR and ± 3 mm Hg for BP. Pulse pressure (PP) was calculated as SP‑DP, MP as



DP + 1/3 PP, rate‑pressure product (RPP) as HR × SP/100, and double product as HR × MP/100.

RT apparatus manufactured by Anand Agencies, Pune was used for the study. The instrument has a built in 4‑digit chronoscope with a display accuracy of 1 ms. It features four stimuli, two response keys, and a ready signal. Switches for selecting right or left response key for any stimulus are provided. In this study, simple ART was recorded for auditory beep sound stimulus and simple VRT for red light stimulus. The subjects were instructed to release the response key as soon as they perceived the stimulus. The signals were given from the front of the subjects to avoid the effect of lateralized stimulus and they used their dominant hand while responding to the signal. All subjects were given adequate exposure to the equipment on two different occasions to familiarize them with the procedure of RT measurement as this is found to be more consistent when subjects have had adequate practice. For statistical analysis of RT, more than 8‑10 trials were recorded and the average of the lowest three similar observations was taken as a single value.[11‑14]

Data were assessed for normality using GraphPad InStat and passed normality testing by Kolmogorov‑Smirnov

Test. Statistical analysis was done using analysis of variance (ANOVA) with Tukey‑Kramer Multiple Comparisons Test for data with identical SDs and Kruskal‑Wallis (non‑parametric ANOVA) with Dunn’s Multiple Comparisons Test for data with non‑identical SDs. Students t (paired) test was done and P values less than 0.05 were accepted as significant differences in pre‑post, intra‑group comparisons.

RESULTS

The overall comparison of ∆ % changes showed statistically significant differences between groups for all parameters [Tables 1 and 2]. As seen in Table 1, HR reduced significantly following both CB and CN, whereas SP fell significantly following CB and NS and a significant rise was seen in DP following SB. PP fell significantly following NS, MP reduced significantly following CB, while it increased following SB and there was significant reduction in RPP and Double product (DoP) following CB and CN, while only RPP decreased significantly following NS. Inter‑group differences were statistically significant for HR, DP, MP, RPP, and DoP comparisons between CB and SB, as well as SB and CN. The comparisons were significant for RPP and DoP between CN and SN as well as CB and SN. The inter‑group differences were statistically significant

Table 1: Overall comparison of ∆ % changes in heart rate, systolic pressure, diastolic pressure, pulse pressure, mean pressure, rate‑pressure product, and double product in 20 subjects following a control period of nine rounds of normal breathing as well as nine rounds of chandra bhedana, surya bhedana, chandra, surya nadi and nadi shuddhi pranayamas(%) ∆ % after NB ∆ % after CB ∆ % after SB ∆ % after CN ∆ % after SN ∆ % after NS P valueHR 0.19±4.79 −4.61±5.99 2.22±6.42* −4.78±7.17 1.13±8.05 0.30±8.41 0.0017SP −0.90±5.05ϒ −2.29±5.58 1.23±5.33ρρρ −1.28±5.13 1.49±5.17υυυ −5.04±4.97 <0.0001DP 0.36±5. 91 −2.42±6.94 4.17±6.46** −2.05±7.59 −0.50±6.36 0.59±6.98 0.0089PP −0.57±18.84ϒ −1.26±13.14 −2.70±13.95 −1.16±13.42 6.12±11.70υυυ −12.83±15.04 0.0008MP 0.34±3.85 −2.40±5.62 2.80±4.98** −1.76±5.70 0.33±5.36 −2.02±4.86ρ 0.0027RPP −1.03±7.83 −6.84±7.25 3.64±10.25** −5.90±9.74 2.74±10.65ψψΩ −4.82±8.70ρυ <0.0001DoP 0.47±7.11 −6.93***±7.52 5.20±9.77 −6.33±10.15 1.56±10.70ψΩ −1.82±8.46 <0.0001Values are given as mean±SD. P values are given for intergroup compassions done by repeated measures of analysis of variance with Tukey‑Kramer Multiple Comparisons Test. For HR: *P<0.05 for CB versus SB; P<0.05 for SB versus CN; For SP: ρρρP<0.001 for SB versus NS; υυυP<0.001 for SN versus NS; ϒP<0.05 for NB versus NS; For DP: **P<0.01 for CB versus SB; P<0.05 for SB versus CN; For PP: ρP<0.05 for CN versus NS; υυυP<0.001 for SN versus NS; ϒP<0.05 for NB versus NS; For MP: **P<0.01 for CB versus SB; P<0.05 for SB versus CN; ρP<0.05 for SB versus NS; For RPP: **P<0.01 for CB versus SB; ψψP<0.01 for CB versus SN; P<0.01 for SB versus CN; ΩP<0.05 for CN versus SN; ΩP<0.05 for SB versus NS; υP<0.05 for SN versus NS; For DoP: ***P<0.001 for CB versus SB; ψP<0.05 for CB versus SN; P<0.001 for SB versus CN; ΩP<0.05 for CN versus SN; For all other comparisons, P>0.05. HR = Heart rate; SP = Systolic pressure; DP = Diastolic pressure; PP = Pulse pressure; MP = Mean pressure; RPP = Rate‑pressure product; Dop = Double product; NB = Normal breathing; CB = Chandra bhedana; SB = Surya bhedana; CN = Chandra nadi; SN = Surya nadi; NS = Nadi shuddhi

Table 2: Overall comparison of ∆ % changes in auditory reaction time and visual reaction time in 20 subjects following a control period of nine rounds of normal breathing as well as nine rounds of chandra bhedana, surya bhedana, chandra nadi, Surya nadi, nadi shuddhi pranayamas(%) ∆ % after NB ∆ % after CB ∆ % after SB ∆ % after CN ∆ % after SN ∆ % after NS P valueART −2.62

(−7.35,7.23)4.73

(−6.88, 7.43)−4.84

(−12.75,8.40)***3.95

(−9.42,10.67)6.596

(−15.05,4.82)ψψψΩΩΩρ1.09

(−8.38,8.97)υυ<0.0001

VRT 1.40 (−4.09, 5.18)

2.02 (−6.86,9.89)

−6.05 (−13.04,6.64)**υ

2.83 (−9.31,10.17)

−6.67 (−0.89,−10.94)ψψψΩΩΩρρρ

1.28 (−7.58,10.66ϒϒϒ♠♠

<0.0001

Values are given as median (range).P values are given for intergroup compassions done by Kruskal Wallis (nonparametric analysis of variance) with Dunn’s Multiple Comparisons Test. For ART:***P<0.001 for CB versus SB; ψψψP<0.001 for CB versus SN; P<0.01 for SB versus CN; ΩΩΩP<0.001 for CN versus SN; ρP<0.05 for SN versus NB; υυP<0.01 for SN versus NS; For VRT: **P<0.01 for CB versus SB; ψψψP<0.001 for CB versus SN; P<0.01 for SB versus CN; υP<0.05 for SB versus NB; ♠♠P<0.01 for SB versus NS; ΩΩΩP<0.001 for CN versus SN; ρρρP<0.001 for SN versus NB; ϒϒϒP<0.001 for SN versus NS; For all other comparisons, P>0.05. ART = Auditory reaction time; VRT = Visual reaction time; NB = Normal breathing CB = Chandra bhedana; SB = Surya bhedana; CN = Chandra nadi; SN = Surya nadi; NS = Nadi shuddhi



for comparisons between NS and SB, SN and NB for SP; between NS and CN, SN and NB for PP; between NS and SB for MP; and between NS and SB and SN for RPP. In contrast to all of this, there were no significant changes following NB.

ART and VRT shortened significantly following SB and SN [Table 2]. There was a significant prolongation of ART and VRT following CB while only ART was prolonged following CN. The overall comparison of ∆ % changes for RT showed statistically significant differences between groups for ART and VRT that were significantly lowered following both SB and SN with no apparent differences between SB and SN or CB and CN and no significant changes following NB and NS.

DISCUSSION

Resting CV parameters

There was an overall reduction in majority of CV parameters following CB, CN, and NS with concurrent increases following SB and SN [Table 1]. The differential effects of right nostril initiated (SB and SN) and left nostril initiated (CB, CN, and NS) UNB and ANB techniques were clearly evidenced by statistically significant differences between them. The changes following NB were insignificant in all respects.

The significant reductions in HR, RPP, and DoP following CB and CN as well as the significant fall in SP following CB and the same coupled with decrease of RPP following NS may be attributed to reduction in sympathetic activity and/improvement of vagal tone as supported by previous studies.[3,6,9,15] The significant decrease in PP following NS may be attributed to the combination of the significant fall in SP coupled with a small and insignificant rise in DP. Interestingly, there was a significant rise in DP and MP and a small insignificant rise in SP following SB. There was also a small but insignificant rise in HR, RPP, and DoP following SB and all of these changes may be attributed to an enhanced sympathetic activity as reported by previous studies.[3,7,9,16]

RPP and DoP are indirect indicators of myocardial O2 consumption and load on the heart, thereby signifying a lowering of strain on the heart.[15,17] Sympathetic activation is known to increase HR and RPP and decrease overall heart rate variability (HRV). RPP provides a simple measure of HRV in hypertensive patients and is a surrogate marker in situations where HRV analysis is not available. It has also been shown that standard deviation of normal to normal beats and total power of HRV are inversely correlated with mean HR and RPP.[17] Hence, the reduction in HR and RPP following CB, CN, and NS implies better autonomic regulation of the heart in our subjects with decreased O2

consumption and load. This can be attributed to either an overall increase of parasympathetic tone and/or a reduction in sympathetic tone as it has also been previously reported that sympathetic activity is lower during left UNB.[18]

Raghuraj and Telles[9] reported significant decreases in SP and MP following 30 min of left UNB, while the small reduction in DP in that study also missed significance as in this study. Though they reported a significant increase in HR, we have found a significant decrease in HR following both CB and CN in this study where the fall in SP was significant only following CB and NS and not after CN. These changes may be attributed to changes in cardiac output (CO), peripheral vascular resistance, and humoral factors.[9] As the HR reduced significantly following CB and CN in this study, it is plausible that the coexisting fall in SP is related to CO. It has been recently suggested that there is an immediate increase in cardiac autonomic modulation following ANB and paced breathing at five BPM without a shift in autonomic balance in individuals inexperienced with yogic breathing.[19]

Breathing at the rate of six BPM is known to increase vagal modulation of sinoatrial (SA) and atrioventricular nodes and enhances baroreceptor sensitivity.[15] This may be responsible for reduction in HR and the BP indices following CB, CN, and NS in this study as it may have harmonized respiratory and CV Meyer rhythms. This may have potentially limited the otherwise influential sympathomimetic effects of SB and SN; it has been earlier suggested that sympathetic activation produced by right UNB may be masked by vagally mediated lung baroreceptor activity due to voluntary breathing efforts.[20]

Srivastava et al. have earlier reported a tilt toward parasympathetic dominance after just 15 min of ANB.[21] It is to be noted that this type of ANB (NS) involves a two breath cycles for each round of the practice as opposed to the one breath cycle as done in SB and CB. It is possible that the significant changes seen in SP, PP, and RPP following NS are a result of the longer duration and double the number of breaths compared to the other techniques.

Our study provides evidence of sympathomimetic effects as manifested by increases in all resting CV parameters following the right nostril pranayamas. This is in agreement with previous studies suggesting that right UNB has sympathomimetic effects including increase in metabolism, baseline O2 consumption, and enhanced cardio‑sympathetic activity.[6,3,7,9,16] These effects have been demonstrated after a month‑long training[3] as well as immediately after 45 min of the practice.[7] A recent study also has reported significant increase in SP, DP, and MP after 30 min of the practice.[9] Earlier studies in normal subjects[3,6,7,16] have reported significant increases



in HR and/or BP following right UNB though Jain et al. conversely reported no significant change in HR and a significant reduction in BP in healthy male subjects with no significant changes in female subjects after 15 min of SN.[20] A month of right UNB practice compared to ANB resulted in a significant increase in the HR and O2 consumption and a decrease in the body weight.[3] Another study, which compared the immediate effects of right UNB with NB, both practiced for 45 min, showed a reduction in skin resistance, digit pulse volume with an increase in SP following right UNB.[7]

Studies on the dog by Levi et al. have reported considerable right left asymmetry in the distribution of sympathetic fibers to the heart with right‑sided stellate ganglion stimulation having greater chronotropic effects while the left produced greater inotropic effects.[4] It is to be noted that there are differences between the right and left vagus nerves too with the right vagus having greater cardiac deceleratory effect compared to the left and the right vagus exerting greater restraint on the SA node than the left.[4] Shannahoff‑Khalsa and Kennedy have suggested that ultradian rhythms of HR may be also governed by alternating rhythmic influences of the right and left branches of the autonomic nervous system with increased HR resulting from right sympathetic with left parasympathetic dominance.[6]

Despite the above findings, it is to be noted that there are no significant differences between right nostril initiated UNB and ANB techniques (SB and SN). Similarly, there are no significant differences between left nostril initiated UNB and ANB techniques (CB and CN). Most of the significant changes seemed to be following SB rather than SN where the changes were on the similar lines but statistically insignificant. The picture was not so demarcated with regard to CN and CB as both seemed to be producing equivalent changes in all parameters. The changes in NS were more on the lines similar to left nostril initiated techniques. On the basis of these findings, we suggest that the main effect of the various UNB and ANB techniques is determined more by the nostril used for inspiration rather than that used for expiration.

Reaction time

Both ART and VRT shortened significantly following SB and SN [Table 2]. There was a significant prolongation of ART following both CB and CN, while VRT was prolonged following CB. These changes were significantly lower following both SB and SN as compared to NB, NS, CN, and CB but there were no apparent differences between SB and SN or CB and CN and no significant changes following NB and NS. All the ART values were significantly shorter than respective VRT values, and this is in agreement with previous reports.[10‑14]

It has been previously suggested that the faster reactivity seen post‑pranayama may be due to a modulation of activity at ascending reticular activating system and generalized alteration in information processing at the primary thalamo‑cortical level occurring during pranayama.[13,14] Changes in breathing period produced by voluntary control of inspiration have been reported to be significantly correlated to changes in RT.[22] According to the traditional wisdom of yoga, pranayama is the key to bringing about psychosomatic integration and harmony. It may be easily understood that a calm mind will be able to process information much better and react appropriately than an agitated one. A previous study from JIPMER reported a reduction in RT following 3 weeks of training in both slow and fast pranayamas.[12]

Decrease in RT signifies an improvement in central neuronal processing ability of the special children. This may be due to (1) greater arousal and faster rate of information processing; (2) improved concentration; and/or (3) ability to ignore or inhibit extraneous stimuli. RT tends to improve as arousal increased and it has been reported that RT is fastest with an intermediate level of arousal and deteriorates when the subject is either too relaxed or too tensed. An enhancement of contralateral hemisphere function has been reported with selective nostril breathing,[23] while Werntz et al. reported relatively greater integrated electro encephalogram (EEG) value in one hemisphere that correlated with predominant airflow in the contralateral nostril, defining a new inter‑relationship between cerebral dominance and peripheral autonomic nervous function.[24] It has also been suggested that forced ANB has a balancing effect on functional activity of left and right hemispheres.[4]

It has been previously suggested that right nostril dominance in the nasal cycle as well as right UNB may be correlated with the “activity phase” of the basic rest‑activity cycle, the time during which sympathetic activity in general exceeds parasympathetic activity throughout the body.[4] Another study suggested that the lowering of intraocular pressure by right UNB indicated sympathetic stimulation.[6] Various mechanisms have been postulated to explain differential physiological and psychological changes due to right and left nostril breathing. Shannahoff‑Khalsa suggested that mechanical receptors in the nasal mucosa register flow of air across membranes (unilaterally) and transmit this signal ipsilaterally to the hypothalamus, the highest center for autonomic regulation.[4] Even alternating left–right levels of catecholamines have been found to occur in peripheral circulation of resting humans with rhythms coupled to the nasal cycle.[25] It is possible that the right nostril initiated techniques are producing such a state of autonomic arousal, whereas left nostril initiated techniques are inducing autonomic relaxation/balance in our subjects.



A major limitation of this study as well as the past studies in UNB and ANB is that most researchers have not taken into account the pre‑intervention nasal dominance pattern of the subjects before initiating their study protocol. As the flow of air in the subjects’ dominant/non‑dominant nostril will already be having its own effects on autonomic function, this is a major lacuna that needs to be addressed in future studies.

CONCLUSION

We conclude that right and left yogic UNB and ANB techniques have differential physiological effects. Right nostril initiated UNB and ANB techniques (SB and SN) induce a state of arousal through sympathetic activation and/through increased ascending reticular activity and/or by central action at the primary thalamo‑cortical level. On the other hand, left nostril initiated UNB and ANB techniques (CB, CN, NS) delay reactivity of the subjects by inducing a sense of inert lethargy and may induce a state of parasympathetic dominance as seen in CV parameters. This finding is in tune with the traditional swara yoga concept that air flow through right nostril (SN and pingala swara) is activatory in nature, whereas the flow through left nostril (chandra nadi and ida swara) is relaxatory.[2] Further studies in different populations and in patients of different conditions, as well as over different periods of time, may provide a more detailed understanding of the therapeutic potential of these simple and effective pranayama techniques.

ACKNOWLEDGMENTS

The authors thank the management and authorities of Sri Balaji Vidyapeeth University for setting up the Centre for Yoga Therapy, Education and Research (CYTER) in Mahatma Gandhi Medical College and Research Institute (MGMCRI). The authors are grateful to Yogacharini Meenakshi Devi Bhavanani, Director ICYER and Dr Madanmohan, Professor and Head Department of Physiology, MGMCRI for their constant motivation, encouragement and supportive guidance. We thank Miss Subashana, ANM for her valuable assistance during the recording sessions and data entry.

REFERENCES

1. Gitananda Swami. Pranayama: The fourth limb of Ashtanga Yoga. Pondicherry, India: Satya Press; 2008.

2. BhavananiAB.SwarodayavigjnanAscientificstudyofthenasalcycle.YogaMimamsa 2007;39:32-8.

3. Telles S, Nagarathna R, Nagendra HR. Breathing through a particular nostril can alter metabolism and autonomic activities. Indian J Physiol Pharmacol 1994;38:133-7.

4. Shannahoff-Khalsa DS. Unilateral forced nostril breathing: Basic science, clinical trials, and selected advanced techniques. Subtle Energies and Energy Med J 2002;12:79-106.

5. Mohan SM, Reddy SC, Wei LY. Modulation of intraocular pressure by

unilateral and forced unilateral nostril breathing in young healthy human subjects. Int Ophthalmol 2001;24:305-11.

6. Shannahoff-Khalsa DS, Kennedy B. The effects of unilateral forced nostril breathing on the heart. Int J Neurosci 1993;73:47-60.

7. Telles S, Nagarathna R, Nagendra HR. Physiological measures of right nostril breathing. J Altern Complement Med 1996;2:479-84.

8. Subbalakshmi NK, Saxena SK, Urmimala, D’Souza UJ. Immediate effect of ‘Nadi-shodhana Pranayama’ on selected parameters of cardiovascular, pulmonary, and higher functions of brain. Thai J Physiol Sci 2005;18:10-6.

9. Raghuraj P,Telles S. Immediate effect of specific nostrilmanipulatingyoga breathing practices on autonomic and respiratory variables. Appl Psychophysiol Biofeedback 2008;33:65-75.

10. Malathi A, Parulkar VG. Effect of yogasanas on the visual and auditory reaction time. Indian J Physiol Pharmacol 1989;33:110-2.

11. Madanmohan, Thombre DP, Balakumar B, Nambinarayanan TK, Thakur S, Krishnamurthy N, et al. Effect of yoga training on reaction time, respiratory endurance and muscle strength. Indian J Physiol Pharmacol 1992;36:229-33.

12. Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. Effect of slow and fast pranayams on reaction time and cardiorespiratory variables. Indian J Physiol Pharmacol 2005;49:313-8.

13. Bhavanani AB, Madanmohan, Udupa K. Acute effect of Mukh bhastrika (a yogic bellows type breathing) on reaction time. Indian J Physiol Pharmacol 2003;47:297-300.

14. Bhavanani AB, Ramanathan M, Harichandrakumar KT. Immediate effect of mukha bhastrika (a bellows type pranayama) on reaction time in mentally challenged adolescents. Indian J Physiol Pharmacol 2012;56:174-80.

15. Bhavanani AB, Sanjay Z, Madanmohan. Immediate effect of sukha pranayama on cardiovascular variables in patients of hypertension. Int J Yoga Therap 2011;21:73-6.

16. Raghuraj P, Telles S. Effect of yoga-based and forced uninostril breathing on the autonomic nervous system. Percept Mot Skills 2003;96:79-80.

17. Madanmohan, Prakash ES, Bhavanani AB. Correlation between short-term heart rate variability indices and heart rate, blood pressure indices, pressor reactivity to isometric handgrip in healthy young male subjects. Indian J Physiol Pharmacol 2005;49:132-8.

18. Mohan SM. Svara (nostril dominance) and bilateral volar GSR. Indian J Physiol Pharmacol 1996;40:58-64.

19. GhiyaS,LeeCM. Influence of alternate nostril breathing on heart ratevariability in non-practitioners of yogic breathing. Int J Yoga 2012;5:66-9.

20. Jain N, Srivastava RD, Singhal A. The effects of right and left nostril breathing on cardiorespiratory and autonomic parameters. Indian J Physiol Pharmacol 2005;49:469-74.

21. SrivastavaRD,JainN,SinghalA.Influenceofalternatenostrilbreathingoncardiorespiratory and autonomic functions in healthy young adults. Indian J Physiol Pharmacol 2005;49:475-83.

22. Gallego J, Perruchet P. The effect of voluntary breathing on reaction time. J Psychosom Res 1993;37:63-70.

23. Telles S, Raghuraj P, Maharana S, Nagendra HR. Immediate effect of three yoga breathing techniques on performance on a letter-cancellation task. Percept Mot Skills 2007;104:1289-96.

24. Werntz DA, Bickford RG, Bloom FE, Shannahoff-Khalsa DS. Alternating cerebral hemispheric activity and the lateralization of autonomic nervous function. Hum Neurobiol 1983;2:39-43.

25. Kennedy B, Ziegler MG, Shannahoff-Khalsa DS. Alternating lateralization of plasma catecholamines and nasal patency in humans. Life Sci 1986;38:1203-14.

How to cite this article: Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time. Int J Yoga 2014;7:60‑5.Source of Support: Nil, Conflict of Interest: None declared

Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 10-131010

DOI: 10.7860/JCDR/2014/7256.3668Original Article

Keywords: Pranayama, Cognitive functions, Reaction time

ABSTRACTObjectives: To compare the cumulative effect of commonly practised slow and fast pranayama on cognitive functions in healthy volunteers.

Settings and Design: 84 participants who were in self-reported good health, who were in the age group of 18-25 years, who were randomized to fast pranayama, slow pranayama and control group with 28 participants in each group.

Material and Methods: Fast pranayama included kapalabhati, bhastrika and kukkuriya. Slow pranayama included nadishodhana, Pranav and Savitri. Respective pranayama training was given for 35 minutes, three times per week, for a duration of 12 weeks under the supervision of a certified yoga trainer. Parameters were recorded before and after 12 weeks of intervention: Perceived stress scale (PSS), BMI, waist to hip ratio and

cognitive parameters-letter cancellation test, trail making tests A and B, forward and reverse digit spans and auditory and visual reaction times for red light and green light.

Statistical Analysis: Inter–group comparison was done by one way ANOVA and intra group comparison was done by paired t-test.

Results and Conclusion: Executive functions, PSS and reaction time improved significantly in both fast and slow pranayama groups, except reverse digit span, which showed an improvement only in fast pranayama group. In addition, percentage reduction in reaction time was significantly more in the fast pranayama group as compared to that in slow pranayama group. Both types of pranayamas are beneficial for cognitive functions, but fast pranayama has additional effects on executive function of manipulation in auditory working memory, central neural processing and sensory-motor performance.

ViVeK Kumar Sharma1, rajajeyaKumar m.2, VelKumary S.3, Senthil Kumar Subramanian4,

ananda b. bhaVanani5, madanmohan6, ajit Sahai7, dineSh thangaVel8

InTRODuCTIOnAnxiety, stress and mental tensions have become almost inevitable companions of human life at all cross sections of populations [1]. Studies have reported higher perceived stress among students in healthcare courses, including dental, medical and nursing courses [2-5], as compared to students from other fields. Yoga and pranayama are ancient sciences which originated in India, which can be practised to combat stress [6]. Pranayama involves manipulation of the breath and it consists of three phases: “puraka” (inhalation); “kumbhaka’ (retention) and “rechaka” (exhalation) [7,8]. Pranayama can be practised as either fast or slow pranayamas. Both fast and slow pranayamas are beneficial [9-11], but their physiological responses are different in healthy participants [12]. Executive functions refer to cognitive processes that regulate, control, and manage other cognitive processes [13]. Executive functions include working memory, concentration span, scanning and retrieval of stored information and mental flexibility, i.e. the ability to shift from one criterion to another in sorting or matching tasks [14,15]. Perceived stress has a negative impact on executive functions [16,17]. There is a paucity of data on evaluation of the cumulative effect of commonly practised slow and fast pranayamas on cognitive parameters such as attention span, executive functions, perceived stress and reaction time. Therefore, the current study aimed to compare the effects of twelve weeks of fast and slow pranayama training on these parameters in young healthcare students.

MATeRIAl AnD MeThODSThis study was conducted in the Department of Physiology, JIPMER, Pondicherry India, during May 2011 to December 2011. Yoga training was given at the Advanced Centre for Yoga Therapy Education and Research (ACYTER), JIPMER, Pondicherry. The

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study was commenced after obtaining approval from the institute’s scientific advisory committee and human ethics committee.

ParticipantsWe considered volunteers who were in the age group of [18-25] years, who were in self-reported good health, who were undergoing various healthcare courses (medical, nursing and allied medical sciences). We excluded volunteers who had practised yoga in the past one-year and those with current or previous mental or neurological diseases. We explained the study design to the volunteers and made them aware that their participation would remain anonymous and that they had the freedom to withdraw from the study at any time.We included only those who gave their written informed consents to participate in the study (n=84).Parameters Measured

1. Height

2. Weight

3. Cognitive Functions Test Battery [19]

Letter Cancellation Test (LCT)

Trail Making Test A (TTA)

Trail Making Test B (TTB)

Forward digit span (FDS)

Reverse digit span (RDS)

4. Reaction time (RT)

Reaction time for the detection of auditory (ART) and visual signals (red and green lights) (VRT- R and VRT – G respectively) was recorded on apparatus supplied by Ananda agencies (Pune, India). RT is an indirect index of the processing capacity of the central nervous system, and it is a simple and inexpensive method

Effect of Fast and Slow Pranayama Practice on Cognitive Functions

in Healthy Volunteers

www.jcdr.net Vivek Kumar Sharma et al., Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers

Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 10-13 1111

Keywords: Pranayama, Cognitive functions, Reaction time

size was adequate and that the strength of the study was good.

There were no significant differences in age, height or weight between the three groups [Table/Fig-1]. There was no significant difference in gender distribution between the groups. The 3 groups were comparable in executive functions and attention span before the intervention [Table/Fig-2]. There was a significant decrease in LCT (time) (p<0.001), number of omissions in LCT (p<0.001), total time taken for TTA (p<0.001), total time taken for TTB (p<0.001), ART (p<0.001) and VRT (both green and red light) (p<0.005) in both the study groups but not in the control group after the study period (12 weeks). We have also observed that practice of fast and slow pranayama lead to siginificant decrease in Perceived stress scale scores [18]. In addition, a significant improvement was seen among participants of both fast pranayama group and slow pranayama group in FDS (p<0.001), whereas a change in RDS was seen only in fast pranayama group participants.

There were no significant differences in the percentage of change from pre- to post-test between fast and slow pranayama groups in stress scores and in all of the executive function parameters. However, the fast pranayama group showed a significantly improved performance as compared to the slow pranayama group

of determining sensorimotor performance [20].

Study designThe persons involved in the recording of the parameters and the analysis of data were blind to the experimental conditions (i.e. the group that the participants belonged to).

We familiarized the participants with the test batteries and gave them adequate practice on the reaction time apparatus on two separate occasions, to produce results that were more consistent. On the day of assessment, participants reported to the Department of Physiology, JIPMER, between 9 and 10 AM, at least two hours after eating a light breakfast. Then, the above-mentioned parameters were recorded. We administered these tests in the same order as are given here, to all the participants.

Then, the participants (n=84) were randomly assigned into three groups:

Fast pranayama group (n = 28):1. Kapalabhati, Bhastrika and Kukkriya.

Slow pranayama group (n = 28):2. Nadishodhana, Pranava and Savitri.

Control group (n = 28):3. No pranayama intervention. All the parameters were recorded again after 12 weeks of intervention.

InterventionWe trained the participants in their respective pranayama technique for one week, before the start of the intervention period. Pranayama intervention was carried out for about thirty-five minutes a day, three times per week, for a duration of 12 weeks. A certified yoga trainer at ACYTER gave the Pranayama training and intervention. Participants practised the pranayama in a quiet room which was maintained at a comfortable temperature (25 ± 2ºC). We followed pranayama techniques followed in ACYTER, JIPMER 21. Typical sessions of fast and slow pranayamas were as follows:

Fast Pranayama: Each cycle (6 minutes) consisted of practising one minute of Kapalabhati, one minute of Bhastrika and one minute of Kukkriya pranayamas, interspersed with one minute of rest between each pranayama. Participants were asked to complete 4 cycles in each session (24 minutes).

Slow Pranayama: Each cycle (9 minutes) consisted of practising two minutes of Nadishodhana, two minutes of Pranava and two minutes of Savitri pranayamas which were interspersed with one minute of rest between each pranayama. While they were sitting in a comfortable posture (sukhasana), participants were asked to perform three rounds per session (27 minutes).

STATISTICAl AnAlySISPower and sample size software, version 3.0 was used to calculate the adequate sample size (at assumed power of 90%) which was required for the study and to analyze the post–test power of the study. Analysis of the data was done by using IBM SPSS, version 19. The normality of the data was tested by Kolmogorov–Smirnov test. Intergroup comparison was done using one way ANOVA, followed by Tukey Krammer post–hoc test for pair wise comparisons. Intragroup comparisons were done by using paired t-test for parametric measures and Wilcoxon signed rank test was used for non-parametric measures. Chi-square test was used to compare intergroup gender distributions. The Mann Whitney U-test was used to compare the percentage change between groups. A p value less than 0.05 was considered to be statistically significant.

ReSulTSA post-test analysis, revealed that the lowest power of the study with a mean RDS difference of 0.36 (SD=1.13) between fast and slow pranayama groups was 85%, which showed that the sample

Parameters Fast pranayamagroup (n=28)

Slow pranayamagroup (n=28)

Control group(n=28)

LCT(time in sec)

Pre 114.03 ± 17.13 104.89 ± 19.20 111.36 ± 18.74

Post 104.17 ± 114.15*** 89.32 ± 19.37*** 109.36 ± 24.05

LCT(omissions)

Pre 2.64 ± 2.52 1.36 ± 1.54 0.86 ± 0.97

Post 0.71 ± 1.08*** 0.42 ± 0.69** 0.70 ± 1.08

LCT(commission)

Pre 0.035 ± 0.18 0.03 ± 0.18 0.06 ± 0.25

Post 0.071 ± 0.62 0.07 ± 0.26 003 ± 0.18

TTA(in sec)

Pre 73.60 ± 23.4 65.12 ± 14.96 74.10 ± 11.64

Post 58.67 ± 21.62*** 51.89 ± 13.14*** 72.10 ± 12.95

TTB(in sec)

Pre 104.57 ± 26.50 97.05 ± 24.36 106.73 ± 34.45

Post 83.96 ± 18.94*** 85.39 ± 25.47*** 98.46 ± 33.47

FDS Pre 6.03 ± 0.83 6.00 ± 0.94 5.93 ± 1.36

Post 6.75 ± 1.07*** 6.42 ± 0.71* 5.73 ± 1.25

RDS Pre 4.14 ± 0.80 4.21 ± 0.95 3.83 ± 1.14

Post 4.50 ± 1.07* 4.57 ± 1.13 3.80 ± 1.32

ART(msec) †

Pre 188.99 ± 30.36 186.61 ± 30.43 189.54 ± 28.08

Post 154.89 ± 29.10*** 167.58 ± 23.99*** 189.76 ± 26.61

VRT–R(msec) †

Pre 219.79 ± 35.21 208.11 ± 37.02 221.88 ± 34.45

Post 177.85 ± 22.22*** 189.32 ± 40.19* 222.0 ± 27.79

VRT-G(msec) †

Pre 240.70 ± 39.44 226.53 ± 41.67 222.68 ± 31.69

Post 186.31 ± 28.02*** 206.32 ± 39.02* 223.21 ± 30.04

PSS Pre 19.21 ± 4.33 19.21 ± 4.38 20.57 ± 3.17

Post 14.42 ± 4.14*** 13.89 ± 2.94*** 19.82 ± 3.41

Parameters Fast pranayamagroup (n=28)

Slow pranayamagroup (n=28)

Control group(n=28)

Age (years) (Mean ± SD) 18.39 ± 1.133 19.28 ± 1.82 19.0 ± 1.56

Height (cm) (Mean ± SD) 158.46 ± 7.30 157.33 ± 9.42 157.25 ± 8.86

Weight (Kg) (Mean ± SD) 49.63 ± 6.12 51.82 ± 11.65 50.21 ± 9.26

gender

Male 5 4 5

Female 23 24 23

[Table/Fig-1]: Comparison of subject’s characteristics amongst threegroups. *P<0.05; **P<0.01; ***P<0.001. One way ANOVA test for intergroup

comparison of Age, Height & Weight. Chi-square test for comparison of intergroup gender

distribution

[Table/Fig-2]: Comparison of pre test and post test values of cognitivetest parameters and reaction time in three groups (Mean ± S.D). LCT- letter

cancellation test, TTA – Trial test A, TTB – Trial test A , FDS- Forward digit span, RDS- Reverse digit

span, ART – Auditory reaction time, VRT–R – Visual reaction time for red, VRT-G – Visual reaction time

for green, PSS- Perceived stress score. *P<0.05; **P<0.01; ***P<0.001; Pre-Post analysis was done by

wilcoxon signed rank test. †Pre-Post analysis was done by Students paired ‘t’ test; #P<0.05; ##P<0.01;###P<0.001; #Intergroup analysis of pre values between groups was done by One way ANOVA

Vivek Kumar Sharma et al., Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers www.jcdr.net

Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 10-131212

Parameters Fast pranayama group(n=28)

Slow pranayama group(n=28)

LCT (time in sec) 7.82 ± 10.91 13.24 ± 15.10

LCT (omissions) 52.45 ± 43.32 35.57 ± 52.36

LCT (commission) 3.57 ± 18.98 -0.035 ± 0.188

TTA (in sec) 18.47 ± 19.92 15.87 ± 23.06

TTB (in sec) 17.65 ± 17.25 7.23 ± 28.66

FDS -13.1 ± 20.32 -9.29 ± 14.83

RDS -9.52 ± 19.74 -10.62 ± 32.94

ART (msec) 16.72 ± 16.38* 8.31 ± 15.27

VRT–R (msec) 17.33 ± 14.91* 8.42 ± 16.32

VRT-G (msec) 20.72 ± 16.80** 7.89 ± 12.75

PSS 23.47 ± 20.38 23.04 ± 18.31

in ART, VRT-R (P<0.05) and VRT-G (P<0.01) [Table/Fig-3].

DISCuSSIOnAccording to the traditional wisdom of yoga, pranayama is the key to bringing about psychosomatic integration and harmony.

Specifically, we observed a significant reduction in perceived stress and improvement in the following cognitive domains: attention, visuo-motor speed and memory retention capacity in both fast and slow pranayama groups. Prefrontal cortex regulates physiological functions by integrating information from ongoing cognitive processes, emotional processes and current stress level [14,22]. Chronic (perceived) stress alters normal patterns of prefrontal cortex activation during cognitive tasks, resulting in enhanced autonomic arousal [14,22]. The reduced stress in both pranayama groups could have enabled their improved cognitive functions. Our results were consistent with those of previous studies, which found significant improvement in various cognitive domains with the practice of different yoga breathing techniques [10,23-25].

In the present study, it was not possible to determine the mechanism of action of pranayama techniques, but we hypothesized that the improvements in cognitive functions in pranayama groups may have occurred due to reduced stress and improved parasympathetic tone.

The particular contribution of pranayama to stress reduction might be mediated by the bidirectional vagal system. Vagal afferents from peripheral receptors are connected with the nucleus tractus solitarius from which fibres ascend to the thalamus, limbic areas and anterior cortical areas. The descending projections then modulate autonomic, visceral, and stress arousal mechanisms at the different levels of the neuraxis [26]. The bottom-up mechanisms of pranayama practice may be induced through the stretch of respiratory muscles, specifically the diaphragm [14,26]. During above tidal inhalation (as was seen in Hering Breuer’s reflex), stretch of lung tissue produces inhibitory signals in the vagus nerve, which ultimately shifts the autonomic nervous sytem into parasympatho-dominance, that results in a calm and alert state of mind [27].

During both fast and slow types of pranayama practice, when participants intentionally focus on breathing at different frequencies of respiration and intend to relax, attention is drawn away from extraneous distracting stimuli. With continuous pranayama practice, the participants’ ability to concentrate is enhanced and the changes in mental processing (e.g., focused attention and reduced stress) are rapidly expressed in the body via the autonomic and neuro endocrine systems. This reorganizes

neural representation within the CNS and improves bidirectional communication between the cerebral cortex and the limbic, autonomic, neuro endocrine, emotional, and behavioural activation [22]. Also, generalized alteration in information processing at thalamo-cortical level induces modification in neural mechanisms which regulate the respiratory system [28].

The shortening of auditory and visual RT in our pranayama groups represents greater arousal, better concentration and faster responsiveness [12]. The improvement was significantly greater in the fast pranayama group as compared to that in slow pranayama group. One previous study found insignificant decreases in ART and VRT, with a shorter (three weeks) training period of Savitri (slow breathing) and Bhastrika (fast breathing) pranayamas [12]. Our study, on the other hand, demonstrated that a prolonged practice (12 weeks) of pranayama could be beneficial in reducing RT.

lIMITATIOnS OF The STuDyThere was a difference in training times between the fast and slow pranayama groups (24 vs. 27 minutes), since the participants in the fast pranayama group found it difficult to do more than four rounds in a session. Also, there was a difference in the number of male and female participants in the study. Nevertheless, the male and female participants were equally distributed between the groups, i.e. the gender ratio was almost similar. Since this study was conducted only on healthy participants, future studies should broaden the current research and include clinical populations such as patients with psychiatric disorders, whose cognitive functions are adversely compromised.

COnCluSIOnSlow and rapid types of pranayama are beneficial for stress reduction and for improving cognitive functions, but fast pranayama has additional effects on sensori-motor performance (i.e. faster auditory and visual RT).

DeClARATIOn FROM The AuThORS:The findings discussed in this research article are a part of the bigger study to evaluate the effect of fast and slow pranayama on various physiological parameters in adolescents. Part of the study has earlier been published in Int J Yoga 2013;6:104-10. [29]

ReFeRenCeS [1] Sharma VK, Das S, Mondal S, Goswampi U, Gandhi A. Effect of Sahaj Yoga on

depressive disorders. Indian J Physiol Pharmacol. 2005 Oct; 49(4):462-8. [2] Birks Y, McKendree J, Watt I. Emotional intelligence and perceived stress in

healthcare students: a multi-institutional, multi-professional survey. BMC Medical Education. 2009; 9(1):61.

[3] Jones MC, Johnston DW. Distress, stress and coping in first-year student nurses. J Adv Nurs. 1997 Sep;26(3):475-82.

[4] Pau A, Rowland ML, Naidoo S, AbdulKadir R, Makrynika E, Moraru R, et al. Emotional intelligence and perceived stress in dental undergraduates: a multinational survey. J Dent Educ. 2007 Feb;71(2):197-204.

[5] Shapiro SL, Shapiro DE, Schwartz GE. Stress management in medical education: a review of the literature. Acad Med. 2000 Jul;75(7):748-59.

[6] Brown RP, Gerbarg PL. Yoga Breathing, Meditation, and Longevity. Annals of the New York Academy of Sciences. 2009;1172(1):54-62.

[7] Ray S Dutta. Yogic Exercises - Physiologic and Psychic Process. New Delhi: Jaypee Brother Medical Publishers. 1998.

[8] Veerabhadrappa SG, Baljoshi VS, Khanapure S, Herur A, Patil S, Ankad RB, et al. Effect of yogic bellows on cardiovascular autonomic reactivity. J Cardiovasc Dis Res. 2011 Oct; 2(4):223-27.

[9] Bhavanani AB, Madanmohan, Udupa K. Acute effect of Mukh bhastrika (a yogic bellows type breathing) on reaction time. Indian J Physiol Pharmacol. 2003 Jul; 47(3):297-300.

[10] Telles S, Raghuraj P, Arankalle D, Naveen KV. Immediate effect of high-frequency yoga breathing on attention. Indian J Med Sci. 2008 Jan; 62(1):20-2.

[11] Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishnamurthy N. Effect of pranayam training on cardiac function in normal young volunteers. Indian J Physiol Pharmacol. 2003 Jan; 47(1): 27-33.

[12] Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. Effect of slow and fast pranayams on reaction time and cardiorespiratory variables. Indian J Physiol Pharmacol. 2005 Jul;49(3):313-8.

[Table/Fig-3]: Comparison of percentage difference between groups.LCT- letter cancellation test, TTA – Trial test A, TTB – Trial test A , FDS- Forwarddigit span, RDS- Reverse digit span, ART – Auditory reaction time, VRT–R – Visualreaction time for red, VRT-G – Visual reaction time for green, PSS- Perceived stressscore. Analysis was done using Mann Whitney U test. *P<0.05; **P<0.01; ***<0.001

www.jcdr.net Vivek Kumar Sharma et al., Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers

Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 10-13 1313

PartiCularS oF ContributorS:1. Assistant Professor, Department of Physiology, JIPMER, Puducherry, India.2. Assistant Professor, Department of Physiology, Chennai Medical College Hospital & Research Centre, Irungalur, Trichy, Tamilnadu, India.3. Assistant Professor, Department of Physiology, JIPMER, Pondicherry, India.4. Senior Resident, Department of Physiology, JIPMER, Pondicherry, India.5. Deputy Director, CYTER, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.6. Professor and Head, Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.7. Professor & Head, Department of Biostatistics, JIPMER, India.8. Assistant Professor, Department of Physiology, Vinayaka Mission’s Medical College & Hospital, Keezhakasakudi, Karaikal, Puducherry, India.

name, addreSS, e-mail id oF the CorreSPonding author: Dr. Senthil Kumar Subramanian, Senior Resident, Department of Physiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry-605 006, India. Phone: 91+ 9962267560, E-mail: [email protected]

FinanCial or other ComPeting intereStS: None.

Date of Submission: aug 04, 2013 Date of Peer Review: Sep 10, 2013 Date of Acceptance: oct 28, 2013

Date of Publishing: jan 12, 2014

[13] Elliott R. Executive functions and their disorders: Imaging in clinical neuroscience. British Medical Bulletin. 2003 Mar 1;65(1):49-59.

[14] M Marsel Mesulam. Aphasia, memory loss and other focal cerebral disorders. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s Principles of Internal Medicine. 16 ed. New York: Mc-Graw Hill Medical publishing division; 2005; 151-2.

[15] Monsell S. Task switching. Trends in cognitive sciences 2003 Mar;7(3):134-40.[16] Kleen JK, Sitomer MT, Killeen PR, Conrad CD. Chronic stress impairs spatial

memory and motivation for reward without disrupting motor ability and motivation to explore. Behav Neurosci. 2006 Aug;120(4):842-51.

[17] Ohman L, Nordin S, Bergdahl J, Slunga BL, Stigsdotter NA. Cognitive function in outpatients with perceived chronic stress. Scand J Work Environ Health. 2007 Jun; 33(3): 223-32.

[18] Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96.

[19] Lezak MD, Howieson DB, Loring DW. Orientation and attention. Neuropsychological assessment. 4 ed. New York: Oxford University Press; 2004; 337-74.

[20] Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. Effect of slow and fast pranayams on reaction time and cardiorespiratory variables. Indian J Physiol Pharmacol. 2005 Jul;49(3):313-8.

[21] Gitananda Swami. Pranayama: The fourth limb of Ashtanga yoga. Satya press; 2008.

[22] Taylor AG, Goehler LE, Galper DI, Innes KE, Bourguignon C. Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research. Explore (NY) 2010 Jan;6(1):29-41.

[23] Jella SA, Shannahoff-Khalsa DS. The effects of unilateral forced nostril breathing on cognitive performance. Int J Neurosci. 1993 Nov; 73(1-2):61-8.

[24] Joshi M, Telles S. Immediate effects of right and left nostril breathing on verbal and spatial scores. Indian J Physiol Pharmacol. 2008 Apr;52(2):197-200.

[25] Telles S, Raghuraj P, Maharana S, Nagendra HR. Immediate effect of three yoga breathing techniques on performance on a letter-cancellation task. Percept Mot Skills. 2007 Jun;104(3 Pt 2):1289-96.

[26] Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model. J Altern Complement Med. 2005 Feb;11(1):189-201.

[27] Jerath R, Edry JW, Barnes VA, Jerath V. Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses. 2006; 67(3):566-71.

[28] Telles S. Alterations of auditory middle latency evoked potentials during yogic consciously regulated breathing and attentive state of mind. 1993 May.

[29] Sharma Vivek, Trakroo Madanmohan, Subramaniam Velkumary, Rajajeyakumar M, Bhavanani Anand, Sahai Ajit. Academic journal article. Int J Yoga. 2013;6:104-10.

Online International Interdisciplinary Research Journal, Bi-Monthly, ISSN 2249-9598, Vol-IV, Jan 2014 Special Issue

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Immediate Effect of Alternate Nostril Breathing On Cardiovascular Parameters and Reaction Time

Ananda Balayogi Bhavanania, Meena Ramanathanb, Madanmohanc

aDeputy Director, CYTER, MGMCRI, Pillayarkuppam, Pondicherry 607402, India bCo-ordinator and Yoga therapist, CYTER, MGMCRI, Pondicherry, India cProfessor and Head, Department of Physiology and Director CYTER, MGMCRI, Pondicherry, India

Corresponding author: Ananda Balayogi Bhavanani Deputy Director, CYTER, MGMCRI, Pillayarkuppam, Pondicherry 607402, India

Background: This study evaluated immediate effects of 27 rounds of left nostril initiated alternate nostril breathing (ANB) technique of nadi shuddi (NS) and right nostril initiated ANB of aloma viloma (AV) pranayama on cardiovascular (CV) parameters and reaction time (RT) in a trained population.

Materials and methods: 16 subjects attending regular yoga sessions were recruited and each subject performed 27 rounds of either technique, selected randomly on different days. Heart rate (HR), systolic pressure (SP), diastolic pressure (DP), auditory and visual reaction time (ART and VRT) were recorded before and after pranayamas. NS was done by breathing in through left nostril and out through right followed by breathing in through right and out through left. AV was done by breathing in through right nostril and out through left followed by breathing in through left and out through right. All data passed normality testing and statistical analysis was carried out using Student’s paired t test.

Results: HR, SP and DP reduced significantly (p < 0.05 to 0.001) after NS while they increased after AV. Post intervention differences as well as ∆% between groups was significant (p < 0.05 to 0.001) for HR, SP and DP. ART and VRT were significantly (p < 0.05 to 0.001) shortened after AV and significantly prolonged after NS. Post intervention differences as well as ∆% between groups was very significant (p < 0.001) for both ART and VRT.

Discussion: Significant reductions of HR, SP and DP after NS and their increase after AV may be attributed to modulation of autonomic tone. Right nostril initiated ANB technique produces autonomic arousal, whereas left nostril initiated ANB technique induces relaxation/balance. These can be selectively applied in various therapeutic settings. Further studies in various clinical conditions and settings can enable us to understand their therapeutic applications better.

KEYWORDS: alternate nostril breathing, pranayama, reaction time, yoga

INTRODUCTION:

Shiva Swarodaya, a classical yogic text describes the ultradian nasal cycle as Swarodaya Vigyan and highlights differential effects of its phases that reflect the lunar cycles (1) Yogic teachings reiterate that breathing exclusively through the left nostril potentiates ida nadi, the “lunar channel” while breathing exclusively through the right activates pingala nadi, the “solar channel”.

Abstract



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In the past few decades scientific studies on uni-nostril breathing (UNB) and alternate nostril breathing (ANB) have reported physiological and psychological effects of pranayama techniques such as right UNB (surya nadi), left UNB (chandra nadi), right initiated ANB (surya bhedana), left initiated ANB (chandra bhedana) and nadi shuddhi (NS). (2, 3, 4, 5, 6) Performance of ANB has been reported to rapidly alter cardiopulmonary responses and improve simple problem solving (7) and a tilt toward parasympathetic dominance has been demonstrated after even just 15 min of ANB involving two breath cycles for each round of the practice.(5)

It is important to scientifically validate specific differential effects of various ANB techniques and to the best of our knowledge no study has compared NS and aloma viloma (AV) pranayama. Both of them are ‘two breath cycle’ ANB techniques, but the breathing is initiated through left nostril in NS (left in-right out-right in-left out) while it is initiated through right nostril in AV (right in-left out-left in-right out).

With the above in mind, this study planned to evaluate immediate effects of 27 rounds of NS and AV on cardiovascular (CV) parameters and reaction time (RT) in a trained population. For CV parameters we selected heart rate (HR) as well as systolic pressure (SP) and diastolic pressure (DP) as these indicate changes in cardiac autonomic regulation while for RT that is an index of processing ability of central nervous system and a simple, non invasive means of determining sensorimotor co-ordination and performance we selected auditory and visual RT (ART and VRT respectively). (8, 9)

MATERIALS AND METHODS:

Sixteen subjects (11 females, 5 males) attending regular yoga sessions at the Centre for Yoga Therapy, Education, and Research (CYTER) twice / thrice weekly for more than 2 months were recruited for this self-controlled study by convenience sampling. Their mean age was 31.06 ± 8.96 (SD) years and all were right handed. Three reported normal health status, whereas others reported that they were on regular treatment for one or more medical conditions like hypertension (2), type 2 diabetes mellitus (1), arthritis (1), bronchial asthma (1), poly cystic ovarian disorder (6) and stress (2). None were receiving autonomic modifying agents like α- or β blockers.

Each subject came to the CYTER lab on two different days. They were instructed to have a light breakfast before 8 am and report for the study between 10 am and 12 noon. On each of the days, they performed 27 rounds of either technique, selected randomly so as to avoid any bias or influence of the different days of recording.

The subjects were instructed to sit in any comfortable posture and relax for 5 min before taking pre-intervention recordings of HR, SP, DP, ART and VRT. They then performed the selected technique and all parameters were recorded immediately after performance of 27 rounds. The entire sequence of recording was randomised to avoid any bias.

Both techniques were performed in an erect sitting posture using a hand gesture (nasika mudra) wherein ring finger of the right hand was used to occlude left nostril by pressing on the outside of the nostril and the thumb to occlude right nostril as required. The left hand was held in jnana mudra and placed on the left thigh in both techniques. The alternate nostril breathing sequence for one round of the technique was as follows:



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• NS was done by breathing in through left nostril and out through right followed by breathing in through right and out through left.

• AV was done by breathing in through right nostril and out through left followed by breathing in through left and out through right.

Participants were instructed to focus their mind on their breath and ensure it was slow, deep, and regular while attempting to utilize all sections of their lungs. Respiratory rate for both techniques was maintained at approximately 5-6 breaths per min (BPM) and this was regulated by one of the investigators providing an audible count of six for both inspiration and expiration. As they were all attending regular yoga sessions, none reported any difficulty in performing 27 rounds of the techniques as given above.

To ensure objectivity in measuring HR and BP, the recordings were done using non-invasive automatic BP monitor (HEM– 7203, Omron Healthcare Co. Ltd, Kyoto, Japan) with an instrumental accuracy of ±5% for HR and ±3 mm Hg for BP. RT apparatus (Anand Agencies, Pune) with a built in 4 digit chronoscope and display accuracy of 1 ms was used for the study. Auditory beep sound stimulus was used for ART and red light stimulus for VRT. The subjects were instructed to release the response key as soon as they perceived the stimulus. Signals were given from the front to avoid effect of lateralized stimulus and they used dominant hand while responding to signals.(3, 4) All subjects were given adequate exposure to the equipment on two different occasions to familiarize them with the procedure as RT is more consistent when subjects have had adequate practice. (6) More than ten trials were recorded and the mean of three similar observations was taken as a single value for purpose of statistical analysis. (10, 11)

Data were assessed for normality using GraphPad InStat version 3.06 for Windows 95, (GraphPad Software, San Diego California USA). All data passed normality testing by Kolmogorov-Smirnov Test and hence intra and inter group analysis was carried out using Student’s paired t test.

RESULTS:

The results are given in Table 1. HR, SP and DP reduced significantly (p < 0.05 to 0.001) after NS while they increased after AV. The post intervention differences as well as ∆% between groups was significant (p < 0.05 to 0.001) for HR, SP and DP.

ART and VRT were significantly (p < 0.05 to 0.001) shortened after AV and significantly prolonged after NS. The post intervention differences as well as ∆% between groups was very significant (p < 0.001) for both ART and VRT.

DISCUSSION:

The significant reductions of HR, SP and DP after NS and their increase after AV may be attributed to modulation of the resting autonomic tone. Previous reports support our finding that right nostril initiated UNB and ANB techniques induce a state of arousal through sympathetic activation and / through increased ascending reticular activity and / by central action at the primary thalamo-cortical level. (4, 6, 12, 13) This autonomic arousal may also explain faster reactivity seen after AV and signifies an enhancement of central neuronal processing ability. This may be due to a faster rate of information processing as well as improved concentration that enables selective



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inhibition of extraneous stimuli. The slower reactivity after NS on the other hand, may be attributed to the induction of a more relaxed state of parasympathetic dominance in our subjects, as evidenced by reductions in all CV parameters. (13)

Some researchers have tried to explain the differential physiological and psychological changes due to right and left nostril breathing and have postulated various mechanisms. Shannahoff-Khalsa suggested that mechanical receptors in the nasal mucosa register flow of air across membranes (unilaterally) and transmit this signal ipsilaterally to the hypothalamus, the highest center for autonomic regulation.(2)

He also suggested that right nostril dominance in the nasal cycle as well as right UNB may be correlated with the “activity phase” of the basic rest-activity cycle, the time during which sympathetic activity in general exceeds parasympathetic activity throughout the body.(2) Differences between right and left vagus nerves have been reported with right vagus having greater cardiac deceleratory effect compared to left and right vagus exerting greater restraint on SA node than left.(2) Another study suggested that ultradian rhythms of HR may be also governed by alternating rhythmic influences of the right and left branches of the autonomic nervous system with increased HR resulting from right sympathetic with left parasympathetic dominance.(12) Kennedy reported alternating left–right levels of catecholamines in peripheral circulation of resting humans with rhythms coupled to the nasal cycle.(14)

As the present study provides more supporting evidence to these earlier reports, we can plausibly conclude that right nostril initiated ANB techniques produce autonomic arousal, whereas left nostril initiated ANB techniques induce autonomic relaxation/balance. These techniques can be selectively applied in various therapeutic settings with NS benefiting those who require relaxation, reduction of stress, anxiety and hypertension while AV can be applied in patients of depression, narcolepsy and learning disorders. Further studies in various clinical conditions and settings can enable us to understand their therapeutic applications better.

ACKNOWLEDGMENTS:

The authors thank the management of Sri Balaji Vidyapeeth University for setting up and supporting the Centre for Yoga Therapy, Education and Research (CYTER) in Mahatma Gandhi Medical College and Research Institute (MGMCRI). We are grateful to Yogacharini Meenakshi Devi Bhavanani, Director ICYER for her constant motivation and supportive guidance. Thanks are due to D Pushpa, G Sarulatha and M Sangeeta for their valuable assistance during training, recording sessions and data entry. We thank all the subjects for their wholehearted cooperation during the training and recording sessions.

REFERENCES:

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3. Mohan SM. Svara (Nostril dominance) and bilateral volar GSR. Indian J Physiol Pharmacol 1996; 40: 58–64.



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10. Madanmohan, Thombre DP, Balakumar B, Nambinarayanan TK, Thakur S, Krishnamurthy N, et al. Effect of yoga training on reaction time, respiratory endurance and muscle strength. Indian J Physiol Pharmacol 1992; 36: 229–33.

11. Bhavanani AB, Ramanathan M, Harichandrakumar KT. Immediate effect of mukha bhastrika (a bellows type pranayama) on reaction time in mentally challenged adolescents. Indian J Physiol Pharmacol 2012; 56: 174-80.

12. Shannahoff-Khalsa DS, Kennedy B. The effects of unilateral forced nostril breathing on the heart. Int J Neurosci 1993; 73: 47-60.


14. Kennedy B, Ziegler MG, Shannahoff-Khalsa DS. Alternating lateralization of plasma catecholamines and nasal patency in humans. Life Sci 1986; 38: 1203-14.



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Table 1: Immediate effect of nadi shuddi and aloma viloma pranayamas on heart rate (HR), systolic pressure (SP), diastolic pressure (DP), auditory reaction time (ART) and visual reaction time (VRT) in the same subjects before (B) and immediately after (A) performance of 27 rounds of the respective technique.

Nadi shuddi

Pranayama

Aloma viloma

Pranayama

Comparison

(p value)

B A ∆% B A ∆% B A ∆%

HR

(beats/min)

86.67

± 9.41

78.67

± 7.31 ***

-8.89

±4.89

82.69

±10.36

85.77

± 12.16

3.72

±7.36 0.13 0.032 <0.001

SP

(mmHg)

119.42

±11.24

113.58

±10.44***

-4.76

±3.76

117.17

±11.27

120.16

±8.91*

2.82

±4.45 0.07 <0.001 <0.001

DP

(mmHg)

74.92

± 8.15

73.00

± 5.05*

-1.98

±4.74

75.67

±7.05

79.76

±7.26***

5.55

±5.28 0.66 <0.001 <0.001

ART

(msec)

193.75

±16.44

204.08

±14.86***

5.51

±3.12

190.35

±18.79

178.65

±19.26***

-6.17

±3.15 0.50 <0.001 <0.001

VRT

(msec)

213.68

±16.44

221.75

± 15.46 **

3.94

±3.87

211.31

±17.83

203.69

± 18.08**

-3.51

±4.82 0.64 0.002 <0.001

Values are given as mean ± SD for 16 subjects. * p < 0.05, ** p < 0.01 and *** p < 0.001 by paired t test for intra group comparisons. Actual p values are given for paired t test for intergroup comparisons. ∆ % comparisons were done by paired t test.

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DOI: 10.1089/act.2014.20110 • MARY ANN LIEBERT, INC. • VOL. 20 NO. 1 ALTERNATIVE AND COMPLEMENTARY THERAPIESFEBRUARY 2014

CAM Therapies

Estimates indicate that > 350 million people are affected by depression worldwide.1 While conventional medicine de-fines depression as a neurochemical disequilibrium disorder, treating it with psychoactive drugs, such as neurotransmitter reuptake inhibitors,2 complementary and alternative medicine (CAM) finds different causes for depression and, therefore, its treatment. Approximately 10%–20% of patients’ conditions respond poorly to conventional therapy or the conditions are nonresponsive.3 Thus, we report some CAM interventions with which we have seen good results in our clinical practice by combining them in an individualized way according to each patient’s needs.

Acupuncture—A significant beneficial effect of acupunc-ture is that it can reduce the severity of depression. One meta-analysis showed that acupuncture and electroacupuncture as monotherapies had similar effects, compared to usual medica-tion,4 although when either of these therapies were combined with antidepressants, the results were no better than medica-tion alone.5

Vitamin D—Research shows that elderly people with vita-min D deficiency have an increased risk of depression, with an association between the severity of symptoms and decreased serum 25OHD3 levels.6 A trial of 600 international units (IU)/day supplementation for 6 months produced significant improvement in the well-being of subjects.7 Although the ideal dose recommended has not been determined yet, higher doses seem to produce better results; thus, we usually recommend 600–800 IU/day.

Homeopathy—“A rapid, gentle and permanent restoration of the health,”8 proposed by Hahnemann, may be achieved by using an individualized homeopathic medicine selected according to the similitude to the patient’s symptoms. In one trial, homeopathy was not considered to be an inferior

treatment, compared to fluoxetine, for acute treatment of pa-tients with depression9; however, inconclusive results were obtained when comparing individualized homeopathic treat-ment with placebo.10

Polyunsaturated fatty acids (PUFAs)—A high proportion of PUFAs are found in brain lipids. n-3 PUFAs may affect serotoninergic and dopaminergic transmissions,11 which are involved in depression. Observational data have shown an as-sociation between lower levels of n-3 PUFAs and depression.3 Although the ideal dose is still debated, we have seen positive results with 2 g/day of flaxseed oil, a precursor of the n-6 and n-3 PUFAs.

References

1. World Health Organization: Depression. 2012. Online document at: www. who.int/mediacentre/factsheets/fs369/en Accessed December 10, 2013.

2. Bondy B. Pathophysiology of depression and mechanisms of treatment. Dialogues Clin Neurosci 2002;4:7–20.

3. Ortega RM, Rodríguez-Rodríguez E, López-Sobaler AM. Effects of omega 3 fatty acids supplementation in behavior and non-neurodegenerative neuro-psychiatricdisorders.BrJNutr2012;107(suppl2):261–270.

4.StubT,AlrækT,LiuJ.Acupuncturetreatmentfordepression—asystematicreviewandmeta-analysis.EurJIntegrMed2011;3:e259–e270.

5.ZhangZJ,ChenHY,YipKC,etal.Theeffectivenessandsafetyofacupunc-turetherapyindepressivedisorders:Systematicreviewandmeta-analysis.JAffect Disord 2010;124:9–21.

6.EylesDW,BurneTH,McGrathJJ.VitaminD,effectsonbraindevelop-ment, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendocrinol 2013;34:47–64.

7.LeedahlDD,CunninghamJL,DrakeMT,etal.HypovitaminosisDinpsy-chiatric inpatients: Clinical correlation with depressive symptoms, cogni-tive impairment, and prescribing practices. Psychosomatics 2013;54:257– 262.

8. Hahnemann S; O’Reilly WB, Decker S, transl. Organon of the Medical Art, 6th ed. Redmond, WA: Birdcage Books, 1996.

9. Adler UC, Paiva NM, Cesar AT, et al. Homeopathic individualized Q-Po-tencies versus fluoxetine for moderate to severe depression: Double-blind, randomized non-inferiority trial. Evid Based Complement Alternat Med 2011; 2011:520182.

10.AdlerUC,KrügerS,TeutM,etal.Homeopathyfordepression:Aran-domized, partially double-blind, placebo-controlled, four-armed study (DEP-HOM). PLoS One 2013;8:e74537.

Clinical RoundupSelected Treatment Options for Depression

All comments, opinions, and recommendations in the Clinical Roundup are those of the authors and do not constitute those of the Journal, its Pub-lisher, or its editorial staff.

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To enhance the treatment effect, the pellets are applied to the reactive region of each identified acupoint as detected by an acu-point detector. The effect of the treatment is evaluated using the

Hamilton Depression Rating Scale and the Subjective Happiness Scale. Based on my and my colleagues’ clinical experiences au-ricular acupuncture provides a holistic, convenient, nonpainful, hygienic, and risk-free therapy to help patients with depression.

References

1. Tsang HWH, Cheung L, Lak DCC. Qigong as a psychosocial interven-tionfordepressedelderlywithchronicphysicalillnesses.IntJGeriatrPsych2002;17:1146–1154.2. Suen LKP, Wong TKS, Leung AWN. Is there a place for auricular therapy in the realm of nursing? Complement Ther Nurs Midwifery 2001;7:132–139.3. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture, 3rd ed. Los Angeles: Health Care Alternatives, 2003.4. Bao AM, Ruhe HG, Gao SF et al. Neurotransmitters and neuropeptides in depression [review]. Handb Clin Neurol 2012;106:107–136.

Lorna Suen, BN, MPH, DipClinAcup, PhDSchool of Nursing

The Hong Kong Polytechnic UniversityHungHom, Hong Kong

Yoga I

Yoga can enhance one’s spiritual life and perspective beyond the physical life regardless of one’s particular religion.1 It en-ables people to attain and maintain a balance between exertion and relaxation, and this produces a healthy and dynamic state of homeostatic equilibrium.2 Recent studies have shown that yoga improves mood3 and reduces depression scores.4 These changes have been attributed to an increased secretion of thal-amic g-aminobutyric acid5 with a greater capacity for emotional regulation.4 Even a 10-day yoga-based lifestyle modification program has been reported to improve subjective well-being scores of patients.6

There has been extensive work done on Sudarshan Kriya Yoga and depression at the National Institute of Mental Health and Allied Sciences in India. This technique has been recom-mended as a potential alternative to drugs for melancholia as a first-line treatment.7

In addition to its benefits for patients themselves, yoga also has a great role for managing depression manifesting in fam-ily caregivers of patients with dementia.8 Researchers also support the promising role of yoga as an intervention for de-pression because the intervention is cost-effective and easy to implement.4 In the yoga therapy practice where I work, at the Centre for Yoga Therapy, Education and Research (CYTER) in Pondicherry, the principles used are2:

(1) Becoming one with the breath—Body movement and breath are synchronized particularly in the use of kriya or structured movements, such as the sun salutation. We use forceful breath patterns, such as bhastrika and kapalbhathi for activation.

Table 1. Eight Specific Auricular Points for Treating Depression

Auricular points Rationale

Shenmen Used to calm the mind

Liver Liver is associated with emotion from the TCM perspective

Occiput Also known as the “Antidepres- sant point”3

Subcortex Also known as the “Excitement point,” to relieve depression & is used to calm the mind.3

Anterior ear lobe Also known as “Master Cerebral” (lower portion) & is near the “Be happy point,” which is located on the back of the ear.3,a

Center of ear Also known as “Point zero,” for achieving general homeostatic balance3

Brainstem Also known as the “Brain”3

Lower tragus Also known as the “Pineal Gland”3

(lower portion)aHuang LC. Auricular Treatment: Formulae and Prescriptions. Orlando: Auricular Medicine International Research and Training Centre, 2001.TCM, Traditional Chinese Medicine.

Figure 1. Location of auricular points for depression.

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(2) Shifting from individuality to universality—Yogic coun-seling aims to help the participant understand the bigger picture and improve self-esteem.

(3) Holistic approach of yoga as a lifestyle—Use of early morning sunlight for healing and rejuvenating activities, use of water for internal and external cleansing, and care-ful attention to diet. Gentle stretching and strengthening static practices (āsanās) are introduced in a graded man-ner, depending on the physical ability of the patient.

References

1.NesporK.Twelveyearsofexperiencewithyogainpsychiatry.IntJPsy-chosom 1993;40:105–107.2. Bhavanani AB. Yoga Chikitsa: The application of yoga as a therapy. Pondi-cherry, India: Dhivyananda Creations, 2013.3. Lavey R, Sherman T, Mueser KT, et al. The effects of yoga on mood in psychiatricinpatients.PsychiatrRehabilJ2005;28:399–402.4. Shapiro D, Cook IA, Davydov DM, et al. Yoga as a complementary treat-ment of depression: Effects of traits and moods on treatment outcome. Evid Based Complement Alternat Med 2007;4:493–502.5. Streeter CC, Whitfield TH, Owen L, et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: A randomized controlled MRS study. JAlternComplementMed2010;16:1145–1152.6. Sharma R, Gupta N, Bijlani RL. Effect of yoga based lifestyle intervention onsubjectivewell-being.IndianJPhysiolPharmacol2008;52:123–131.7.JanakiramaiahN,GangadharBN,NagaVenkateshaMurthyPJ,etal.An-tidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: A ran-domizedcomparisonwithelectroconvulsivetherapy(ECT)andimipramine.JAffect Disord 2000;57:255–259.8. Waelde LC, Thompson L, Gallagher-Thompson D. A pilot study of a yogaandmeditation intervention fordementiacaregiver stress. JClinPsy-chol 2004;60:677–687.

Ananda Balayogi Bhavanani, MBBS, ADY, FIAY, MD (AM)Centre for Yoga Therapy, Education and Research

Mahatma Gandhi Medical College & Research Institute Pillayarkuppam, Pondicherry, India

Yoga II

Depression, a significant contributor to the global burden of disease, is estimated to affect 350 million people worldwide.1 The World Health Organization estimates that depression will be the number-one health concern in both developed and de-veloping nations by 2030.2

Yoga is cost-effective; easy to implement; and produces beneficial emotional, psychologic, and biologic effects. Thus, it appears to be a promising intervention for depression.3 In a study, it was found that yogāsanās featuring backbends of long duration, both passive and active, along with vigorous hand balancing and, finally, restful supported backbending relax-ation, were beneficial in depression.4 Iyengar yoga also places a great deal of emphasis on postures that involve opening of the chest, such as backbends, as they may have direct effects

on the blood circulation, thus elevating mood and psychologic well-being.5

A study of 28 young adults with depression, who were randomly divided into two groups (yoga and wait-list con-trol), showed that two classes of Iyengar yoga per week for 5 weeks led to a significant reduction in self-reported symptoms of depression, negative mood, and fatigue.6 Yoga postures emphasized in this study were backbends, stand-ing and inverted postures with brief periods of relaxation, and breathing exercises in between.6 In another study, Shavāsana was examined as a therapeutic technique for de-pression, which revealed this type of yoga’s effectiveness for alleviating depression.7

In a randomized clinical trial, 45 untreated patients with depression were divided into three groups who received (1) antidepressant medication (i.e., imipramine), (2) electrocon-vulsive therapy, or (3) Sudarshana Kriyā Yoga (SKY). Assess-ments were made at baseline and performed every week for 4 weeks. All three groups had reductions in depression scores (based on the Beck Depression Inventory and the Hamilton Rating Scale for Depression). In the third week, the SKY group and the group taking imipramine had similar scores, but the SKY group had higher scores than the electroconvulsive therapy group.8

The practice of Sahaja Yoga meditation produced additional improvement in executive functions. These included manipu-lation of information in verbal working memory and added improvement in attention span and visual–motor speed of pa-tients with depression.9

The following yogic practices10 (60 minutes daily for 3 months) may be useful for managing depressive disorders:

(1) Loosening practices11—Shithilikarana vyāyāma for ~ 15 minutes:

(A) Standing practices are jogging, jumping, hip twisting, forward and backward bending, alternate toe touching, and side bending

(B) Sitting practices are Tiger stretch and Halāsana- Paschimottānāsanā stretch

(C) Supine practices are straight leg raising, both legs raising, and cycling(2) Breathing practices10—Prānāyāma for ~ 8 minutes involves forceful exhalation (Kapālbhāti for 2 minutes), right nostril breathing (Suryānuloma Viloma prānāyāma for 2 minutes), Bellow breathing (Bhastrikā for 2 minutes); or SKY and Oceanic breathing (Ujjayi for 2 minutes).(3) Physical postures10—Āsanas for a total of ~ 12 minutes:

(A) Standing āsanas are Sun Salutation (Surya Nama- skāra for 5 minutes) and Half wheel pose

(Ardha Chakrāsana; 1 minute for each side) (B) Sitting āsanas are Camel pose (Ustrāsana for 1

minute), and Posterior Stretching Pose (Paschimottānāsana for 1 minute) (C) A prone āsana is the Cobra pose (Bhujangāsana for

1 minute)

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International Journal of Physiology, January-June 2014, Vol. 2, No. 1 59DOI Number: 10.5958/j.2320-608X.1.2.001

INTRODUCTION

Ageing is a progressive, generalised impairmentof function, resulting in a loss of adaptive response tostress and in a growing risk of age-related disease. (1) Itis a natural process characterised by declining physicalperformance, slower speed of reaction, inadequateworking of various systems with poor motor andsensory conduction. The process of aging is

Immediate effect of Chandra and Suryanadi Pranayamason Cardiovascular Parameters and Reaction Time in a

Geriatric Population

Meena Ramanathan1, Ananda Balayogi Bhavanani2

1Co-ordinator and Yoga Therapist, Centre for Yoga Therapy, Education and Research, 2Deputy Director, CYTER,MGMCRI, Pillayarkuppam, Pondicherry

ABSTRACT

Previous studies have reported differential physiological and psychological effects of exclusive rightand left nostril breathing. Though potential health benefits have been postulated, further clinicalresearch is required to prove immediate and sustained efficacy of these techniques. This studyevaluated immediate effects of exclusive right (SNP) and left (CNP) nostril breathing on cardiovascular(CV) parameters and reaction time (RT) in a geriatric population. 26 subjects attending regular yogasessions at a senior citizen hospice, were recruited for this self-controlled study. They were instructedto sit in any comfortable posture and relax for 5 min before taking the pre-intervention recordings ofHeart rate (HR), blood pressure (BP), auditory and visual RT (ART and VRT respectively). They thenperformed the selected technique and parameters were recorded immediately after performance of 9rounds of either SNP or CNP. The entire sequence of recordings was randomised to avoid any bias.Intra and inter group statistical analysis was carried out using Student's paired t test for data thatpassed normality testing and Wilcoxon matched-pairs signed-ranks test applied for the others. Overallintra-group comparison of pre-post data and inter-group Δ % comparisons showed statisticallysignificant (p < 0.05) differences for all parameters. There was an overall reduction in HR and BP-based parameters following both SNP and CNP. However, inter-group Δ % comparisons revealed asignificantly greater reduction after CNP for all parameters. Inter-group comparisons revealed highlysignificant decreases (p < 0.001) in VRT and ART after SNP. In conclusion, our study sheds new lighton the physiological changes occurring after SNP and CNP in a geriatric population. While bothtechniques reduce HR and BP, CNP does it more significantly. There is shortening of RT followingSNP and this may be attributed to enhance sensory motor function that is of great significance in theelderly. We suggest that Yoga should be part of the heath care facilities for the elderly as it can enhancetheir quality of life and improve their overall health status.

Keywords: Cardiovascular, Geriatrics, Pranayama, Reaction Time, Yoga

characterised by progressive and generalisedimpairment of homeostasis resulting in decliningability to respond to external or internal stresses andincreased risk of diseases. (2)

Yoga is a conventional long-established and time-tested art and therapeutic science that has positivecontribution to make in maintenance of generalwellbeing and happiness. According to theHathapradipika, one of the traditional Yoga texts, it isa safe and reliable practice that can be done at any age(Yuva vrddho’thivrddho va vyadhito durbalo’pi va abhyasatsiddimapnoti sarvayogeshvatandritah. Whether young,

Corresponding author:Ananda Balayogi BhavananiDeputy DirectorCYTER, MGMCRI, Pillayarkuppam, Pondicherry

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60 International Journal of Physiology, January-June 2014, Vol. 2, No. 1

old or very old, sick or debilitated, one who is vigilantattains success in all yoga, by means of practice,provided they abide to the rules and regulationsproperly- Hathapradipika I:64). (3) Yoga has preventive,curative as well as rehabilitative potential and this maybe explained on the basis of its ability to modulateautonomic functions, relieve stress, improvephysiological functions including cardio-respiratoryfitness and improve quality of life. (4,5,6)

Swarodaya vigyan, the science of understandingthe ultradian nasal cycle has been traditionally codifiedin Shiva Swarodaya wherein differential effects ofdifferent phases of the nasal cycle are given in greatdetail (7) It is traditionally taught that breathingexclusively through the left nostril or chandra nadipranayama (CNP) potentiates ida nadi, the “lunarchannel” while breathing exclusively through the rightin surya nadi pranayama (SNP), activates the pingalanadi, the “solar channel”.

There is some evidence that the practice ofPranayama (the fourth limb of Ashtanga Yoga) cansignificantly lower dangerous free radicals whileincreasing the body’s intrinsic potential to produceprotective antioxidants. (8) This may be one of theintrinsic mechanisms by which it helps improvepsycho-physiological wellbeing in patients sufferingfrom chronic degenerative diseases that are morecommon in the elderly.

Previous studies have reported differentialphysiological and psychological effects of exclusiveright and left nostril breathing. (9,10,11) Though potentialhealth benefits have been postulated, further clinicalresearch is required to prove immediate and sustainedefficacy of these techniques especially in a geriatricpopulation.

With the above in mind, this study planned toevaluate immediate effects of SNP and CNP oncardiovascular (CV) parameters and reaction time (RT)in a geriatric population. We selected heart rate (HR)and blood pressure (BP) as these indicate changes incardiac autonomic regulation while RT is an index ofprocessing ability of central nervous system and asimple, non invasive means of determiningsensorimotor co-ordination and performance. (12, 13)

MATERIALS AND METHOD

Twenty six subjects (21 females, 5 males) attendingregular yoga sessions at a senior citizen hospice, twiceweekly for more than 3 months were recruited for thisself-controlled study by convenience sampling. Theirmean age and body mass index (BMI) were 61.38 ±3.61 (SD) years and 25.26 ± 6.33 units respectively. Allof them were right handed. Three of them reported

normal health status, whereas others reported that theywere on regular treatment for one or more medicalconditions like hypertension (14), hypothyroidism (3),type 2 diabetes mellitus (15), knee pain (4), low backpain (3), arthritis (1), asthma (2), dyslipidemia (4) andinsomnia (2). None were receiving autonomicmodifying agents like α- or β-blocking drugs.

The study was conducted on four different daysbetween 4pm and 5.30 pm. To avoid any confoundingeffects of recording on different days, subjects wererandomly assigned to do one of the techniques on twodays of their recording. One half of the subjectsperformed CNP, while the others performed SNP andthis was reversed on the next day. The subjects wereinstructed to sit in any comfortable posture and relaxfor 5 min before taking the pre-intervention recordingsof HR, systolic pressure (SP), diastolic pressure (DP),auditory and visual RT (ART and VRT respectively).They then performed the selected technique and theparameters were recorded immediately after theperformance of 9 rounds of either the SNP or CNP.The entire sequence of recordings was randomised toavoid any bias.

SNP was performed using nasika mudra whereinthe ring finger of the right hand was used to occludethe left nostril by pressing on the outside of the nostril.CNP was performed using nasika mudra wherein thethumb was used to occlude right nostril by pressingon the outside of the nostril. The left hand was held inJnana Mudra on both the occasions. Participants wereinstructed to focus their mind on their breath andensure it was slow, deep, and regular while attemptingto utilize all sections of their lungs. Respiratory ratefor all techniques was maintained at 5-6 breaths permin (BPM) and this was regulated by providing anaudible count of six for both inspiration and expiration.As they were all attending regular Yoga sessions, nonereported any difficulty in doing the techniques.

HR, SP and DP were recorded using non-invasivesemi-automatic BP apparatus (CH – 432, CitizenSystems, Tokyo, Japan) having range from 40 to 180beats/min and accuracy ± 5%. Mean pressure (MP),pulse pressure (PP), rate-pressure product (RPP) anddouble product (Do P) were calculated by respectiveformulae.

RT apparatus (Anand Agencies, Pune) with a builtin 4 digit chronoscope and display accuracy of 1 mswas used for the study. Simple ART was recorded forauditory beep sound stimulus and simple VRT for red

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International Journal of Physiology, January-June 2014, Vol. 2, No. 1 61

light stimulus. The subjects were instructed to releaseresponse key as soon as they perceived stimulus.Signals were given from the front to avoid effect oflateralized stimulus and they used dominant handwhile responding to signals.(10,11) All subjects weregiven adequate exposure to the equipment on twodifferent occasions to familiarize them with theprocedure as RT is more consistent when subjects havehad adequate practice. (14) More than ten trials wererecorded and the mean of three similar observationswas taken as a single value for purpose of statisticalanalysis. (15, 16)

Data were assessed for normality using GraphPadInStat version 3.06 for Windows 95, (GraphPadSoftware, San Diego California USA). Intra and intergroup statistical analysis was carried out usingStudent’s paired t test for data that passed normalitytesting by Kolmogorov-Smirnov Test. Wilcoxon

matched-pairs signed-ranks test was applied for otherdata. P values less than 0.05 were accepted as indicatingsignificant differences for pre-post and intergroupcomparisons.

RESULTS

The results are given in Table 1. Overall intra-groupcomparison of pre-post data and inter-group Δ %comparisons showed statistically significant (p < 0.05)differences for all parameters. There was an overallreduction in HR and BP-based parameters followingboth SNP and CNP. However, inter-group Δ %comparisons revealed a significantly greater reductionafter CNP for all parameters except DP and HR (thatjust missed statistical significance). Inter-groupcomparisons revealed highly significant decreases (p< 0.001) in VRT and ART after SNP.

Table 1: Immediate effect of chandra nadi pranayama (CNP) and surya nadi pranayama (SNP) on heart rate (HR),systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), pulse pressure (PP), rate pressure

product (RPP), double product (DoP), auditory reaction time (ART) and visual reaction time (VRT) in a geriatricpopulation before (B) and immediately after (A) nine rounds of the technique.

Parameters CNP SNP Comparison

(n = 26) (n = 26) (p value)

B A ΔΔΔΔΔ % B A ΔΔΔΔΔ% B A ΔΔΔΔΔ%

HR 79.19 74.46 -4.64 79.81 77.65 -1.69 0.408 0.047 0.0889

(beats/min) ± 12.52 ± 7.54** ± 11.13 ± 12.75 ± 8.59 ± 9.26

SP 142.42 132.85 -6.31 142.12 138.65 -2.17 0.7593 0.0097 0.0032

(mmHg) ± 18.61 ± 13.7*** ± 6.05 ± 18.51 ± 15.28* ± 4.27

DP 83.46 79.73 -3.77 83.85 80.35 -3.56 0.4836 0.5779 0.7222

(mmHg) ± 11.09 ± 7.25** ± 7.58 ± 11.19 ± 8.24** ± 7.21

MP 103.12 97.44 -5.05 103.27 99.78 -3.05 0.7531 0.0313 0.0182

(mmHg) ± 11.81 ± 7.77*** ± 5.78 ± 11.89 ± 9.21** ± 4.63

PP 58.96 53.12 -7.91 58.27 58.31 2.03 0.5113 0.0248 0.0254

(mmHg) ± 16.13 ± 12.94** ± 17.71 ± 15.91 ± 13.13 ± 14.66

RPP 112.99 99 -10.44 113.79 107.83 -3.76 0.6476 0.0057 0.0101

(units) ± 23.86 ± 5.34** ± 13.78 ± 25.12 ± 17.64* ± 10.62

DoP 81.81 72.58 -9.24 82.66 77.48 -4.63 0.2999 0.007 0.029

(Units) ±16.28 ± 9.70** ±13.90 ± 17.17 ± 11.01** ± 10.63

ART 297.83 292.03 -1.12 293.28 279.73 -4.59 0.0215 0.0003 0.0038

(ms) ± 56.21 ± 37.48 ±5.67 ± 52.9 ± 50.18*** ± 2.81

VRT 315.05 316.89 0.82 307.65 296.21 -3.68 0.0132 <0.0001 <0.0001

(ms) ± 68.7 ± 64.82 ±2.7 ± 54.06 ± 51.38*** ± 2.12

Values are given as mean ± SD for 26 subjects. * p < 0.05, ** p < 0.01 and *** p < 0.001 by paired t test for intra group comparisons of HR,SP (SNP), DP, MP, PP, RPP and DoP and Wilcoxon matched-pairs signed-ranks test for SP (CNP), ART and VRT. Actual p values are givenfor paired t test (HR, DP, MP, PP, RPP and DoP) and Wilcoxon matched-pairs signed-ranks test (SP, ART and VRT.) are given for theintergroup comparisons. Δ % comparisons were done by paired t test for PP and RPP and by Wilcoxon matched-pairs signed-ranks testfor the rest.

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DISCUSSION

In the present study we have found a reduction inall CV parameters following 9 rounds of both CNPand SNP, but these changes were more significantfollowing CNP. This may be due to the fact that slowand deep breathing at the rate of 5-6 BPM has beenreported to enhance cardiac autonomic regulation. (17)

A normalization of autonomic CV rhythms as a resultof increased vagal modulation and/ or decreasedsympathetic activity and improved baroreflexsensitivity have been suggested in an earlier report onCNP in hypertensive patients (18) It has been howeverreported that yogic breathing through right, left, orthrough both nostrils in normal subjects producesdistinct autonomic changes and that SNP increased SPand DP, whereas CNP resulted in significant reductionin SP and MP. (11) Jain et al suggested that sympatheticactivation produced by right nostril breathing may bemasked by vagally mediated lung baroreceptoractivity enhanced by voluntary breathing efforts. (19)

Hence changes following CNP may be attributed to aparasympatho-mimetic effect as the nasal cycle isdependent upon tonic activity of limbic autonomicnervous system with hypothalamus as control centre,as well as levels of circulating catecholamines andother neuro-hormones. (20, 21)

Interestingly in our geriatric population, even rightnostril breathing decreased CV parameters. This seemsto be a contradiction to concepts of swara yoga but arecent report has found that SNP is safe inhypertensives and attributed this to in-built safetymechanisms of yoga that enhances homeostaticnormalcy. (22) The goal of Yoga is to restore homeostasis,hence, if sympathetic reactivity of a subject is alreadyhigher than normal, it is suggested that yogictechniques will not further increase such a hyperreactivity but rather bring it back to normal. Hence,we suggest that SNP may be practiced safely by thegeriatric population though CNP has greater benefits.Changes in the RPP and DoP signify a reduced workload on the heart with reduced O2 consumption, andthis is indeed a positive finding in the geriatricpopulation.

The RT changes following CNP and SNP werehowever very divergent with significant reductionbeing seen in SNP and no such changes in CNP. Theactivation following SNP may be attributed to animproved central neuronal processing ability due togreater arousal and faster rate of information

processing. (15) This is usually attributed to an alert stateproduced by sympathetic activation, but in the presentstudy, as CV parameters haven’t shown such a change,it must be due to other mechanisms. Earlier studiesby the authors have reported shortened RT followingmukha bhastrika in both normal and mentallychallenged children and also after surya namaskar. (16,

23) It has been previously suggested that right nostrildominance in the nasal cycle as well as right uninostrilforced breathing, may be correlated with the “activityphase” of the basic rest-activity cycle, the time duringwhich sympathetic activity in general exceedsparasympathetic activity throughout the body.(24)

Werntz et al have also reported relatively greaterintegrated electro encephalogram (EEG) value in onehemisphere correlating with predominant airflow incontralateral nostril, defining the inter-relationshipbetween cerebral dominance and peripheralautonomic nervous function.(25) In this study, the widervariation in RT values may be attributed to reducedsensory awareness and attention span in the elderly.This may also be why there were significant differencesin pre-test values too.

In conclusion, our study sheds new light onphysiological changes occurring after SNP and CNPin a geriatric population. While both techniques reduceHR and BP, CNP does it more significantly. There isshortening of RT following SNP and this may beattributed to enhanced sensory motor function of greatsignificance in the elderly. We suggest that Yoga shouldbe part of heath care facilities for elderly as it canenhance quality of life and improve overall healthstatus.

Conflict of Interest: None

Source of Funding: Mahatma Gandhi Medical Collegeand Research Institute (MGMCRI), Sri BalajiVidyapeeth Deemed University, Pondicherry.

Ethical clearance: IHEC of MGMCRI approved theresearch study at the meeting held on 13th December2011. (FAC/2011/05)

ACKNOWLEDGMENTS

The authors thank Mrs D Pushpa, Miss G Sarulatha,Miss Imma Sivaraj and Miss Visalakshi for theirvaluable assistance during recording sessions and dataentry. We thank the inmates and authorities of theHospice of Saint Cluny for their wholeheartedcooperation during the training and recording sessions.

13. Yognat --59--.pmd 3/20/2014, 7:26 AM62


REFERENCES

1. KirkwoodTBL. The evolution of aging. Reviewsin Clinical Gerontology 1995; 5: 3-9

2. Sircar S. Apoptosis and Aging. In: Sircar S, ed.Medical Physiology. New Delhi: CBS publication;2001; 34–39.

3. The Forceful Yoga (being the translation of theHathayoga Pradipika, Gheranda Samhita andSiva Samhita). Translated into English byPancham Sinh, Rai Bahadur Srisa Chandra Vasuand Romanized and edited by GP Bhatt. MothilalBanarsidas Publishers Private Limited, Delhi.2004.

4. Madanmohan, Udupa K, Bhavanani AB,Vijayalakshmi P, Surendiran A. Effect of slow andfast pranayams on reaction time and cardiorespiratory variables. Indian J PhysiolPharmacol 2005; 49: 313-18.

5. Innes KE, Bourguignon C, Taylor AG.Risk indices associated with the insulin resistancesyndrome, cardiovascular disease, and possibleprotection with yoga: a systematic review. J AmBoard Fam Pract 2005; 18: 491-519.

6. Sengupta P. Health Impacts of Yoga andPranayama: An art-of-the-state review. Int J PrevMed 2012; 3: 444-58.

7. Bhavanani AB, Swarodaya Vigjnan- A ScientificStudy of the Nasal Cycle. Yoga Mimamsa 2007;39 : 32-8.

8. Bhattacharya S, Pandey US, Verma NS.Improvement in oxidative status with yogicbreathing in young healthy males. Indian JPhysiol Pharmacol 2002; 46: 349-54.

9. Shannahoff-Khalsa DS, Kennedy B. The effectsof unilateral forced nostril breathing on the heart.Int J Neurosci 1993; 73: 47-60.

10. Mohan SM. Svara (Nostril dominance) andbilateral volar GSR. Indian J Physiol Pharmacol1996; 40: 58–64.

11. Raghuraj P, Telles S. Immediate effect of specificnostril manipulating yoga breathing practices onautonomic and respiratory variables. ApplPsychophysiol Biofeedback 2008; 33: 65–75.

12. Lofthus GK. Sensory motor performance andlimb preference. Percepts Motor Skills 1981; 52:688-93.

13. Das S, Gandhi A, Mondal S. Effect ofPremenstrual stress on Audiovisual reaction timeand audiogram. Ind J Physio Pharmacol 1997; 41:67-70.

14. Telles S, Nagaratna R, Nagendra HR. Breathingthrough a particular nostril can alter metabolismand autonomic activities. Indian J PhysiolPharmacol 1994; 38: 133–7.

15. Madanmohan, Thombre DP, Balakumar B,Nambinarayanan TK, Thakur S, KrishnamurthyN, et al. Effect of yoga training on reaction time,respiratory endurance and musclestrength. Indian J Physiol Pharmacol 1992; 36:229–33.

16. Bhavanani AB, Ramanathan M,Harichandrakumar KT. Immediate effect ofmukha bhastrika (a bellows type pranayama) onreaction time in mentally challenged adolescents.Indian J Physiol Pharmacol 2012; 56: 174-80.

17. Bhavanani AB, Sanjay Z, Madanmohan.Immediate effect of sukha pranayama oncardiovascular variables in patients ofhypertension. Int J Yoga Therap 2011; 21: 73-76.

18. Bhavanani AB, Madanmohan, Sanjay Z .Immediate effect of chandra nadi pranayama (leftunilateral forced nostril breathing) oncardiovascular parameters in hypertensivepatients. Int J Yoga 2012; 5: 108-11.

19. Jain N, Srivastava RD, Singhal A. The effects ofright and left nostril breathing oncardiorespiratory and autonomic parameters.Indian J Physiol Pharmacol 2005; 49: 469-74.

20. Deshmukh VD. Limbic autonomic arousal: Itsphysiological classification and review of theliterature. Clin Electroencephalogr 1991; 22:46–60.

21. Eccles R. Nasal airflow in health and disease. ActaOtolaryngol 2000;120: 580–95.

22. Bhavanani AB, Sanjay Z, Madanmohan.Suryanadi pranayama (right unilateral nostrilbreathing) may be safe for hypertensives. J Yogaand Phys Ther 2012; 2: 118.

23. Bhavanani AB, Ramanathan M, Balaji R, PushpaD. Immediate effects of suryanamaskar onreaction time and heart rate in female volunteers.Indian journal of physiology andpharmacology 2013; 57: 199-204.

24. Shannahoff-Khalsa DS. Unilateral forced nostrilbreathing: Basic science, clinical trials, andselected advanced techniques. Subtle Energiesand Energy Med J 2002; 12: 79-106.

25. Werntz DA, Bickford RG, Bloom FE, Shannahoff-Khalsa DS. Alternating cerebral hemisphericactivity and the lateralization of autonomicnervous function. Hum Neurobiol 1983; 2: 39-43.

13. Yognat --59--.pmd 3/20/2014, 7:26 AM63

International Journal of Physiology, January-June 2014, Vol. 2, No. 1 39DOI Number: 10.5958/j.2320-608X.1.2.001

INTRODUCTION

The ancient Indian science of Yoga makes use ofvoluntary regulation of the breathing to make

Immediate effect of Different Pranayam on Short TermHeart Rate Variability in Health Care Students - A

Preliminary Study

Rajajeyakumar M1, Amudharaj D2, Bandi harikrishna3, Madanmohan T4, Jeyasettiseloune5, Bhavanani AB6

1Assistant Professor, Department of Physiology, Chennai Medical College Hospital & Research Centre, Trichy,,2Assistant Professor, Department of Physiology, Aarupadai Veedu Medical College & Hospital Pondicherry,

3PhD Scholar, Department of Physiology, JIPMER), Pondicherry, 4Professor & Head, Department of Physiology,Mahatma Gandhi Medical College & Research Centre, Pondicherry, 5Senior Research Fellow, Department of ACYTER(JIPMER), Pondicherry, 6Deputy Director, CYTER, Mahatma Gandhi Medical College & Research Centre Pondicherry

ABSTRACT

Introduction: Yoga produces consistent physiological changes and have sound scientific basis. Heartrate variability (HRV) has come to be widely used as a non-invasive tool to assess autonomicfunction in physiological as well as disease states. In view of this, the present study was aimedto study the effect of suryanadi(SNP) and chandranadi pranayams(CNP) on HRV in healthy youngvolunteers.

Methodology: 11male volunteers aged between 20-30yrs were assigned to a sequence randomly.Each volunteer was taught both SNP and CNP by trained yoga teacher and made to practice underdirect supervision between 4-6.30 pm in ACYTER lab, JIPMER. HRV was recorded by usingBIOHARNESS AcqKnowledge 4.1 version and analyzed by Kubios HRV 2.00 software. Basal restingparameters and HRV were recorded for 5 minutes after that SNP was performed in six cycles perminute for 5 minutes followed by 5 min rest. Three such sessions (before, during and after) HRVwere recorded. The same procedure and recording ware followed for CNP.

Results: The time domain analysis of SNP revealed an increased heart rate with a decreased RMSSD,However the SDNN was increased. Frequency domain analysis, increased LF power and decreasedHF power and LF/HF ratio increased after the intervention. In CNP, the time domain analysis, showeddecreased heart rate and an increased pNN50. The frequency domain analysis revealed an increasedHF power with decreased LF/HF ratio.

Discussion: SNP increase the sympathetic activity and CNP increases the parasympathetic activityand these can be appropriately advocated in many chronic cardiovascular diseases where theautonomic imbalance is one of the primary derangements.

Keywords: Suryanadi Pranayam, Chandranadi Pranayam , Heart Rate Variability

Corresponding author:M RajajeyakumarAssistant ProfessorDepartment of Physiology, Chennai Medical CollegeHospital & Research Centre, Irungalur, TrichyEmail id: rajakumar60@ gmail.com.Contact No: 09751382650

respiration rhythmic and to calm the mind1, 8. Thispractice is called Pranayama. Nadisuddhi pranayamameans “purification of subtle energy paths”, inhalationand exhalation are through alternative nostrils forsuccessive respiratory cycles.

Surya Anuloma Viloma Pranayama means “heatgenerating breathing particle” when the respiratorycycle of inhalation and exhalation is completedthrough the right nostril exclusively. When completedthrough the left nostril alone the practice is called “

9. Rajajeykumar--39--.pmd 3/20/2014, 7:26 AM39


Chandra Anuloma Viloma Pranayam” which meansa heat dissipating or cooling liberating practice2,3

Heart rate variability (HRV) has come to be widelyused as a non-invasive tool to assess autonomicfunction in a variety of physiologic as well asdisease states4. However, there is paucity of literatureon immediate effect of suryanadi and Chandranadipranayam on HRV.In view of this, the present studywas aimed to study the immediate effect of suryanadiand chandranadi pranayams on HRV in healthy youngvolunteers.

MATERIALS AND METHOD

Materials

HRV was recorded by using BIOHARNESSAcqKnowledge 4.1 version and analyzed by KubiosHRV 2.00 software. Blood pressure and heart rate wererecorded with the subject seated comfortably, usingthe noninvasive automated BP monitor (NIBP).

Methods & procedure

Study involves human subjects only

Inclusion criteria

• Subjects aged between 20-30years males

• Willing for learning pranayam technique

Exclusion criteria

• Subjects with history of previous or current organicdiseases.

• Subjects currently receiving yoga therapyincluding meditation & biofeedback.

The present study was conducted on 11malevolunteers’ 20-30yrs. after obtaining ethical clearancefrom the institutional Human Ethics Committee. Allconsenting subjects meeting inclusion and exclusioncriteria of the study will be selected and informedwritten consent will be obtained after thoroughlyexplaining the procedure.

Their height, weights were recorded and BMI wascalculated. Each volunteer was taught both suryanadi

(SNP) and chandranadi pranayam (CNP) by trainedyoga teacher and made to practice under directsupervision until they were familiar. The proceduresand recordings were carried out in lying down posturefor all volunteers between 4-6.30 pm in ACYTER lab,JIPMER.Basal resting parameters and HRV wererecorded for five minutes followed by

Day 1: SNP (only right nostril breathing) wasperformed in six cycles per minute (each cycle consistsof five seconds for each inspiration and expiration) forfive minutes followed by five min rest. Three suchsessions (before, during and after) HRV were recorded.

Day 2: The same procedure and parameters wererecorded for CNP (left nostril breathing only).

Statistical analysis:

Statistical analysis was done using SPSS version16 (Repeated measures of ANOVA followed by posthoc analysis with Benferroni adjustment) and the levelof statistical significance is considered at a p value <0.05.

RESULTS

The results of our study were much in accordancewith the previous studies. The time domain analysisof SNP revealed an increased heart rate with adecreased RMSSD, the index of short term HRV.However the SDNN which is considered the index oflong term HRV increased. Also, in the frequencydomain analysis there is an increased LF power anddecreased HF power.

The index of sympathovagal balance as reflectedby LF/HF ratio increased i.e. from 1.8 to 2.2 after theintervention. All the observation showed that SNP issympathomimetic. In CNP, the time domain analysisof HRV revealed a decreased heart rate and anincreased pNN50. The frequency domain analysisrevealed an increased HF power with decreased LF/HF ratio i.e. from 2.1 to 1.5. The observations of CNPclearly indicated that CNP is an activator of theparasympathetic activity.



Table 1: Shows the effect of Suryanadi pranayam on short term heart rate variability parameters before, during &immediate after the procedure.

Parameters Before During After P Value F/df

Time domain

Mean RR 867.16±21.262 826.04±18.264** 868.17±19.798 0.007 6.361/(2,10)

SDNN 27.7673±1.386 40.918±2.088*** 29.609±0.976££ 0 20.964/(2,10)

Mean HR* 69.79±1.758 73.27±1.644** 69.70±1.618 0.004 7.310/(2,10)

STD HR 2.956± 0.189 4.159± 0.289** 3.331± 0.281 0.005 6.989/(2,10)

RMSSD 26.736±1.276 22.327±0.870** 25.200±1.165* 0.005 6.926/(2,10)

NN50 23.455±3.987 13.364±1.557** 18.364±3.336** 0.021 4.728/(2,10)

pNN50 6.755± 1.179 3.655± 0.460* 5.20± 0.941** 0.013 5.496/(2,10)

RR triangular index 8.096± 0.365 11.246± 0.657** 8.677± 0.266£ 0 11.552/(2,10)

TINN 139.09±6.634 194.54±12.293** 147.727±5.367£ 0 12.373/(2,10)

Frequency domain

VLF (0"0.04 Hz) 119.27±47.703 115.09±36.784 148.72±32.618 0.811 0.212/(2,10)

LF (0.04"0.15 Hz) 406.72±85.557 1415 ±170.840*** 468.445±62.848£££ 0 24.56/(2,10)

HF (0.15"0.4 Hz) 271.909±34.034 122.909±34.784** 267..909±40.423£ 0.002 8.760/(2,10)

Total power 797.909±113.806.557 1653 ±143.30** 885.09±81.267££ 0 18.321/(2,10)

LF/HF ratio 1.886± 0.458 32.878± 15.796 2.287± 0.512 0.041 3.765/(2,10)

Percentage power

PVLF (0"0.04 Hz) 12.127± 3.340 7.755± 2.829 15.236± 2.742 0.231 1.579/(2,10)

PLF (0.04"0.15 Hz) 48.155± 4.950 81.264± 5.662*** 51.527± 4.632£ 0 16.462/(2,10)

PHF (0.15"0.4 Hz) 39.70± 6.425 10.99± 5.439** 33.245± 5.615 0.002 8.247/(2,10)

Normalized units

NLF (0.04"0.15 Hz) 56.09± 6.195 88.382± 5.680** 61.51± 5.755£ 0.001 10.711/(2,10)

NHF (0.15"0.4 Hz) 43.90± 6.195 11.618± 5.680** 38.482± 5.755£ 0.001 10.711/(2,10)

Values are expressed as Mean ± SEM. . *P d” 0.05 **P d” 0.01 ***P d” 0.001

* comparison of during the technique with before SNP

* Comparision of after the technique with before

£ comparison of after the technique with during

Changes during the test and after the test were both compared with pretest values by Student’s paired’t’ test. The two P values reportedare for the pretest vs. during and pretest vs. after comparisons respectively.

Table 2: Shows the effect of Chandranadi pranayam on short term heart rate variability parameters before, during& immediate after the procedure.

Parameters Before During After P Value F/dfTime domainMean RR 853.58±21.564 816.14±25.84 852.98±23.05 0.026 4.426/(2,10)SDNN 28.39±1.38 43.12±1.608*** 29.20±0.951£££ 0 32.645/(2,10)Mean HR* 70.99±1.835 74.629±2.409 71.06±2.014£ 0.016 5.136/(2,10)STD HR 3.33± 0.228 4.615± 0.376 3.156± 0.150££ 0.002 8.748/(2,10)RMSSD 26.66±0.799 23.04±0.877* 26.49±1.165£ 0.004 7.324/(2,10)NN50 22.27±2.78 14.09±1.988 24.09±4.303£ 0.025 4.455/(2,10)pNN50 6.155± 0.825 3.809± 0.579 6.755± 1.298£ 0.024 4.51/(2,10)RR triangular index 8.386± 0.241 10.769± 0.437*** 8.390± 0.280££ 0 20.134/(2,10)TINN 140.00±7.717 221.81±16.614** 145.90±4.662££ 0 13.895/(2,10)Frequency domainVLF (0"0.04 Hz) 140.09±44.05 123.54±41.908 74.27±13.163 0.419 0.419/(2,10)LF (0.04"0.15 Hz) 427.18±90.69 1460 ±83.51*** 434.45±40.127£££ 0 85.351/(2,10)HF (0.15"0.4 Hz) 244.09±25.208 131.09±16.017** 305..09±36.914£££ 0 20.190/(2,10)Total power 811.182±119.583 1714 ±113.450*** 813.90±67.840£££ 0 29.026/(2,10)LF/HF ratio 2.166± 0.630 13.659± 2.317** 1.582± 0.171£££ 0 25.214/(2,10)



Table 2: Shows the effect of Chandranadi pranayam on short term heart rate variability parameters before, during& immediate after the procedure. (Contd.)

Parameters Before During After P Value F/df

Percentage power

PVLF (0"0.04 Hz) 12.127± 3.340 6.482± 1.702 9.273± 1.756 0.074 2.978/(2,10)

PLF (0.04"0.15 Hz) 48.155± 4.950 85.627± 1.419*** 53.60± 2.183£££ 0 41.374/(2,10)

PHF (0.15"0.4 Hz) 39.70± 6.425 7.900± 1.038*** 37.136± 3.159£££ 0 33.244/(2,10)

Normalized units

NLF (0.04"0.15 Hz) 56.09± 6.195 91.655± 1.024*** 59.44± 2.896£££ 0 41.908/(2,10)

NHF (0.15"0.4 Hz) 43.90± 6.195 8.345± 1.024*** 40.536± 2.897£££ 0 41.823/(2,10)

Values are expressed as Mean ± SEM. *P d” 0.05 **P d” 0.01 ***P d” 0.001

* comparision of during with before

* comparision of after with before

£ comparison of after with during

Changes during the test and after the test were both compared with pre-test values by Student’s paired’t’ test. The two P values reportedare for the pre-test vs. during and pre-test vs. after comparisons respectively.

DISCUSSION

The present study evaluated the effect of SNP andCNP on HRV in three different sessions (before, during& after). Heart rate variability has come to be widelyused as a non-invasive tool to assess autonomicfunction in a variety of physiologic as well asdisease states 4. HF component predominately aconsequence of vagal activity. LF component probablydue to combination of sympathetic andparasympathetic activity.

LF/HF ratio has been used as a non-invasive indexof sympathovagal balance. Our studies show that SNPrevealed an increased heart rate with a decreasedRMSSD, the index of short term HRV. Frequencydomain analysis there is an increased LF power anddecreased HF power. The index of sympathovagalbalance as reflected by LF/HF ratio increased. All theobservation showed that SNP is sympathomimetic.

CNP, the time domain analysis of HRV revealed adecreased heart rate and an increased pNN50. Thefrequency domain analysis revealed an increased HFpower with decreased. The observations of CNPclearly indicated that CNP is an activator of theparasympathetic activity. It seems possible thatmechanical receptors in the nasal mucosa are activatedwith air flow in to the nostril and this signal isunilaterally transmitted to the hypothalamus5.Thisindicates that the practice of slow breathing exerciseimproves vagal activity. Practice of pranayam has beenknown to modulate cardiac autonomic status with animprovement in cardio-respiratory functions 6.

A long-term improvement in autonomic balanceas well as in respiratory, cardiovascular and brainfunction can be achieved if mechanical forces areapplied to the body with the aim of reducing existingimbalances of mechanical force vectors. This techniqueimplies continually Controlling the body functions forprecise timings like in Pranayamic breathingtechniques. 7

The hypothalamus is considered the highest centerfor autonomic regulation. SNP increase thesympathetic activity and CNP increases theparasympathetic activity and these can beappropriately advocated in many chroniccardiovascular diseases where the autonomicimbalance is one of the primary derangements. Thebeneficial effect of SNP and CNP can be applied to allschool children to improve the physical health andsports activities of the students.

Limitation

All participants were right hand dominant used tomanipulate the nostrils. There was no separate controlfor this study.

Recommendation

• Sample size has to be increased

• Female can be include to find out the genderdifference.

• To compare the immediate effect with long termtraining.



ACKNOWLEDGMENT

The authors thank Dr. E.S.Prakash, AssociateProfessor of Physiology, Division of Basic MedicalSciences, Mercer University School of Medicine, USA,for helping me to write the manuscript.

Conflict of Interest: No Conflict of interest applicablefor this study.

Source of Funding: Not applicable

Ethical Clearance: Enclosed (Human ethicalcommittee certificate -JIPMER).

REFERENCES

1. Sri Paramhansa Yogananda. God talks witharjuna. The bhagavad gita royal science of god-realization. The immortal dialogue between souland spirit. A new translation and commentary(2002), chapter IV Verse 29 p 496-507.

2. Bhargava R, Gogate MG,& Mascarchas JF.Autonomic responses to breath holding and itsvariations following pranayama. Indian JPharmacol( 1988); 32(4):257-264.

3. Keuning J. On the nasal cycle. J Int Rhinol(1968);6:99-135.

4. Task Force of the European Society of Cardiologyand the North American Society of Pacing andElectrophysiology. Heart rate variability.Standards of measurement, physiologicalinterpretation, and clinical use. Eur Heart J (1996);17: 354–381.

5. Shannahoff-khalsa, D.S. Lateralized rhythms ofthe central and autonomic nervoussystems. International Journal of Neuroscience:(1991) ; 11: 222-251.

6. Pal GK, Velkumary S,& Madanmohan. Effectof short term practice of breathing exercises onautonomic functions in normal humanvolunteers. Indian J Med Res( 2004); 120:115-121.

7. Sharma VK, Trakroo M, Subramaniam V,Rajajeyakumar M, Bavavani AB, Sahai A.Effect of fast and slow pranayam on perceivedstress and cardiovascular parameters in younghealth-care students. Int J Yoga 2013; 6:104-10.

8. Dinesh T, Sharma V K, Rajajeyakumar M, SyamSunder A, Gopinath M Ananda BalayogiBhavanani. Effect of 8 weeks of PranavPranayama Training on Pulmonary Function TestParameters in Young Healthy Volunteers ofJipmer Population. Int. Res J Pharm. App Sci.,2013; 3(4):116-118.


Bhavanani et al. Yoga Mimamsa 2013; 45 (1&2): 1-13

1

IMMEDIATE EFFECT OF CHANDRANADI PRANAYAM ON HEART RATE

VARIABILITY AND CARDIOVASCULAR PARAMETERS IN PATIENTS OF

DIABETES MELLITUS AND HYPERTENSION

ANANDA BALAYOGI BHAVANANI1*, E JAYASETTIASEELON2, ZEENA SANJAY3,

MADANMOHAN4

PRESENT AFILIATIONS:

1 Deputy Director, Centre for Yoga Therapy, Education and Research (CYTER), MGMCRI,

Puducherry.. Email: [email protected]

2 Senior Research Fellow, ACYTER, JIPMER, Puducherry- 6. Email: [email protected]

3 Senior Research Fellow, ACYTER, JIPMER, Puducherry-6. Email: [email protected]

4 Director, CYTER, MGMCRI, Puducherry. Email: [email protected]

*Corresponding author

ACKNOWLEDGEMENTS:

The authors thank Sri G Dayanidy and Selvi L Vithiyalakshmi, yoga instructors at ACYTER for

their assistance during the study. We also thank the Director, MDNIY and Director, JIPMER for

their support as this study was possible because ACYTER has been established as a

collaborative venture between the Morarji Desai National Institute of Yoga, New Delhi and

JIPMER, Puducherry with funding from Department of AYUSH, Ministry of Health and Family

Welfare, Government of India.






2

ABSTRACT:

Diabetes mellitus (DM) and hypertension (HT) are widely prevalent psychosomatic lifestyle

disorders that often coexist. Chandranadi pranayama (CNP), an exclusive left nostril breathing

technique, has been reported to be useful in reducing heart rate (HR) and blood pressure (BP) in

normal subjects as well as hypertensives and is part of yoga therapy schedules for patients of HT

and DM. This study investigated the immediate effects of 5 minutes of CNP on HR, BP and

heart rate variability (HRV) in patients of HT, DM and in those having both (DMHT). Thirty

nine participants receiving standard medical care from the department of medicine, JIPMER

were recruited. HR, BP and short-term supine HRV were recorded before and after 5 minutes of

CNP. Analysis showed significant (p < 0.05) fall of HR and BP indices in all three groups with

no difference between groups. However in short term HRV analysis, there were differences

between the responses of DM and HT patients with regard to mean RR and mean HR.

Preexisting intergroup differences with regard to SDNN, RMSSD, HF power and total power

were negated after the performance of CNP. Pre-post intra group comparisons showed

significant increases in Mean RR and Mean HR in both HT and HTDM groups while there were

significant increases in LFnu and LF/HF ratio with significant decrease in HFnu in DM group.

The post CNP responses of DM group in Mean RR, SDNN, Mean HR, RMSSD, LF power and

total power were contrary to responses in the other groups. This is the first report comparing

immediate effects of CNP in patients of HT and DM. The reduction in HR and BP indices in all

three groups may be attributed to an overall normalization of autonomic cardiovascular rhythms

along with improvement in baroreflex sensitivity irrespective of the disorder. The HRV findings

are more complicated but show a trend towards a normalization of the pre existing autonomic

differences between groups that is typical of Yoga techniques. HRV changes in DM patients

were contrary to HT and DMHT patients in many parameters and this may be due to a greater

degree of cardiac autonomic neuropathy in them. Further studies are required to enable better

understanding of mechanisms involved as well as to determine how long such effects persist.

We recommend the addition of this simple and cost effective technique to regular management

protocols of HT and DM.

Key words: chandra nadi pranayama, heart rate variability, diabetes mellitus, hypertension


3

INTRODUCTION:

Heart rate variability (HRV), the beat-to-beat alterations in heart rate, is a simple noninvasive

measurement for investigating autonomic influence on the cardiovascular system. (1) Low HRV

and baroreflex sensitivity reflect impaired cardiovagal adaptability and suggest excessive

sympathetic and/or insufficient parasympathetic tone that are, in turn, strong independent

predictors of cardiovascular morbidity and mortality. (2)

Streeter et al recently proposed a theory to explain the benefits of Yoga practices in diverse,

frequently comorbid medical conditions based on the concept that Yoga practices reduce

allostatic load in stress response systems such that optimal homeostasis is restored. (3) They

hypothesized that stress induces an imbalance of the autonomic nervous system (ANS) with

decreased parasympathetic and increased sympathetic activity, under activity of the gamma

amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter system, and

increased allostatic load. They further hypothesized that Yoga-based practices correct

underactivity of the parasympathetic nervous system and GABA systems in part through

stimulation of the vagus nerves, the main peripheral pathway of the parasympathetic nervous

system, and reduce allostatic load. According to their theory the decreased parasympathetic

nervous system and GABAergic activity that underlies stress-related disorders can be corrected

by Yoga practices resulting in amelioration of disease symptoms. HRV testing has a great role to

play in our understanding intrinsic mechanisms behind such potential effects of Yoga.

Diabetes mellitus (DM) and hypertension (HT) are widely prevalent psychosomatic lifestyle

disorders that often coexist and in whom factors such as sedentary habits and physical,

emotional and mental stress play a major role. They also probably have synergistic detrimental

effects on the cardiovascular system especially with regard to the cardiac autonomic function.

Various reviews have suggested that Yogic practices may have a role in prevention and

management of diabetes as well as co-morbid conditions like HT and dyslipidemia (2, 4, 5). It is

interesting to note that even a short lifestyle modification and stress management education

program based on yoga reduces risk factors for cardiovascular disease and DM within a period

of 9 days. (6)

Chandranadi pranayama (CNP), an exclusive left nostril breathing technique, has been reported

to be useful in reducing heart rate (HR) and blood pressure (BP) in normal subjects as well as

hypertensives and is part of yoga therapy schedules for patients of HT and DM. Potential health

benefits of unilateral forced nostril breathing (UFNB) have been postulated and many studies

done on normal subjects. (7, 8, 9 ) Further clinical research is however needed to establish the


4

efficacy of these techniques in various psychosomatic conditions such as HT and DM and we

have recently reported beneficial HR and SP reducing effects of CNP in hypertensive patients on

regular standard medical management. (10) This was attributed to a normalization of autonomic

cardiovascular rhythms with increased vagal modulation and / or decreased sympathetic activity

along with improvement in baroreflex sensitivity.

With the above in mind, the present study planned to investigate immediate effects of 5 minutes

of CNP on HR, BP and HRV in established patients of HT, DM and in those having both

(DMHT).

Table 1: Demographic characteristics of the different study groups of patients of hypertension (HT), diabetes mellitus (DM) and both hypertension and diabetes mellitus (DMHT). HT DM DMHT

Number 14 12 13

Age 50.14 ± 12.04 41.08 ± 9.73 ϯ 56.15 ± 8.49

Gender 8 M / 6 F 8 M / 4 F 9 M / 4 F

BMI 27.21 ± 3.21 25.00 ± 2.05 26.62 ± 3.66

Respiratory rate during basal recording

18.43 ± 2.68 19.31 ± 5.88 18.00 ± 3.34

Respiratory rate during CNP 8.29 ± 4.10 7.62 ± 4.17 6.62 ± 1.26

Respiratory rate during post CNP recording

18.14 ± 3.46 * 17.77 ± 5.10 16.15 ± 4.04 **

Medications Amlodipine, Enalopril

Atorvastatin and Aspirin

Glimipride, Glibenclamide

Metformin, Rosaglitazone Proglitazone,

Insulin

Amlodipine, Enalopril

Atorvastatin, Glimipride

Glibenclamide, Metformin

Rosaglitazone, Progiltazone

Insulin and Aspirin

ϯ , p = 0.0143 for inter group comparisons of age by ANOVA with * for DM vs DMHT. * p < 0.05, ** p< 0.01 by paired t test for comparisons between pre and post CNP RR during HRV recordings.


5

MATERIALS AND METHODS:

This study was conducted at the Advanced Centre for Yoga Therapy Education and Research

(ACYTER) that has been established as a collaborative venture between the Morarji Desai

National Institute of Yoga, New Delhi and JIPMER, Puducherry with funding from Department

of AYUSH in the Ministry of Health and Family Welfare, Government of India. Ethical

approval has been obtained by ACYTER from the Institutional Ethics Committee for studies on

the effect of yoga therapy on HT and DM. The present study was conducted as a pilot study as

part of this larger study.

Thirty nine participants were recruited from those attending regular Yoga therapy sessions at

ACYTER, JIPMER by convenience sampling. All were receiving standard medical care for

more than 3 years on outpatient in the department of medicine, JIPMER. Demographic

characteristics of the participants are given in Table 1.

All tests were carried out in ACYTER Yoga Research laboratory between 9 and 11 am. The

environment was quiet, with comfortable temperature and subdued lighting. The subjects were

briefed about the study protocol and written informed consent was obtained from them. They

were advised to come at least one hour after light breakfast, with empty bowel and bladder,

refrain from smoking and alcohol on the day of test and take their morning dosage of

antihypertensive agent after the procedure to avoid interference with cardiac autonomic

functions.

Anthropometric parameters such as height (cm) and body weight (Kg) were recorded and BMI

calculated using Quetlet formula. Height was measured by a wall mounted stadiometer and

weight with spring balance avoiding zero and parallax errors. The subjects were then asked to lie

in a comfortable supine posture on the couch and relax for 5 minutes.

HR and BP were measured using non-invasive semi-automatic BP monitor (CH – 432, Citizen

Systems, Tokyo, Japan) apparatus and short-term supine HRV was recorded using ZephyrTM

BioHarnessTM USA and analyzed using Kubio software V 2.0 Finland. The following frequency

and time domain indices were calculated from the HRV recordings.

Time domain indices:

1. Mean RR in milliseconds (ms).

2. SDNN- standard deviation of normal to normal intervals in ms.

3. Mean heart rate (1/min)


6

4. RMSSD- root mean square of successive standard deviations in ms.

Frequency domain indices:

1. LF Power (ms2): Power in low frequency range ( 0·04–0·15 Hz)

2. HF (ms2): Power in high frequency range 0·15–0·4 Hz

3. LF norm (nu): LF power in normalised units - LF / (Total Power–VLF)*100

4. HF norm (nu): HF power in normalised units - HF / (Total Power–VLF)*100

5. Total power (ms2): LF power + HF power

6. LF / HF Ratio: LF [ms2] / HF [ms2]

The subjects were then instructed to close their right nostril with their right thumb and use gentle

pressure to occlude the right nostril. They then performed the pranayama by breathing in and out

though the unblocked left nostril in a calm and regular manner for a total duration of 5 minutes.

They were instructed to use a conscious effort to breathe in low, mid and upper parts of their

lungs in a sequential manner for both inspiration and expiration. Post test HR and BP

measurements were recorded again at the end of the 5 minutes of CNP. Pulse pressure (PP) was

calculated as SP-DP, mean pressure (MP) as DP + 1/3 PP, rate-pressure product (RPP) as HR ×

SP / 100 and double product (Do P) as HR × MP / 100.

Statistical analysis of pre and post intervention data was done using GraphPad InStat version

3.06 for Windows 95, GraphPad Software, San Diego California USA, www.graphpad.com.

Wilcoxon matched-pairs signed-ranks test was used for intra group comparisons while inter

group comparisons were done using ANOVA with Tukey-Kramer Multiple Comparisons Test

for data with identical SDs and Kruskal Wallis with Dunn’s Multiple Comparisons Test for data

with non identical SDs. P values less than 0.05 were accepted as indicating significant

differences between pre and post test data.

RESULTS:

The results are given in Table 2 and 3. CNP resulted in a significant (p < 0.05) fall of HR and

BP indices in all three groups of patients with no difference between groups (Table 3). However

in short term HRV analysis, there were differences between the responses of DM and HT

patients with regard to mean RR and mean HR. Preexisting intergroup differences with regard to

SDNN, RMSSD, HF power and total power were negated after the performance of CNP (Table

2). Pre-post intra group comparisons showed significant increases in Mean RR and Mean HR in


7

both HT and DMHT groups while there were significant increases in LFnu and LF/HF ratio with

significant decrease in HFnu in DM group. The post CNP responses of DM group in Mean RR,

SDNN, Mean HR, RMSSD, LF power and total power were contrary to responses in the other

groups.

Table 2: Resting HRV analysis of patients of hypertension (HT), diabetes mellitus (DM) and both hypertension and diabetes mellitus (DMHT) before (B) and after (A) the performance of 5 minutes of chandra nadi pranayama (left uninostril breathing).

HT (n=14) DM (n=12) DMHT (n=13) ANOVA

B A B A B A B A

Mean RR (ms)

852.21 ±

105.57

880.67 ±

109.86 **

774.24 ±

83.77

769.77 ±

97.48

774.22 ±

134.76

786.83 ±

127.29 *

P = 0.1219 P= 0.0187 with * for D vs HT

SDNN (ms)

30.44 ± 16.33

34.14 ± 15.62

33.16 ± 15.21

29.12 ± 14.70

20.30 ± 10.32

23.31 ± 12.91

P = 0.0224 with * for

DM vs DMHT P = 0.0782

Mean HR (1/min)

71.56 ± 8.68

69.40 ± 8.84**

78.53 ± 7.89

79.24 ± 9.07

79.40 ± 11.23

77.93 ± 10.31

* P = 0.0724

P = 0.0184 with * for DM vs HT

RMSSD (ms)

35.51 ± 23.92

36.45 ± 18.38

39.16 ± 19.84

29.17 ± 14.50

23.15 ± 12.08

24.35 ± 9.75

p = 0.0087 with ** for

DM vs DMHT P = 0.1145

LF Power (ms 2)

407.00 ±

493.854

615.143 ±

638.313

507.33 ±

750.13

475.00 ±

613.00

163.15 ±

170.29

331.85 ±

396.50 P= 0.0675 P=

0.3237

HF Power (ms 2)

576.93 ±

1092.44

379.79 ±

580.14

536.83 ±

483.83

372.58 ±

429.20

212.77 ±

339.50

301.85 ±

478.96

P=0.0125 with * for

DM vs DMHT

P= 0.4891

LF (n.u)

47.19 ±

23.61

58.03 ±

20.60

45.36 ±

19.46

59.13 ±

21.00*

46.38 ±

15.65

52.39 ±

16.95 P = 0.9731 P = 0.6499

HF (n.u)

52.81 ±

23.61

41.97 ±

20.60

54.64 ±

19.46

40.88 ±

21.00*

53.62 ±

15.65

47.61 ±

16.95 P = 0.9731 P = 0.6499

Total Power (ms 2)

984.29 ±

1501.74

994.86 ±

1105.56

1044.0 ±

1143.18

848.00 ±

867.43

376.00 ±

494.36

633.69 ±

774.61

P=0.0115 with * for

DM vs DMHT and * for HT vs

DMHT

P = 0.2979

LF/HF 1.44 ± 1.44

2.02 ± 1.52

1.03 ± 0.64

2.06 ± 1.42*

1.09 ± 0.92

1.39 ± 0.93 P = 0.9994 P = 0.3614

Values are given as mean ± SD. * p < 0.05, ** p < 0.01, *** p < 0.001 by Wilcoxon matched-pairs signed-ranks test for intra group comparisons. Inter group comparisons by ANOVA with Tukey-Kramer Multiple Comparisons Test for data with identical SDs and Kruskal Wallis with Dunn’s Multiple Comparisons Test for data with non identical SDs. * p < 0.05 for intergroup post hoc comparisons.


8

Table 3: Heart rate (HR), systolic pressure (SP), diastolic pressure (DP), pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and double product (Do P) in of patients of hypertension (HT), diabetes mellitus (DM) and both hypertension and diabetes mellitus (DMHT) before (B) and after (A) the performance of 5 minutes of chandra nadi pranayama (left uninostril breathing).

HT (n=14)

DM (n=12)

DMHT (n=13) ANOVA

B A B A B A B A

HR (beats/min) 70.86

± 11.18

67.86 ±

9.80 *

74.67 ±

6.62

71.08 ±

7.49 **

74.69 ±

11.31

71.92 ±

10.07 ** P= 0.6415 P=0.4894

SP (mm Hg) 137.00

± 14.54

130.50 ±

13.53 *

126.00 ±

12.48

123.25 ±

12.75 *

130.85 ±

8.19

128.00 ±

12.27 P= 0.0804 P=0.2332

DP (mm Hg) 83.71

± 8.42

80.86 ±

8.37 *

80.08 ±

8.58

78.67 ±

9.36

82.00 ±

7.78

79.08 ±

6.93 * P=0.5412 P=0.7686

PP (mm Hg) 53.29

± 14.54

49.64 ±

9.20

45.92 ±

6.60

44.58 ±

6.99

48.85 ±

10.60

48.92 ±

12.12 P=0.2555 P=0.2440

MP (mm Hg) 101.48

± 8.41

97.40 ±

9.43 **

95.39 ±

9.55

93.53 ±

10.09 **

98.28 ±

6.14

95.38 ±

7.04 P=0.1762 P=0.5478

RPP (units) 97.47

± 20.57

89.27 ±

19.14 **

94.03 ±

11.70

87.32 ±

10.14 **

97.48 ±

14.46

91.46 ±

11.68 ** P=0.8306 P=0.7747

DoP (units) 72.35

± 15.22

66.66 ±

14.02**

71.13 ±

8.42

66.25 ±

7.86***

73.50 ±

12.38

68.41 ±

9.45** P=0.8938 P=0.8693

Values are given as mean ± SD. * p < 0.05, ** p < 0.01, *** p < 0.001 by Wilcoxon matched-pairs signed-ranks test for intra group comparisons. Inter group comparisons by ANOVA with Tukey-Kramer Multiple Comparisons Test for data with identical SDs and Kruskal Wallis with Dunn’s Multiple Comparisons Test for data with non identical SDs. * p < 0.05 for intergroup post hoc comparisons.

DISCUSSION AND CONCLUSION:

This is the first report of the immediate cardiovascular effects of CNP in patients of HT and DM

utilizing HRV analysis. We have also measured resting cardiovascular parameters, thus

enabling us to understand the resultant effects and also to confirm previous reports on

cardiovascular effects of CNP.

There was a significant fall of HR and BP indices in all three groups of patients and this

reduction may be attributed to an overall normalization of autonomic cardiovascular rhythms

along with improvement in baroreflex sensitivity irrespective of the underlying disorder. It has

been previously reported that sympathetic activity is lower during left nostril breathing. (11) This


9

is also supported by Innes et al who had earlier postulated two interconnected pathways by

which Yoga reduces the risk of cardiovascular diseases through the mechanisms of

parasympathetic activation coupled with decreased reactivity of sympathoadrenal system and

HPA axis.(2)

The cardiovascular effects with regard to the RPP and Do P are more significant (p< 0.01 to p<

0.001) and this can be attributed to the cumulative benefits from a reduction in HR as well as

BP. RPP and Do P are especially important in patient care as they are indirect indicators of

myocardial oxygen consumption and load on the heart, and hence this reduction implies a

lowering of the strain on the heart. (12) As RPP is also a surrogate marker of overall HRV, its

reduction implies an improved cardiac autonomic regulation in our subjects. (13) As the HR also

reduced significantly in our study, the fall in SP can be attributed to a reduction in cardiac output

due to decreased venous return as well as decreased HR. Slow and deep regular breathing is

known to harmonize respiratory and cardiovascular Meyer rhythms that then result in changes in

HR as well as BP. Increased vagal modulation of SA and AV nodes along with enhancement of

baroreceptor sensitivity may be responsible for reduction in HR and subsequent fall in SP in our

subjects irrespective of their condition.

The HRV findings in all three groups are more complicated but show a trend towards a

normalization of the pre existing autonomic differences between groups that is typical of Yoga

techniques. Preexisting intergroup differences with regard to SDNN, RMSSD, HF power and

total power were negated after the performance of CNP.

Significant increases in Mean RR with conversely significant decreases in Mean HR in both the

HT and DMHT groups may be explained by the factors discussed above and strengthen the

possibility of an enhanced harmonization of cardiac autonomic function. This seems to be more

evident in the patients of HT and DMHT as LF power and total power also increased in these

groups while it reduced in DM group. Increases in LF power are traditionally interpreted as an

index of enhanced sympathetic activity but recent understanding is that LF power reflects

baroreflex function and not cardiac sympathetic innervation. Moak et al reported that LF power

derived from the interbeat interval spectrogram predominantly reflects baroreflex-mediated,

phasic changes in cardiovagal and sympathetic noradrenergic outflows. (14) They concluded that

in the setting of baroreflex failure, baseline LF power is reduced, regardless of the status of

cardiac sympathetic innervation.

Changes in all three groups following CNP suggests that an improvement is occurring in the

cardiac autonomic modulation irrespective of the increase or decrease in different HRV


10

parameters. This implies a healthier heart, capable of responding to external and internal

changes in an adequate manner. Our hypothesis is supported by a recent report that the period

immediately following alternate nostril breathing as well as paced breathing is marked by

elevated autonomic modulation of the heart. (15)

It is to be noted that in virtually all of the short term HRV analysis, there were differences

between the responses of DM and HT patients with regard to mean RR and mean HR. This may

be attributed to a greater degree of cardiac autonomic neuropathy that is known to occur in

patients of DM. Pre-post intra group comparisons showed significant increases in Mean RR and

Mean HR in both HT and DMHT groups while there were significant increases in LFnu and

LF/HF ratio with significant decrease in HFnu in DM group. The post CNP responses of DM

group in Mean RR, SDNN, Mean HR, RMSSD, LF power and total power were contrary to

responses in the other groups.

HRV is known to be lower in patients of DM and HT and in our study, SDNN, RMSSD, LF

power, HF power and total power were much lower in the DMHT group compared to the other

groups and this may be attributed to a synergetic detrimental effect on the cardiac autonomic

nervous system due to concurrent DM and HT. a previous study by Sridar et al has also reported

reduced baseline HRV in patients having DMHT as compared to those having only DM (16) This

can be attributed to the cardiac aautonomic neuropathy in DM and HT resulting in impaired

regulation of BP and HRV due to a shift in cardiac autonomic balance towards sympathetic

dominance. Improvements in all HRV parameters following CNP in our patients may be

attributed to a balancing of the autonomic function with a shift from the sympathetic dominant

state to one of parasympathetic balance. Sridar et all had also reported that the degree of

increase in HRV was greater in hypertensive diabetic patients as opposed to normotensive

diabetic patients (16) and our findings are similar to some extent as there was a greater ∆% change

in DMHT group.

A recent study from JIPMER assessing sympathovagal imbalance by spectral analysis of HRV

reported that that autonomic imbalance in pre-hypertensives was due to proportionate increased

sympathetic activity and vagal inhibition, whereas in hypertensives, vagal withdrawal was more

prominent than sympathetic over activity. (17) This may explain the major differences between

the groups at baseline and also the changes in DMHT group as the cardiac autonomic imbalance

was of a greater degree of severity. Increased sympathetic activity, enhanced cardiovascular

reactivity and reduced parasympathetic tone have been strongly implicated in the pathogenesis

of insulin resistance syndrome, atherosclerosis and cardiovascular diseases. Innes and Vincent


11

have suggested that yoga reduces this risk profile by decreasing activation of the sympatho-

adrenal system and the hypothalamic-pituitary-adrenal axis and also by promoting a feeling of

wellbeing along with direct enhancement of parasympathetic activity via vagus nerve. (18)

Although decreased HRV is the most powerful predictor of cardiac mortality, there are a few

limitations in any study using HRV as a tool for research. It is still unclear as to which is the best

HRV variable to measure as none provides significant, consistent and accurate outcome. (19)

Since HRV deals with RR interval variations, its measurement is limited to subjects with sinus

rhythm and to those with low number of ectopic beats. (20)

As the present study lacked an appropriate paired control group of patients, further controlled

studies are planned to ascertain a deeper understanding of the mechanisms involved. Such

studies can also determine how long such an autonomic modifying effect persists in clinical

situations. It is recommended that this simple and cost effective technique be added to the

regular management protocol of HT and DM and utilized when immediate reduction of HR and

BP are required in day-to-day as well as clinical situations.

REFERENCES:

1. Madanmohan, Bhavanani AB, Prakash ES, Kamath MG, Amudhan J. Effect of six weeks of

shavasan training on spectral measures of short term heart rate variability in young healthy

volunteers. Indian J Physiol Pharmacol 2004; 48: 370-3.

2. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome,

cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam

Pract 2005; ,18: 491-519

3. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic

nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic

stress disorder. Med Hypotheses 2012;78: 571-9

4. Sahay BK. Role of yoga in diabetes. J Assoc Physicians India 2007; 55: 121-26.

5. Yang K.A Review of yoga programs for four leading risk factors of chronic diseases. Evid Based

Complement Alternat Med. 2007; 4 : 487-91.

6. Bijlani RL, Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma R et al. A brief but comprehensive

lifestyle education program based on yoga reduces risk factors for cardiovascular disease and

diabetes mellitus. J Altern Complement Med. 2005; 11 : 267-74.


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7. Shannahoff-Khalsa DS, Kennedy B. The effects of unilateral forced nostril breathing on the heart. Int

J Neurosci 1993; 73 : 47-60.

8. Telles S, Nagaratna R, Nagendra HR. Breathing through a particular nostril can alter metabolism and

autonomic activities. Indian J Physiol Pharmacol 1994; 38: 133-37.

9. Raghuraj P, Telles S. Immediate effect of specific nostril manipulating yoga breathing practices on

autonomic and respiratory variables. Appl Psychophysiol Biofeedback 2008; 33: 65-75.

10. Bhavanani AB, Zeena S, Madanmohan. Immediate effect of chandra nadi pranayama (left unilateral

forced nostril breathing) on cardiovascular parameters in hypertensive patients. Int J Yoga 2012; 5:

108-11

11. Mitti Mohan S. Svara (Nostril dominance) and bilateral volar GSR. Indian J Physiol Pharmacol

1996; 40: 58-64.

12. Madanmohan, Udupa K, Bhavanani AB, Chetan Chinmaya Shatapathy, Ajit Sahai. Modulation of

cardiovascular response to exercise by yoga training. Indian J Physiol Pharmacol 2004; 48: 461-65.

13. Prakash ES, Madanmohan, Sethuraman KR, Narayan SK. Cardiovascular autonomic regulation in

subjects with normal blood pressure, high-normal blood pressure and recent-onset hypertension. Clin

Exp Pharmacol Physiol 2005; 32: 488-94.

14. Moak JP, Goldstein DS, Eldadah BA, Saleem A, Holmes C, Pechnik S, Sharabi Y. Supine low-

frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic

innervation. Cleve Clin J Med 2009 ; 76 Suppl 2: S51-9.

15. Ghiya S, Lee CM. Influence of alternate nostril breathing on heart rate variability in non-practitioners

of yogic breathing. Int J Yoga 2012 5:66-9

16. Sridhar B, Haleagrahara N, Bhat R, Kulur AB, Avabratha S, Adhikary P. Increase in the heart rate

variability with deep breathing in diabetic patients after 12-month exercise training. Tohoku J Exp

Med 2010 ;220 :107-13.

17. Pal GK, Adithan C, Amudharaj D, Dutta TK, Pal P, Nandan PG, Nanda N. Assessment of

sympathovagal imbalance by spectral analysis of heart rate variability in prehypertensive and

hypertensive patients in Indian population. Clin Exp Hypertens 2011; 33:478-83.

18. Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2

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Noninvasive Electrocardiol 2005; 10:88-101.

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Journal of Clinical and Diagnostic Research. 2014 May, Vol-8(5): BC01-BC03 11

DOI: 10.7860/JCDR/2014/7452.4390 Original Article

Effect of Slow and Fast Pranayama Training on Handgrip Strength and

Endurance in Healthy Volunteers Phy

sio

log

y S

ectio

n

DineSh Thangavel1, girwar Singh gaur2, vivek kumar Sharma3,

ananDa Balayogi Bhavanani4, rajajeyakumar m.5, Syam SunDer a.6

keywords: Pranayama, Physiological parameters

ABSTRACTBackground: Pranayama has been assigned very important role in yogic system of exercises and is said to be much more important than yogasanas for keeping sound health. Also different pranayamas produce divergent physiological effects.

Aim: To study the effect of 12 weeks training of slow and fast pranayama on handgrip strength and endurance in young, healthy volunteers of JIPMER population.

Settings and Design: Present study was conducted in the Department of Physiology, JIPMER in 2011-12 (1.06.11 to 1.04.12).

Materials and Methods: Total of 91 volunteer subjects were randomised into slow pranayama (SPG) (n=29), fast pranayama (FPG) (n=32) and control groups (CG) (n=30). Supervised pranayama training (SPG - Nadisodhana, Pranav pranayama and Savitri pranayama; FPG - Kapalabhati, Bhastrika and Kukkuriya pranayama) was given for 30 minutes thrice a week for 12 weeks to both slow and fast pranayama groups by certified yoga trainer. Hand grip strength (HGS) and endurance (HGE) parameters were

recorded using handgrip dynamometer (Rolex, India) at baseline and after 12 weeks of pranayama training.

Statistical Analysis Used: Longitudinal changes in each group were compared by using Student’s paired t-test. Delta changes in each group were analysed by ANOVA with Tukey post-hoc analysis.

Results: In SPG significant improvement occurred only in HGE parameter from 83.95±45.06 to 101.62±53.87 (seconds) (p<0.001) whereas in FPG, significant improvement was observed in HGS from 33.31±9.83 to 37.9±9.41 (Kilograms) (p=0.01) as well as in HGE from 92.78±41.37 to 116.56±58.54 (seconds) (p=0.004). Using Students unpaired t-test difference between the groups in HGS is found to be 1.17±5.485 in SPG and in FPG is 4.59±7.26 (p=0.39); HGE difference in SPG is 1.77±21.17 and in FPG is 2.38±43.27 (p>0.05).

Conclusion: Pranayama training decreases sympathetic activity, resulting in mental relaxation and decreased autonomic arousal thereby, decreasing force fluctuations during isometric contraction. This is reflected as improvement in HGS and HGE.

InTRODUCTIOnThe spiritual-scientific discipline of yoga incorporates a wide variety of practices and many scientific researches conclusively document its preventive, therapeutic and excelling powers in the individuals [1,2].

The versions of pranayama vary from single nostril breathing to bellow breathing and it consists of three phases: purak (inhalation), kumbhak (retention) and rechak (exhalation) and these phases can be practised in either slow or fast manner [3]. Hand grip strength (HGS) is an indicator of muscle function and nutritional status. It has been used as an objective clinical measure in a variety of situations including assessing the general strength in order to determine work capacity [4]. HGS is influenced by effort, skeletal muscle bulk and contractility. Regular practice of pranayama has shown improvement in HGS of both hands [5]. One previous study has compared the effect of six months practice of fast (FSN) and slow (SSN) practice of Suryanamaskar (SN) (type of yogasana) on adolescents and found out that both types of SN had positive physiological benefits but the effects of FSN were similar to physical aerobic exercises, whereas the effects of SSN were similar to those of yoga training [6]. As different types of pranayamas have also been demonstrated to produce different physiological benefits in the subjects [7–9], the present study was planned to study the effect of 12 weeks of slow and fast pranayama training on handgrip strength and handgrip endurance in young adult subjects of JIPMER population.

SUBjeCTS AnD MeThODSPresent study was conducted in the Department of Physiology, JIPMER, Puducherry. The subjects were recruited from the students of various courses conducted in JIPMER, Puducherry as well as staff, friends and relatives of them. The study involved less than minimal risk.

Inclusion criteria• Healthyvolunteersofbothgenderintheagegroupof18-30

years.

exclusion criteria• Historyofchronicrespiratoryillness.• Subjectsreceivingmedicationforanychronicailment.• Smokersandalcoholics.• Athletes.• Any history of previous yoga or bio feedback techniques

training in last one year.

The purpose of the study, procedures and benefits were briefed to them. The willing participants were randomised into SPG (n=29), FPG (n=32) and CG (n=30) after getting informed written consent, by simple randomisation method using random numbers generated through computer. Average age of the volunteers was average age of 18.58 ±2.27 (mean ± SD) were considered for analysis. Among these 91 volunteers, 72 were females and the remaining 19 were

Vivek Kumar Sharma et al., Effect of Slow and Fast Pranayama Training on Handgrip Strength and Endurance in Healthy Volunteers www.jcdr.net

Journal of Clinical and Diagnostic Research. 2014 May, Vol-8(5): BC01-BC0322

Control group: consisted of group of volunteers who were not included in 12 week training of pranayama.

ReSUlTSThe comparison of parameters between baseline and post test amongst the groups on hand grip dynamometry parameters are given in [Table/Fig-1]. The details on the comparison of handgrip dynamometry parameters considered for the study at baseline were comparable (p>0.05).

The analysis on the effect of 12 weeks of slow pranayama on HGS and HGE parameters shows a statistically significant improvement (p<0.001) for HGE and statistically insignificant change (p>0.05) for HGS parameter. The analysis on the effect of 12 weeks of fast pranayama on HGS and HGE shows statistically significant improvement in both HGS and HGE (p=0.01 and p=0.004, respectively).

In CG there was no significant change observed in both HGS and HGE parameters (p>0.05) after 12 weeks of study period. In HGS parameter, longitudinal changes amongst the groups were not statistically significant (p>0.05). In HGE parameter, changes amongst the groups were statistically significant (p=0.003).An average increase of 2.38 ± 43.27in FPG and 1.77 ± 21.17in SPG was observed (P=0.003 and P=0.03 respectively) compared to the CG.

Also, [Table/Fig-2] demonstrates that on comparing HGS and HGE parameters, there was no significant difference between SPG and FPG groups. Therefore, our study demonstrates that the effect of slow and fast pranayama groups can be considered comparable on handgrip dynamometer parameters (HGS & HGE).

DISCUSSIOnSince pranayama can be practiced in either slow or fast manner [3], the beneficial effects obtained by the practice of different prana-yamas may be derived from the differences in duration of the phases of the breathing cycle, tidal volume and other factors including the use of mouth, nostrils, constriction of the laryngeal muscles and position of the glottis [10].

Results of our study demonstrate that there was no significant differ-ence in the baseline values of handgrip dynamometry parameters.Therefore, all the three groups can be considered comparable for the present study. There was significant improvement in HGS and HGE in fast pranayama group whereas in slow pranayama group, there was significant improvement in only HGE parameter (p<0.001) along with statistically non significant but definite trend towards increase in HGS. However, on comparing longitudinal changes

males. The study did not involve invasive procedures at any stage. Hand grip strength (HGS) and endurance (HGE) parameters were recorded at baseline and after 12 weeks of pranayama training using handgrip dynamometer (Rolex, India). The subjects were asked to sit comfortably and proper instructions were given to them. They were asked to perform maximum voluntary contraction (MVC) using the handgrip dynamometer. The test was repeated three times with a gap of two minutes and the highest value was recorded as HGS. Following HGS, the subjects were instructed to maintain one-third of HGS for as long as possible. Duration in seconds was noted as HGE using the stop watch. Supervised pranayama training (SPG - Nadisodhana, Pranav pranayama and Savitri pranayama; FPG - Kapalabhati, Bhastrika and Kukkuriya pranayama) was given for 30 minutes/ day, thrice/week for the duration of 12 weeks by certified yoga trainer as per the guidelines of Morarji Desai National Institute of Yoga, New Delhi. The details of pranayama training are as follows:

1. Fast Pranayama: Each cycle consisted of practicing one minute of Kapalabhati, Bhastrika and Kukkriya pranayama interspersed with one minute of rest between each pranayama. Subjects were asked to complete three or more cycles in each session.

• Kapalabhatipranayama:Thesubjectsforcefullyexpelledduringthe expiration but the inhalation was passive. One hundred and twenty rounds per sitting was the maximum allowed.

• Bhastrikapranayama (Bellows):Subjectswere instructed totake deep inspiration followed by rapid expulsion of breath following one another in rapid succession. This is called as ‘bellow’ type of breathing. Each round consisted of 10 such ‘bellows’.

• Kukkriyapranayama(DogPant):Thesubjectssatinvajrasanawith both palms on the ground in front with wrists touching knees and fingers pointing forward. With wide open mouth and the tongue pushed out as far as possible subjects breathed in and out at a rapid rate with their tongue hanging out of their mouth. The whole practice was repeated for three rounds.

2. Slow Pranayama: Each round (seven minutes) of session consisted of practicing two minutes of nadishodhana, pranava and savitri pranayama interspersed with one minute of rest between each pranayama done in comfortable posture (sukhasana). Subjects were asked to perform nine or more rounds according to their capacity.

• Nadishodhana pranayama: is rhythmic and slow alternatenostril breathing. One round consisted of inhaling through one nostril, exhaling through other nostril and repeating the same procedure through other nostril.

• Savitri pranayama is a slow, deep and rhythmic breathing,each cycle having a ratio of 2:1:2:1 between inspiration (purak), held-in breath (kumbhak), expiration (rechak), and held out breath (shunyak) phases of the respiratory cycle.

• Pranava pranayama is slow, deep and rhythmic breathingwhere emphasis is placed on making the sound AAA, UUU and MMM while breathing out for duration of two to three times the duration of the inhaled breath.

At the end of session, all SPG and FPG subjects were instructed to lie down in shavasana and relax for 10 minutes.

Parameters

SPg(n=29) FPg (n=32) Cg (n=30)

Baseline Post test Baseline Post test Baseline Post test

HGS (Kg) 32.83 ± 11.33 34 ± 11.90 33.31 ± 9.83 37.9 ± 9.41* 30.43 ± 10.15 32.40 ± 9.25

HGE (s) 83.95 ± 45.06 101.62 ± 53.87*** 92.78 ± 41.37 116.56 ± 58.54** 71.83 ± 40.86 65.80 ± 34.06

[Table/Fig-1]: Comparison of handgrip dynamometry parameters between baseline and post test amongst the study groups (Mean ± SD)SPG - slow pranayama group, FPG - fast pranayama group,CG - control group. Handgrip strength (HGS) in Kilograms and handgrip endurance (HGE) in seconds. Analysis done by Student’s paired t-test. *p<0.05, **p<0.01, ***p<0.001.

Parameters SPg (n=29) FPg (n=32) Cg (n=30)

HGS (Kg) 1.17 ± 5.28 4.59 ± 7.26 1.97 ± 7.42

HGE (s) 1.77 ± 21.17 2.38 ± 43.27 -6.03 ± 35.53*, ##

[Table/Fig-2]: Comparison of the delta changes (difference between post test & baseline) amongst the studygroups on handgrip strength (HGS) and endurance (HGE) parameters (Mean ± SD).SPG - slow pranayama group, FPG - fast pranayama group, CG - control group. *with respect to slow pranayama group, # with respect to fast pranayama group.Analysis done by one way ANOVA with Tukey post-hoc analysis .*p<0.05, **p<0.01, ***p<0.001. #p<0.05, ##p<0.01, ###p<0.001.

Journal of Clinical and Diagnostic Research. 2014 May, Vol-8(5): BC01-BC03 33

www.jcdr.net Vivek Kumar Sharma et al., Effect of Slow and Fast Pranayama Training on Handgrip Strength and Endurance in Healthy Volunteers

between fast and slow pranayama groups, there was no statistically significant difference between these groups. Therefore, our study demonstrates that both slow and fast pranayamas are beneficial on the handgrip dynamometer parameters (HGS & HGE) and the beneficial effect of the two groups can be considered comparable.

To the best of our knowledge, there is no previous study which compared the effect of slow and fast pranayamas on HGE and HGS. However, many previous studies had shown beneficial effect of integrated yoga practices which included various pranayama techniques.AstudybyMadanmohanetal.,observed21percentincrease in HGS on healthy volunteers with 12 weeks of yoga training [11]. Another study done by Raghuraj et al. on school children aged 11–18 years found that 10 days of pranayama training significantly improved HGS ranging from 4.1 percent to 6.5 percent without lateralised effect [5].

The improvement in HGS & HGE after pranayama training can be ascribed to the state of calm alertness, better subjective wellbeing and hypo metabolic state in the subjects which may have resulted in better concentration on the task. This may be due to improved autonomic tone resulting in increased parasympathetic drive, calming of stress responses, neuroendocrine release of hormones and thalamic generators [12]. Improved autonomic tone may reduce oxygen requirement by pranayama practice, as the availability ofenergy and oxidation of glucose is believed to influence the HGS [13]. Also, cognitive components and non specific arousal can be the possible factors for the improvement in HGS [14]. Ray et al., reported that yogic exercises produce significant increase in muscle endurance and delay in onset of fatigue [15]. Raju et al., also reported that yoga training resulted in a significant increase in maximal work output with a significantly reduced level of oxygen consumption per unit work [16].

To conclude, our results demonstrate that both slow and fast pranayamas are beneficial on handgrip dynamometry parameters and fast pranayama was more effective than slow pranayama.

Key MeSSAgeSDifferent pranayamas produce different physiological effects. Especially fast pranayama training when practiced regularly for longer duration, it produces parasympatho dominance in contrast to the short duration training which evokes sympathetic activity.

ACKnOwleDgeMenTSpecial thanks are due to the Advanced Centre for Yoga Therapy Education and Research (ACYTER) team of Mr. Dayanidy G and Ms. Vithiyalakshmi L, Yoga Instructors, for an excellent conduct of pranayama training sessions. We are also grateful to the subjects for cooperating during the study in all possible aspects.

ReFeRenCeS[1] Ornish, D. Intensive life style changes and health reform. The Lancet Oncology.

2009; 10: 198–99.[2] Khalsa S. Yoga as a therapeutic intervention. Indian J Physiol Pharmacol. 2004;

48 (3): 269–85.[3] Chodzinski J. The effect of rhythmic breathing on blood pressure in hypertensive

adults. J Undergrad Res. 2000; 1(6).[4] Gilbert JC, Knowlton RG. Simple method to determine sincerity of effort during a

maximal isometric test of grip strength. Am J Phys Med. 1983; 62(3): 135–44.[5] Raghuraj P, Nagarathna R, Nagendra HR, Telles S. Pranayama increases

grip strength without lateralized effects. Indian J Physiol Pharmacol. 1997; 41(2): 129–33.

[6] Bhavanani AB, Udupa K, Madanmohan, Ravindra P. A comparative study of slow and fast suryanamaskar on physiological function. Int J Yoga. 2011; 4(2): 71–76.

[7] Madanmohan, Lakshmi jatiya, Udupa K, Bhavanani AB. Effect of yoga training on handgrip, respiratory pressures and pulmonary function. Indian J PhysiolPharmacol. 2003; 47 (4) : 387–92.

[8] Bijlani RL. The Yogic Practices: Asanas, Pranayams and Kriyas. Bijlani RL, editor, Understanding medical physiology, Third edition. New Delhi, India: Jaypee Brothers Medical Publishers 2004; 883–89.

[9] Pal GK, Velkumary S, Madanmohan. Effect of short- term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res. 2004; 120:115–21.

[10] Telles, Desiraju T. Heart rate alterations in different types of pranayamas. Indian J Physiol Pharmacol. 1992; 36(4):287-88.

[11] Madanmohan, Thombre DP, Bharathi B, Nambinarayanan TK, Thakur S, krishnamurthy N, Chandrabose A. Effect of yoga training on reaction time, respiratory endurance and musle strength. Indian J Physiol Pharmacol. 1992; 36: 229–33.

[12] Brown RP, Gerbarg PL. SudarshanKriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model. J Altern Complement Med. 2005; 11(1):189–201.

[13] Mohinder P, Malik SL. Effect of smoking on anthropometric somatotype and grip strength. Indian J Med Res. 1988;87: 494–99.

[14] Peynirciolu ZF, Thompson JL, Tanielian TB: Improvement strategies in free-throw shooting and grip-strength tasks. J Gen Psychol. 2000; 127(2): 145–56.

[15] Ray US, Hegde KS, Selvamurthy W. Improvement in muscular efficiency as related to a standard task after yogic exercises in middle aged men. Indian J Med Res. 1986; 83: 343–48.

[16] Raju PS, Madhavi S, Prasad KV, Reddy MV, Reddy ME, Sahay BK, Murthy KJ. Comparison of effects of yoga & physical exercise in athletes. Indian J Med Res. 1994; (100):81-86.

ParTiCularS oF ConTriBuTorS:1. Assistant Professor, Department of Physiology, Vinayaka Mission’s Medical College, Karaikal-609605, India.2. Additional Professor, Department of Physiology, JIPMER, Puducherry-605006, India.3. Assistant Professor, Department of Physiology, JIPMER, Puducherry-605006, India.4. Deputy Director, CYTER, Mahatma Gandhi Medical College and Research Institute, Puducherry-607 402, India.5. Assistant Professor, Department of Physiology, Chennai Medical College Hospital and Research Centre,Tiruchirappalli, Tamilnadu-621105, India.6. Phd Scholar, Department of Physiology, JIPMER, Puducherry-605006, India.

name, aDDreSS, e-mail iD oF The CorreSPonDing auThor:Dr. Vivek Kumar Sharma, Assistant Professor, Department of Physiology, JIPMER, Puducherry-605006, India.Phone: 9442529673, E-mail: [email protected]

FinanCial or oTher ComPeTing inTereSTS: None.

Date of Submission: aug 25, 2013 Date of Peer Review: jan 17, 2014 Date of Acceptance: mar 12, 2014

Month of Publishing: may, 2014

Ann. SBV, Jan - Jun 2014;3(1)


Introduction“Oh, East is East, and West is West, and never the twain shall meet,” said Rudyard Kipling. This dichotomy however seems to have been overcome in recent times, as many eastern healing traditions have slowly and steadily percolated the health care system worldwide. This is especially true of mind–body therapies that focus on the health promotive intrinsic connections that exist between the human brain, mind, body, and individual behaviour. This includes techniques of meditation (mantra meditation, mindfulness meditation, and others), qi gong, tai chi, and yoga.1 In the USA, reported use of deep breathing, meditation, and yoga increased between 2002 and 2007 with 12.7% of adults using deep-breathing exercises, 9.4% practicing meditation, and 6.1% taking up yoga.2,3 Pain related issues were the top usage statistics while more than 40% of adults with neuropsychiatric symptoms were drawn to the usage of various mind–body therapies.4

Yoga As A Therapy Yoga as a mode of therapy (yoga chikitsa) has become extremely popular, and a great number of studies and systematic reviews offer scientific evidence of its potential in treating a wide range of psychosomatic conditions. Yoga understands health and well-being as a dynamic continuum of human nature and not merely a ‘state’ to be reached and maintained. Yoga helps the individual to establish “sukha sthanam”, which may be defined as a dynamic sense of physical, mental, and spiritual well-being. Yogamaharishi Dr. Swami Gitananda Giri Guru Maharaj, the visionary founder of Ananda Ashram at the ICYER, Pondicherry (www.icyer.com) and one of the foremost authorities on Yoga in the past century exclaimed lucidly, “Yoga chikitsa is virtually as old as yoga itself, indeed, the return of mind that feels separated from the Universe in which it exists

represents the first yoga therapy. Yoga chikitsa could be termed as man’s first attempt at unitive understanding of mind-emotions-physical distress and is the oldest wholistic concept and therapy in the world.” 5

To achieve this yogic integration at all levels of our being, it is essential that we take into consideration the all encompassing multi dimensional aspects of yoga that include the following: a healthy life-nourishing diet, a healthy and natural environment, a wholistic lifestyle, adequate bodywork through asana, mudra-bandha and kriya, invigorating breath work through pranayama and the cultivation of a healthy thought process through jnana yoga and raja yoga.

The International Association of Yoga Therapists (IAYT), USA has taken this idea into account in defining Yoga therapy as follows6: “Yoga therapy is the process of empowering individuals to progress toward improved health and well-being through the application of the philosophy and practice of yoga.” This has been further elabourated by the IAYT in its “Recommended Educational Standards for the Training of Yoga Therapists”, published on 1 July, 2012.7 This is one of the best documents on standards in yoga therapy and is a path breaking effort covering comprehensively all aspects of yoga as a holistic therapy.

The need of the hour is for a symbiotic relationship between yoga and modern science. To satisfy this need, living, human bridges combining the best of both worlds need to be cultivated. It is important that more dedicated scientists take up yoga and that more yogis study science, so that we can build a bridge between these two great evolutionary aspects of our civilization. The process as well as the goal of yoga is all about becoming “one” with an integrated state of being.8

yoGa anD MInD BoDy theRaPIeS In health anD DISeaSe: a BRIef RevIewananda Balayogi Bhavanani *, Meena Ramanathan **, Madanmohan ***

* ananda Balayogi Bhavanani , Deputy Director, e mail: [email protected] ** Meena Ramanathan, Co-ordinator and yoga therapist, e mail: [email protected]

*** Madanmohan, Director, Prof & head, Dept. of Physiology, e mail: [email protected] for yoga therapy, education and Research (CyteR)

Mahatma Gandhi Medical College and Research Institute, Puducherry 607402, India



Promotes Positive HealthHealthy life can be considered as a by-product of practicing yogic techniques since it has been observed that Yoga practitioners are physically and mentally healthier and have better coping skills to stressors than the normal population. Knowledge of inexpensive, effective and easily administrable yogic techniques by health professionals will go a long way in helping us achieve the goal of the World Health Organisation to provide “physical, mental, spiritual and social health” for all sections of human society.

Some of the important documented health promoting benefits of mind-body practices such as yoga and meditation include: 1. Improvement in cardio-respiratory efficiency 9,

10, 11, 12

2. Improvement in exercise tolerance 13, 14, 15, 16

3. Harmonious balance of autonomic function 17,

18, 19, 20

4. Improvement in dexterity, strength, steadiness, stamina, flexibility, endurance, and neuro-musculo-skeletal coordination 13, 21, 22, 23, 24, 25, 26

5. Increase in alpha rhythm, inter-hemispheric coherence and homogeneity in the brain 27, 28,

29, 30

6. Improved sleep quality 31

7. Improved cognitive functions 9, 32, 33, 34, 35, 36, 37, 38

8. Alteration in brain blood flow and brain metabolism 39, 40, 41, 42

9. Modulation of the neuro-endocrine axis 43, 44, 45,

46, 47, 48

We can say that the eastern mind-body techniques affect every cell of the human body. They bring about better neuro-effector communication, improve strength, and enhance optimum functioning of all organ-systems while increasing resistance against stress and diseases with resultant tranquillity, balance, positive attitude and equanimity.

Figure1: Possible Factors Responsible For Physical Performance Improvement By Yoga (Ray US, Pathak A, Tomer OS. Hatha Yoga Practices: Energy Expenditure, Respiratory Changes And Intensity Of Exercise. Evid based complement alternat med. 2011; 2011: 241294.)

Managing Stress It is well established that stress weakens our immune system. Scientific research in recent times has shown that the physiological, psychological and biochemical effects of yoga are of an anti-stress nature. A majority of studies have described beneficial effects

of yoga interventions in stress with an Agency for Healthcare Research and Quality (AHRQ) report stating that “Yoga helped reduce stress.”49 Reductions in perceived stress following yoga are reported to be as effective as therapies such as relaxation, cognitive behavioural therapy and dance therapy.



Mechanisms postulated include the restoration of autonomic balance as well as an improvement in restorative, regenerative and rehabilitative capacities of the individual. A healthy inner sense of wellbeing produced by a life of yoga percolates down through the different levels of our existence from the higher to the lower levels producing health and wellbeing of a holistic nature. Streeter et al recently proposed a theory to explain the benefits of yoga practices in diverse, frequently co-morbid medical conditions based on the concept that yoga practices reduce allostatic load in stress response systems so that optimal homeostasis is restored.50

They hypothesized that stress produces an: • Imbalance of the autonomic nervous

system with decreased parasympathetic and increased sympathetic activity,

• Under activity of the gamma amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter system, and

• Increasedallostaticload.

They further hypothesized that yoga-based practices i) correct under activity of the parasympathetic nervous system and GABA systems in part through stimulation of the vagus

nerves, the main peripheral pathway of the parasympathetic nervous system, and ii) reduce allostatic load.

According to the theory proposed by them, decreased parasympathetic nervous system and GABAergic activity that underlies stress-related disorders can be corrected by yoga practices resulting in amelioration of disease symptoms. A review by Bhavanani concluded that heart rate variability (HRV) testing has a great role to play in our understanding of the intrinsic mechanisms behind such potential autonomic balancing effects of yoga.51 Innes et al had earlier postulated two interconnected pathways by which yoga reduces the risk of cardiovascular diseases through the mechanisms of parasympathetic activation coupled with decreased reactivity of sympathoadrenal system and HPA axis.52

It is notable that one of the newer applications of yoga has been in managing the aftermaths of natural disasters. Studies have shown that yoga significantly reduces symptoms of posttraumatic stress disorder (PTSD), self-rated symptoms of stress (fear, anxiety, disturbed sleep, and sadness) and respiration rate.53

Figure 2: Impact Of Stress On Hypothalamic–Pituitary–Adrenal (Hpa) Axis And Sympathetic Nervous System. (Sengupta P. Health Impacts of Yoga and Pranayama: A State-of-the-Art Review.Int J Prev Med 2012; 3:444–58. * Yoga has significant beneficial effects at these levels)



Mental Health Yoga can enhance one’s spiritual life and perspective beyond the physical life regardless of one’s particular religion.54 It enables people to attain and maintain a balance between exertion and relaxation, and this produces a healthy and dynamic state of homeostatic equilibrium.5 Recent studies have shown that yoga improves mood and reduces depression scores.55,56 These changes have been attributed to an increased secretion of thalamic GABA with greater capacity for emotional regulation.56,57 Even a 10 day yoga-based lifestyle modification program has been reported to improve subjective wellbeing scores of patients.20

There has been extensive work done on Sudarshan Kriya Yoga and depression at the National Institute of Mental Health and Neuro Sciences (NIMHANS) in India. This technique has been recommended as a potential alternative to drugs for melancholia as a first-line treatment.58

A review by Carim-Todd et al on yoga and smoking cessation, reported positive benefits of mind–body interventions.59 These interventions produced changes in smoking behaviour/in predictors of smoking behaviour such as abstinence, decreased number of cigarettes smoked, lower intensity of cravings and attitudinal changes regards smoking. However, definite conclusions

on their benefits for smoking cessation couldn’t be drawn due to scarcity of papers, low quality of some publications, and numerous limitations of these studies like inadequate sample size, limitations of study design, lack of adherence monitoring, lack of objective measures, inadequate or absent control conditions and absence of blinding.

A large number of studies show that the practice of yoga can produce significant decrease in the basal anxiety scores in different populations. 60, 61, 62, 63, 64, 65 These reports have shown significant improvements in perceived stress, state and trait anxiety, subjective well-being, vigour and decrease in salivary cortisol, fatigue and depression. Physical well-being also increased, and those subjects suffering from headache or back pain reported marked pain relief. We can conclude that yoga and other mind body therapies do have a potential role in management of depressive and anxiety disorders.

In addition to its benefits for patients themselves, yoga also has a great role for managing depression manifesting in family caregivers of patients with dementia.66 Researchers also support the promising role of yoga as an intervention for depression because it is cost-effective and easy to implement.61 However a point to consider is that all the mind-body interventions do seem to be effective when compared to passive controls but reports are less conclusive when compared with active controls.67

Figure 3: Interconnections Between Inner Correspondence / Peaceful Harmony (Icph), Mindful Acceptance & Mental /Emotional Stabilization In Response To Mind-Body Interventions Such As Yoga. (Arndt B¨ussing et al. Inner Correspondence and peacefulness with practices among participants in Eurythmy Therapy & Yoga: A Validation Study. Evid Based Complement Alternat Med 2011; 2011: 329023.)



Cardiovascular Conditions Many studies have tried to explore the mechanisms by which yoga modifies coronary artery disease risk factors. Manchanda et al68, Ornish et al69 and Yogendra et al70 have conducted prospective, randomized and controlled trials on angiographically proven coronary artery disease patients with yoga intervention and demonstrated that yoga based lifestyle modification helps in regression of coronary lesions and improvement in myocardial perfusion. The effect of yogic lifestyle on some of the modifiable risk factors could probably explain the preventive and therapeutic beneficial effect observed in coronary artery disease.

A review of 70 eligible studies investigating the effects of yoga on risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga, reported that most had a reduction of systolic and/or diastolic pressure. However, the reviewers also noted that there were several noted potential biases and limitations that made it difficult to detect an effect specific to yoga.52 Another literature review reported significant improvements in overall cardiovascular endurance of young subjects who were given varying periods of yoga training.71 Physical fitness increased as compared to other forms of exercise and longer duration of yoga practice produced better cardiopulmonary endurance. In fact a detailed review of yoga in cardiac health concluded that it can be beneficial in the primary and secondary prevention of cardiovascular disease and that it can play a primary or a complementary role in this regard.72

Respiratory Disorders Scientific basis of using yoga as an adjunct therapy in chronic obstructive pulmonary diseases is well established with significant improvements in lung function, quality of life indices and bronchial provocation responses coupled with decreased need for regular and rescue medicinal usage.73,74 Behera reported perceptible improvement in dyspnea and lung function in patients of bronchitis after 4 weeks of yoga therapy that used a variety of postures and breathing techniques.75 Yogic cleaning techniques such as dhautikriya (upper gastrointestinal cleaning

with warm saline or muslin cloth) and netikriya (warm saline nasal wash) remove excessive mucous secretions, decrease inflammation and reduce bronchial hypersensitivity thereby increasing provocation threshold while kapalabhati through forceful exhalations improves the capacity to exhale against resistance.76 A nonspecific broncho protective or broncho relaxing effect has been also postulated77 while improved exercise tolerance has been reported following yoga therapy in patients of chronic severe airways obstruction.78 It has been reported that well-performed slow yogic breathing maintains better blood oxygenation without increasing minute ventilation, reduces sympathetic activation during altitude-induced hypoxia79 and decreased chemoreflex sensitivity to hypoxia and hypercapnia80. These help bring about both objective and subjective improvements in the condition of patients with bronchitis. Yoga as a therapy is also cost effective, relatively simple and carries minimal risk and hence should be advocated as an adjunct, complementary therapy in our search for an integrated system of medicine capable of producing health and wellbeing for all.

Metabolic/Endocrine Conditions A few RCTs have suggested that yoga and meditation practices act on the hypothalamic–pituitary–adrenal axis (HPA) axis to reduce cortisol levels in plasma, 81, 82, 83, 84 as well as reduce sympathetic nervous system tone, increase vagal activity, 85,86 and elevate brain GABA levels62.

Major systematic reviews of the effects of yoga on risk indices associated with insulin resistance syndrome and risk profiles in adults with type 2 diabetes have been done in recent times.52,87 They reported post-intervention improvement in various indices but with results varying by population and study design. Another systematic review addressed the management of type 2 diabetes and concluded that the reviewed trials suggest favourable effects of yoga on short-term parameters related to diabetes but not necessarily for long-term outcome.88 The AHRQ cites two studies comparing yoga versus medication which reported a large and significant reduction of fasting glucose in individuals with type 2 diabetes in one, and a smaller but still significant improvement in the other.49



Figure 4: Proposed Relationships Among Dyspnea, Benefits of Yoga, and Outcomes of Participation In A Yoga Program. (Donesky-Cuenco D, Nguyen Hq, Paul S, Carrieri-Kohlman V. Yoga Therapy Decreases Dyspnea-Related Distress and Improves Functional Performance In People With Chronic Obstructive Pulmonary Disease: A Pilot Study. J Altern Complement Med 2009; 15: 225–234).

Figure 5 Postulated Mechanisms By Which Yoga Can Help Reduce Risk For Type 2 Diabetes Mellitus And Its Complications (Innes Ke, Vincent Hk. The Influence Of Yoga-Based Programs On Risk Profiles In Adults With Type 2 Diabetes Mellitus: A Systematic Review. Ecam 2007; 4: 469-86.)



A recent systematic review of yoga on menopausal symptoms reported small effects on psychological symptoms with no effects on total menopausal symptoms, somatic symptoms, vasomotor symptoms, or urogenital symptoms.89

Musculoskeletal ConditionsA review by Posadzki et al90 found that 10 of 11 RCTs reported significantly greater effects in favor of Yoga when compared to standard care, self-care,

therapeutic exercises, relaxing yoga, touch and manipulation, or no intervention. Yoga was more effective for chronic back pain than the control interventions such as usual care or conventional therapeutic exercises though some studies showed no between group differences.91 Recently two well designed trials of yoga for back pain reported clinically meaningful benefits over usual medical care but not over an intensive stretching intervention.92,93

Figure 6: Mechanisms Underlying Effectiveness Of Yoga For Chronic Low Back Pain. (Sherman et al., Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care trial. Trials 2010; 11:36

Cancer According to the findings of a comprehensive meta-analysis of role of yoga in cancer, improvements in psychological health were seen in yoga groups when compared to waitlist or supportive therapy groups.94 With respect to overall quality of life, there was a trend towards improvement. To explain the positive outcomes, Smith and Pukall suggested various complex pathways which may involve relaxation, coping strategies, acceptance, and self-efficacy.95 Kochupillai et al reported increase in natural killer cells in cancer patients who had completed their standard therapy after practicing Sudarshan Kriya Yoga and pranayam breathing techniques.96

A systematic review and meta-analysis of RCTs on the physical and psychosocial benefits of yoga in cancer patients and survivors by Buffart and colleagues concluded that yoga may be a feasible intervention as beneficial effects on several physical and psychosocial symptoms were reported.97 They showed that it has strong beneficial effects on distress, anxiety and depression, moderate effects on fatigue, general HRQoL, emotional function and social function, small effects on functional well-being, and no significant effects on physical function and sleep disturbances. It was suggested that yoga can be an appropriate form of exercise for cancer patients and survivors who are unable or unwilling to participate in other traditional aerobic or resistance exercise programs.



PregnancyPreliminary evidence from various scientific studies supports yoga’s potential efficacy, particularly if started early in the pregnancy. Women practicing yoga in their second trimester reported significant reductions in physical pain from baseline to post intervention compared with women in the third trimester whose pain increased.98 Women in their third trimester showed greater reductions in perceived stress and trait anxiety. Another study reported significantly fewer pregnancy discomforts at 38-40 weeks of gestation.99 Subjects who participated in the yoga programme exhibited higher outcome and self-efficacy expectancies during active and second stage of labour. Provision of booklets and videos on yoga during pregnancy may contribute to a reduction in pregnancy discomforts and improved childbirth self-efficacy.

Satyapriya et al concluded that yoga reduces perceived stress and improves adaptive autonomic response to stress in healthy pregnant women100 while Chuntharapat et al101 concluded that yoga

produced higher levels of maternal comfort during labour and 2 hour post-labour with a decrease in subject evaluated labour pain. They also reported shorter duration of the first stage of labour, as well as total time of labour in subjects practicing yoga.

A study by Narendran et al reported a lower trend in the occurrence of complications of pregnancy such as pregnancy-induced hypertension, intrauterine growth retardation and pre-term delivery in subjects who practiced yoga.102 They concluded that an integrated approach to yoga during pregnancy is safe and that it improved birth weight, decreased preterm labour, and reduced IUGR either in isolation or associated with PIH, with no increased complications.

A review by Field reported that alternative therapies have been found effective for reducing pregnancy-related back and leg pain and nausea and for reducing depression and cortisol levels and the associated prematurity rate.103 It also noted that alternative therapies reduce pain and thereby the need for medication.

Figure 7: Postulated Mechanisms of Benefits of Yoga In Pregnancy. Chuntharapat S, Petpichetchian W, Hatthakit U. Yoga during pregnancy: effects on maternal comfort, labor pain and birth outcomes. Complement Ther Clin Pract 2008; 14(2): 105-15.

Paediatric PopulationClinical applications of Yoga have been studied in paediatric and young adult populations with focus on physical fitness, cardio-respiratory effects, mental health, behaviour and development, irritable bowel syndrome, eating disorders, and prenatal effects on birth outcomes. Though a large majority of studies

are positive, due to methodological limitations, evidence provided is still in its infancy.104 Yoga has been suggested as an option for children to increase physical activity and fitness and that yoga may be a gateway for adopting a healthy active lifestyle in sedentary children who are intimidated by more vigorous forms of exercise. They recommended



that further research is necessary to identify clinical applications of yoga for children and that such research needs to be conducted with rigorous methodology in RCTs with detailed description of protocols and reporting of results. Methodological issues specific to mind-body interventions should be addressed including adequate description of the intervention and control group, and single blinding of the outcome assessor.

A review by Galantino et al concluded that “the evidence shows physiological benefits of yoga for the paediatric population that may benefit children through the rehabilitation process, but larger clinical trials, including specific measures of QOL are necessary to provide definitive evidence.”105 They rightly suggested that the type and intensity of yoga, the specific postures for the intended outcome, and the measurement of adherence beyond the clinic have to be determined. Their review showed that yoga may benefit children with mental challenges by improving their mental ability, along with motor coordination and social skills and that restoration of some degree of functional ability is possible in those having physical disabilities. It was suggested that physical therapists might apply these findings in the neuromuscular areas of learning, motor control, and coordination. A notable point mentioned by them was that, “Regardless of the goal, yoga appears to be a multitasking modality that simultaneously treats both physical impairments as well as more global issues such as stress, anxiety, or hyperactivity.”

In ConclusionAll of the above studies and reviews suggest a number of areas where mind-body therapies such as yoga may be beneficial, but more research is required for virtually every one of them to establish their benefits conclusively. This is true in the process of introducing any new therapy into the modern health care system and is not surprising when we realize that the proper studies on yoga as a therapeutic modality are not older than a few decades.

Some of the major issues highlighted by these studies and reviews include:1. Individual studies on yoga for various

conditions are small 2. Poor-quality trials in general with multiple

instances for bias3. Substantial heterogeneity with regards to the

• populationsstudied,• yogainterventions,• durationandfrequencyofyogapractice,• comparisongroups,and• outcomemeasures.

4. Compliance was not routinely noted, thus preventing an understanding of the apt ‘dosage’ requirements with regard to the mind-body interventions

5. Yoga requires active participation and motivation that requires active efforts from both the researcher as well as the participants.

6. Changes in attitudes and behavior need to be documented and understood better, especially in the lifestyle, stress induced psychosomatic conditions.

7. It is not clear which patients may benefit from the mind-body interventions, and which aspects of the interventions or which specific styles were more effective than others.

It has been suggested that yoga may help improve patient self-efficacy, self-competence, physical fitness, and group support, and may well be effective as a supportive adjunct to mitigate medical conditions. Büssing et al concluded that yoga may have potential to be implemented as a safe and beneficial supportive/adjunct treatment that is relatively cost-effective, may be practiced at least in part as a self-care behavioral treatment, provides a life-long behavioral skill, enhances self-efficacy and self-confidence, and is often associated with additional positive side effects.106

It is important to develop objective measures of various mind-body therapies and their techniques while including them in intervention trials. It has also been suggested that the publication of specific interventions used in future studies in manual form can allow reliable replication and future implementation. It is also important to develop tools to monitor objectively the participants’ self-practice, compliance, and adherence to the interventions. Yoga has preventive, promotive as well as curative potential and a yogic lifestyle confers many advantages to



the practitioner. Since lifestyle related diseases are alarmingly on the rise in our modern society, yogic lifestyle should be given a special place in preventing and managing these diseases.

As suggested by Bussing et al, “Yoga may well be effective as a supportive adjunct to mitigate some medical conditions, but not yet a proven stand-alone, curative treatment. Larger-scale and more rigorous research with higher methodological quality and adequate control interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct treatment that is relatively cost-effective, may be practiced at least in part as a self-care behavioural treatment, provides a life-long behavioural skill, enhances self-efficacy and self-confidence and is often associated with additional positive side effects.”106

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Introduction:Yoga is first and foremost a moksha shastra meant to facilitate the individual to attain the final freedom, liberation or emancipation. One of the important by-products of the Yogic way of living is attainment of health and well being. This is brought about by right-use-ness of the body, emotions and mind with awareness and consciousness. This must be understood to be as healthy a dynamic state that may be attained in spite of the individual’s sabija karma that manifests as their genetic predispositions and the environment into which they are born. Yoga also helps maintain and sustain this dynamic positive state of health after it has been attained through disciplined self effort.

The central theme of Yoga is the golden mean, finding the middle path, a constant search for moderation and a harmonious homoeostatic balance. Yoga is the “unitive impulse” of life, which always seeks to unite diverse streams into a single powerful force. Proper practice produces an inner balance of mind that remains stable and serene even in the midst of chaos. This ancient science shows its adherents a clear path to the “eye of the storm” and ensures a stability that endures within, even as the cyclone rages externally.

Causation of Psychosomatic Disorders: Yogamaharishi Dr Swami Gitananda Giri, founder of Ananda Ashram at Pondicherry (www.icyer.com) has written extensively about the relationship between health and disease. He says, “Yoga views the vast proliferation of psychosomatic diseases as a natural outcome of stress and strain created by desire fostered by modern propaganda and abuse of the body condoned on all sides even by religion, science and philosophy. Add to this the synthetic “junk food” diet of modern society and you have the possibility of endless disorders developing…even the extinction of man by his own ignorance and misdeeds”.

He explains the root cause of disease as follows. “Yoga, a wholistic, unified concept of oneness, is adwaitam or non-dual in nature. It suggests happiness, harmony and ease. Dis-ease is created when duality or dwaitam arises in the human mind. This false concept of duality has produced all conflicts of human mind and the vast list of human disorders. Duality (dis-ease) is the primary cause of man’s downfall. Yoga helps return man to his pristine, whole nature.

All diseases, maladies, tensions, are manifestations of divisions of what should be man’s complete nature, the atman or ‘Self ’. This ‘Self ’ is “ease”. A loss of “ease” creates “dis-ease”. Duality is the first insanity, the first disease, the unreasonable thought that “I am different from the whole…. I am unique. I am me.” The ego is a manifestation of disease. Only a distorted ego could feel alone, suffer from “the lonely disease”, in a Universe, a Cosmos totally filled with the ‘Self ’.

Interestingly, he points out that one of the oldest words for man is “insan”. Man is “insane”. A return to sanity, “going sane,” is the subject of real Yoga Sadhana and Yoga Abhyasa. Yoga Chikitsa is one of the methods to help insane man back onto the path of sanity. A healthy man or woman may be known by the term-Yogi”. A very strongly worded yet very true statement indeed from the Lion of Pondicherry!

Yogic Perspective of Depression:According to the Yoga Darshan codified by Maharishi Patanjali, depression or rather daurmanasya is one of the four vikshepa sahabhuvah that are the manifestations that accompany the obstacles to yoga sadhana, the nava antaraya. The other sahabhuvah are duhkha or suffering, angamejayatva or tremors and shvasaprasvasa or irregular respiration. (duhkhadaurmanasya angamejayatva shvasaprasvasa vikshepasahabhuvah Yoga Darshan -1:31). When we analyze this sutra deeply we find that they are very true reflections of our inner state.

yoGIC PeRSPeCtIveS on Mental healthDr ananda Balayogi Bhavanani *

* Dr ananda Balayogi Bhavanani, Deputy Director, CyteR, Mahatma Gandhi Medical College and Research Institute, Puducherry 607402, India, email: [email protected]



Duhkha or painful suffering at the physical, emotional and mental level can drive us to despair. Suffering is an excellent trick our mind plays as very few can overcome the ‘moment’ of suffering. Very few are capable of realizing what is really happening in the process of their evolutionary journey. The moment ‘suffering’ is felt, most people give up, and the lower mind survives to fight another day.

Daurmanasya refers to dejection and despair. We must remember that depression is not just in the mind but has many physical aspects too. A state of depression is another tool by which the lower mind tries to halt the spiritual progress of a sadhaka. However we must realise that the greatest teachings are often given at moments of great despair. The art and science of Yoga understands that this may be the best ‘teachable’ moment and hence we find the highest teachings of the Bhagavad Gita and Ramayana coming at this point.

Our Guru Swami Gitananda Giri Guru Maharaj used to say, “A nervous breakdown is actually an opportunity for a spiritual breakthrough if we can realise the positive implications in our moment of despair and dejection”. The teachings of the Yoga Vasishtha and the Bhagavad Gita which may be said to be the first and second recorded ‘psychological counseling’ sessions in human history were delivered when both Lord Rama and Arjuna respectively were at the depths of their depression. If we realise that this is indeed a window of opportunity for growth, success will come to us the soonest. But if we miss this golden chance, then even the Divine will struggle to help us out of our own deep pit of self pity.

Angamejayatva are the physical tremors of the body. The practice of asana helps us to attain to a state of physical control over our body. This enables us to go beyond the dwandwa, the pair of opposites that are the cause of these tremors. Tremors are an externalized manifestation of internal imbalances of our emotions and mind. Imbalance at the higher level causes the imbalance in the neuro-chemical transmitters and psycho-physiological pathways of the body, resulting in these physical tremors. When confronted with such a frightening manifestation,

many aspirants get scared whether they are harming themselves and stop their Sadhana out of fear.

Shvasaprasvasa refers to the irregularity in breathing patterns. One of the main physical manifestations of mental and emotional upsets is the haphazardness of respiration. Ancient Yogis contemplated this deeply and found that mental disturbances cause irregularity and instability of respiration. Though their jnana drishti (perspective of wisdom) they realised that by stabilizing the breath, we can conversely produce a stability of emotions and mind. This knowledge is used even today in the practice of pranayama, when it is used as a means of altering the higher (mind) through the lower (body). This is one of the best examples of the numerous somato-psychic applications found in the practices of hatha yoga, the physical science of balancing equal and opposite energies.

Yogic Methods To Attain and Maintain Health: The science of Yoga has numerous practical techniques as well as advice for proper life style in order to attain and maintain health and well being. Bahiranga practices such as yama, niyama, asana and pranayama help produce physical health while antaranga practices of dharana and dhyana work on producing mental health along with pratyahara. Yoga works towards restoration of normalcy in all systems of the human body with special emphasis on the psycho-neuro-immuno-endocrine axis.

In addition to its preventive and restorative capabilities, Yoga also aims at promoting positive health that will help us to tide over health challenges that occur during our lifetime. Just as we save money in a bank to tide over financial crises, so also we can build up our positive health balance to help us manage unforeseen health challenges with faster recovery and recuperation. This concept of positive health is one of Yoga’s unique contributions to modern healthcare as Yoga has both a preventive as well as promotive role in the healthcare of our masses. It is also inexpensive and can be used in tandem with other systems of medicine in an integrated manner to benefit patients.



Becoming One With The Breath:In the science of Yoga, body movement and breath must be synchronized. The breath pattern is important. Particularly in the use of kriya or structured movements like Surya namaskar, the body is normally lifted on an incoming breath and lowered on an outgoing breath. Some of the breath patterns such as the bhastrika strengthen the whole solar plexus area as well as the diaphragm, building up stamina while producing internal cleansing of organs and the blood stream. Kapalbhathi is another dynamic technique that enables us to break out of the deep hole of depression by creating a sense of activation. Surya nadi and ujjayi pranayama can also help in activating those who need the activation for healthy well being. The bandha trayam as well as the aswini mudra are both a God-send for those suffering from depression as they revitalise the entire psycho-neuro-endocrine system. The pranava and bhramari pranayama work towards creating an inner harmony that results in the attainment of a state of mental calmness.

According to Dr Swami Gitananda Giri, one of the foremost exponents of Yoga in the 20th century, the inherent message of Pranayama can be summarised as follows:

• Thereisanabsoluteanddirectcorrelationbetween the way an organism breathes and its energy level.

• Thereisanabsoluteanddirectcorrelationbetween the way a man breathes and the length of his life span.

• Thereisanabsoluteanddirectcorrelationbetween the way a man breathes and the state of mind and clarity of thought, which he enjoys.

• There is an absolute correlation betweenthe way a man breathes and the quality of emotions, which he experiences.

• Thereisanabsoluteanddirectcorrelationbetween the way a man breathes and the subtlety of the thoughts, which pass through his mind.

Shifting From Individuality To Universality:Yoga, which emphasizes the universal, is a perfect foil to those human activities, which glorify the

personal. The ego which is fixated only on its own shallow self will soon run into the blank wall of depression and despair, overwhelmed by its own superficiality. That striving spirit which looks within at the universal aspect of its own nature and sees the oneness of the whole of creation will find an endless fountain of inspiration and joy. In short it may be safely said that the practice of Yoga as a unified whole helps the individual shift from an ‘I”-centric approach to a “we”-centric approach.

The Srimad Bhagavad Gita says, “yogaha karmasu koushalam” meaning thereby that Yoga is skill in action (BG 2:50). The real Yogi, immensely conscious and aware at the physical, mental and emotional levels gains great control through that consciousness over all aspects of life thus developing a real skill in living. Part of that skill springs from his cultivated detachment, his ability to work for “work’s sake,” and not for the sake of the reward. He realizes that his duty is to do his best but that the ultimate result is not in his hands. The Yogi performs the needed action not for the sake of the fruits of that action, but because it is good and necessary to do so.

Such an attitude of mind produces consummate skill in whatever action the Yogi undertakes. Consummate concentration, consummate controls are all offshoots of good Yoga Sadhana. This belies the age-old belief that the competitive spirit produces the highest skill. To this the Yogic answer is: detachment from the fruits of the action produces the greatest efficiency, for one is then emotions connected with “goal-oriented”, competitive thinking. The beauty of Yoga is that these abstract principles become concrete in the daily practice of the techniques available in the Yoga system. Once the “seed of Yoga” finds fertile soil, these concepts grow naturally, slowly but surely taking root in all aspects of life.

Wholistic Approach of Yoga:The Yogic wholistic approach to life that ‘everything is important and everything has its effect’ could do much to improve the mind, body and emotional states of well being. These practical approaches to health include:

• The use of early morning sunlight forhealing and rejuvenative activities



• Theuseofwater for internalandexternalcleansing

• Carefulattentiontodietofasattvicnature• Realisingthenecessityforbalancebetween

exertion and relaxation as all tension must be balanced using concept of spanda nishpanda or “exertion-relaxation-exertion-relaxation” in an alternating rhythm of activity,

• Learning how to “unwind” through themany relaxation techniques available in the Yoga science which can balance the immense amount of stress and strain that are part and parcel of day to day life

• Realisingtheneedforcleanair,waterandfood

• Becoming aware of the effect of modernmodes of entertainment and addictive habits in general debilitation of the physical, emotional and mental nature

• Providing a “working philosophy” whichwill sustain one in triumph and defeat

• Learningtobesensitivetoone’sownbio-rhythms, one’s own physical, mental and emotional cycles

• Being aware of the effects of the seasonsand the various unnatural life styles to which the modern man is exposed

In short, all of these aspects of Yoga as a way of natural living can provide relief for many of the psychosomatic ailments affecting humankind today.

Cultivation of Positive Health:According to Yogacharini Meenakshi Devi Bhavanani, Director ICYER at Ananda Ashram in Pondicherry, Yoga has a step-by-step method for producing and maintaining perfect health at all levels of existence. She explains that social behaviour is first optimized through an understanding and control of the lower animal nature (pancha yama) and development and enhancement of the higher humane nature (pancha niyama).

The body is then strengthened, disciplined, purified, sensitized, lightened, energized and made obedient to the higher will through asana. Universal pranic energy that flows through body-

mind-emotions-spirit continuum is intensified and controlled through pranayama using breath control as a method to attain controlled expansion of the vital cosmic energy. The externally oriented senses are explored, refined, sharpened and made acute, until finally the individual can detach themselves from sensory impressions at will through pratyahara.

The restless mind is then purified, cleansed, focused and strengthened through concentration (dharana). If these six steps are thoroughly understood and practiced then the seventh, dhyana or meditation (a state of union of the mind with the object of contemplation) is possible. Intense meditation produces samadhi, or the enstatic feeling of Union, Oneness with the Universe. This is the perfect state of integration or harmonious health.

Yogic Tools For Positive Mental Health:In order to create an environment conducive to the development of positive mental health as also to prevent and manage the psychosomatic lifestyle disorders that are threatening humankind, Yoga offers us many practical ‘day-to-day’ methods of action. Some of these tools for positive health are as follows.

1. Become aware of your body, emotions and mind: Without awareness there cannot be health or healing. Awareness of body implies conscious body work that needs to be synchronized with breath to qualify as a psychosomatic technique of health and healing. Psychosomatic disorders cannot be tackled without awareness.

2. Improve your dietary habits: Most disorders are directly or indirectly linked to improper dietary patterns that need to be addressed in order to find a permanent solution to health challenges. One of the most important lifestyle changes that needs be implemented in management of any lifestyle disorder is diet.

3. Relax your whole body: Relaxation is most often all that most patients need in order to improve their physical condition. Stress is the major culprit and may be the causative, aggravating, or precipitating factor in so many psychosomatic



disorders. Doctors are often found telling their patients to relax, but never tell them how to do it! The relaxation part of every Yoga session is most important for it is during it that benefit of practices done in the session seep into each and every cell producing rest, rejuvenation, reinvigoration and reintegration.

4. Slow down your breath making it quiet and deep: Rapid, uncontrolled, irregular breathing is a sign of ill health whereas slow, deep and regular controlled breathing is a sign of health. Breath is the link between body and mind and is the agent of physical, physiological and mental unification. When breath is slowed down, metabolic processes are also slowed and anabolic activities begin the process of healing and rebuilding. If breath is calm, mind is calm and life is long!

5. Calm down your mind and focus it inwardly: The mind is as disturbed as a drunken monkey bitten by a scorpion say our scriptures. To bring that wayward agitated mind under control, and take it on a journey into our inner being is fundamental in finding a way out of the ‘disease maze’ in which we are entangled like a fly in the spider’s web. Breath work and sensory control are the base on which mind training can occur; hence much importance is given to pranayama and pratyahara. It is only after this that concentration practices leading to meditation can have any use. Just sitting and thinking about something is not meditation!

6. Improve the flow of healing ‘Pranic Life Energy’: Improve the flow of healing ‘Pranic Life Energy’ to all parts of the body, especially to those diseased parts, thus relaxing, regenerating and reinvigorating ourselves. Prana is life and without it there cannot be healing. The different prana and upa prana vayu that are energies driving different physiological functions of the body need to be understood and applied as per needs of the patient.

7. Fortify yourself against omnipresent stressors: Decrease your stress level by fortifying yourself against the various omnipresent stressors in your life. When face to face with the innumerable thorns in a forest, one may either choose to spend all their time picking them up one by one while

other thorns continue falling or choose to wear a pair of shoes and walk through the forest. The difference is in attitude. Choosing the right attitude can change everything and bring about a resolution of the problem by healing the core. Stress is more about how you react to the stressor than about the nature of the stressor itself !

8. Increase your self reliance and self confidence: Life is full of challenges that are there only to make us stronger and better. The challenges should be understood as opportunities for change and faced with confidence. We must understand we have the inner power to overcome each and every challenge that is thrown at us by life. The Divine is not a sadist to give us challenges that are beyond our capacity!

9. Facilitate natural emanation of wastes: Facilitate natural emanation of waste from the body by practicing shuddi kriyas like dhauti, basti and neti. Accumulation and stagnation of waste materials either in inner or outer environment always causes problems. Yogic cleaning practices help wash out impurities (mala shodhana) thus helping the process of regeneration and facilitating healing.

10. Take responsibility for your own health: Remember that ultimately it is “YOU” who are responsible for your own health and well being and must take the initiative to develop positive health to tide you over challenging times of ill health. Yoga fixes responsibility for our health squarely upon our own shoulders. If we do healthy things we are healthy and if we do unhealthy things we become sick. No use complaining that we are not well when we have been the cause of our problem. As Swamiji Gitananda Giri would say, “You don’t have problems-you are the problem!”

11. Health and happiness are your birthright: Health and happiness are your birthright, claim them and develop them to your maximum potential. This message of Swamiji is a firm reminder that the goal of human existence is not health and happiness but is moksha (liberation). Most people today are so busy trying to find health and happiness that they forget why they are here in the first place. Yoga helps us regain our birthright and attain the goal of human life.



Conclusion: The dedicated practice of Yoga as a way of life is no doubt a panacea for problems related to psychosomatic, stress related physical, emotional and mental disorders and helps us regain our birthright of health and happiness. It is only when we are healthy and happy that we can fulfil our destiny.

Recommended Reading:

1. Yoga Chikitsa: The application of Yoga as a Therapy. Dr. Ananda Balayogi Bhavanani. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2013.

2. Ancient Yoga and Modern Science. TR Anantharaman. Mushiram Manoharlal Publishers Pvt Ltd, New Delhi. 1996

3. Back issues of International Journal of Yoga Therapy. Journal of the International Association of Yoga Therapists, USA. www.iayt.org

4. Back issues of Yoga Life, Monthly Journal of ICYER at Ananda Ashram, Pondicherry. www.icyer.com

5. Four Chapters on Freedom. Commentary on Yoga Sutras of Patanjali by Swami Satyananda Saraswathi, Bihar School of Yoga, Munger, India. 1999

6. Srimad Bhagavad Gita by Swami Swarupananda. Advaita Ashrama, Kolkata. 2007

7. Yoga and Sport. Dr Swami Gitananda Giri and Meenakshi Devi Bhavanani. Satya Press. Pondicherry. 1991. www.icyer.com



Introduction: All aspects of our human personality are cultured through the process of Yoga helping us evolve towards perfection until we are “One” with the Divine Self. Yoga helps destroy the Kleshas, the psychological afflictions that warp our vision, as well as eradicates Karma Bandha that prevents us from realizing our potential Divinity. Our great Rishis like Veda Vyasa and Maharishi Patanjali have given us a clear road map for this evolutionary journey with vital clues towards understanding both the internal and external culturing processes of Yoga. The cultural teachings of Yoga help us become “All One” by losing our sense of individuality to gain an unparalleled sense of universality.

In our day-to-day personal and inter-personal social life, Yoga has given us multitudes of tools, concepts, attitudes and techniques through which we can attain inner contentment leading to happiness and spiritual realization while simultaneously creating harmony in all relationships. All psycho-social qualities essential for healthy inter-personal relationships are cultivated when we live a life of Yoga that is in tune with the eternal Dharma. These humane qualities include loving understanding, innate sensibility that sees other’s perspectives, compassion, empathy, respect, gratitude, fidelity and responsibility. In fact the Srimad Bhagavad Gita delineates very similar qualities of a spiritually healthy person in Chapter XVI. These include: fearlessness (Abhayam), purity of inner being (Sattva Samshuddhih), steadfastness in the path of knowledge ( Jnanayoga Vyavasthitih), charity (Danam), self control (Dama), spirit of sacrifice (Yajna), self analysis (Svadhyaya), disciplined life (Tapa), uprightness (Arjavam), non violence (Ahimsa), truthfulness (Satyam), freedom from anger (Akrodhah), spirit of renunciation (Tyagah), tranquility (Shanti), aversion to defamation (Apaishunam), compassion to all living creatures (Daya Bhutesv), non covetedness (Aloluptvam),

gentleness (Maardavam), modesty (Hrir Acaapalam), vigor (Tejah), forgiveness (Kshama), fortitude (Dhritih), cleanliness of body and mind (Saucam), freedom from malice (Adroho), and absence of pride (Naa Timaanita). One who is blessed with these qualities is indeed a divine blessing to the social life of their immediate family, friends, relatives and their society itself.

The Four Pronged Approach:Our ancient Indian culture, a vibrant living culture till even today, has a lot to offer in every sphere of life. The elevated spiritual, psychological and metaphysical concepts of our great Maharishis hold true even today and it is up to us to delve into them and reap benefits of psycho-physiological health, happiness as well as intra-personal and inter-personal social harmony. Our Rishis were visionary seers who codified innumerable concepts that produce physically, emotionally and mentally healthy individuals who are valuable for betterment of society.

Our ancients in their infinite wisdom realised that we need to deal with different people differently. Some people can be held close whereas with others an arm’s length or often a six feet pole’s length is required. Sensitive, sensible people may respond to a soft carrot approach while the arrogant who are usually dull and inert may only respond to a heavy and strong stick. The Rishis have codified a four pronged approach to deal with different types of human personalities at different times and in different ways. Saint Thiyagaraja in his composition “sarasa sama dana bheda danda chatura” describes Lord Rama as the perfect example of a human possessing these qualities of Kingship and kinship.

The first of these four methods is known as Sama and is the dealing with people using a sense of equanimity and treating them as equals in the search for truth. This can only be applied with the noble ones and will be misused by others as seen in

the yoGa of InteRPeRSonal RelatIonShIPSDr ananda Balayogi Bhavanani *

* Dr ananda Balayogi Bhavanani, Deputy Director, CyteR, Mahatma Gandhi Medical College and Research Institute, Puducherry 607402, India and Chairman: International Centre for yoga education and Research,

and yoganjali natyalayam Puducherry. www.rishiculture.org and www.icyer.com



today’s chaotic environment. The second method is Dana, which implies the affording of concessions towards those who are truly needy. This may be in the material, physical, mental or emotional form and is the giving of a bit of leeway that can help those who are in trouble to come up to par with others and then slowly develop into one who can be treated at the Sama level. Bheda is the third method and is a separation from troublesome elements in order to reduce the extent of the problem. When used in a proper and judicious manner this can help many situations to normalize and prevent them from going from “bad to worse”. When things get really bad or worse, then Danda or minimal deterrent action through judicious punishment can be of use when we considering the holistic picture.

In modern times the “spare the rod” mentality is prevalent and we do seem to end up spoiling our children and youth by making them weaker in all aspects. We take away their ability to be responsible citizens by teaching then indirectly that “anything that happens is not your fault- you are the victim”. I reiterate clearly that I am not a supporter of any form of corporal punishment, but I do realize the need for a determent in order for the betterment of the whole. One rotten apple is all that we need to spoil a barrel and the same can be said of the repeated offenders. Such situations need to be nipped in the bud and the Danda method has its uses too in such situations. Of course this requires a lot of Viveka on the part of the parent, teacher or person in authority and also needs safety precautions so that it is not misused by ignorant egotistical persons who want to be the “star of the show” at the cost of the others. The most basic qualities required for a good parent, teacher and leader in any field of endeavor are intelligence and empathy. Yet how many of our people have these qualities today?

Evolutionary Quirks of the Human Brain:Ammaji, Kalaimamani Meenakshi Devi Bhavanani often talks about the five quirks of the human brain and quotes the Ken Keyes Jr who in his book “Your Road Map to Lifelong Happiness” argues that there is an essential “lack of communication”

between the “old” (reptilian - mammalian) and the “new” (conscious, neo-cortex) parts of the human brain. As the “old brain” developed over 60 to 375 million years it is powerful and well-set in its ways. Its habitual responses to environmental survival challenges are strong and automatic – “kill or be killed”. On the other hand, the “New Brain” of human consciousness is only 40 to 100 thousand years old and hence the new boy on the block. The lack of communication between the old and new brains produces the “Five Quirks” that are the major causes behind innumerable problems we face in all interpersonal relationships. These quirks are:

1. The Object Quirk – the animal brain sees objects only in a very vague, hazy, general sense and not in a specific sense. It views objects and classifies them as to how they may fulfill its needs or in what way they may threaten its safety. Thus, it confuses different people and things. It sees everything generally as friend or foe, provider of food or as a sexual possibility. It does not need to see any object with specific characteristics. For example, it does not choose a mate on personal charm or elevated character but simply as a means to gratify sex drive. Other objects and other creatures are important only as means to satisfy basic needs.

2. The Time Quirk – Keyes says the “Old Brain” has no time sense. It does not perceive past or future. It lives only in the present moment. It “eats or is eaten.” There is no sense of tomorrow or yesterday. Everything is immediate, now, urgent. At that lower level of life, every experience is in the “Now” of survival.

3. The Unsafe Stranger Quirk – The “Old Brain” views all strangers with suspicion. The “unknown stranger” is a possible threat to survival or a competitor for resources. Any creature “different” from oneself and one’s species is a potential threat.

4. The Unchanging Entity Quirk – To the “Old Brain” incapable of perceiving subtleties, everything remains the same – a tree is always a tree. It does not perceive the various changes, which all things pass through. It sees all things as “unchanging” as the perception of intricate subtleties of change is not necessary for survival.



5. Adaptable Memory Quirk – The animal does not need memory. The only memory necessary is what enables it to survive. Hence, what it remembers can be “adjusted” to whatever best helps it to survive. There is no objective truth. The only “Truth” to the animal brain is “survival of the fittest.”

The manner in which animals and reptiles perceive the world is a much dimmer, less precise, less clear, survival-oriented perception totally geared to survival. This is much less than that available to the conscious mind. The “Old Brain” is fuelled by emotional responses. The basic motivating emotion is fear. The other important drives-sex, survival instinct, herd mentality, dominance, power struggles, nurturing and being nurtured-are all tied to the organism’s basic need to survive at all costs and fear of death or extinction.

For example, the “Object Quirk” manifests in human experience when a person in the past was abused by a red-haired woman and hence, in future, always has a dislike for red-haired women. The “Old Brain” cannot see the possibility that all red-haired women will not abuse it. Similarly the Time Quirk manifests itself in human behavior in this manner: when one experiences unhappiness, one feels one is “always unhappy.” This may cause one to perceive another person as “always angry”, even though the person may only be angry at that moment. Witness how many husband-wife or parent-child quarrels begin with the words… ‘You always do this…”

The “Unsafe Stranger Quirk” is evidenced in the suspicion that people feel when a foreigner enters their circle, or someone of a different religion a different race, a different culture etc comes into their social circle. There is an instinctual fear, even though that person may be perfectly harmless. This is highly visible in today’s society where everyone wants “their” country, state, language, religion etc to be the “best”. Linguistic, religious and regional fanaticism springs forth from such “old” conditioned responses that are so deeply ingrained in the animal brain that people lose all ‘sense’ and do things that they would never do in even their wildest dreams.

The “Unchanging Entity Quirk” manifests when people cannot see that those around them are constantly changing, that they are not what they were yesterday. A thief may have reformed himself, but others may always perceive him as “a thief.” The husband may have overcome his bad habit, but the wife cannot see him anew. This is carried further by the “Adjustable Memory Quirk” that occurs when people deliberately or unconsciously “re-arrange” their memories to support or justify their emotions or desires. For example, a couple who wish to divorce may “adjust their memories’ to “remember” only the “bad times” or the “bad characteristics” of their partners. This is very common in most relationships and cannot be overcome without awareness and consciousness that springs from introspectional self analysis of Swadyaya.

Animals are prisoners of their genes. They are incarnated into a conditioned, stimulus-response programming and they have no choice, but to follow their instincts. Man, the new being, the first “Conscious Organism” has the power of choice. He / she may now act, and choose to respond in a dignified and adequate manner, rather than re-act in an uncontrolled and totally inappropriate manner. The human being has the power to think, to recall past situations and compare them to the present reality. Man has the power of reason which frees him from the instinctive responses to challenge which is the mode of behavior of the reptilian and mammalian kingdom. But the power of the unconscious emotions and instincts rising from the “Old Brain” in a kind of “evolutionary lag” sometimes overpowers the “Rational Brain” and causes “The New Being” to react in an irrational manner. Man as a social, conscious being has lifted himself from the jungle environment with its moment to moment dangers and constant life and death challenges. He no longer faces challenges to his very survival on a constant basis. His life is relatively secure on the physical level (barring wars and other unusual circumstance). Yet, his “Old Brain” is hard wired to react as though every threat (physical or psychological) is a life and death matter. Hence, even psychological challenges, or innocuous frictions trigger off “Old Brain” extreme responses, especially on the emotional level.



We can witness in so many human relationships that the old, animal and reptilian autonomic responses and reactions cloud the “human” or conscious perception. The “Old Brain” reacts out of past conditioning. It is heavily “loaded” with emotions which are part of the mammalian complex, and hence, “unconscious.” The animal-reptile (Pashu) is not “free” to choose as it is bound by the tight noose (Pasha) of its conditioned stimulus-response mechanism. If it is threatened, it will flee or fight. These are the only options open to it. We must remember that on the other hand, the “New Brain” has the power to act after considering the reality of the present situation. We have the choice of using discernment, rationality and deliberation to choose consciously our actions and responses in any given circumstance. This power of choice is concomitant to the event of consciousness. The multiple million dolor question is however, “Are we ready and willing to be real human beings?”

Importance of Adhikara Yoga:The Pancha Yama and Pancha Niyama are considered as Adhikara Yoga by Dr TR Anantharaman as they give us the self resplendent authority and inner resolve for spiritual realizations. They provide a strong moral and ethical foundation for our personal and social life. They guide our attitudes with regard to the right and wrong in our life and in relation to our self, our family unit and the entire social system.

The higher, conscious power to reflect, to perceive the current situation freed of all past conditioning, and then to consciously choose an appropriate response is the essence of Yama-Niyama, the moral and ethical system of Rishiculture Ashtanga Yoga. Yama may be understood to be a conscious restraint of primitive instincts and impulses rising from the “Old Brain.” Yama is thus the control of our unconsciousness tendencies, our Vasanas and the deeply ingrained habitual patterns of our Samskaras. Niyama may be on the other hand said to be a positive and conscious reinforcement of the higher consciousness, those Divine characteristics that propel one’s evolution into more advanced states of being. Niyama is the cultivation of consciousness. Pujya Swamiji, Gitananda Giri called the Yama and Niyama as “No-Option Yoga”

for they are the “sarvabhauma mahavratam” of Maharishi Patanjali. If we want to grow, to evolve out of our reptilian – mammalian past into the truly human, humane and divine nature, we must restrain the primordial instincts through Yama and consciously reinforce our Divine nature through the observances and practice of Niyama.

The Pancha Yamas are Ahimsa (Non – violence), Satya (truthfulness), Asteya (non-stealing), Brahmacharya (control of the creative impulse) and Aparigraha (non – covetedness). These are the “DO NOT’S” in a Yoga Sadhaka’s life. Do not kill, do not be untruthful, do not steal, do not waste your god given creativity and do not covet that which does not belong to you. These guide us to say a big “NO” to our lower self and the lower impulses of violence etc. When we apply these to our life we can definitely have better personal and social relationships as social beings.

The Pancha Niyamas are Soucha (cleanliness), Santhosha (contentment), Tapa (discipline), Swadyaya (study of one’s-self ) and Ishwar Pranidhana (gratitude to the Divine). The Pancha Niyamas guide us with “DO’S” - do be clean, do be contented, do be disciplined, do self - study (introspection) and do be thankful to the divine for all of his blessings. They help us to say a big “YES” to our higher self and the higher impulses. Definitely a person with such qualities is a God-send to humanity.

We must remember that even if we are unable to live the Yama-Niyama completely, the attempt by us to do so will bear fruit and make us a better person, of value to those around us and a valuable person within our family and society. These are values which need to be introduced to our children and youth, making them aware and conscious of these wonderful concepts of daily living. These are indeed qualities that are to be imbibed in a natural and Sahaja manner and not learnt under the threat of fear or compulsion. The parents and teachers can by example show their children the importance of these qualities and when the children see the good examples of their parents and teachers living there principles they will surely follow suit sooner than later.



Other Important Yogic Concepts: There are many important Yogic concepts that help guide us in shaping our personal lives as well as helping us to create harmonious interpersonal relationships that make up our daily social life. Some examples of these spiritually uplifting concepts that transform all aspects of our social life include:

• Vasudeiva Kudumbakam: The whole world is one family. This is an excellent concept which helps one to understand that division on the basis of class, creed, religion and geographical distribution are all ‘man made’ obstructions towards oneness. One can then look upon all as his own and can bond with everyone irrespective of any barrier. All the great Yogic saints such as Tirumoolar, Tiruvalluvar, Basava, Periyalvar and Tirunavukkarasar have reminded us again and again in so many lovely verses of the singular teachings that there is only “One Humanity and One God”.

• Chaturvidha Purusharthas: The four legitimate goals of life tell us how we can set legitimate goals in this life and work towards attaining them in the right way, following our dharma to attain Artha (material prosperity), Kama (emotional prosperity) and finally the attainment to the real goal of our life, Moksha (spiritual prosperity). These four are termed as Aram, Porul, Inbam and Veedu respectively in Nannool, an ancient Dravidian text and the great life enhancing teachings in the Tirukkural of Tiruvalluvar deal directly with the first three and hints at the fourth.

• Pancha Klesha: Avidya (ignorance), Asmita (ego), Raaga (attraction), Dwesha (repulsion) and Abinivesha (urge to live at any cost) are the five Kleshas or mental afflictions with which we are born into this human life. Through Yoga we can understand how these control our life and see their effects on our behavior. These ‘Kleshas’ hinder our personal and social life and must be destroyed through the practice of Patanjali’s Kriya Yoga which is Tapa, Swadyaya and Ishwar Pranidhana.

• Jiva Karunya: Empathic compassion towards all living beings is extolled in the teachings of Tirumoolar, Tiruvalluvar and Vallalar

Ramalinga Adigalar. Tirumoolar says that the most important aspects of right living are the devoted loving offering to the Divine while in daily life the feedings of other human beings and animals with loving compassion. He also stresses the need of speaking good and kind words to others as the means to spiritual upliftment. Tiruvalluvar asks us the poignant question, “Of what use is intelligence if one cannot empathize with the pain of others and help them”

• Chatur Bhavana: The four attitudes that Patanjali advises us to cultivate are given in the 33rd Sutra of the Samadhi Pada. These attitudes that help us to control our mental processes are: friendliness towards those who are happy (Maitri – Sukha); compassion towards those who are miserable (Karuna – Dukha); cheerfulness towards the virtuous (Mudhita – Punya); and indifference towards the wicked (Upekshanam – Apunya). These help us create a Yogic attitude of Sama Bhava or equal mindedness in all situations. They also help us to overcome the Kleshas, and provide us with answers on how to live a Yogic life. They make us humane and help us to live within the social structure in a healthy and happy manner.

• Pratipaksha Bhavanam: The concept of Pratipaksha Bhavanam is an amazing teaching and must be inculcated in our Sadhana of day-to-day living as we face it so many times each day. Even if we cannot replace negative thoughts with emotion-laden positive reinforcements, we must at least make an attempt to stop them in their troublesome track! I have personally found that a strong ”STOP” statement works wonders in helping block out the negative thoughts that otherwise lead us into the quicksand-like cesspool of deeper and greater trouble. Tiruvalluvar advises us to repay negative actions done to us by others with positive selfless actions towards them.

• Karma Yoga: Selfless action and the performance of our duty without any motive are qualities extolled by the Bhagavad Gita which is one of the main Yogic texts. Performing one’s duty for the sake of the duty itself and not with any other motive helps us to develop detachment (Vairagya) which is a quality vital for a good life. Karma Yoga includes important concepts of



action-reaction and teaches us the importance of right action. This includes the concepts of selfless action (Nishkama Karma) as well as skill in action (Karmasu Koushalam). Selfless action and the performance of our duty without any motive are qualities extolled by the Bhagavad Gita which is one of the main yogic texts. Performing one’s duty for the sake of the duty itself and not with any other motive helps us to develop detachment (Vairagya) which is a quality vital for a good life. Yoga is skill in action according to Yogeshwar Krishna in the Bhagavad Gita. ‘To do our best and leave the rest’ is how Pujya Swamiji Gitananda Giri Guru Maharaj used to describe the best way of life. Even if we don’t practice the other aspects of Yoga, we can be ‘living’ Yoga, by performing all our duties skill fully and to the best of our ability. A great teacher can be a true Yogi by performing doing their duty to perfection and without care for the rewards of the action, even if they do not practice any Asanas or Pranayama.

• Samatvam: ‘Yoga is equanimity’ says the Bhagavad Gita. Development of a complete personality who is neither affected by praise nor blame through development of Vairagya (detachment) leads to the state of “Stitha Prajna” or “Sama Bhava”. This is a state of mind which is equally predisposed to all that happens, be it good or bad. Such a human is a boon to society and a pleasure to live and work with.

• Bhakti Yoga: The self effacing, loving path of Bhakti enables us to realize the greatness of the Divine and understand our puniness as compared to the power of the Divine or nature. We realize that we are but ‘puppets on a string’ following his commands on the stage of the world and then perform our activities with the intention of them being an offering to the Divine and gratefully receive HIS blessings. “It is only with the blessings of the Divine, that we can even worship his holy feet (avanarulal avan thal vanangi)” says the Shiva Puranam, a Shaivite Dravidian classic.

Shifting From Individuality To Universality:Yoga, which emphasizes the universal, is a perfect foil to those human activities, which glorify the

personal. The ego which is fixated only on its own shallow self will soon run into the blank wall of depression and despair, overwhelmed by its own superficiality. That striving spirit which looks within at the universal aspect of its own nature and sees the oneness of the whole of creation will find an endless fountain of inspiration and joy. In short it may be safely said that the practice of Yoga as a unified whole helps the individual shift from an ‘I”-centric approach to a “we”-centric approach. Tirumoolar stresses the importance of cutting the ego sense (Anava Mala) in countless verses of the 3000 versed classic Tirumandiram.

Yoga not only considers the importance of attaining a dynamic state physical health but also more importantly mental health. Qualities of a mentally healthy person (Stitha Prajna) are enumerated in the Bhagavad Gita as follows:

• Beyondpassion,fearandanger(veetaragabhaya krodhah- II.56)

• Devoid of possessiveness and egoism(nirmamo nirahamkarah- II.7)

• Firminunderstandingandunbewildered(sthira buddhir asammudhah- V.20)

• Engaged in doing good to all creatures(sarva bhutahiteratah- V.25)

• Friendlyandcompassionatetoall(maitrahkaruna eva ca- XII.13)

• Pureheartedandskilfulwithoutexpectation(anapekshah sucir daksah- XII.16)

Maharishi Patanjali tells us that we can gain unexcelled happiness, mental comfort, joy and satisfaction by practicing and attaining a state of inner contentment (santoshat anuttamah sukha labhah- PYS II: 42). This link is quite apparent once we think about it, but not too many associate the need for contentment in their greed for anything and everything in this material world. The Srimad Bhagavad Gita says, “yogaha karmasu koushalam” meaning thereby that Yoga is skill in action (II.50). The real Yogi, immensely conscious and aware at the physical, mental and emotional levels gains great control through that consciousness over all aspects of life thus developing a real skill in living. Part of that skill springs from his cultivated detachment, his ability to work for “work’s sake,”



and not for the sake of the reward. He realizes that his duty is to do his best but that the ultimate result is not in his hands. The Yogi performs the needed action not for the sake of the fruits of that action, but because it is good and necessary to do so. Such an attitude of mind produces consummate skill in whatever action the Yogi undertakes. Consummate concentration, consummate controls are all offshoots of good Yoga Sadhana. This belies the age-old belief that the competitive spirit produces the highest skill. To this the Yogic answer is: detachment from the fruits of the action produces the greatest efficiency, for one is then emotions connected with “goal-oriented”, competitive thinking. The beauty of Yoga is that these abstract principles become concrete in the daily practice of the techniques available in the Yoga system. Once the “Seed of Yoga” finds fertile soil, these concepts grow naturally, slowly but surely taking root in all aspects of life.

Regaining Our Health And Happiness Through Yoga:“Health and happiness are your birthrights, Moksha is your goal. Reclaim your birthrights and attain your goal though Yoga” roared the Lion of Modern Yoga, Yogamaharishi Dr Swami Gitananda Giri. Living a happy and healthy life on all planes is possible through the unified practice of Hatha Yoga Asanas and Pranayamas, Dharana, Dhyana and Bhakti Yoga especially when performed consciously and with awareness. Asanas help to develop strength, flexibility, will power, good health, and stability and thus when practiced as a whole give a person a “stable and unified strong personality”. Pranayama helps us to control our emotions which are linked to breathing and the Pranamaya Kosha (the vital energy sheath or body). Slow, deep and rhythmic breathing helps to control stress and overcome emotional hang-ups. Dharana and Dhyana help us to focus our mid and dwell in it and thus help us to channel our creative energy in a wholistic manner towards the right type of evolutionary activities. They help us to understand our self better and in the process become better humans in this social world.

The true Yogic life involves a sustained struggle against past conditioning, an attempt to control

one’s inner environment in order to focus inward. Yoga is isometric, pitting one part of the body against the other and the Yogi strives to be “more perfect today, than he/she was yesterday”. It is practically impossible for classical Yoga Sports, Pranayamas and other Yoga practices to harm the practitioner when they are performed in the proper manner.

Yoga is not just performing some contortionist poses or huffing and puffing some Pranayama or sleeping our way through any so-called meditation. It is an integrated way of life in which awareness and consciousness play a great part in guiding our spiritual evolution through life in the social system itself and not in some remote cave in the mountains or hut in the forest. Yoga can be rightly said to be the science and art of right-useness of body, emotions and mind.

Tiruvalluvar says, “The loving ones live for the sake of others while the unloving live only for themselves”. Yogis have immense love and compassion for all beings and wish peace and happiness not only for themselves, but for all living beings. They are not “individualists” seeking salvation for themselves but on the contrary are “universalists” seeking to live life in the proper evolutionary manner to the best of their ability and with care and concern for their fellow human brethren and those beings living at all planes of existence. This is well exemplified by Yogic prayers such as, “Om, loka samasta sukhino bhavanthu sarve janaha sukhino bhavanthu Om shanti, shanti, shanti Om”.

May we all become true Yogis as extolled by Yogeshwar Sri Krishna when he says, “tasmad yogi bhavarjuna –become thou a Yogi, Oh Arjuna”. Hari Om Tat Sat- May that be the reality!

Suggested Reading:1. A Primer of Yoga Theory. Dr. Ananda Balayogi

Bhavanani. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2008.

2. A Yogic Approach to Stress. Dr Ananda Balayogi Bhavanani.. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. (2nd edition) 2008.

3. Ancient Yoga and Modern Science. Dr. TR



Anantharaman. Mushiram Manoharlal Publishers Pvt Ltd, New Delhi. 1996

4. Ashtanga Yoga of Patanjali. Dr Swami Gitananda Giri. Edited by Meenakshi Devi Bhavanani. Satya Press, Pondicherry.1995

5. Culturing one’s self though Yoga. Ananda Balayogi Bhavanani. Yoga Mimamsa 2011; 43 (1): 84-94.

6. Evolutionary quirks, yama – niyama & the human brain. Meenakshi Devi Bhavanani. Yoga Vijnana 2009; 2 (3 &4): 1-8.

7. Frankly speaking. Dr Swami Gitananda Giri. Edited by Meenakshi Devi Bhavanani. Satya Press, Pondicherry.1995

8. Srimad Bhagavad Gita. Swami Swarupananda. Advaita Ashrama, Kolkata. 2007

9. Thiruvalluvar on Yogic Concepts. Meena

Ramanathan, Aarogya Yogalayam, Venkateswara Nagar, Saram, Pondicherry-13.2007

10. Tirumandiram: A Tamil Scriptural Classic. Translated by Dr. B. Natarajan, Sri Ramakrishna Math, Chennai. 2006

11. Understanding the Yoga Darshan. An Exploration of the Yoga Sutras of Maharishi Patanjali by Ananda Balayogi Bhavanani. Dhivyananda Creations, Pondicherry. 2011

12. Yoga for Health and Healing. Dr Ananda Balayogi Bhavanani. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2007

13. Yoga Therapy Notes. Dr Ananda Balayogi Bhavanani. Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2007

14. Yoga: Step by Step. Dr Swami Gitananda Giri. Satya Press, Pondicherry. 1975

Volume 7 | Issue 2 | July-December | 2014

Official Publication ofSwami Vivekananda Yoga Anusandhana Samsthana University

Online full text athttp://www.ijoy.org.in

IJ YOInternational Journal of Yoga

Guest Editorial

Original ArticlesComparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteersEffect of trataka on cognitive functions in the elderlyEffect of Bhramari pranayama and OM chanting on pulmonary function inhealthy individuals: A prospective randomized control trial

Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain

Toward building evidence for yoga

Contents

ISSN 0973-6131

International Journal of Yoga • Volume 7 • Issue 2 • July-D

ecember 2014 • P

ages 87-170

89International Journal of Yoga • Vol. 7 • Jul-Dec-2014

Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers

Ananda Balayogi Bhavanani, Meena Ramanathan, Balaji R, Pushpa D Centre for Yoga Therapy, Education and Research, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.

Address for correspondence: Dr. Ananda Balayogi Bhavanani, Centre for Yoga Therapy, Education and Research,

Mahatma Gandhi Medical College and Research Institute, Puducherry, India. E-mail: [email protected]

Original Article

of studies documenting various facets of this art and science.[1‑4] However, though many studies have elucidated applied aspects of Yoga in different health conditions, very few have focused on the basic research needed to understand the intricate mind‑body mechanisms involved in the different yogic techniques.[5]

The different Yogic psychophysiological techniques are bound to have different effects on each and every cell of the human body and this in turn will depend on the various body systems, organs, and tissues involved in the performance of such practices.[6] As the role of the spinal

INTRODUCTION

Yoga has truly captured the imagination of scientists in recent times with a dramatic increase in the number

Introduction: This study planned to compare immediate cardiovascular effects of different yoga asanas in healthy young volunteers.

Materials and Methods: Heart rate (HR), systolic pressure (SP), and diastolic pressure (DP), blood pressure (BP), were recorded using the non invasive blood pressure ( NIBP) apparatus in 22 healthy young subjects, before and after the performance of Dhanurasana (DA), Vakrasana (VA) (both sides), Janusirasasana (JSA) (both sides), Matsyasana and Shavasana for 30 s. HR and BP were further recorded during supine recovery at 2, 4, 6, 8, and 10 min. A repeated measure of ANOVA was used for statistical analysis.

Results: There were significant changes in HR and BP both immediately after the Asanas as well as during the recovery period. Overall comparisons of ∆% changes immediately after the performance of the Asanas revealed significant differences with regard to HR that increased significantly after DA. In the recovery phase, there were significant intergroup differences from 2 min onward in both SP and DP. The decrease of SP after VA (right side) (VA‑R) was significantly greater than Shavasana (4th, 6th, and 8th min) and JSA (left side) (JSA-L) at 6th and 8th min. DP decreased significantly after performing JSA‑L compared to VA‑R at the 6th and 8th min.

Discussion: The cardiovascular changes immediately after the Asanas and during the recovery phase reveal inherent differences between the selected postures. The rise of HR in DA may be attributed to increased sympathetic response due to the relative difficulty of the posture as well as abdominal compression occurring in it. The effect of supine relaxation is more pronounced after the performance of the Asanas as compared to mere relaxation in Shavasana. This may be attributed to a normalization and resultant homeostatic effect occurring due to a greater, healthier de-activation of the autonomic nervous system occurring towing to the presence of prior activation. There were also subtle differences between the right sided and left sided performance of VA and JSA that may be occurring due to the different internal structures being either compressed or relaxed on either side.

Conclusion: Our study provides initial evidence of differential cardiovascular effects of Asanas and subtle differences between right and left sided performance. Further, cardiovascular recovery is greater after the performance of the Asanas as compared to shavasan; thus, implying a better response when effort precedes relaxation.

Key words: Asana; cardiovascular effects; research; Yoga.

ABSTRACT

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DOI: 10.4103/0973-6131.133870

Bhavanani, et al.: Differential effects of Asanas

International Journal of Yoga • Vol. 7 • Jul-Dec-201490

column is emphasized in Yoga, it follows logically that the effects of forward bending postures would be different than those of back bending ones and that these in turn may be different from the physiological effects of twisting postures. As both intra thoracic and intra‑abdominal pressure‑volume changes affect the cardiovascular system, it is plausible that these Asanas will produce changes in the heart rate (HR) and blood pressure (BP). The conscious self‑effort made in Asana practice may be understood as the Spanda (tension) component whereas the relaxation of effort (Prayatna shaithilya) may be understood as the Nishpanda (relaxation) component. Even Maharishi Patanjali tells us that the pair of opposites (Dwandwa) is transcended (Dwandanabigata) when one perfects the state of Asana. Hence, it is essential to physiologically evaluate not only the actual performance of an Asana, but also the period of recovery following it.

However, there is a lacuna of studies on such effects and there is only one study[7] comparing cardiovascular effects of some Asanas and that too was carried out in untrained subjects with only a single recording without pre‑post comparisons. That study had evaluated only the BP during the performance of Sukhasana, Vajrasana, and Dhanurasana (DA) by 25 medical students and compared these findings with the supine, sitting, and standing positions. As a pre‑post comparison was lacking in that study, no concrete conclusion could be inferred about the actual effects of performing Asanas or about the recovery following their performance.

The Swara Yoga tradition[8] also emphasizes the subtle differences existing between energy flows on the right and left sides (Pingala and Ida nadi respectively) manifesting through the ultradian rhythmicity of right or left nostril dominance (Surya and Chandra Swara respectively). Autonomic function is affected by right‑left brain activity[9,10] and as there is a sensory‑motor crossover relationship between right and left sides of the body and the contralateral hemispheres, this leads to speculation to differences in autonomic function depending on techniques performed utilizing either right/left sides.

With the above rational in mind, this study was planned to compare the immediate cardiovascular effects of different Yoga Asanas in healthy young volunteers. In addition to studying the immediate effect of the Asanas, we also studied the post posture supine recovery period for ten min. Hence, Shavasana also served as a control to the supine rest being carried out after the performance of the other Asanas.


This study was conducted at the Center for Yoga Therapy Education and Research (CYTER) functioning in Mahatma

Gandhi Medical College and Research Institute, Puducherry, India. Ethical clearance was obtained from the Institutional Human Ethics Committee and 22 students (16 female, 6 male), aged 19.05 ± 0.79 standard deviation (SD) years, with body mass index of 20.54 ± 3.15 (SD) undergoing the B Sc., Nursing course at Kasthurba Gandhi Nursing College, Sri Balaji Vidyapeeth, Puducherry were recruited for the study by convenience sampling. CYTER staff was conducting regular Yoga training sessions twice weekly for 6 months for nursing students and these participants were selected as they could perform the required set of Asanas with an adequate level of proficiency. Asanas selected for the study were: DA, Vakrasana (VA) (both sides), Janusirasasana (JSA) (both sides), Matsyasana, and Shavasana [Figure 1].

We selected these Asanas as they manipulated the spinal column indifferent positions. The human spine is given great importance in the Yoga tradition (Brahma Danda or Meru Danda). The forward bending (JSA), backward bending (DA from the prone position and Matsyasana from supine position) and twisting VA nature of the Asanas was taken into consideration and also the fact that the effects of two of them (VA and JSA) could be evaluated on both right and left sides. These Asanas were also part of the syllabus of Yoga training the subjects had received earlier and hence an adequate level of proficiency in performance of the postures was also ensured.

Each subject came to CYTER on seven different days and the entire study took 3 weeks for its completion as all subjects couldn’t be studied on the same day due to the lack of space and manpower. On each of the days, they performed one of the Asanas that was selected by random selection of both subject and technique so as to avoid any bias or influence of different days on the group. All tests were carried out in CYTER between 10 and 12 noon. The environment was quiet, with a comfortable temperature and subdued lighting. The subjects were briefed about the study protocol and written informed consent was obtained from them. They were advised to finish their breakfast at least 2 h earlier and come after emptying bowel and bladder.

To ensure objectivity in measuring HR and BP, the recordings were performed using non‑invasive semi‑automatic BP monitor (CH – 432, Citizen Systems, Tokyo, Japan) with an instrumental accuracy of ± 5% for HR and ± 3 mm Hg for BP. Pre intervention HR and BP was recorded after 5 min of supine rest. The subjects then performed one of the Asanas for 30 s, following which the post‑intervention recordings were taken. HR and BP were further recorded during the supine recovery period at 2,4,6,8 and 10 min.



Data were assessed for normality using GraphPad InStat version 3.06 for Windows 95, (GraphPad Software, San Diego California USA, www.graphpad.com). As all data passed normality testing by Kolmogorov‑Smirnov Test, statistical analysis was carried out using repeated measures of ANOVA with Tukey‑Kramer multiple comparisons test to compare differences between groups at each point of time. Student’s paired t test and P values less than 0.05 were accepted as indicating significant differences for pre‑post and recovery period intra‑group comparisons.

RESULTS

There were significant changes in HR and BP both immediately after performing asanas as well as during the recovery period [Tables 1‑3 and Figures 2‑4]. Overall comparisons of changes immediately after the performance of the Asanas revealed significant differences with regard to HR that increased significantly after

DA [Table 1, Figure 2]. In the recovery phase, there were significant intergroup differences from 2 min onward in both systolic pressure (SP) and diastolic pressure (DP) as given in Tables 2 and 3 and Figures 3 and 4. The decrease of SP after VA (right side) (VA‑R) was significantly greater than Shavasana (4th, 6th, and 8th min) and JSA‑L at 6th and 8th min [Table 2 and Figure 3]. DP decreased significantly after performing JSA‑L compared to VA‑R at the 6th and 8th min [Table 3 and Figure 4]. The plot of ∆% changes during the recovery period showed greater fall in SP and DP after all the other Asanas as compared to that following Shavasana [Figures 3 and 4].

DISCUSSION

The cardiovascular changes immediately after performing the Asanas and during the recovery phase as evidenced in this study reveal inherent differences between the selected postures [Tables 1‑3, Figures 2‑4]. Differences between

Figure 1: Asanas performed by participants in the study: Janusirasasana (right), Janusirasasana (left), Vakrasana (right), Vakrasana (left), Dhanurasana, Matsyasana, and Shavasana



the selected Asanas were especially significant for HR immediately after performing DA [Table 1 and Figure 2]. There was a higher stress response to DA as opposed to the other Asanas and this may be attributed to an increased sympathetic response due in part to the relative difficulty of the posture as well as the intense abdominal compression occurring while performing it.

Each of the Asanas had its own pattern and through there were overall similarities, some differences can be made out in a detailed examination. VA‑R had the greatest fall in HR during the recovery period while JSA‑R had the greatest fall of both SP and DP by the end of the 10 min recovery period [Tables 1‑3, Figures 2‑4]. There were significant differences between the selected Asanas mainly during the recovery period after 2 min and this finding helps us to understand that the effects of the Asanas is quite similar

after 2 min. This also implies that a rest of 2 min should be given in between the Asanas if one is to attain the best relaxatory effect of Yoga practices.

A previous study on individual Asanas evaluated the BP while 25 medical students performed Sukhasana, Vajrasana and DA and also compared these findings with the supine, sitting, and standing positions.[7] DA had the highest BP as compared to all other postures in that study too. The main difference between our present study and that study is that they had measured the BP while the subjects were in the posture, whereas we have measured before and after the posture along with a 10 min recovery period. They had only recorded a single value and thus there was no pre‑post comparison in their study. It is also to be noted that their subjects were not regular practitioners of Yoga while our subjects

Table 1: Immediate HR response to the performance of DA, JSA‑R, JSA‑L, VA‑R, VA‑L, MA and SA for 30 s followed by subsequent HR recovery at 2,4,6,8 and 10 minTime frame

DA JSA‑R JSA‑L VA‑R VA‑L MA SA P

Pre 73.91±10.01 74.27±7.64 76.41±11.49 80.09±8.27 75.55±10.31 72.23±12.34 73.50±10.19 0.1367Zero 89.14±11.21***¥¥¥ 70.95±9.23 72.86±10.07** 73.91±7.08*** 73.59±10.55 72.14±9.54 68.14±7.88* <0.00012 min 68.91±10.06** 67.23±9.58*** 67.82±11.13*** 70.23±7.43*** 66.36±7.78*** 66.64±10.40*** 67.41±9.67** 0.77184 min 68.36±9.66*** 66.73±9.58*** 68.23±9.71*** 69.27±9.09*** 66.09±7.43*** 67.09±9.96** 65.73±8.22*** 0.77136 min 66.64±8.35*** 65.82±11.22*** 68.14±11.86*** 66.59±7.46*** 65.05±9.25*** 65.91±10.19** 64.59±7.11*** 0.86218 min 67.32±8.91*** 67.32±11.16** 67.68±10.50*** 66.77±8.35*** 65.00±7.60*** 65.32±10.25*** 63.50±9.66*** 0.612510 min 67.95±9.52** 65.95±12.14*** 66.50±10.21*** 67.55±6.88*** 65.09±10.24*** 65.09±10.70*** 63.95±0.11*** 0.7844HR = Heart rate, DA = Dhanurasana; JSA‑R = Janusirasasana‑R; JSA‑L = Janusirasasana‑L; VA‑R = Vakrasana; VA‑L = Vakrasana‑L; MA = Matsyasana; SA = Shavasana; *P<0.05, **for P<0.01 and *** for P<0.001 for comparison with pre values by Student’s paired t test, ¥¥¥P<0.001 for DA versus all other Asanas at zero min by RMANOVA with Tukey‑Kramer Multiple comparisons test

Table 2: Immediate SP response to the performance of DA, JSA‑R, JSA‑L, VA‑R, VA‑L, MA and SA for 30 s followed by subsequent HR recovery at 2,4,6,8 and 10 minTime frame


Pre 108.55±11.38 109.50±7.86 111.41±11.29 105.77±11.26 110.36±11.78 109.68±11.54 109.86±14.08 0.5865Zero 106.27±11.92 107.32±10.16 108.27±10.41* 104.18±8.74 107.14±9.24* 105.95±12.66* 105.18±11.61** 0.74732 min 101.55±10.15*** 100.23±8.79*** 104.09±10.23*** 98.91±7.85** 103.640±09.26*** 100.45±9.31*** 105.23±12.13** 0.05744 min 100.09±11.01*** 99.59±7.52*** 103.36±7.82*** 97.73±7.98***µ 102.82±9.76*** 100.27±9.18*** 105.68±12.05 0.01406 min 98.41±10.64*** 99.09±7.75*** 102.59±10.00***¥ 96.32±8.23***µ 102.09±9.43*** 99.82±8.38*** 103.45±10.66*** 0.00648 min 98.41±9.79*** 98.59±8.23*** 103.09±7.98***¥ 96.68±8.23***µ 101.73±9.32*** 98.86±9.49*** 102.91±10.46*** 0.007910 min 98.27±9.56*** 98.05±8.40*** 102.32±7.46*** 97.32±8.58*** 102.91±9.69*** 99.14±9.69*** 102.68±9.06*** 0.0146SP = Systolic; DA = Dhanurasana; JSA‑R = Janusirasasana‑R; JSA‑L = Janusirasasana‑L; VA‑R = Vakrasana; VA‑L = Vakrasana‑L; MA = Matsyasana; SA = Shavasana; HR = Heart rate; *P<0.05, **For P<0.01 and ***for P<0.001 for comparison with pre values by Student’s paired t test; µP<0.05 for VA‑R versus SA at 4, 6 and 8 min and ¥P<0.05 for JSA‑L versus VA‑R at 6 and 8 min by RMANOVA with Tukey‑Kramer Multiple comparisons test

Table 3: Immediate DP response to the performance of DA, JSA‑R, JSA‑L, VA‑R, VA‑L, MA and SA for 30 s followed by subsequent HR recovery at 2,4,6,8 and 10 minTime frame


Pre 64.82±7.03 69.41±11.93 68.18±6.49 67.27±7.9 68.09±7.62 68.41±8.25 64.18±6.48 0.2195Zero 62.82±11.75 61.91±8.69** 63.82±8.15* 60.32±6.18*** 64.41±8.2 59.23±6.47*** 60.55±6.16** 0.21502 min 57.09±4.75*** 57.00±5.03*** 59.55±7.18*** 55.86±7.17*** 58.32±4.61*** 57.14±5.66*** 60.86±6.87* 0.04384 min 56.55±4.91*** 57.00±4.84*** 59.95±5.74*** 56.64±6.08***µ 57.73±5.03*** 57.23±4.77*** 60.50±6.46* 0.02546 min 56.77±4.53*** 57.77±5.52*** 59.32±6.18*** 55.86±6.19***µ 58.32±4.78*** 57.86±4.58*** 60.64±6.57** 0.04278 min 56.27±4.57*** 57.95±5.38*** 59.50±5.19***¥ 54.91±6.04***µ 58.36±3.67*** 58.45±5.96*** 59.36±6.87*** 0.023410 min 56.86±5.34*** 57.50±4.90*** 59.41±8.24*** 57.32±7.42*** 58.55±4.79*** 57.55±4.96*** 60.36±5.83** 0.3520DP = Diastolic; DA = Dhanurasana; JSA‑R = Janusirasasana‑R; JSA‑L = Janusirasasana‑L, VA‑R = Vakrasana; VA‑L = Vakrasana‑L; MA = Matsyasana; SA = Shavasana; HR = Heart rate; *P<0.05, **for P<0.01 and *** for P<0.001 for comparison with pre values by Student’s paired t test, µFor VA‑R versuss SA at 4,6 and 8 min and ¥P<0.05 for JSA‑L versus VA‑R at 8 min by RMANOVA with Tukey‑Kramer Multiple comparisons test



Figure 2: Heart rate response in ∆% immediately following performance of Dhanurasana, Janusirasasana‑R, Janusirasasana‑L, Vakrasana‑R, Vakrasana‑L, Matsyasana, and Shavasana for 30 s and at 2,4,6,8, and 10 min

Figure 3: Systolic pressure response in ∆% immediately following performance of Dhanurasana, Janusirasasana‑R, Janusirasasana‑L, Vakrasana‑R, Vakrasana‑L, Matsyasana and Shavasana for 30 s and at 2, 4, 6, 8 and 10 min

were undergoing a Yoga training program and had been practicing the techniques for more than 3 weeks at the time of the study.

Previous studies have reported the energy expenditure and ventilatory responses of Yogic standing (Virasana) and sitting (Siddhasana) postures.[11,12] They reported

that Virasana induces temporarily a hyper metabolic state characterized by enhance sympathetic activity that gets inhibited upon the adoption of Shavasana.[11] Siddhasana was reported to be a mild type of exercise as it had higher energy expenditure and ventilatory responses as compared to supine and chair sitting postures.[12]



The effect of supine relaxation is more pronounced after the performance of the Asanas as compared to just relaxing in Shavasana [Figures 2‑4]. This may be attributed to a normalization and resultant homeostatic effect occurring towing to a greater, healthier de‑activation of the autonomic nervous system occurring due to the presence of prior activation.

A study by Telles et al. studied O2 consumption and respiration following four Yoga postures interspersed with relaxation and supine relaxation alone, and concluded that the combination of stimulating and relaxing techniques reduced physiological arousal better than the mere practice of relaxation techniques alone.[13] They also pointed out that though the practical performance of Yoga techniques seem to be stimulatory in nature, their physiological effects are in fact more relaxatory. This is corroborated by a previous study from JIPMER reporting that Shavasana relaxation is enhanced with the addition of Savitri Pranayama thus decreasing O2 consumption by 26%.[14]

Manjunatha et al. studied the effects of selected Yogic postures on fasting and postprandial glycaemia and insulinemia in healthy young subjects and concluded that the performance of Asanas led to increased sensitivity of the β cells of the pancreas to the glucose signal.[15] It was found in that study that the performance of four different sets of Asanas had similar effects of reducing fasting and postprandial glycaemia and that blood insulin levels also fell after the performance of the

Asanas. However, when oral glucose tolerance test ( GTT) was administered, there was a greater insulin response that may be interpreted as an enhanced sensitivity of pancreatic β cells to the glucose challenge too. At the metaphysical level, this may be taken to imply a dynamic state of balance where one is balanced, yet ready to face any challenge that may occur.

One of the extra findings of this study is the revelation of subtle differences between the right sided and left sided performance of VA and JSA that may be occurring as a result of the different internal structures being either compressed or relaxed on either side. This requires further exploration and studies with a greater number of subjects and doing the Asanas in different positions may help unravel the scientific basis of such differences.

The aim of Yoga is harmony or homeostatic balance at all levels of existence (Samatvam yogah uchyate) as elucidated in the Bhagavad Gita[16] and the psychophysiological nature of Yoga Asanas may be producing such a balance even if they initially have a hyper metabolic or cardio‑respiratory stimulatory action. This is well evidenced by the cardiovascular responses to all the Asanas in our study, as the post postural HR and BP both fell below the initial values during the recovery period and this was consequently seen to be even lower than the responses to supine relaxation in Shavasana. This has been corroborated by recent reports that both the sympathetic and parasympathetic limbs of the autonomic nervous

Figure 4: Diastolic pressure response in ∆% immediately following performance of Dhanurasana, Janusirasasana‑R, Janusirasasana‑L, Vakrasana‑R, Vakrasana‑L, Matsyasana, and Shavasana for 30 s and at 2, 4, 6, 8 and 10 min



system activity were enhanced in hypertensives following Yoga training.[17,18]

In conclusion, our study provides initial evidence of differential cardiovascular effects of Asanas and subtle differences between right and left sided performance. Further, cardiovascular recovery is greater after the performance of the Asanas as compared to Shavasana; thus, implying a better response when effort precedes relaxation.

ACKNOWLEDGMENTS

The authors thank the management and authorities of Sri Balaji Vidyapeeth University for setting up the Centre for Yoga Therapy, Education and Research (CYTER) in Mahatma Gandhi Medical College and Research Institute (MGMCRI). The authors are grateful to Yogacharini Meenakshi Devi Bhavanani, Director ICYER and Dr. Madanmohan, Professor and Head Department of Physiology, MGMCRI for their constant motivation, encouragement and supportive guidance. We thank Miss Subashana, ANM for her valuable assistance during the recording sessions and data entry.

REFERENCES

1. Khalsa SB. Yoga as a therapeutic intervention: A bibliometric analysis of published research studies. Indian J Physiol Pharmacol 2004;48:269-85.

2. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: A systematic review. J Am Board Fam Pract 2005;18:491-519.

3. Innes KE, Vincent HK. The influence of yoga‑based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evid Based Complement Alternat Med 2007;4:469-86.

4. Bhavanani AB. Yoga as a therapy: A perspective. Yoga Mimamsa 2011;42:235-41.

5. Bhavanani AB. Don’t put yoga in a small box: The challenges of scientifically

studying yoga. Int J Yoga Therap 2011;21:21.6. Swami GG. Yoga: Step-by-Step. Pondicherry: Satya Press; 1981.7. Malhotra V, Tandon OP. A study of the effect of individual Asanas on blood

pressure. Indian J Tradit Knowl 2005;4:367-72.8. Bhavanani AB. Swarodaya vijnana‑A scientific study of the nasal cycle. Yoga

Mimamsa 2007;39:32-8.9. Werntz DA, Bickford RG, Bloom FE, Shannahoff-Khalsa DS. Alternating

cerebral hemispheric activity and the lateralization of autonomic nervous function. Hum Neurobiol 1983;2:39-43.

10. Shannahoff-Khalsa DS. Unilateral forced nostril breathing: Basic science, clinical trials, and selected advanced techniques. Subtle Energies and Energy Medicine Journal 2002;12:79-106.

11. Rai L, Ram K. Energy expenditure and ventilatory responses during Virasana – A yogic standing posture. Indian J Physiol Pharmacol 1993;37:45-50.

12. Rai L, Ram K, Kant U, Madan SK, Sharma SK. Energy expenditure and ventilatory responses during Siddhasana – A yogic seated posture. Indian J Physiol Pharmacol 1994;38:29-33.

13. Telles S, Reddy SK, Nagendra HR. Oxygen consumption and respiration following two yoga relaxation techniques. Appl Psychophysiol Biofeedback 2000;25:221-7.

14. Madanmohan S, Rai UC, Balavittal V, Thombre DP, Gitananda S. Cardiorespiratory changes during savitri pranayama and shavasan. Yoga Rev 1983;3:25-34.

15. Manjunatha S, Vempati RP, Ghosh D, Bijlani RL. An investigation into the acute and long-term effects of selected yogic postures on fasting and postprandial glycemia and insulinemia in healthy young subjects. Indian J Physiol Pharmacol 2005;49:319-24.

16. Swami C. The Bhagavad Gita. Trichy: Ramakrishna Tapovanam; 1984.17. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Babu K. Modulation

of stress induced by isometric handgrip test in hypertensive patients following yogic relaxation training. Indian J Physiol Pharmacol 2004;48:59-64.

18. Bhavanani AB, Madanmohan S, Zeena S. Suryanadi pranayama (right unilateral nostril breathing) may be safe for hypertensives. J Yoga Phys Ther 2012;2:118.

How to cite this article: Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers. Int J Yoga 2014;7:89-95.

Source of Support: Nil, Conflict of Interest: None declared

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ONGOING PROJECTS

ONGOING RESEARCH PROJECTS

1. EFFECT OF 12-WEEKS OF YOGA TRAINING ON CARDIO-

RESPIRATORY, NEUROLOGICAL AND PSYCHOLOGICAL

PARAMETERS IN A GERIATRIC POPULATION. Pre and post test

recordings have been completed and 12 weeks Yoga training sessions

conducted twice weekly in the Hospice of St. Cluny, Pondicherry.

2. INTRA OCULAR PRESSURE VARIATIONS IN FORWARD

BENDING YOGA POSTURES. Collaborative project with Department

of Ophthalmology, MGMCRI. Proposal approved by IHEC in April 2014

and subjects are being recruited.

3. EFFECTS OF TRATAK AND BHRAMARI PRANAYAMA

(YOGIC EYE CARE MODULE) ON OCULAR MUSCLE

BALANCE AND ACCOMMODATION IN COMPUTER VISION

SYNDROME. Collaborative project with Department of Ophthalmology,

MGMCRI. Proposal approved by IHEC in April 2014 and subjects are

being recruited.

4. A STUDY TO ASSESS THE EFFECTIVENESS OF PRANAYAMA

ON LEVEL OF DEPRESSION AMONG THE TRANSGENDER.

Collaborative project with KGMC. Proposal approved by IHEC, KGNC

in March 2014 and subjects are being recruited.

5. EFFECT OF YOGA TRAINING ON CARDIORESPIRATORY

HEALTH IN OBESE SUBJECTS. Proposal submitted to CCRYN,

Deptt of AYUSH, Ministry of Health & FW, Govt of India after

clearance from IHEC.

CHRONOLOGICAL REPORT

Sri Balaji Vidyapeeth

Mahatma Gandhi Medical College & Research Institute

Pillaiyarkuppam, Pondicherry - 607 402

CENTRE FOR YOGA THERAPY, EDUCATION AND RESEARCH (CYTER)

CHRONOLOGY OF IMPORTANT EVENTS

MONTH DATE EVENTS M F TG Total

2010

NOVEMBER 1.11.2010 Inaugural function: lamp lighted by Yogacharya Dr. Ananda Balayogi Bhavanani, Hon Advisor CYTER in presence of Yoga Therapy and Music Therapy unit members.

3 5 - 8

DECEMBER

15.12.2010

Chairman visited CYTER, had a discussion and asked for our suggestions to improve therapy unit. MCI team visited CYTER

25

25

-

50

2011

JANUARY 25.1.2011 CYTER unit shifted to deluxe ward. 38 25 - 63

FEBRUARY

Regular therapy, consultation and classes.

65

63

6

134

MARCH

10.3.2011 11.3.2011

Shifted back into the renovated therapy unit. A team of doctors from Royal College of London visited the therapy unit.

42

52

-

94

APRIL 5.4.2011 29.4.2011

Yoga therapy unit members participated in the CAM seminar conducted by SAF team of MGMC&RI. Yogacharini Kalaimamani Smt. Meenakshi Devi Bhavanani (Ammaji) visited CYTER, with her students from ICYER.

41

71

3

115

MAY 25.5.2011 A group of students along with their professor and ethical committee members visited the dept. a yoga demonstration was given to them and the students also participated and did the practices.

45

51

-

96

JUNE Regular therapy consultation and classes 30 92 - 122

JULY Regular therapy consultation and classes 29 105 - 134

AUGUST

Regular therapy, consultation and classes

24

82

-

106

SEPTEMBER

9.11.2011

A team of faculty members from Glasgow University visited the therapy unit and Yoga demonstration was given to them.

26

38

-

64

OCTOBER

Regular therapy consultation and classes 33

39 7 79

NOVEMBER Regular therapy consultation and classes 37

61 7 105

DECEMBER 7.12.2011 9.12.2011 23.12.2011

MCI team visited our department. Inaugural Yoga session for 2nd year nursing students of KGNC (Kasturuba Gandhi Nursing College) by CYTER team. A write up about CYTER was published in the Tamil daily, Dinakaran and Tamilmurasu.

32

69

4

105

2012

JANUARY

Regular therapy consultation and classes

23 35 2 60

FEBRUARY


26

57

- 84

MARCH


31

65

96

APRIL

Regular therapy consultation and classes 20 76 96

MAY 14.5.2012 Visitors from United Kingdom High Commission visited the department.

29 42 8 79

JUNE Regular therapy consultation and classes 11 39 50

JULY 06.7.2012 27.7.2012

Valedictory function of Yoga training for 2nd year nursing students of KGNC (Kasturuba Gandhi Nursing College) CME/workshop on synergistic effect of yoga and music-CYTER gave a presentation and demonstration.

5

46

51

AUGUST Regular therapy consultation and classes

21

25

46

SEPTEMBER Regular therapy consultation and classes 8 44 52

OCTOBER 26.10.2012

Regular therapy, consultation and classes. Awareness programme for obesity - presentation & demonstration

15 32 47

NOVEMBER Regular therapy, consultation and classes. 6 33 39

DECEMBER Regular therapy, consultation and classes.

15 48 63

2013

JANUARY Regular therapy, consultation and classes.

5 55 2 62

FEBRUARY

25.2.13

Regular therapy, consultation and classes. A team of international music therapists visited and discussed on the various modalities of Yoga as a form of therapy

3 50

53

MARCH 9.3.13 The yoga instructors of the yoga therapy unit participated in the workshop “medical student well being” conducted on March 9th, under the guidance of dr. Madanmohan, Professor & Head Dept of Physiology, on Stress and its Management by Yoga,(Lecture Demonstration).

6 64 70

27.3.2013 Members of Yoga therapy unit attended/participated/conducted the workshop “ZENFORIANS”, conducted by the MSc Nursing students of KGNC, MGMCRI, on 27.3.13, as part of their Staff/Faculty welfare programme. Workshop was conducted on “Yoga and lifestyle modification to combat stress” followed by a practice session for alleviating STRESS. All the participants enjoyed the sessions.

APRIL Regular therapy, consultation and classes. 17 76 93

MAY 19.5.2013

Regular therapy, consultation and classes. An interactive session was conducted on 19.5.2013 by CYTER as a CNE for nurses, staff and faculty of Rajiv Gandhi Government Women and Children Hospital, Ellapillaichavadi, Pondicherry. Mrs Meena Ramanathan gave an interactive talk cum practical session on “Stress destructs- yoga constructs” with a demo by Sangeeta.

59 57 116

JUNE Regular therapy consultation and classes. Yoga Instructor Ms. Sarulatha gave classes for the Nursing students more than two weeks as part of Phd study for the Mr.Vasantham and Dr. Prem.

37 54 91

JULY

5.7.2013

Regular therapy consultation and classes. Yoga therapy unit members participated in the programme conducted by SAF (Scientific Academic Forum) of MGMC&RI on 5.7.2013. A presentation was given by the coordinator Meena Ramanathan on Yoga

29 105 134

11.7.2013

& Psychosomatic Ailments, following which an interactive demonstration was conducted with demo by Ms. Sarulatha. Dr. Ananda Balayogi Bhavanani joined as Deputy Director CYTER (Department of Yoga and Music Medicine), MGMC & RI on 11th July 2013. He had been previously associated with the centre as Honorary Advisor since its inception in 2010. Proposal for a RCT on “Effect of yoga training on cardio-respiratory health in obese subjects” was prepared for submission to CCRYN, Ministry of Health & FW, New Delhi. Detailed syllabus for a PG Diploma in Yoga therapy for medical professionals was prepared and submitted to Dean, PG Studies.

AUGUST

7.8.2013 18.8.2013

Regular therapy, consultation and classes. Proposal for a RCT on “Effect of yoga training on cardiorespiratory health in obese subjects” was presented in the IHEC for its approval. A research paper entitled, “Hematological, biochemical and psychological effects of a yoga training programme in nursing students” was submitted to Biomedical Human Kinetics. Five posters and abstracts were prepared for presentation in Sanjeevita 2013.

20 50 70

SEPTEMBER

6.9.2013

Regular therapy consultation and classes. Dr. Madanmohan (Professor & Head, Department of Physiology and Director CYTER) was an invited speaker in the panel discussion on medical pluralism during Sanjeevita 2013, Annual Summit organized by CIDRF at MGMC&RI on 6th September 2013. Dr. Madanmohan, Dr. Ananda Balayogi Bhavanani (Deputy Director

54 109 - 163

4, 18 & 25 September 13.9.2013

CYTER) and Mrs. Meena Ramanathan (Coordinator and Yoga Therapist) also presented five posters and abstracts on behalf of CYTER. Topics presented included:

1. Health, rejuvenation and longevity: an Ayurvedic perspective,

2. Yoga and modern medicine: need for integration,

3. Yoga works, but how? 4. Immediate cardiovascular effects

of pranayamas in patients of hypertension,

5. Effect of Yoga training on cardiorespiratory health in obese subjects.

Yoga Awareness and Counselling Programmes are being held in the MRD of MGMC & RI from 10AM to 12 noon every Wednesday since 4th September 2013 with good response from patients to this initiative. The programme was conducted on 4, 18 & 25 September and 63 patients benefited from the consultation and cessing sessions. Two new books namely, Yoga Chikitsa: the Application of Yoga as a Therapy and Saraswati’s Pearls: Dialogues on the Yoga of Sound authored by Dr. Ananda Balayogi Bhavanani (Deputy Director CYTER) were released on September 13th 2013 by Kalaimamani Yogacharini Meenakshi Devi Bhavanani, Director, ICYER at Ananda Ashram, Pondicherry. The book on Yoga Chikitsa also has chapters contributed by Dr. Madanmohan (Professor & Head, Department of Physiology and Director CYTER) and Mrs. Meena Ramanathan (Coordinator and Yoga Therapist) while Saraswati’s Pearls is a series of conversations between Dr. Ananda Balayogi Bhavanani and Dr. Sangeeta Laura Biagi of Italy who is visiting professor in Italian Folklore and Music at New York University and Vassar College (NY).

OCTOBER 1.10.2013 6.10.2013 10.10.2013 15.10.2013 and 16.10.2013 29.10.2013 9,16, 23 & 30.10.2013

Regular therapy consultation and classes. Paper entitled, “Immediate cardiovascular effects of a single yoga session in different conditions” based on a review of data at CYTER was submitted to the Journal of Alternative & Integrative Medicine. An article entitled, “Modern Medicine, Meet Yoga!” by Dr Ananda Balayogi Bhavanani was published in the Fall 2013 issue (Pg 21-23) of the prestigious Integral Yoga Magazine, USA. A group of Yoga teachers and students from Yoga Academy of Berlin, Germany led by Yogacharya Ananda Leone, visited CYTER and expressed appreciation of the good work being done and admired the management for this novel integration of yoga with modern medicine. CYTER participated in the Orthopedic Awareness Week conducted by the orthopedic department, MGMCRI in MRD. Meena Ramanathan gave a talk on Importance of Yoga for maintaining the Spinal health, and a presentation on Yoga for Arthritis and Yoga for Low Back Pain on 15th and 16th along with demonstration by Yoga Instructors M. Sangeetha and G. Sarulatha. CYTER participated in the Obesity Awareness conducted by the MGMCRI in MRD Meena Ramanathan gave a talk on Importance of Yoga for obesity with demonstration by Yoga Instructors M.Sangeetha and G.Sarulatha. Yoga Awareness and Counselling Programmes are being held in the MRD of MGMC & RI from 10AM to 12 noon every Wednesday with good response from patients to this initiative. 58 patients benefited from the programme.

102 75 - 177

30.10.2013 Paper entitled, “Immediate effect of chandra and suryanadi pranayamas on cardiovascular parameters and reaction time in a geriatric population” was submitted to the International Journal of Physiology and accepted for publication.

NOVEMBER

14.11.2013 22.11.2013

Regular therapy consultation and classes. Orientation session was conducted by Dr Ananda and Mrs Meena for 20 newly joined nursing staff members who visited CYTER supervised by Mrs Deepa, Nursing educator, MGMCRI. Department of Medicine with Dietetics and Yoga in association with Department of Corporate Health Services organized a public awareness programme on 14th November 2013, at 9 am in MRD , MGMCRI in view of WORLD DIABETIC DAY celebration. Meena Ramanathan gave a talk on Importance of Yoga for diabetes mellitus with demonstration by Yoga Instructor G. Sarulatha. CME cum Workshop on “Yoga & Lifestyle Disorders” was organized by CYTER and Dept of Physiology at MGMCRI. More than 250 delegates participated and CYTER Phase-II was officially inaugurated by Prof KR Sethuraman, VC, SBVU. Research paper entitled, “Immediate cardiovascular effects of a single yoga session in different conditions” was published in the journal of Alternative and Integrative Medicine. It also received wide publicity through news coverage in ‘The Hindu’ newspaper.

127 51 - 178

DECEMBER

2.12.2013

Regular therapy consultation and classes. Health Awareness camp for Senior Citizen at the Serene Pelican Belfort Township as part of the Out-reach program of CYTER. Consultation and Yoga Therapy advice was

95 70 - 165

3.12.2013

given to 15 senior citizens during this occasion. CYTER was part of the Team from MGMCRI, who attended the Health Awareness camp at NCR, a company in Pillayar Kuppam- consultation , Yoga Therapy and dietary advice was given to more than 35 staff members there at their office as part of the CYTER Out-reach Prog. Paper entitled, “Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time” was published in International Journal of Yoga. A research paper entitled, “Hematological, biochemical and psychological effects of a yoga training programme in nursing students” was published in International Research Journal of Pharmacological and Applied Sciences. “Immediate effect of chandra and suryanadi pranayamas on cardiovascular parameters and reaction time in a geriatric population” was submitted to the International Journal of Physiology and accepted for publication.

2014

JANUARY 4.1.2014 to

7.1.2014 8.1.2014

Regular therapy consultation and classes. The CYTER team of Prof Madanmohan (Director), Dr Ananda Balayogi Bhavanani (Deputy Director) and Smt. Meena Ramanathan (Coordinator - cum- Yoga therapist) presented a special Workshop on Yoga Therapy and Yoga awareness programme was conducted via a CYTER stall at the 20th International Yoga festival organized by the Department of Tourism, Government of Pondicherry at Gandhi Tidal. CYTER received wide publicity through coverage in national editions of ‘The Times

90 74 164

21.1.2014 27th & 28th Jan 2014 30.1.2014

of India’ newspaper. Orientation visit by nursing students from Paul’s Nursing college. Introductory Yoga session conducted by CYTER for 150 students of 1st MBBS at MGMCRI by Dr Madanmohan, Dr Ananda and Smt Meena. Inauguration of PGDYT course.

FEBRUARY 1,8,15 & 22.2.2014 2.2.2014 6.2.2014 20, 22, & 26-2-2014 24 and 26, 2.2014

Regular therapy consultation and classes. Regular classes for the students of PGDYT course from 9am to 2pm Presentation on “Yoga for pediatricians” by Meena Ramanathan during CME for Pondy Pediatric Forum at Annamalai International. A group of 20 Nurses of MGMC&RI attended a orientation session at CYTER The well-known Yoga therapists and directors of Integrative Yoga Therapy (IYT), USA & Enchanted Mountain Center for Yoga and Well-Being in Brazil, Joseph and Lilian le Page visited CYTER. They interacted and interviewed the VC-SBVU, Dean (PG&R) and Director CYTER and observed the various yoga therapy sessions and PGDYT classes at CYTER. They were making an educational video on Yoga Therapy in India and interviewed recipients of yoga therapy, students of PGDYT as well as Dr Ananda and Smt. Meena on the novel, integrative approach to yoga therapy adopted at CYTER. Dr Ananda gave an introductory session on “Yoga for health” for senior teachers of Pondicherry at State training Centre, Directorate of School Education, Pondicherry.

100 93 193

MARCH 1,8,15,22& 29.3.2014 7.3.2014 21.3.2014 23.3.2014 24.3.2014

Regular therapy consultation and classes. Regular classes for the students of PGDYT course from 9am to 2pm Smt. Meena gave a special presentation on “Yoga for women” at the VCRC, Pondicherry during the International Women’s Day celebrations organised on 7th March 2014. An inspector from MCI (Psychiatry) visited CYTER and inspected the proceedings. Smt Meena directed a special demonstration by the SADAY students at Gandhi Tidal as part of the Women’s day celebration of ARUMAI rehabilitation organization. Dr Ananda was invited to present workshops, seminars and talks at various venues in Australia and New Zealand from 24th March to 14th April 2014. He presented highly successful programmes organized by the Gitananda Yoga Association of Australia at IYTA-Wellington, Lotus Yoga Centre-Paraparaumu in New Zealand and Anand Yoga Academy at Adelaide. He also conducted intensive 3-day retreats at Tatum Park, NZ and Integral Yoga Academy of Australasia at Adelaide. He presented a special 2-day workshop at the International Yoga Teachers Association at Sydney, Australia and visited the Sivanna Integrative Health Centre, Sydney to discuss further collaboration in Yoga therapy. He had special personal meetings with Yogashri Dr Eric Dornekamp, the senior most Yoga authority of New Zealand and the world famous authority on Yantra-Tantra, Dr. Swami Anandakapila Saraswathi (Jonn Mumford) of Sydney, Australia.

153 179 --

332

APRIL 5,12.19& 26.4.2014 8.4.14 15.4.14 16.4.14

Regular therapy consultation and classes. Regular classes for the students of PGDYT course from 9am to 2pm Nine TG members from the SCHOD (Sagodaran Community Health Development Society) attended Yoga sessions @CYTER IHEC meeting approved the following studies from CYTER. 1. Effect of 12-weeks yoga training on

cardiorespiratory, neurological & psychological parameters in a geriatric population.

2. Effect of tratak and bhramari pranayama on ocular muscle balance and accommodation in computer vision syndrome.

3. Intra ocular pressure variations in ‘head below the heart’ yoga postures.

Dr Ananda rejoined duty after successful tour down under.

200 179 9 388

MAY 3, 10, 24 and 31 19.5.14

Regular therapy consultation and classes. Regular classes for the students of PGDYT course from 9am to 2pm. Dr. Ananda was nominated to the Editorial Board of Yoga Mimamsa, the bimonthly Yoga journal of Kaivalyadhama, Lonavla. He has previously served as an advisor to the journal since 2010. This appointment is prestigious as Yoga Mimamsa is one of the oldest and premier Yoga journals of India having been founded by the legendary Swami Kuvalayananda.

155 216 - 371

JUNE 14th &15th

Regular therapy consultation and classes. Regular classes for the students of PGDYT course from 9am to 2pm Dr. Ananda was invited to attend the Board of Studies meeting of the GS College of Yoga and Cultural Synthesis, at

123 177 - 300

16.6.2014 25.6.2014

Kaivalyadhama in Lonavla. He has been nominated as the chairperson for the subject, “Anatomy and Physiology of the Human Body in the Context of Yoga.” This appointment is prestigious as Kaivalyadhama is one of the oldest and premier Yoga institutions of India. He was also Chief Guest for the inauguration of the Foundation Course in Yoga & Ayurveda at Kaivalyadhama. Smt. Meena Ramanthan, Coordinator and Yoga Therapist CYTER submitted her PhD dissertation to the Tamil Nadu Physical Education and Sports University, Chennai. The title of her 250 page dissertation is “Effect of selected yogasanas and pranayama on selected cardiorespiratory, psychological and psychomotor variables among low and highly depressed geriatric women.”

Dr. Ananda attended the Governing Body Meeting of the South Zone Cultural Centre at Chennai that was presided by the Governor of Tamil Nadu who is also Chairman of the SZCC. Dr. Ananda was nominated by Pondicherry Govt Department of Art and Culture to the Governing Body of the South Zone Cultural Centre, Tanjavur under Ministry of Culture, Govt of India in 2013. He has also served as member in the Expert committee of SZCC to select “Young Talented Artistes awardees for 2013-14.

JULY 2.7.2014

Regular therapy consultation and classes. Regular classes for the students of PGDYT course from 9am to 2pm A group of 11 staff nurses who joined duty in MGMCRI from July visited CYTER and had an interactive pranayama / relaxation session.

124 217 - 341

4.7.2014 29.7.2014

28, 30 and 31st July

Dr. Ananda Balayogi Bhavanani was invited to be Resource Person for the One Day National Seminar on "Dimensions of Yoga and its dynamics" at MoP Vaishnav College for Women, Chennai. He delivered an invited lecture on “Diverse Dimensions of Yoga for the youth" in the event organized jointly by the Krishnamacharya Yoga Mandiram and MoP Vaishnav College.

Dr. Ananda Balayogi Bhavanani was invited to be a peer reviewer for BioPsychoSocial Medicine, an open access, peer-reviewed online journal that is the official journal of the Japanese Society of Psychosomatic Medicine, and publishes research on psychosomatic disorders and diseases that are characterized by objective organic changes and/or functional changes that could be induced, progressed, aggravated, or exacerbated by psychological, social, and/or behavioral factors and their associated psychosomatic treatments.

Model/send-up theory examinations were conducted for students of PGDYT course from 10am to 12.30pm.

AUGUST 2.8.2014 3.8.2014

Regular therapy consultation and classes. Model/send-up practical examination conducted for students of PGDYT course from 10am to 1pm. An interactive session was conducted by CYTER as a CNE for nurses, staff and faculty of Indira Gandhi Government General Hospital and Post Graduate Institute (IGGGH&PGI) Pondicherry. Mrs Meena Ramanathan gave an interactive talk cum practical session on “Stress–a Curse; Yoga- a Boon; Yogic Integration for Healthcare Givers” with a demo by Sangeeta and Danush Apnadesh.

190 184 7 381

7.8.2014 2,5,7,9 & 12 August 18,19 & 20 August 21 August 25 August 28 August

Yoga Awareness programme was conducted by Smt Meena Ramanathan, Coordinator-cum-Yoga therapist CYTER for Senior Citizens at the Serene Pelican Belfort Township as part of Out-reach programs of CYTER. Consultation and Yoga Therapy advice was given to more than 25 senior citizens on the occasion. Smt Latha, the Yoga instructor from CYTER gave a demonstration and then Smt Meena led a practical session on simple practices for seniors. Revision classes for the students of PGDYT course from 9am to 2pm. Final theory examinations conducted for students of PGDYT course from 10am to 12.30pm. CYTER inaugurated a special Silver Citizens Yoga and Health Programme for Senior Citizens of the Serene Pelican Belfort Township. More than 25 senior citizens attended the sessions at CYTER. Dr Ananda gave an introduction and then the practice session was led by Meena Ramanthan and supported by Yoga instructors Latha and Dhanush. Practical examination was conducted for students of PGDYT course from 10am to 12.30pm. Silver Citizens Yoga and Health Programme

SEPTEMBER 4th Sept 10th Sept

Regular therapy consultation and classes. Silver Citizens Yoga and Health Programme Inauguration of classes for 1st and 2nd batches of PGDYT.

PHOTO GALLERY

INTERNATIONAL YOGA FESTIVAL 2014

Department of Tourism, Government of Pondicherry -

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4/25/2014 Lowering pressure without medicine no longer a stretch - The Hindu

http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/lowering-pressure-without-medicine-no-longer-a-stretch/article4388329.ece?css=print 1/1

Today's Paper » NATIONAL » TAMIL NADU

Published: February 7, 2013 00:00 IST | Updated: February 7, 2013 06:01 IST

Lowering pressure without medicine no longer a stretch

Kavita Kishore

Expert advises simple yoga and chanting for decreasing one’s blood pressure

Calming chantsA study conducted at the Advanced Centre for Yoga Therapy, Education and Research, showed that pranava pranayama , a yogictechnique with chanting, could significantly blood pressure

If you are suffering from hypertension, new research shows that a certain yoga posture could help you significantlylower your blood pressure fairly rapidly. The results can be seen with a very simple aasana and just involves basicchanting, the study has found.

According to a study conducted at the Advanced Centre for Yoga Therapy, Education and Research (ACYTER), by Dr.Anandan Balayogi Bhavanani, pranava pranayama , when performed in the supine position, could significantlyreduce systolic pressure, pulse pressure and mean pressure (diastolic pressure + 1/3 pulse pressure). These resultswere not observed when the subjects underwent what Dr. Bhavanani terms ‘sham relaxation’ — a technique wherethey were asked to lie down and relax various parts of their bodies.

According to Dr. Bhavanani, pranava pranayama is the practice of taking three slow and deep breaths followed bymaking a prolonged “aaa ooo mmm” sound when exhaling. This pranayama is typically done in a seated posture, butfor the sake of this research he decided to experiment with it in a supine position to see if it was more effective.

For the purpose of the study, 29 subjects (15 male and 14 female), with the average age of 57 years, were chosen. Allthe subjects were undergoing treatment for hypertension and diabetes for more than three years. They were thendivided into two groups. One group was asked to practice the pranava pranayama , while the other group underwentsham relaxation. Both these groups were asked to do the exercise for 10 minutes a day.

The pranava group was asked to practice shavasana — simple conscious resting for the first two and the last twominutes — and for the remaining six minutes they were asked to perform pranava pranayama in the supine position.

The pre-relaxation and post-relaxation heart rate and blood pressure was taken from all of the patients and therequired variables were calculated.

For the patients that underwent the sham relaxation, the results were not as striking as for those who performed thepranava relaxation, he said.

The ACYTER group is now conducting a similar research on the effect of pranava pranayama on patients who havesuffered from stroke, he said.

Printable version | Apr 25, 2014 5:49:14 PM | http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/lowering-pressure-without-medicine-no-longer-a-stretch/article4388329.ece

© The Hindu

http://www.thehindu.com/

4/25/2014 Yoga could reduce cardiovascular markers - The Hindu

http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/yoga-could-reduce-cardiovascular-markers/article5438837.ece?css=print 1/1

Today's Paper » NATIONAL » TAMIL NADU

Published: December 9, 2013 00:00 IST | Updated: December 9, 2013 05:53 IST

Yoga could reduce cardiovascular markers

Kavita Kishore

CYTER’s study concludes one yoga session can reduce heart rate, BP

For the study, data of 1896 patients, from the ages of 24 to 48, was analysed. Yoga session in progress at CYTER

A new study by the Centre of Yoga Therapy, Education and Research, Mahatma Gandhi Medical College & ResearchInstitute reveals that a single session of yoga can significantly reduce heart rate and blood pressure

According to the conclusion of the study, a single yoga session can reduce the heart rate, blood pressure and derivedcardiovascular indices. The magnitude of the reduction depends on the pre-existing medical conditions, as well as theprotocol of yoga therapy that is adopted.

The changes in cardiovascular could be attributed to an enhanced harmony in cardiac autonomic functions, resultingfrom the coordinated breath-body work, as well as the relaxation of mind and body, Deputy Director (Yoga) of CYTERAnanda Balayogi Bhavanani told The Hindu .

For the study, data of 1896 patients – 1229 women, 633 men and 34 transgender – from the ages of 24 to 48 wasanalysed. These people attended yoga sessions between November 2010 and September 2012 and heart rate, systolicand diastolic pressure were measured after a 60 minute yoga session. Pulse pressure, mean pressure, rate pressureproduct and double produce were derived from the data.

In patients with hypertension, there was a significant reduction in cardiovascular parameters following the session.People with skin problems and musculoskeletal problems, the reduction was less significant, while in patients with nohealth conditions as well as those with psychiatric and respiratory conditions, there was a moderate change in thecardiovascular markers, the study indicates.

According to Dr. Bhavanani, although there have been several studies on the physiological, psychological andbiochemical changes following yoga practice, only very few have focussed on the effect of a single session. CYTER alsoconducted a one day CME to discuss papers on Lifestyle Diseases and Yoga recently.

Printable version | Apr 25, 2014 5:50:09 PM | http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/yoga-could-reduce-cardiovascular-markers/article5438837.ece

© The Hindu

http://www.thehindu.com/

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