A Thesis of Compilation of Research Pape PDF

A THESIS OF
COMPILATION OF RESEARCH PAPERS, ARTICLES

& WORK DONE
Submitted for
Doctor of Science (Yoga)

(Honoris Causa)
By
Yogacharya
Dr. Ananda Balayogi Bhavanani
MBBS, MD (AM), ADY, DSM, DPC, PGDFH, PGDY, FIAY, C-IAYT
December 2018
SWAMI VIVEKANANDA YOGA ANUSANDHANA SAMSTHANA

Bangalore, India - 560 019
A THESIS OF
COMPILATION OF RESEARCH PAPERS, ARTICLES
& WORK DONE
Submitted for
Doctor of Science (Yoga)

(Honoris Causa)
By
Yogacharya
Dr. Ananda Balayogi Bhavanani
MBBS, MD (AM), ADY, DSM, DPC, PGDFH, PGDY, FIAY, C-IAYT
December 2018
SWAMI VIVEKANANDA YOGA ANUSANDHANA SAMSTHANA

Bangalore, India - 560 019
Contents
Acknowledgement
Curriculum Vitae
Life Sketch
Selected Published Research papers
Selected Published Articles
Books and Proceedings
DVDs and CDs
News Paper Cuttings
Awards and Recognitions
Photographs
Acknowledgement
Om Gururadir anadischa guruh paramadaivatam
Guroh parataram nasti tasmai shri gurave namah Om- Guru Stotram
I gratefully acknowledge the great blessings and good fortune I have had to be
born the son of the "Greatest Yoga Team" of the last century. I pray that I can
always prove worthy of this Divine Gift that is of the rarest of the rare in countless
lifetimes.
I offer this honour and compilation of my literary and research efforts at the lotus
feet of my Guru-Father Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj
and my Guru-Mother Ammaji Kalaimamani Yogacharini Meenakshi Devi
Bhavanani who have inculcated in me the discipline of Yoga as well as sowing the
seeds of this great art and science in my heart. They have given me the grand
opportunity to be born human, the loving guidance, care and training to imbibe
the greatness of our beloved Indian Culture through Mantra, Puja, Yoga, Natya,
and Sangeeta; medical training to bridge the ancient and modern sciences of life;
and finally bless me with their potent Divine blessings every moment of my life;
that enables me to be what I am today, and do what I can for humanity.
I offer my eternal gratitude to all the Gurus of the great Rishiculture Ashtanga
Yoga Guru Parampara that traces its lineage back to Rishi Brighu on the Dakshina
Marga Tantra side through Yogamaharishi Srila Sri Kanakananda Swamigal; and
to Rishi Agasthya through Srila Sri Akanda Paripurna Satchidananda Kambali
Jnanananda Desika Swamigal on the Siva Siddhantha side.
All of this would not have manifested but for the loving guidance, motivation and
sustained enthusiastic support from my Yoga Research Guru, the one and only
Professor Madanmohanji. He may be credited as being the planter of the “Seed of
Yoga Research” in my heart and is the one who has set me off on this path of self
discovery, one that amalgamates Yoga with modern scientific inquiry. He has
always been the best “boss” one can ask for; and been the best role model of a true
Yogi-Scientist par excellence. I place my head with gratitude at your feet, dearest
Sriji.
I have been truly privileged to receive the blessings and goodwill of some of the
greatest Masters of Modern Yoga and I offer my gratitude to these doyens of Yoga
who include Padmabhushan Sri BKS Iyengar, Sri Yogendraji, Sri TKV Desikachar,
Sri Sant Keshavdas, Swami Chimayananda, Swami Dayananda, Yogi Amrit Desai,
Sri Direndra Brahmachari, Swami Chidananda Saraswathi, Sri Ma Yoga Shakti,
Shri O.P. Tiwari, Swami Veda Bharati, Dr. HR Nagendra, , Maharishi K
Arunachalam, Dr. Georg Feurstein, Dr. Jayadeva Yogendra and Smt. Hamsaji
Yogendra, Swami Suddananda Bharati, Sri Yogeshwar, Srila Sri Shankara Giri
Swamigal and Sri Kannaya Yogi.
I am blessed to be mentored by towering Yogic personalities who are inspirations

in my life and I thank all of them notably: Prof KR Sethuraman, Prof N
Ananthakrishnan, Dr Ramesh Bijlani, Yogacharya S Sridharan, Dr Jonn Mumford
(Swami Anandakapila), Dr IV Basavaraddi, Prof TM Srinivasan, Dr W
Selvamurthy, Prof TR Anantaraman, Dr B Ramamurthy, Dr MV Bhole, Sri DR
Kartikeyan, Prof RC Gupta, Dr SV Rao, Dr BV Adkoli, Dr C Adithan, Dr RP
Pandey and Dr MD Khapre. All of them have stimulated me in my attempts to
unite the ancient science of Yoga with the modern science of Medicine and Health
Professions Education.
In this I must especially mention the support I receive from the benevolent
management and visionary administrators of Sri Balaji Vidyapeeth, a premier
medical institution of India that is innovatively uniting Yoga therapy with modern
medical education and healthcare services. I especially thank our Chancellor Shri
MK Rajagopalan, Vice Chancellor Prof SC Parija and Dean of Faculty Prof N
Ananthakrishnan for their unstinting support for the CYTER of SBV that enables
us to share the wisdom and applications of Yoga therapy with so many
worldwide.
All of the research work we have done over the past three decades has been due to
the loving support from my illustrious colleagues, co-researchers and students
who have enabled me to bring forth our best at all times. I especially wish to
mention and offer my gratitude to my dearest Dr Kaviraja Udupa, Yogachemmal
Dr Meena Ramanathan, Dr Zeena Sanjay, Sri G Dayanidy, Dr R Balaji, Dr Vivek
Sharma and Dr Dinesh Thangavel for enabling me to be part of such a great
TEAM.
A special word of gratitude is due to my dearest and most loving seniors and
unstinting supporters in Yoga therapy internationally with special mention of
Yogathilakam Sri Larry Payne, Sri Leigh Bhaski, Sri Joseph le Page, Sri John
Kepner, Dr Sat Bir Khalsa and my dear Yoga Mitras Sri Subodh Tiwari and Dr
Kausthub Desikachar.
A few years ago my dear mentors Prof N Ananthakrishnan and Prof Madanmohan
blessed me that I would receive DSc in Yoga in the near future and today this
award by the prestigious SVYASA is a dream come true for me. I humbly express
my gratitude to the entire SVYASA Yoga family led by the inimitable Guruji Dr
HR Nagendraji and my dear Didi Dr R Nagarathnaji for selecting me for this
honour and motivating me to continue to do my best for the Divine and Universal
art and science of Yoga.
I thank my dear students and able colleagues Yogachemmal Dr. Meena

Ramanathan and Yogachemmal G Dayanidy for assisting me in this compilation
that traces my literary and research journey over the past three decades in JIPMER
and now at SBV.
Last but not least, I thank my Dharmapathni Yogacharini Devasena Bhavanani for
her constant encouragement and inspiration and for bringing into my life the
"Future of the Gitananda tradition' my dearest and most promising Dhivya Priya
and Anandraj Bhavanani.
May we all grow and glow in Yoga together and through our example guide
aspirants on this wonderful path that leads us towards realization of our own
inherent Divinity.
Yogacharya Dr Ananda Balayogi Bhavanani

Curriculum Vitae
CURRICULUM VITAE
NAME : Yogacharya Dr. ANANDA BALAYOGI BHAVANANI
PARENTS NAME : Yogamaharishi Dr. Swami Gitananda Giri Guru Maharaj

Kalaimamani Yogacharini Smt. Meenakshi Devi Bhavanani
DATE OF BIRTH : 16th April 1972, Pondicherry, South India
ADDRESS : No. 25, 2nd Cross, Iyyanar Nagar, Pondicherry - 605 013.
Phone: +91-413 – 2241561, 2622902. Mobile: +91-98423 11433
E-mail: yognat@gmail.com (&) ananda@icyer.com
Website: www.icyer.com (&) www.rishiculture.in
EDUCATION :
 Diploma (DY) and Advanced Diploma in Yoga (ADY) at ICYER, Ananda Ashram,
Pondicherry under direct guidance of Yogamaharishi Dr. Swami Gitananda Giri
Guru Maharaj and Yogacharini Meenakshi Devi Bhavanani in 1991-92 and 1992-
93.
 M.B.B.S Degree from Nagpur University at Jawaharlal Nehru Medical College -
Wardha – Maharasthra during 1993-1997. Passed Final M.B.B.S. with Distinction in
General Surgery and Gold Medal in Community Medicine. Completed internship
at JIPMER, Pondicherry during 1998-99.
 Diploma in Psychological Counseling from Institute for Health Care
Administration, Chennai, Tamil Nadu. (2001)
 Diploma in Stress Management from Institute for Health Care Administration,
Chennai, Tamil Nadu. (2001)
 Two Year Post Graduate Diploma in Family Health (PGDFH) from Sri
Ramachandra Medical College and Research Institute (Deemed University), Porur,
Chennai-116, Tamil Nadu. (2001-2003). (Achieved merit distinction)
 Completed the Post Graduate Certificate course in Pediatrics (PGCP) from IMA
AK Sinha Institute, New Delhi and designated as counselor with 180 hours of CME
credit in February 2005.
 Passed with Merit Distinction the Post Graduate Diploma in Yoga (PGDY) course
from Annamalai University, Chidambaram, Tamil Nadu topping more than 450
students to stand FIRST RANK overall. 2005.
 Awarded MD (Alternative Medicine) by the Indian Council of Alternative
Medicines, Kolkata, West Bengal in 2013.
 Carnatic Vocal Training for Twenty years under Kalaimamani, Sri Kanchi Kamakoti
Peeta Asthana Vidwan, Sangeetha Bhushanam, Guru Sri Rengam Sri R.
Ranganathan. Initially trained under Kalaimamani Puduvai V Manikannan and
performed Arangetram under his guidance at the age of only 12 years on August 11,
1984. For the past two decades, he has shared a special Manasika Guru-Sishya
relationship with Padma Bhushan Sangeeta Kalanidhi Sri TV Sankaranarayanan,
one of India’s greatest vocalists.
 Mridungam Training from age eight to present under Sri Kanchi Kamakoti Peeta
Asthana Vidwan Thiruvaroor Sri R. Krishnamurthy. Performed Arangetram in
1987 at the age of only 15 years.
 Bharata Natyam training from age of Six years under guidance of Guru Padmashri
Natya Kalanidhi Adyar K. Lakshmanan and Puduvai Kalaimamani Meenakshi
Devi Bhavanani. Has been performing on stage since the age of 8 years.
 Sanskrit Mantra (Vedic) training from age of five under guidance of Shivacharya Sri
Mangalanath Gurukkal and later under Sri Raja Shastrigal.
AWARDS :
 “YOGACHARYA” title received from Yogamaharishi Dr Swami Gitananda Giri on

behalf of ICYER in March 1992.
 “MARUDHA RAMALINGANAR AWARD and Rolling Shield for Outstanding
Young Person 2002” received from Thiru A V Subramaniyam, Deputy Speaker of
the Pondicherry Legislative Assembly on behalf of Youth Peace Centre on 16th June
2003.
 “K.S. Jayarama Iyer Award for Best Instrumentalist”. Three years from 1986 to
1989 at BGV, Kodaikanal, Tamil Nadu.
 ‘PUDUVAI MANNIN MAINDHAN’ title awarded by the Puduvai Kuber
Iyakkam, Pondicherry during Mridungam Arangetram, 1987.
 “SHRI H. B. SINGH MEMORIAL GOLD MEDAL” in Community Medicine
(Nagpur University) (1998) for achieving top rank out of five medical colleges
affiliated to Nagpur University, Maharasthra. Also achieved Distinction in General
Surgery and topped his batch of 100 students in 1st, 2nd and 3rd MBBS exams.
 “PALKALAI CHEMMAL” title awarded by Valluvar Villisai Kuzhu, Pondicherry
during Navarathri at Sringeri Saradha Madam (2000).
 “YOGA VIBHUSHAN” title awarded by Tamil Nadu State Yoga Association and
Sports Development Authority of Tamil Nadu at the 15th TN State Yogasana
Championship, Kovilpatti, Tamil Nadu (2003).
 Nominated as HONORARY ADVISOR to the WORLD YOGA COUNCIL of the
INTERNATIONAL YOGA FEDERATION, South America in 2002.
 Nominated as HONORARY MEMBER of the YOGA SPORT COUNCIL of the
INTERNATIONAL YOGA FEDERATION, South America in July 2003.
 “ACHIEVER AWARD” (SADANAIYALAR VIRUDHU) presented by Vinayagar
Chathurthi Celebrations Committee, Pondicherry (2003).
 Nominated as the INTERNATIONAL CULTURAL AMBASSADOR OF YOGA
(World Yoga Community) by the International Yoga Federation, South America in
August 2004.
 “YOGA BISHMACHARYA” awarded by Tirumoolar Yoga and Natural Diet
Trust, Chennai and Tamil Nadu State Yoga Association (2004).
 “YOGACHARIAR BANGALORE SUNDARAM AWARD 2005” received from
Shri Surjeet Singh Barnala, His Excellency the Governor of Tamil Nadu on behalf
of Asana Andiappan Sundara Yoga & Natural Living Development Trust at
Chennai on 26.2. 2005.
 Elected as a FELLOW of the INDIAN ACADEMY OF YOGA in the year 2005 and
received the prestigious fellowship at the Annual Convocation of the Academy held
on March 12th 2005 at the Yoga Sadhana Kendra, Banaras Hindu University,
Varanasi.
 “YOGA CHAKRAVARTHY” title awarded by Gitanjali Yoga Centre at the 1st
Annual Day Celebrations held at Pondicherry on 21st September 2005.
 Nominated as HONORARY SECRETARY FOR ALL INDIA by executive board of
International Yoga Federation, South America (2006).
 Received the "Dr. Sushila K. Thaker Prakruti Mandir Annual Research Award and
Gold Medal for work at the National Level in the field of Yoga” from the Academy
of Ayurveda Development and Research (AADAR), Ahmedabad, Gujarat (2006).
 “MATTALA VITTAGA MAMANI” title by Valluvar Villisai Kuzhu, Pondicherry
(2008).
 “MUTHAMIZH SUVAIGNAR” title awarded by Valluvar Villisai Kuzhu,
Pondicherry (2008).
 “SEVAI THILAKAM” title awarded by Kalaithai Kalai Sangam in July 2008.
 “SHIVA YOGA CHUDAR” title awarded by Muthamizh Mamani Pulavar I
Pattabiramane at Sambandar Charitram Dance Drama (2008).
 “YOGA KALAIMAMANI” title awarded by Valluvar Villisai Kuzhu, under
direction of Muthamizh Mamani Pulavar I Pattabiramane on occasion of the 23rd
Pondicherry State Yoga Sports Championship (2008).
 “YOGA THILAKAM” title awarded by Shakthi Medical Trust, under direction of
Dr Paramakedou on 21st May 2009.
 Awarded SILVER MEDAL by PT Pazhaniraja Trust on 25th July 2009 at
Pondicherry in appreciation of social upliftment through Yoga and the Indian
cultural arts.
 “SIVANERI ISAI CHEMMAL” title awarded by Paniru Thirumurai Pannatu
Manadu (World Shaiva Tamil Conference) on 13th February 2010 at Pondicherry.
 Awarded SRI AUROBINDO AWARD (MAHAN ARVINDAR VIRUDU) on
November 16th 2010 by the Pondicherry State Artists Association in recognition of
his service for the cause of spirituality.
 Honoured for Yoga Seva by Kumari Selja Union Minister for Tourism during 18th
International Yoga Festival 2011 in the presence of Sri V Narayanasamy, Union
Minister for Culture, Lt Governor of Pondicherry Dr Iqbal Singh, Chief Minister Sri
Vaithiyalingam, Home Minister Sri Valsaraj, Tourism Minister Sri Malladi Krishna
Rao & Social Welfare Minister Sri Kandasamy.
 Awarded a “LIFETIME ACHIEVEMENT IN FIELD OF YOGA AWARD” on
January 7th 2011 by the Department of Tourism, Govt of Pondicherry during the 18th
International Yoga Festival, Pondicherry-Jan, 2011.
 “PALKALAISUDAR MAMANI” title awarded by Valluvar Villisai Kuzhu, under
direction of Muthamizh Mamani Pulavar I Pattabiraman during 20th Annual Day of
Yoganjali Natyalayam, Pondicherry (7th July, 2013).
 Awarded the SCHOOL PSYCHOLOGY: BEST PERFORMANCE AWARD 2013
by Indian School Psychology Association (InSPA), during 3rd National Conference
on School Psychology Services to Multiple Disabled Children, held 22-24 November
2013 at NIEPMD, Muttukadu, Tamil Nadu, India.
 Awarded BIODIVERSITY AWARD 2014 for excellence in spreading the awareness
of nature and culture internationally through Yoganjali Natyalayam. Award
presented on behalf of ARANYA Forest and Sanctuary, Auroville by Shri N
Balabaskar IAS, Secretary Auroville Foundation in the presence of Ms Aster Patel,
Kavignar R Meenakshi and Shri Sanjeev Agarwal of the Sri Aurobindo International
Institute of Educational Research (SAIIER).
 Included in REFERENCE ASIA: Asia’s Who’s Who of Men and Women of
Achievement (Revised Ed Vol. III) published by Rifacimento International, New
Delhi- April 2014.
 Included in EMERALD WHO’S WHO IN ASIA (First Ed) published by
Rifacimento International, New Delhi- June 2014.
 Included in BIOGRAPHY INDIA (First Ed) published by Rifacimento
International, New Delhi- August 2014.
 Included in ASIA PACIFIC WHO’S WHO (XIII Ed) published by Rifacimento
International, New Delhi- January 2015.
 Included in FAMOUS INDIA: NATION’S WHO’S WHO published by Reguerdon
Inc, New Delhi- February 2015.
 Included in ASIA: MEN & WOMEN OF ACHIEVEMENT (Vol.VII) published by
Reguerdon Inc, New Delhi- February 2015.
 Included in KOHINOOR PERSONALITIES OF ASIA (Vol. III) published by
Reguerdon Inc, New Delhi- April 2015.
 Included in ASIAN AMERICAN WHO’S WHO (Vol. VII) published by
Rifacimento International, New Delhi, India.- May 2015
 Honoured for his Yoga Seva for the Youth of Pondicherry by NEHRU YUVA
KENDRA on the 1st International Day of Yoga (21 June 2015). Award was presented
by Shri V Sabhapathy, Speaker Puducherry legislative Assembly in the presence of
Honorable Minsters, MLAs and eminent citizens of Pondicherry.
 BHARAT EXCELLENCE AWARD and certificate of honor and felicitation from
Friendship Forum, New Delhi for his contribution towards promoting greater
friendship and India-International cooperation. Award given by Dr GVG
Krishnamurthy, Former Election Commissioner of India. June 2015.
 He was honored with the SIGARAM (Peak of Excellence) award by the Pondicherry
Drama Association during its annual event on June 28th 2015. This prestigious honor
was bestowed upon him in recognition of his service and achievements in the field
of music, dance and yoga.
 BEST PERSONALITIES OF INDIA AWARD from Friendship Forum, New Delhi
for his excellent contribution towards welfare of people. August 2015.
 Included in ASIAN ADMIRABLE ACHIEVERS (Vol. VIII) published by
Rifacimento International, New Delhi, India.- September 2015.
 "MAHATMA GANDHI AWARD for Excellence to Outstanding Men and Women
of India" from Friendship Forum, New Delhi-November 2015.
 SHINING ACHIEVERS OF INDIA AWARD from Friendship Forum, New Delhi-
November 2015.
 Awarded BEST PAPER AWARD in the theme "Experiential Paradigm of Yoga in
Education" in the 8th International Conference on Yoga & Education at
Kaivalydhama, Lonavla, India from 27th - 30th December 2015. He received the
award from the hands of Swami Maheshanandaji (Chairman Kaivalydhama) in the
august presence of Dr BM Hegde and Sri DR Karthikeyan.
 BEST INDIAN PERSONALITIES AWARD 2016 from Friendship Forum, New
Delhi for Excellence in Yoga - Feb 2016.
 Included in ASIA PACIFIC WHO’S WHO (XIV Ed) published by Rifacimento
International, New Delhi- March 2016.
 Included in FAMOUS INDIA: NATION’S WHO’S WHO published by Reguerdon
Inc, New Delhi- October 2016.
 Recognized as PhD Guide (Yoga Therapy and Inter Disciplinary Research) by Sri
Balaji Vidyapeeth, Pondicherry in August 2016.
 Recognized as IAYT CERTIFIED YOGA THERAPIST by International
Association of Yoga Therapists, USA in September 2016. First Indian to receive
this honor.
 Honored with the InSPA PK Subbaraja Trust Best Performance Award by the CM
of Puducherry Sri V Narayanasamy during 6th InSPA International Conference and
3rd International Conference of the Department of Applied Psychology of
Pondicherry University at Convention Centre of the Pondicherry University on 13
Oct 2016.
 Nominated to the prestigious NATIONAL BOARD for the Promotion and
Development of Yoga and Naturopathy, Ministry of AYUSH, Govt of India on 3.12.
2017
 Included in ASIAN ADMIRABLE ACHIEVERS (Vol. X) published by Rifacimento
International, New Delhi, India. - March 2018.
 Nominated to the Standing Finance Committee of the CCRYN, Ministry of
AYUSH, Govt of India on 22.6. 2018
 “IRAINERI CHEMMAL” title awarded by Paniru Thirumurai Pannatu Manadu
(World Shaiva Tamil Conference) on 12 August 2018 at Pondicherry.
 Nominated to the Technical Committee of the Yoga Certification Board, MDNIY,
Ministry of AYUSH, Govt of India on 6.9. 2018
PUBLICATIONS IN YOGA AND YOGA THERAPY:
I. BOOKS (23)
1. YOGA FOR CHILDREN (1985)
2. YOGA FOR MODERN MAN (2002) & e-book 2013
3. THEORY SYLLABUS FOR YOGA COMPETITIONS (2002)
4. A YOGIC APPROACH TO STRESS (2003, 2007, 2018) - Italian ed & e-book 2013
5. A PRIMER OF YOGA THEORY (2004, 2008, 2014, 2017) & e-book (2013, 2014)
6. YOGA VINA VIDAI THOGUPPU (Tamil-2005) - 2nd ed, 2010- Meena
Ramanathan
7. YOGA: 1 TO 10 (2005) - Italian edition 2009 & e-book 2013
8. BASIC LESSONS IN HATHA YOGA (Tamil-2006) - Meena Ramanathan
9. Revised and edited the second edition of Dr Swami Gitananda Giri’s
CORRECTION OF BREATHING DISORDERS THROUGH
RISHICULTURE ASHTANGA YOGA (2006). - e-book 2013
10. Revised and edited the second edition of Dr Swami Gitananda Giri’s MUDRAS
(2006). - e-book 2013
11. YOGA FOR WEIGHT REDUCTION.(2008) & e-book 2013
12. YOGA FOR HEALTH AND HEALING (2008) & e-book 2013
13. CHAKRAS: THE PSYCHIC CENTRES OF YOGA & TANTRA (2008) - e-book
2013
14. PRANAYAMA IN THE GITANANDA YOGA TRADITION (2008)-Italian
edition 2009 - e-book 2013
15. YOGA FOR WEIGHT REDUCTION (TAMIL-2009) -With Meena Ramanathan
16. HATHA YOGA OF THE GITANANDA YOGA TRADITION (2009) -Italian
edition 2011 - e-book 2013
17. MEDITATION THE INNER YOGA (2009) - e-book 2013
18. Revised and edited the second edition of Dr Swami Gitananda Giri’s SURYA
NAMASKAR (2011). - e-book 2013
19. YOGA AND WELLNESS. A Yoga Module for Wellness by ICYER & Yoganjali
Natyalayam, Puducherry. Published by MDNIY, New Delhi for the National
Yoga Week- Feb 2011. - e-book 2013
20. UNDERSTANDING THE YOGA DARSHAN. An exploration of the Yoga
Sutra of Maharishi Patanjali. (2011) - e-book 2013
21. YOGA FOR A WHOLISTIC PERSONALITY. A Guide to Concepts and
Practices of Rishiculture Ashtanga Yoga as Taught by Yogamaharishi Dr Swami
Gitananda Giri Guru Maharaj, Founder Ananda Ashram. Published by MDNIY,
New Delhi for the National Yoga Week- Feb 2012. - e-book 2013
22. YOGA CHIKITSA: The Application of Yoga as a Therapy (2013) - e-book 2013
23. SARASWATI’S PEARLS –Dialogues on the Yoga of Sound with Dr. Sangeeta
Laura Biagi (2013). - e-book 2013
II. COMPILATIONS IN YOGA AND YOGA THERAPY: (29)
1. NOTES FOR PRACTICAL YOGA CLASSES. A booklet prepared for the
International Yoga Festival conducted by Pondicherry Government’s Tourism
Department. (2000 copies printed in 2006, 1500 copies reprinted in 2007, 1500 in 2008
and 1500 in 2009)
2. Compiled and edited 130 paged notes for the subject, “SCIENTIFIC BASIS OF
YOGA EDUCATION” for students of the D.Y.Ed course at Pondicherry University
Community College (2006).
3. Compiled and edited 135 paged notes for the subject, “PRINCIPLES AND
METHODS OF YOGA THERAPY” for students of the D.Y.Ed course at
Pondicherry University Community College (2007).
4. Compiled and edited 41 paged notes for the subject, “YOGA PRACTICALS-I” for
students of the PGDY and D.Y.Ed courses at Pondicherry University Community
College (2007).
5. Compiled and edited 62 paged notes for the subject, “YOGA PRACTICALS-II” for
students of the PGDY and D.Y.Ed courses at Pondicherry University Community
College (2007).
6. Compiled and edited 122 paged notes for the subject, “PRINCIPLES AND
METHODS OF YOGA PRACTICES” for students of the D.Y.Ed course at
Pondicherry University Community College (2009).
7. Assisted Dr Madanmohan, Programme Director ACYTER, JIPMER in compiling
Proceedings of the National Workshop on Introducing Yoga in the Medical
Curriculum (2009-10).
8. Assisted Dr Ishwara Acharya (PO YT) and Dr IV Basavaraddi, Director, MDNIY,
New Delhi in compiling a booklet on “YOGA & TECHNOSTRESS” for Yoga Week
2010 conducted by MDNIY (2010).
9. Compiled 60 paged handout materials for the National Workshop on Role of Yoga
in Prevention and Management of Hypertension, ACYTER, JIPMER, Pondicherry
(2010).
10. Compiled 60 paged educational handout materials on the Role of Yoga in
Prevention and Management of Diabetes Mellitus, ACYTER, JIPMER,
Pondicherry (2010).
Proceedings of the National Workshop on Role of Yoga in Hypertension (2010).
12. Editorial Board Member: YOGA TEACHER’S MANUAL for School Teachers.
MDNIY, Dept of AYUSH, Ministry of Health, Govt of India, New Delhi (2010).
Proceedings of the National Workshop on Role of Yoga in Diabetes Mellitus
(2011-12).
14. Compiled 125 paged monograph on Report on Yoga research Studies at ACYTER,
JIPMER: 2008-12 (2012).
15. Compiled and edited Compilation of ACYTER bulletins from April 2009 to
February 2012 (2012).
16. Compiled and edited 80 paged E-SOUVENIR and handout materials for the CME-
cum-Workshop on Yoga & Lifestyle Disorders at MGMC&RI, Pondicherry on 22
November 2013. This event was organized by Department of Physiology and Centre
for Yoga Therapy, Education and Research (CYTER), MGMC&RI, SBVU.
17. Guest Editor for the “Yoga and Lifestyle Disorders” section in a special issue on
Complementary and Alternative Medicine of the Annals of SBV (July-December)
2013.
18. Edited the YOGA DRISHTHI - A compilation of Swami Gitananda Giri’s
quotations by Dr Alan Davis. (2014) - e-book 2014
19. Compiled and edited 72 paged SOUVENIR for the CME on “Sleep, consciousness
and meditation: neurophysiological correlates” at MGMC&RI, Pondicherry on 27
November 2014. This event was organized by Department of Physiology and Centre
for Yoga Therapy, Education and Research (CYTER), MGMC&RI, SBVU.
20. Invited to be part of the team for putting together the first medical textbook on yoga
and yoga therapy, entitled The Principles and Practice of Yoga in Health Care that
is under contract with a well-respected British textbook publisher (Handspring
Publishing), and released in 2016. Was invited to be an advisor on the Yoga Therapy
section for various disorders and be author for a chapter on the "Historical
developments of Yoga as a therapy". The editorial team includes Timothy McCall,
Sat Bir Khalsa, Lorenzo Cohen, and Shirley Telles.
21. Compiled and edited 126 paged SOUVENIR for the INTERNATIONAL DAY OF
YOGA celebrations at Sri Balaji Vidyapeeth University held at Pondicherry from 21
to 26 June 2015. This event was organized by the Centre for Yoga Therapy,
Education and Research in association with Pondicherry Yogasana Association and
Department of Physiology, MGMCRI.
22. EDITOR of the Newsletter of the INDIAN YOGA ASSOCIATION, MDNIY, New
Delhi from December 2015 onwards.
Education and Research in association with Pondicherry Yogasana Association,
Department of Physiology, MGMCRI and Department of Tourism, Govt of
Pondicherry.
24. Compiled and edited 96 paged Yoga Practical Notes for CYTER at Sri Balaji
Vidyapeeth, Pondicherry-2 November 2016.
Education and Research in association with Pondicherry Yogasana Association,
Department of Physiology, MGMCRI and Department of Tourism, Govt of
Pondicherry.
26. Compiled and edited 260 paged SOUVENIR for the Golden Jubilee of Ananda
Ashram and Silver Jubilee of YOGNAT Celebrations held at Pondicherry on 5
August 2018.
27. Compiled and edited 130 paged notes for the subject, “SCIENTIFIC BASIS OF
YOGA EDUCATION” for students of the D.Y.Ed course at Pondicherry University
Community College (2006).
28. Compiled and edited, “Compilation of Best Practices of CYTER” for Sri Balaji
Vidyapeeth (2018).
29. Compiled and edited, “Notes on Anatomy & Physiology for Yoga Education” for
CYTER of Sri Balaji Vidyapeeth (2018).
III. VIDEO PRODUCTIONS IN YOGA AND YOGA THERAPY:

1. DVDs/ CDs with Super Audio Chennai:
1. Pranayama For Health And Well Being
2. Yoga for insomnia by Ammaji (Dhivyananda creations)
3. Satyam-Shivam-Sundaram (Dhivyananda creations)
4. Yoga Mudras- gestures for your hands, feet and eyes
5. Body Talk- Yoga gestures of the human body
6. Yoga Stress Busters
7. Yoga for breathing disorders
8. Yoga for weight loss
9. Meditation: The Inner Yoga
10. Chakras: the psychic centres of Yoga and Tantra
11. Yoga for diabetes
12. Yoga for hypertension
13. Yoga for spinal health
14. Yoga for healthy digestion
15. Yoga for arthritis
16. Yoga for pelvic health
17. Yoga for sleeping disorders
18. Advanced Pranayamas
19. Yoga in Your Office –Also available as applications for iPhone and iPad
2. MUSIC THERAPY AND YOGA (One DVD-three VCDs). Artistic choreography
of Yogasanas performed by students of Yognat the under direction of Dr Ananda in
tune with music composed by Dr Harre Harren, musicologist and music therapist.
These three VCDs are available separately or in combination in one DVD from Vedu
Electronics, Chennai.
3. Coordinated production of the DVD “HOMAGE TO THE NAVAGRAHAS” (live
performance) of Yognat’s dance drama (2006).
4. Coordinated the production of “KARNA CHARITRAM” a DVD (live performance)
of the dance drama by Yoganjali Natyalayam (2007).
5. Coordinated the production of “SAMBANDAR CHARITRAM” a DVD (live
performance) of dance drama by Yoganjali Natyalayam (2008).
6. Coordinated the production of “PANCHALI SABADAM” a DVD (live
performance) of dance drama by Yoganjali Natyalayam (2009).
7. Coordinated the production of “MURUGA MURUGA” a DVD (live performance)
of dance drama by Yoganjali Natyalayam (2010).
8. Coordinated the production of “SHAKUNTALA” a DVD (live performance) of
dance drama by Yoganjali Natyalayam (2011).
9. Coordinating Yoga expert with the STILL WATERS Company in Chennai for the
Advert film on the International Yoga Festival that won a BRONZE MEDAL at
CANNES 2008. Reported in The Hindu Metro Plus, Chennai the 7th July 2008.
10. Presented 5 episodes on Yoga for NDTV Good times (Reebok life channel) on Yoga
for neck pain, thyroid disorders, balance and stability, breathing disorders and
Pranayamas (2008) with numerous repeat broadcasts in 2009.
11. BASICS OF MRIDUNGAM: a VCD on basic lessons on the Mridungam.
12. Featured in Yoga: An Ancient Vision of Life, a full length documentary film by the
famed art historian Shri Benoy K Behl that has been showcased in many prestigious
films festivals worldwide (2014).
13. Featured in Yoga Therapy in India, a video project by Joseph and Lilian Le Page,
Directors of Integrative Yoga Therapy (IYT) in the USA and Enchanted Mountain
Yoga Center in Brazil. (2014-15)
14. Featured in Yoga: The Divinity of Grace, a documentary film by famed art historian
Shri Benoy K Behl showcased in many prestigious films festivals worldwide (2016).
IV. MUSIC ALBUMS:

1. Coordinated, composed and sang Classical Carnatic Music in English for the music
album THE YOGA OF SOUND. (1998)
2. Coordinated and sang exclusive Classical Carnatic Tamil compositions for the music
album TAMIL INBAM. 1999
3. Played Mridungam for Kalaimamani Pulavar Thiru I Pattabiraman’s Music Album-
SENDHEN TAMILISAI (2002)
4. Coordinated and played Mridungam for Smt Jyothirmayi’s Carnatic Vocal Music
Album “BHAKTI MANI MALA” (2003)
5. Coordinated the re-mastering and release of “BHAJANS WITH SWAMIJI” audio
album of Ananda Ashram Bhajans (2003)
6. Coordinated the production of “PANCHAKSHARA JAPA” audio album of
Ananda Ashram’s Maha Shivaratri Chanting (2004)
7. Coordinated the production of “PRANAVA SADHANA” audio album of Ananda
Ashram’s AUM (OM) Chanting (2004)
8. Played Mridungam for Dr M Harre Harren’s (Music therapist and healer) Indian
Music Therapy (2005) produced by Magnetic Marketing (P) Ltd, Chennai.
9. Played Mridungam for Dr M Harre Harren’s (Music therapist and healer) Nada
Yoga Sangam (2005) produced by Magnetic Marketing (P) Ltd, Chennai.
10. Played Mridungam for Dr M Harre Harren’s (Music therapist and healer) Music
Therapy (2005) produced by Magnetic Marketing (P) Ltd, Chennai.
11. Coordinated the production of “YOGNAT DANCE ITEMS-1” an audio album with
a collection of various items from Yoganjali Natyalayam live performances.
14. Coordinated the production of “VINTAGE CLASSICAL VOCAL” an audio album
with an archival collection of songs from a concert by Kalaimamani Srirengam R
Ranganathan one South India’s greatest classical vocalist who was Dr Ananda’s
musical Guru.
15. Coordinated the production of “DIKSHITAR KRITHIS” an audio album with an
archival collection of Muthuswami Dikshitar compositions sung by Kalaimamani
Srirengam R Ranganathan one South India’s greatest classical vocalist who was Dr
Ananda’s musical Guru.
16. Composed and choreographed an entire Bharata Natyam Margam that has been
released as a live audio CD “ANANDA NARTANA MARGAM” by Dhivyananda
Creations in 2007.
17. Coordinated and led CHANTING THE YOGA SUTRA, a two disc Audio CD
compilation produced and distributed by Super Audio, Chennai in 2011. Also
available as applications for iPhone and iPad
V. PUBLISHED PAPERS IN YOGA AND YOGA THERAPY: (197)

1. Madanmohan, Udupa K, Bhavanani AB, Krishnamurthy N, Pal GK. Modulation of
cold pressor- induced stress by Shavasan in normal adult volunteers. Indian J
Physiol Pharmacol 2002; 46 (3): 307-12.
2. Madanmohan, Bhavanani AB, Udupa K. Effect of direction of head on heart rate and
blood pressure. Yoga Mimamsa 2002; 34: 116-22.
3. Bhavanani AB. A scientific analysis of the nasal cycle and its applications.
Nisargopachar Varta (National Institute of Naturopathy, Pune); 2002; 5: 18-20.
4. 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(1): 27-33.
5. Bhavanani AB, Madanmohan, Udupa K. Acute effect of Mukh Bhastrika (a bellows
breathing) on reaction time. Indian J Physiol Pharmacol 2003; 47(3): 297-300.
6. Madanmohan, Jatiya L, Udupa K, Bhavanani AB. Effect of Yoga training on
handgrip, respiratory pressures and pulmonary function. Indian J Physiol
Pharmacol 2003; 47(4): 387-392.
7. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Kumar Babu PBVP.
Modulation of stress induced by isometric handgrip test in hypertensive patients
following yogic relaxation training. Indian J Physiol Pharmacol 2004; 48(1): 59-64.
8. Bhavanani AB. Recent studies on Yoga at JIPMER. Yoga Life 2003; 34(6): 3-11.
9. Madanmohan, Vijayalakshmi P, Udupa K, Bhavanani AB, Prakash ES. Review of
Shavasan studies conducted at JIPMER during 2001-02. Yoga Mimamsa 2003; 35 (1
and 2): 26-34.
10. Bhavanani AB. A study of the pattern of nasal dominance with reference to different
phases of the lunar cycle. Yoga Life 2004; 35(6): 19-24.
11. Bhavanani AB. Integral psychology of Yoga. Nisargopachar Varta (National
Institute of Naturopathy, Pune); 2004; 7: 9-11.
12. Bhavanani AB. Yoga for stress management. Nisargopachar Varta (National
13. Madanmohan, Prakash ES, Bhavanani AB, 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(3): 370-73.
14. Madanmohan, Udupa K, Bhavanani AB, Shatapathy CC, Sahai A. Modulation of
cardiovascular response to exercise by Yoga training. Indian J Physiol Pharmacol
2004; 48(4): 461-65.
15. 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(2): 132-38.
16. Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P and Surendiran A. Effect
of slow and fast Pranayamas on reaction time and cardio respiratory variables.
Indian J Physiol Pharmacol 2005; 49(3): 313-18.
17. Bhavanani AB. Introducing integral Yoga psychology in the teacher education
curriculum. Journal of the Indian Academy of Applied Psychology 2006; 32 (No.2)
Special Issue: 204-13.
18. Bhavanani AB. Yoga and modern medicine: possible meeting points. Proceedings of
the symposia on “Role of Yoga in enhancement of human performance and Yoga in
contemporary medicine”. JIPMER. Dec 2005. pg 6-19.
19. Bhavanani AB. Pranayama and its therapeutic potential. Proceedings of the National
Workshop on Pranayama: techniques, physiological basis and therapeutic potential.
JIPMER. Dec 2005.pg 17-25.
20. Bhavanani AB. Guidelines for the practice of Pranayama and classification of
Pranayamas. Proceedings of the National Workshop on Pranayama: techniques,
physiological basis and therapeutic potential. JIPMER. Dec 2005. pg 26-33.
21. Bhavanani AB. Introducing integral Yoga psychology in the teacher education
curriculum. Applying Psychology in Teacher Education. Pondicherry Cooperative
Book Society 2006. pg 111-27.
22. Bhavanani AB. Yoga for health in children. Souvenir of the National Yoga Week
2007. MDNIY, New Delhi, March 2007. Pg 74-80.
23. Bhavanani AB. Yoga and modern medicine: possible meeting points. Souvenir of the
National Yoga Week 2007. MDNIY, New Delhi, March 2007. Pg 81-87.
24. Bhavanani AB. Yoga for breathing difficulties. Applications of yoga therapy. A
collection of articles by eminent teachers and Gurus by Federation Francophone de
yoga. Quebec, Canada. 2007. pg 132-48
25. Bhavanani AB. Concepts and methods of teaching yoga. Effective teaching skills.
Pondicherry Cooperative Book Society 2007. pg 126-34
26. Bhavanani AB. Yoga and stress. Yoga Vijnana, a quarterly journal of Morarji Desai
National Institute of Yoga, New Delhi. July-Sept 2007: pg 9-26.
27. Bhavanani AB. Classification of actions according to the Gunas. Yoga Mimamsa
2006; 37 : 176-81
28. Bhavanani AB. Swarodaya Vijnana- A scientific study of the nasal cycle. Yoga
Mimamsa 2007; 39: 32-38.
29. Bhavanani AB. Scientific basis for some Yoga practices in sinusitis. Yoga Mimamsa
2007; 39 : 56-61.
30. Bhavanani AB. Basic practice of some pranayamas. Nisargopachar Varta (National
31. Bhavanani AB. Yoga for health in children. Nisargopachar Varta (National Institute
of Naturopathy, Pune); 2007; 5: 5-8.
32. Bhavanani AB. Indian approaches to school psychology. Souvenir of the National
Yoga Week. MDNIY, New Delhi, February 2009. Pg 90-93.
33. Therapeutic potential of Yoga. Souvenir of the UGC sponsored National Seminar on
Yoga and Holistic health. Nabira Mahavidyalaya, Katol, RTM Nagpur University,
5th April 2009. Pg 19-23.
34. Bhavanani AB. Rheumatological and immunological aspects of aging and the
importance of integrated approach of yoga in senior citizens. Yoga Mimamsa 2009;
41 : 23-33.
35. Bhavanani AB. Learning the art of relaxation. Yoga Mimamsa 2009; 41 : 303-14.
36. Bhavanani AB and Bhavanani D. Bharatanatyam and Yoga. Yoga Mimamsa 2009; 41
: 388-408.
37. Bhavanani AB. Therapeutic potential of Yoga (revised). Proceedings of the National
Workshop on Introducing Yoga in Medical Curriculum. ACTYER, JIPMER,
Pondicherry. March, 2009. Pg 51-55.
38. Bhavanani AB. Yoga and modern medicine: possible meeting points. Proceedings of
the National Workshop on Introducing Yoga in Medical Curriculum. ACTYER,
JIPMER, Pondicherry. March, 2009. Pg 25-36.
39. Bhavanani AB. Classification of actions according to the gunas. Nisargopachar Varta
2009; May: 21-24.
40. Bhavanani AB. Principles of Yoga Chikitsa (Yoga Therapy). Asana Journal. August
2009: 20-23
41. Bhavanani AB. Integral Psychology of Yoga Therapy. Integral Yoga Magazine, USA.
Summer 2009: 14-17.
42. Bhavanani AB. Are We Practicing Yoga Therapy Or Yogopathy? Integral Yoga
Magazine; Fall 2009: 10-11.
43. Bhavanani AB. Application of Yogic concepts in promotion of positive health.
Souvenir of the National Yoga Week 2010. MDNIY, New Delhi, Feb 2010. Pg 140-
143
44. Bhavanani AB. Combating technostress through Yoga. Souvenir of the National
Yoga Week 2010. MDNIY, New Delhi, Feb 2010. Pg 201-214
45. Bhavanani AB. Yoga practices for health. Nisargopachar Varta 2010; March: 28-35.
46. Bhavanani AB and Ramanathan M. Vairagya: Bedrock of Yoga Sadhana. Yoga
Mimamsa 2010;42: 48-57.
47. Bhavanani AB. An overview of the Yoga Sutras. Integral Yoga Magazine USA.
Spring 2010: 8-10.
48. Bhavanani AB. Yoga and cervical spondylosis. Proceedings of the National Seminar
cum Workshop on Role of Yoga in Geriatric Care with special reference to
Osteoarthritis. ACYER, Gujarat Ayurved University, Jamnagar. March 2010. pg 34.
49. Ramanathan M and Bhavanani AB. Yoga for the silver citizens. Proceedings of the
National Seminar cum Workshop on Role of Yoga in Geriatric Care with special
reference to Osteoarthritis. ACYER, Gujarat Ayurved University, Jamnagar. March
2010. pg 38.
50. Bhavanani AB. Yoga: A boon for maternal and child health. Yoga Mimamsa 2010;
42: 146-52.
51. Bhavanani AB and Bhavanani MD. Hatha Yoga: The Sadhana of Kali Yuga. Integral
Yoga Magazine USA. Summer 2010: 8-11.
52. Bhavanani AB. Yoga and hypertension. Proceedings of the National Workshop cum
Seminar on Role of Yoga in Prevention & Management of Hypertension. ACYTER,
JIPMER, Pondicherry. Mar 2010. pg 43-50.
53. Bhavanani AB. Yoga practices for hypertension. Proceedings of National Workshop
cum Seminar on Role of Yoga in Prevention & Management of Hypertension.
ACTYER, JIPMER, Pondicherry. March 2010. pg 89-103.
54. Bhavanani AB. Pranayama: its therapeutic and spiritual potential. Integral Yoga
Magazine; Fall 2010: 12-15.
55. Bhavanani AB. Normalization of the blood pressure with Yoga. Proceedings of the
International Interdisciplinary Scientific Conference “Yoga in Science - Future and
Perspectives” organised by the Yoga Federation of Serbia, Belgrade Sept 23-24, 2010.
pg 184-88
56. Bhavanani AB.Yogic perspectives on depression and mental health.Proceedings of
the Seminar on Yoga and Depression organised by Advanced Centre for Yoga,
NIMHANS, Bangalore. Sept 2010. pg 25-34.
57. Bhavanani AB. Application of yoga concept in the health improvement. Proceedings
of the International Interdisciplinary Scientific Conference “Yoga in Science - Future
and Perspectives” organised by Yoga Federation of Serbia, Belgrade Sept 23-24,
2010. pg 189-93
58. Bhavanani AB. Ante natal and post natal Yoga practices. Souvenir of the 8th
National Conference of the Society of Midwives-India. JIPMER, Pondicherry.
November 2010. pg 37-49
59. Bhavanani AB. Health and Well Being: A Yogic Perspective. Souvenir of the
National Yoga Week 2011. MDNIY, New Delhi, Feb 2011. Pg 70-79.
60. Bhavanani AB, Udupa K, Madanmohan, Ravindra PN. A comparative study of slow
and fast suryanamaskar on physiological functions. Int J Yoga 2011; 4: 72-77.
61. Bhavanani AB. Yoga practices for prevention and management of diabetes.
Proceedings of the National Workshop-cum-Seminar on Role of Yoga in Prevention
and Management of Diabetes Mellitus. ACTYER, JIPMER, Pondicherry. March 2011.
p 77-94.
62. Bhavanani AB. Nada Yoga Techniques for Prevention and Management of
Breathing Disorders. Yoga Life 2011. 42; (March): 3-6.
63. Bhavanani AB, Sanjay Z, Madanmohan. Effect of yoga on subclinical
hypothyroidism: a case report. Yoga Mimamsa 2011; 43: 102-107.
64. Bhavanani AB, Sanjay Z, Madanmohan. Immediate effect of sukha pranayama on
cardiovascular variables in patients of hypertension. International J Yoga Therapy
2011; 21: 4-7.
65. Bhavanani AB. A basic yoga therapy programme for patients of multiple sclerosis.
Souvenir of the Golden Jubilee Celebrations of Kaivalyadhama’s SrimatiAmolak
Devi Tirathram Gupta Yogic Hospital and Health Care Centre, 2011. p 14-20.
66. Bhavanani AB. Are we practicing yoga therapy or yogopathy? Yoga Therapy
Today 2011; 7 (2): 26-28
67. Bhavanani AB. Culturing one’s self though Yoga. Yoga Mimamsa 2011; 43 (1): 84-94.
68. Bhavanani AB. Don’t put yoga in a small box: the challenges of scientifically
studying yoga. International J of Yoga Therapy 2011; 21 ; 21.
69. Bhavanani AB. Hatha Yoga-The Science of Balance. Yoga Life 2011; 42 (7): 3-13
70. Bhavanani AB. Eka Dasi Prakriya of the Gitananda Tradition. Yoga Life 2011; 42 (11):
3-7.
71. Bhavanani AB. Meditation: The Inner Yoga. Integral Yoga Magazine, USA. Spring
2011. pg 22-25
72. Bhavanani AB. Perspective says it all or we see what we are. Yoga Life 2011; 42 (12):
5
73. Bhavanani AB. The Yoga of Responsibility. Yoga Life 2011; 42 (9): 3-10
74. Bhavanani AB. The Yoga Sutras of Maharishi Patanjali. Yoga Life 2011; 42 (8): 3-11
75. Bhavanani AB. Understanding the Science of Yoga. SENSE 2011; 1 (1): 334-344
76. Bhavanani AB. Yoga as a therapy: A perspective. Souvenir of the Yoga Update 2011
organised by ICYHC Kaivalyadhama, Mumbai. January 29-30, 2011. pg 91-100
77. Bhavanani AB. Yoga polarity: questions and answers. Yoga Life 2011; 42 (12): 3-4.
78. Bhavanani AB. Yogic perspective on depression and mental health. Yoga Mimamsa
2011; 43: 254-264.
79. Bhavanani AB. Understanding the Science of Yoga. Yoga Life 2011; 42: (5) 3-18.
80. Madanmohan, Bhavanani AB, Sanjay Z, G Dayanidy, L Vithiyalakshmi, E
Jayasettiaseelon. Results of a survey of participant feedback at ACYTER, JIPMER
Pondicherry. Yoga Life 2011; 42 (Nov): 11-13.
81. Bhavanani AB and Sanjay Z. The role of yoga in managing bronchitis. Clinical
Roundup: Selected Treatment Options for Bronchitis. Alternative and
Complementary Therapies. December 2011: 349-353.
82. Bhavanani AB. Yoga as a therapy: A perspective. Yoga Mimamsa 2011; 42 : 235-41.
83. Bhavanani AB. The yoga of interpersonal relationships. Souvenir of the National
Yoga Week 2012. MDNIY, New Delhi, Feb 2012. p 51-59.
84. Bhavanani AB, Madanmohan, Sanjay Z, Basavaraddi IV. Immediate cardiovascular
effects of pranava pranayama in hypertensive patients. Indian J Physiol Pharmacol
2012; 56 (3): 273–78.
85. Bhavanani AB, Sanjay Z, Madanmohan, Jayasettiaseelon E, Dayanidy G,
Vithiyalakshmi L. A Review of Selected Yoga Research Findings from ACYTER,
JIPMER in 2008-12. SENSE, 2012, Vol. 2 (2), 203-13.
86. Bhavanani AB, Madanmohan, Sanjay Z, Vithiyalakshmi L. Immediate
cardiovascular effects of pranava relaxation in patients of hypertension and
diabetes. Biomedical Human Kinetics 2012; 4:66-69.
87. Bhavanani AB, Madanmohan, Sanjay Z. Suryanadi pranayama (right unilateral
nostril breathing) may be safe for hypertensives. Journal of Yoga and Physical
Therapy 2012; 2: 118.
88. Bhavanani AB, Meena Ramanathan. Immediate cardiovascular effects of savitri
pranayama in sitting and supine positions in female volunteers. Yoga Mimamsa
2012; 44 (2): 101-12.
89. Bhavanani AB. Vairagya: The foundation of Yoga Sadhana. Integral Yoga Magazine
2012; Spring: 23-25.
90. Bhavanani AB, Ramanathan M, Harichandrakumar K T. Immediate effect of
mukhabhastrika (a bellows type pranayama) on reaction time in mentally
challenged adolescents. Indian J Physiol Pharmacol 2012; 56 : 174–180
91. Bhavanani AB, Sanjay Z, Madanmohan. Immediate effect of chandranadi
pranayama (left unilateral forced nostril breathing) on cardiovascular parameters in
hypertensive patients. Int J Yoga 2012; 5: 108-11
92. Bhavanani AB. A brief geographical history of yoga in modern India. International
J Yoga and Allied Sciences 2012; 1 (2): 156-68.
93. Bhavanani AB. HRV as a research tool in yoga. Souvenir of the CME–cum-
Workshop on “Heart rate variability: a diagnostic and research tool.” Dept of
Physiology, MGMCRI, Puducherry. 12.06.2012. pp 16-24.
94. Bhavanani AB. Importance of body mass index (BMI) and waist circumference (WC)
in yoga therapy in preempting possible complications of obesity. Yoga Mimamsa
2012; 43: 4: 316-325
95. Bhavanani AB. Understanding the Science of Yoga. Yoga Mimamsa 2012; 44 (3): 228-
45.
96. Bhavanani AB. Obstacles on the path of Yoga. Yoga Life 2012; 43: (9) 3-9
97. Bhavanani AB. Positive health through Yoga. Nisargopachar Varta 2012; 4 (9): 31-
34.
98. Bhavanani AB. Yoga in Healthcare. Proceedings of Patient First - Joint International
Conference on Quality Assurance and Patient Safety. Organized by Sri Balaji
Vidyapeeth & Royal College of Physicians & Surgeons Glasgow. Puducherry. Nov
2012. pp 96-105.
99. Bhavanani AB. Yoga: The original mind-body medicine. Integral Yoga Magazine.
Fall 2012. pg 16-17.
100. Bhavanani AB. HRV as a research tool in yoga. Yoga Mimamsa 2012; 44 (3): 188-99.
101. Madanmohan, Bhavanani AB, Dayanidy G, Sanjay Z, 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.
102. Bhavanani AB. Concepts of Health in Dravidian Yogic Treatises. Open Access
Scientific Reports (Journal of Yoga & Physical Therapy) 2012; 1: 123.
103. Bhavanani AB. Yoga for a healthy back. International Light (Official Journal of
IYTA, Australia) 2012; July-September: 6-11.
104. Bhavanani AB. Yoga is not an intervention, but maybe Yogopathy is. Int J Yoga
2012; 5: 157-58.
105. Bhavanani AB. Psychosomatic mechanisms of Yoga. Nisargopachar Varta 2013; 5
(4): 31-35.
106. Bhavanani AB, Sanjay Z, Jayasettiaseelon E, Dayanidy G, Vithiyalakshmi L,
Madanmohan. Physiological and psychological effects of a yoga training
programme in paramedical students. Yoga Mimamsa 2013; 44 (4): 246-64.
107. Gaur GS, Madanmohan, Bhavanani AB, Subramanian SK. Effect of yoga on cardio-
respiratory functions. Biomedicine 2013; 32 (2): 182-86.
108. Sharma VK, Trakroo M, Subramaniam V, Rajajeyakumar M, Bhavanani AB, Sahai
A. Effect of fast and slow pranayama on perceived stress and cardiovascular
parameters in young health-care students. Int J Yoga. 2013;6(2):104-10.
109. Madanmohan, Bhavanani AB. Studies on the Beneficial Effects of Yoga Training on
Adolescents of Pondicherry. Souvenir of the National Yoga Week 2013. MDNIY,
New Delhi, Feb 2013. Pg 48-53.
110. Madanmohan, Bhavanani AB, Pal GK, Udupa K, Krishnamurthy N. A comparative
study of the effects of asan, pranayama and asan-pranayama training on
neurological and neuromuscular functions of Pondicherry police trainees. Int J Yoga
2013; 6: 96-103.
111. Madanmohan, Bhavanani AB, Sanjay Z, 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 (3): 535-
41.
112. Bhavanani AB. Yoga: The ideal way of life. Yoga Mimamsa 2013; 44 (4): 314-25.
113. Bhavanani AB. Role of Yoga in geriatric psychiatric disorders. International J Yoga
& Allied Sciences 2013; 2 (1): 59-68.
114. Bhavanani AB. Yoga in health care. Annals of SBV 2012; 1 (2): 15-24.
115. 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.
116. Bhavanani AB. Modern Medicine, Meet Yoga. Integral Yoga Magazine USA. Fall
2013. pg 21-23.
117. 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.
118. 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.
119. Bhavanani AB, Ramanathan M, Madanmohan. Immediate cardiovascular effects of
a single yoga session in different conditions. AlternInteg Med 2013; 2: 144.
120. 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
121. Bhavanani AB. Psychosomatic mechanisms of yoga. Annals of SBV 2013; 2 (2): 27-
31.
122. Bhavanani AB. Yoga practices for prevention and management of lifestyle
disorders. Annals of SBV 2013; 2 (2): 32-40.
123. 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.
124. 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.
125. Bhavanani AB, Ramanathan M, Madanmohan. Immediate effect of alternate nostril
breathing on cardiovascular parameters and reaction time. Online International
Interdisciplinary Research Journal 2014; 4; (Sp Issue): 297-302.
126. Bhavanani AB. Yogic perspectives on mental health. International Light 2014. Jan-
March: 14-17.
127. Bhavanani AB. Yoga. Clinical Roundup: Selected Treatment Options for
Depression. Alternative and Complementary Therapies 2014; 20: 54-55.
128. Bhavanani AB, Madanmohan, Ramanathan M, Srinivasan AR. Yoga improves
psychophysical health of nursing students. Souvenir of the National Yoga Week
2014. MDNIY, New Delhi, Feb 2014. Pg 65-70.
129. Bhavanani AB. Introducing integral yoga education for the youth. Souvenir of the
National Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 84.
130. Ramanathan M and 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.
131. Rajajeyakumar M, Amudharaj D, Bandiharikrishna, 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.
132. Bhavanani AB. Yoga: A novel integrative therapy. NisarVarta 2014; 6 (5): 13-15.
133. 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.
134. 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 Research2014; 8 (5): BC01-03.
135. Bhavanani AB. Diverse dimensions of Yoga for the youth. Proceedings of National
Seminar on "Dimensions of Yoga and its dynamics" organized by Krishnamacharya
Yoga Mandiram and MoP Vaishnav College, Chennai. 4.7.2014. pg 39-52.
136. Bhavanani AB, Ramanathan M, Madanmohan. Yoga and mind body therapies in
health and disease: a brief review. Annals of SBV 2014; 3 (1): 29-41.
137. Bhavanani AB. Yogic perspectives on mental health. Annals of SBV 2014; 3 (1):47-
52.
138. Bhavanani AB. The yoga of interpersonal relationships. Annals of SBV 2014; 3(1):
53-60.
139. 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.
140. Bhavanani AB. Diverse dimensions of Yoga. Yoga Mimamsa. 2014; 46:3-8.
141. Majewski L and Bhavanani AB. A novel rejuvenation program for cancer patients
at Kaivalyadhama, India. Yoga Mimamsa 2014; 46:20-24.
142. Bhavanani AB and Ramanathan M. Meditation the Inner Yoga. Souvenir of the
CME on “Sleep, consciousness and meditation: neurological correlates.”
Department of Physiology & CYTER, Puducherry. 27.11.2014. pg 30-3532.
143. Dinesh T, Gaur G S, Sharma V K, Madanmohan T, Harichandra Kumar K,
Bhavanani AB. Comparative effect of 12 weeks of slow and fast pranayama training
on pulmonary function in young, healthy volunteers: A randomized controlled trial.
Int J Yoga 2015; 8: 22-26.
144. Bhavanani AB. Role of yoga in health and disease. Journal of Symptoms and Signs
2014; 3(5): 399-406.
145. Bhavanani AB. Role of yoga in non-communicable diseases: A brief review.
Souvenir of the National Yoga Week 2015. MDNIY, New Delhi, Feb 2015. Pg 53-60.
146. Bhavanani AB, Ramanathan M, Trakroo M. Single session of integrated ‘silver
yoga’ program improves cardiovascular parameters in senior citizens. J Intercult
Ethnopharmacol 2015; 4(2): 134-37.
147. Bhavanani AB. Potential of yoga as a therapy. Souvenir of International Day of
Yoga celebrations. SBVU, Puducherry. 21-26, June 2015. pg 80-83.
148. Bhavanani AB and Ramanathan M. Yoga practices for prevention and management
of psychosomatic stress disorders. Souvenir of International Day of Yoga
celebrations. SBVU, Puducherry. 21-26, June 2015. pg 92-106.
149. Punita P, Trakroo M, Palamalai SR, Subramanian S, Bhavanani AB, Madhavan C.
Randomized controlled trial of 12-week yoga therapy as lifestyle intervention in
patients of essential hypertension and cardiac autonomic function tests. Natl J
Physiol Pharm Pharmacol 2016; 6: 19-26.
150. Bhavanani AB, Ramanathan M, Trakroo M, Thirusangu S. Effects of a single session
of yogic relaxation on cardiovascular parameters in a transgender population.
International Journal of Physiology 2016; 4 (1) : 27-31.
151. Ramanathan M, Bhavanani AB. Health status of elderly women residing in a
hospice in Pondicherry. International Journal of Physiology 2016 ; 4 (1): 76-80.
152. Bhavanani AB, Raj JB, Ramanathan M, Trakroo M. Effect of different pranayamas
on respiratory sinus arrhythmia. Journal of Clinical and Diagnostic Research 2016;
10: CC04-CC06.
153. Bhavanani AB, Ramanathan M. Nasal cycle and its therapeutic applications: a yogic
perspective. Proceedings of the National Conference on Chronobiology and Health.
MGMCRI, Sri Balaji Vidyapeeth, Pondicherry. 18-19 March 2016. pp 26-28.
154. Bhavanani AB. A brief qualitative survey on the utilization of yoga research
resources by yoga teachers. J Intercult Ethnopharmacol. 2016; 5(2): 168-173
155. Sovik R, Bhavanani AB. History, Philosophy, and Practice of Yoga. In: Sat Bir
Khalsa, Lorenzo Cohen, Timothy McCall, and Shirley Telles editors. The Principles
and Practice of Yoga in Health Care. East Lothian, UK: Handspring Pub Ltd ; 2016.
p 17-29.
156. Bhavanani AB. Yoga and Cardiovascular Health: Exploring Possible Benefits and
Postulated Mechanisms. SM J Cardiovasc Dis. 2016; 1(1):1003.
157. Bhavanani AB. Integrating yoga and modern medical science. Souvenir of the
National Seminar and CME on Introducing Yoga in Health Professions Education.
SBVU, Puducherry. 19-21 June 2016. Pg 48-55.
158. Bhavanani AB. Yoga as a therapy in modern medical settings. Souvenir of the
159. Bhavanani AB. Simple yoga practices for health professionals. Souvenir of the
160. Madanmohan T and Bhavanani AB. Physiological Benefits Of Yogic Practices: A
Brief Review. International Journal of Traditional and Complementary Medicine
2016; 1(1): 0031-0043.
161. Bhavanani AB. Understanding Yoga as a Therapy. Journal of Yoga and
Physiotherapy 2016; 1 (1): 555551.
162. Bhavanani AB. Mental Health and Wellbeing through Yoga. Jacobs Journal of Yoga
and Natural Medicine 2016; 1(1): 004.
163. Bhavanani AB, Majewski L, Tiwari S. Effects of an Intensive 3-Week Yoga Retreat
on Sense of Well Being in Cancer Survivors. J Alt Med Res 2016; 2(2): 116.
164. Majewski L, Bhavanani AB. Enhancing Quality of Life in Cancer Survivors through
Yoga. Annals of SBV 2016; 5 (2): 7-13.
165. Bierski K, Bhavanani AB, Eswaran S, Madanmohan. Finding Peace on a Psychiatric
Ward with Yoga: Report on a Pilot Anthropological Study in Pondicherry, India.
Annals of SBV 2016; 5 (2): 14-19.
166. Bhavanani AB. Yoga Therapy: An Overview. Annals of SBV 2016; 5 (2): 28-30.
167. Bhavanani AB. Integrating Yoga in Health Professional Education: The SBV
Experience. Annals of SBV 2017; 6 (1): 28-32.
168. Vasanthan S, Madanmohan, Bhavanani AB, Hanifah M, Jaiganesh K. Comparative
study on the effect of yogic relaxing asanas and pranayamas on cardiovascular
response in healthy young volunteers. Natl J Physiol Pharm Pharmacol
2017;7(1):127-130.
169. Ramanathan M, Bhavanani AB, Trakroo M. Effect of a 12-week yoga therapy
program on mental health status in elderly women inmates of a hospice. Int J Yoga
2017; 10: 24-28.
170. Ramanathan M, Bhavanani AB. Understanding how yoga works: a short review of
findings from CYTER, Pondicherry, India. EJPMR 2017; 4(1): 256-262.
171. Ramanathan M, Bhavanani AB. Mental health and wellbeing in silver citizens
through yoga. EJBPS 2017; 4 (3): 288-292.
172. Vasanthan S, Madanmohan, Bhavanani AB, Hanifah M , Jaiganesh K.Effect of yogic
relaxing asans and pranayams on heart rate variability and perceived stress in
healthy Young volunteers - a comparative study. Int J Pharm Bio Sci 2017; 8 (2): 71-
76.
173. Ramanathan M, Bhavanani AB. Research studies on the role of yoga in chronic
diseases. Souvenir of International Day of Yoga celebrations 2k17 at SBVU,
Puducherry. 19-23, June 2017. pg 47-51.
174. Ramanathan M, Bhavanani AB. Resilience as an antidote to chronic diseases:
Possible role of Yoga. Souvenir of International Day of Yoga celebrations 2k17 at
SBVU, Puducherry. 19-23, June 2017. pg 52-56.
175. Bhavanani AB, Ramanathan M. Yoga therapy for chronic diseases: psychosomatic
aspects. Souvenir of International Day of Yoga celebrations 2k17 at SBVU,
Puducherry. 19-23, June 2017. pg 57-63.
176. Bhavanani AB. Integrating Yoga in Health Professional Education: The SBV
Experience. Journal of Education Technology in Health Sciences, May-August,
2017;4(2): 42-46.
177. Bhavanani AB and Ramanathan M. Psychophysiology of Yoga Postures: Ancient
and Modern Perspectives of Asanas. In: Shirley Telles and Nilkamal Singh editors.
Research-Based Perspectives on the Psychophysiology of Yoga. IGI Global,
Editors:,2017. p.1-16
178. Bhavanani AB. Efficacy of Yoga in Respiratory Disorders: Some Research Finding.
Tamilnadu and Puducherry State Conference on Pulmonary Diseases TAPPCON
2017 at SBVU, Pondicherry. Pg 55-57.
179. Bhavanani AB. Yoga for Dental Professional : Scope and Simplified Practices.
Journal of Scientific Dentistry, 2017;7(1):1-11.
180. Bhavanani AB. Role of yoga in prevention and management of lifestyle disorders.
Yoga Mimamsa 2017; 49: 42-7.
181. Pal D, K, Bhalla A, Bammidi S, Telles S, Kohli A, Kumar S, Devi P, Kaur N, Sharma
K, Kumar R, Malik N, Thakur V, Bhargava G, G, Goyal A, K, Devi G, Chauhan S,
Singh G, Ahmad S, Joshi M, Narwal S, Sharma K, Tyagi R, Modgil S, Bali P, Bhatt V,
Sharma J, Singh A, Negi J, Rajesh S, K, Sharma G, Sharma P, Vats R, Nagarathna R,
Bhavanani A, B, Burugupalli K, M, Vetrivendan R, Nagendra H, R, Anand A. Can
Yoga-Based Diabetes Management Studies Facilitate Integrative Medicine in India
Current Status and Future Directions. Integr Med Int 2017;4: 125-141
182. Bhavanani AB, Ramanathan M, Dayanidy G, Trakroo M, Renuka K. A Comparative
Study of the Differential Effects of Short Term Asana and Pranayama Training on
Reaction Time. Ann Med Health Sci Res. 2017; 7: 80-83.
183. Bhavanani AB. Somato-Psychic Aspects of Asana (Yogic Postures). Ann Yoga Phys
Ther. 2018; 3(1):1038.
184. Dutta A, Green SR, Balayogi AB, Hemachandar R, Dhivya P, Mathew KT. Effect of
yoga therapy on fasting lipid profile in chronic kidney disease: a comparative study.
International Journal of Advances in Medicine 5 (2), 294-298.
185. Raghul S, Vasanthan S, Bhavanani AB, Jaiganesh K, Madanmohan T. Effects of
overnight sleep deprivation on autonomic function and perceived stress in young
health professionals and their reversal through yogic relaxation (Shavasana). Natl J
Physiol Pharm Pharmacol 2018;8 (Online First). Doi:
10.5455/njppp.2018.8.0415003052018
186. Ramanathan M, Bhavanani AB. Understanding the third gender: a yogic
perspective. Souvenir of the National Seminar and CME on Swastha Manas: Mental
Health and Well-being through Yoga. SBVU, Puducherry. 18-26 June 20186. Pg 57-
62.
187. Dayanidy G, Bhavanani AB. Mental health and personality development through
yoga. Souvenir of the National Seminar and CME on Swastha Manas: Mental Health
and Well-being through Yoga. SBVU, Puducherry. 18-26 June 20186. Pg 67-70.
188. Ramanathan M, Bhavanani AB. A 12-Week “Silver Yoga” Program Enhances Lung
Function in Elderly Women Residents of a Hospice. Journal of Clinical & Diagnostic
Research 2018; 12 (8): KC01 - KC04
189. Ramanathan M, Bhavanani AB. Addressing Autism Spectrum Disorder through
Yoga as a Complementary Therapy. SBV Journal of Basic Clinical and Applied
Health Science 2018; 2 (2): 3-7.
190. Dayanidy G, AB Bhavanani, M Ramanataan. Enhancing awareness of yoga in
health professions education students through a single interactive session: A
pretest-post test study. Journal of Education Technology in Health Sciences 2018; 5
(1): 20-24.
191. Bhavanani AB. Model, methods, and perspectives in yoga. Int J Yoga 2018;11:258-
60.
192. Sharma VK, Dinesh T, Rajajeyakumar M, Grrishma B, Bhavanani AB. Impact of Fast
and Slow Pranayam on Cardio Vascular Autonomic Function among Healthy
Young Volunteers: Randomized Controlled Study. Altern Integr Med 2018; 7:
1000265.
193. Artchoudane S, Ranganadin P, Bhavanani A, Ramanathan M, Trakroo M. Effect of
adjuvant yoga therapy on pulmonary function and quality of life among patients
with chronic obstructive pulmonary disease (COPD) : A randomized control trial.
JBCAHS 2018; 2(3):117-22.
194. Vasundhara VR, Bhavanani AB, Ramanathan M, Ghose S, Dayanidy G. Immediate
effect of Sukha Pranayama: A slow and deep breathing technique on maternal and
fetal cardiovascular parameters. Yoga Mimamsa 2018;50:49-52
195. Effectiveness of adjuvant yoga therapy in diabetic lung: a randomized control trial.
(In press)
196. The efficacy of Yogic breathing exercise Bhramari pranayama in relieving
symptoms of chronic rhinosinusitis. (In press)
197. A comparative study on the effect of music therapy alone and a combination of
music and yoga therapies on the psycho-physiological parameters of cardiac
patients posted for angiography. (In press)
VI. SCIENTIFIC ABSTRACTS IN YOGA AND YOGA THERAPY: (76)

1. Effect of yogic breathing exercises on systolic time intervals in normal young adults.
Proceedings of the 47th Annual Conference of Association of Physiologists and
Pharmacologists of India (APPI). Indian J Physiol Pharmacol 45 (5) 2001. Pg. 117.
2. Effect of direction of head on heart rate and blood pressure during Shavasan.
Pharmacologists of India (APPI). Indian J Physiol Pharmacol 45 (5) 2001.pg 60.
3. Modulation of cold pressor- induced stress by Shavasan in normal adult volunteers.
Yogic Prakritik Jeevan Sandesh. 2002; 2 (2, 3, 4): pg. 3.
4. Effect of Pranayama training on cardiac function in normal young adults. Yogic
Prakritik Jeevan Sandesh. 2002 ; 2 (2,3,4): pg 4.
5. Effect of Mukh Bhastrika (a Yogic bellows type breathing) on reaction time. Souvenir
and abstracts 23rd Annual Conference of the Indian Association of Biomedical
Scientists, JIPMER, Pondicherry, 6.10. 2002. Pg 38.
6. Effect of Yoga training on pulmonary functions and handgrip endurance. Souvenir
and abstracts 23rd Annual Conference of the Indian Association of Biomedical
Scientists, JIPMER, Pondicherry, 6.10. 2002. Pg 37
7. Effect of Suryanamaskar training on pulmonary functions and handgrip endurance.
Souvenir and abstracts 23rd Annual Conference of the Indian Association of
Biomedical Scientists, JIPMER, Pondicherry, 6.10. 2002. Pg 44
8. A comparative study of the effect of slow and fast Suryanamaskar training on blood
pressure and handgrip endurance. Souvenir and abstracts 23rd Annual Conference
of the Indian Association of Biomedical Scientists, JIPMER, Pondicherry, 6.10. 2002.
Pg 39
9. Effect of Shavasan on heart rate variability in normal student volunteers. Souvenir
and abstracts 23rd Annual Conference of the IABMS, JIPMER, Pondicherry, 6.10.
2002. Pg 39
10. Modulation of stress induced by isometric handgrip test in hypertensive patients
following yogic relaxation training. Souvenir and abstracts 23rd Annual Conference
of the IABMS, JIPMER, Pondicherry, 6.10. 2002. Pg 37.
11. Modulation of cardiovascular response to exercise stress by Yoga training.
Pharmacologists of India (APPI). Indian J Physiol Pharmacol 46 (5) 2002. Pg 67.
12. Review of Shavasana studies. Abstracts of 4th International Conference on Yoga
Research and Value Education, Kaivalyadhama, Lonavla 2002.
13. Review of Yoga studies at JIPMER. Souvenir of the Annual Conference of
Association of Physiologists and Pharmacologists of India (APPI), Pondicherry
Branch, April 2003.
14. Integral Psychology of Yoga. Souvenir of the International Seminar on Integral Yoga
Psychology conducted by the Pondicherry Psychology Association in collaboration
with the Indian Academy of Applied Psychology, Pondicherry, June 2004.
15. Yoga for educators. Souvenir of 2nd International Seminar on Integral Yoga
Psychology and 6th National Conference on Integral Education conducted by
Pondicherry Psychology Association in collaboration with All India Association for
Educational Research, Pondicherry, January 2005.
16. Therapeutic Aspects of Yogic Pranayama. Souvenir of International CME on Yoga
Therapy in Current Millennium & Annual Meet of Indian Academy of Yoga
organised by Indian Academy of Yoga, Yoga Sadhana Kendra & Institute of Medical
Sciences, BHU, India - March 2005.
17. Yoga and Modern Medicine: Possible meeting points. Souvenir of International
CME on Yoga Therapy in Current Millennium & Annual Meet of Indian Academy
of Yoga organised by Indian Academy of Yoga, Yoga Sadhana Kendra & Institute of
Medical Sciences, BHU, India - March 2005.
18. De-stress for a happy and healthy life. Workshop manual of the National Workshop
on Stress and its Management by Yoga Relaxation Techniques. Organised by
Department of Physiology, JIPMER, Pondicherry, 16 to 18 March 2005. Pg 24-25.
19. Therapeutic potential of Pranayama. Proceedings of the 51st Annual Conference of
Association of Physiologists and Pharmacologists of India (APPI). IJPP 2005; 49 (5) :
22.
20. Physiological benefits of Yoga training. Proceedings of the 51st Annual Conference
of Association of Physiologists and Pharmacologists of India (APPI). IJPP 2005; 49
(5): 29.
21. The art of relaxation in Gitananda Yoga. Souvenir of the 2nd International
conference on Psychotherapy, Yoga and Spirituality. Haridwar. November 27-29,
2005. pg 53.
22. Introducing integral Yoga education in the teacher training curriculum. Souvenir of
the 7th National Conference on Integral Education conducted by the Pondicherry
Psychology Association, Pondicherry, January 2006.
23. Yoga for health in children. Abstracts of National Yoga Week 2007. MDNIY, New
Delhi. pg 14.
24. The art of relaxation in Gitananda Yoga. Souvenir of the 3rd International conference
on Psychotherapy and Yoga. Sagar (MP). November 23-25, 2007. pg 29-30.
25. Yoga for weight reduction. Abstracts of National Yoga Week 2008. MDNIY, New
Delhi. pg 24-25.
26. Rheumatological and immunological aspects of aging and the importance of
integrated approach of Yoga in senior citizens. Yogic Prakritik Jeevan Sandesh. Jan-
March 2009; 7 (4): pg. 19-21.
27. Culturing one’s self though Yoga. Abstracts of 12th National Conference on
Developing School Psychology in India conducted by Pondicherry Psychology
Association, Jan 2010. pg 51-52.
28. Yoga and stress: A perspective. Souvenir of workshop on Yoga for Stress
Management & Personality Development. Anandita Trust, New Delhi at
Pondicherry. 2010. Pg 1-2.
29. Culturing oneself. Souvenir of Workshop on Yoga for Stress Management and
Personality Development, organized by Anandita Trust, New Delhi at Pondicherry.
2010. Pg 16-17.
30. Yoga and cervical spondylosis. Abstracts of the National Seminar cum Workshop
on Role of Yoga in Geriatric Care. ACYER, Gujarat Ayurved University,
Jamnagar.2010. pg 14.
31. Immediate effect of sukha pranayama on heart rate and blood pressure of patients
with hypertension. Proceedings of National Workshop cum Seminar on Role of
Yoga in Prevention and Management of Hypertension. ACTYER, JIPMER,
Pondicherry. March 2010. pg 109.
32. Immediate cardiovascular effects of kaya kriya in normal healthy volunteers.
Proceedings of the National Workshop cum Seminar on Role of Yoga in Prevention
and Management of Hypertension. ACTYER, JIPMER, Pondicherry. March 2010. pg
109.
33. Immediate effect of shavasana and savitri pranayama on heart rate and blood
pressure of hypertensive patients. Proceedings of National Workshop cum Seminar
on Role of Yoga in Prevention & Management of Hypertension. ACTYER, JIPMER,
Pondicherry. Mar 2010: p110.
34. Immediate effect of chandra nadi pranayama on heart rate and blood pressure of
hypertensive patients Proceedings of the National Workshop cum Seminar on Role
of Yoga in Prevention and Management of Hypertension. ACTYER, JIPMER,
Pondicherry. March 2010. pg 111.
35. Immediate effect of pranava pranayama in patients of hypertension Proceedings of
the National Workshop cum Seminar on Role of Yoga in Prevention and
Management of Hypertension. ACTYER, JIPMER, Pondicherry. March 2010. pg 111.
36. Immediate effects of yoga nidra on heart rate and blood pressure Proceedings of the
National Workshop cum Seminar on Role of Yoga in Prevention and Management
of Hypertension. ACTYER, JIPMER, Pondicherry. March 2010. pg 112.
37. Teaching Concepts and Techniques of Yoga to Children. Abstracts of the National
Seminar cum Workshop on Role of Yoga in Respiratory Tract Disorders with Special
Reference to Bronchial Asthma. ACYER, Gujarat Ayurved University,
Jamnagar.2011. pg 14.
38. Yoga for Breathing Disorders. Abstracts of the National Seminar cum Workshop on
Role of Yoga in Respiratory Tract Disorders with Special Reference to Bronchial
Asthma. ACYER, Gujarat Ayurved University, Jamnagar.2011. pg 19-20.
39. A Study of Swara (Nasal Dominance) Pattern With Reference to Different Phases of
the Lunar Cycle. First international conference on yoga for health and social
transformation. Organized by the University of Patanjali & Patanjali Research
Foundation, Haridwar, India. Jan 2011. Pg. 148.
40. Immediate effect of suryanadi and chandranadi on short term heart rate variability
in healthy volunteers. Indian J Physiol Pharmacol 2011; 55 (5 supplement) : 43-44.
41. Yoga and the educational process. Souvenir of the 19th International conference on
frontiers in yoga research and its applications. Organized by sVYASA, Bengaluru,
India. Dec 2011. Pg. 122.
42. Effect of yoga therapy on reaction time, biochemical parameters and wellness score
of peri and post-menopausal diabetic patients. Proceedings of National Workshop-
cum-Seminar on Role of Yoga in Prevention and Management of DM. ACYTER,
JIPMER. Mar 2011. p 97-98.
43. Immediate effect of shavasana on short term heart rate variability in heart failure
patients. Abstracts of the International Conference on Cardiovascular Research
Convergence. February 2012. AIIMS, New Delhi. Pg 141.
44. HRV as a research tool in yoga. CME–cum- Workshop on “Heart rate variability: a
diagnostic and research tool.” Department of Physiology, MGMCRI, Puducherry.
12.06.2012. pp 30.
45. Impact of yoga-based lifestyle intervention for distal symmetric polyneuropathy
associated with type 2 diabetes mellitus. X Diabetic Foot Study Group Meeting,
Berlin-Potsdam, Germany, 28-30, September 2012. P 47
46. Psychosomatic mechanisms of yoga. Souvenir and proceedings of the National
Conference on Mind Body medicine. Department of Physiology, JNMC, DMIMSDU,
Wardha, Maharasthra. 21.12.2012. pp 13.
47. Differential effects of uninostril and alternate nostril pranayamas on cardiovascular
parameters and reaction time. Abstracts of the 7th International Conference on Yoga
at Kaivalyadhama, Maharasthra. 27 -30 December, 2012. pp 18-19.
48. Immediate effect of chandranadi pranayam on heart rate variability and
cardiovascular parameters in patients of diabetes mellitus and hypertension.
Abstracts of 2nd international conference on yoga for health and social
transformation. Organized by the University of Patanjali and Patanjali Research
Foundation, Haridwar, India. January, 2013. Pg. 120.
49. Health, rejuvenation and longevity: an ayurvedic perspective. 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.
50. Yoga and modern medicine: need for integration. 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.
51. Effect of yoga training on cardiorespiratory health in obese subjects. 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.
52. Yoga works, but how? 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.
53. Immediate cardiovascular effects of pranayamas in patients of hypertension.
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.
54. Effect of 12 weeks of pranayama training on tested basal physiological parameters
in young, healthy volunteers. Indian J Physiol Pharmacol 2013; 57 (5 supplement) :
122-23.
55. Yoga improves psychophysical health of nursing students. Abstracts of the National
Yoga Week 2014. MDNIY, New Delhi, Feb 2014. Pg 21.
56. Introducing integral yoga education for the youth. Abstracts of the National Yoga
Week 2014. MDNIY, New Delhi, Feb 2014. Pg 22.
57. Therapeutic potential of meditation. Souvenir of the CME on “Sleep, consciousness
and meditation: neurological correlates.” Department of Physiology and CYTER,
MGMCRI, Puducherry. 27.11.2014. pg 25
58. Meditation the inner Yoga. Souvenir of the CME on “Sleep, consciousness and
meditation: neurological correlates.” Department of Physiology and CYTER,
MGMCRI, Puducherry. 27.11.2014. pg 30-35
59. Role of yoga in non-communicable diseases. Abstracts of the National Yoga Week
2015. MDNIY, New Delhi, Feb 2015. Pg 6-7.
60. Experiencing deeper relaxation through Gitananda Yoga. Abstracts of 8th
International Conference on Yoga and Education, Kaivalyadhama, Lonavla -27-30
December 2015. Pg 19.
61. Adaptive resilience exercises as envisioned in yoga. Proceedings of National
Conference on Chronobiology & Health. MGMCRI, SBV, Pondicherry. 18-19 March
2016. pp 37-38.
62. Bhavanani AB. Power of Pranayama. Abstracts of International Conference on Yoga
for Body & Beyond. Ministry of AYUSH, Govt of India. New Delhi. 22-23 June 2016.
pg 20.
63. Restoring human values in medicine: Role of Yoga. National Conference on
Changing Trends in Health Professions Education (NC-CTHPE 2016). SBV,
Pondicherry. 18-21 Aug 2016. pp.85-86.
64. Psychophysiological benefits of yoga training in physiotherapy students. National
Conference on Changing Trends in Health Professions Education (NC-CTHPE
2016). SBV, Pondicherry. 18-21 Aug 2016. pp.87-88.
65. Yoga for nursing students: rationale and psychophysical benefits. National
Conference on Changing Trends in Health Professions Education (NC-CTHPE
2016). SBV, Pondicherry. 18-21 Aug 2016. pp.95-96
66. A comparative study of the effect of yogic relaxing asanas and pranayamas on HRV
and perceived stress in healthy young volunteers. 10th Annual Conference of
Association of Physiologists of Tamil Nadu (ENVOCCON). Sri Balaji Medical
College and Hospital, Bharat University, Chennai. 9-11 September 2016. Pp. 202.
67. Mental Health and Wellbeing through Yoga. Book of abstracts. 6th InSPA
International Conference and 3rdInternational Conference of the Department of
Applied Psychology of Pondicherry University. Pondicherry, 13-15 October 2016.
68. Enhancing Management of Type 2 Diabetes through Yoga. Souvenir of the CME on
‘Translational Medicine in the Diagnosis and Management of Diabetes Mellitus’,
organized by Dept of Biochemistry, MGMCRI, Pondicherry on 10 November 2016.
69. Vasanthan S, Raghul S, Bhavanani AB, Jaiganesh K. Effect of overnight sleep
deprivation on autonomic function test and perceived stress in young healthy
medical professionals. Abstracts of SYMMEDCON 2017, International conference
on Stress, Yoga, Mind-Body Medicine. Sri Ramachandra Medical College &
Research Institute, Porur, Chennai. 2- 4 January 2017. Pg 54.
70. Bhavanani AB. Role of Yoga in prevention and management of lifestyle disorders.
Proceeding & abstracts of the Golden Jubilee International Conference of Indian
Pharmacological Society, Southern Region – 2017 at MGMCRI, Puducherry on 4 &
5 July 2017. Pg 63-65.
71. Uthiravelu P, Jaiganesh K, A B Bhavanani, Mohamed Hanifah. Effect of eight
weeks yoga therapy on blood pressure, heart rate variability and oxidative stress
markers in newly diagnosed essential hypertension. Abstracts of SYMMEDCON
2018, 2nd International conference on Stress, Yoga, Mind-Body Medicine. Sri
Ramachandra Medical College & Research Institute, Porur, Chennai. January 2018.
Pg 161
72. Selvakumar S, Jaiganesh K, Srinivasan AR, Bhavanani AB. Effect of yogic
intervention on resting heart rate variability and markers of oxidative stress in
geriatric volunteers. Abstracts of SYMMEDCON 2018, 2nd International conference
on Stress, Yoga, Mind-Body Medicine. Sri Ramachandra Medical College &
Research Institute, Porur, Chennai. January 2018. Pg 165.
73. Bhavanani AB, Ramanathan M, Dayanidy G, Madanmohan Trakroo and Renuka K.
A Comparative Study of the Differential Effects of Short Term Asana and
Pranayama Training on Reaction Time. Annals of SBV 2018; 7 (1): 90.
74. Bhavanani AB. Role of Yogic relaxation in cardiac rehabilitation. Souvenir of
AYUSH International Conference on Yoga for Public Health, Goa Kala Academy.
12-13 November 2018. Pg 21.
75. Adkoli BV, Bhavanani AB, Dayanidy G, and Meena Ramanathan. Can Yoga be
incorporated in the Curriculum of Health Professions Education? The experience
from Sri Balaji Vidyapeeth (Deemed University), Pondicherry. NCHPE 2018,
Nagpur.
76. Bhavanani AB. The role of yoga in multidimensional detoxification. Conference
Souvenir. STOX2018. Pondicherry. 13 & 14 December 2018.Pg 5.
VII. PUBLISHED NUMEROUS ARTICLES IN:

 YOGA LIFE. International Journal of Yoga Jivana Satsangha (International),
Ananda Ashram, Pondicherry.
 INTEGRAL YOGA MAGAZINE, Yogville, USA
 YOGA SADHANA Journal. Yoga Journal of the Lotus Yoga Retreat, New Zealand.
 YOGA VIJNANA, Journal of MDNIY, New Delhi, India
 YOGA NEWS. e-newsletter of the International Yogalayam
 NISARGOPACHAR VARTA. Journal of National Institute of Naturopathy, Pune,
India.
 KAIVALYADHAMA NEWSLETTER from Lonavla, India
 YOGA STUDIES. Tri-annual e-newsletter of the Yoga Research and Education
Center (YREC) and International Association of Yoga Therapists (IAYT), USA.
 INTERNATIONAL LIGHT. Yoga Journal of International Yoga Teachers
Association (IYTA), Australia.
 YOGIC PRAKRITIK JEEVAN SANDESH. Newsletter of CCRYN, Ministry of
Health and Family Welfare, New Delhi.
 SOUVENIR OF INTERNATIONAL YOGA FESTIVAL, Tourism Dept, Govt. of
Pondicherry. 2001, 2002 and 2003.
 WEEKLY YOGA COLUMN in Tamil newspaper DHINAGARAN : Sept 2004 –Mar
2006.
 EDITOR OF INTERNATIONAL YOGA FESTIVAL SOUVENIR, Tourism Dept,
Govt. of Pondicherry. (2002, 2003 and 2004).
 WEEKLY YOGA COLUMN in Tamil newspaper MALAR PLUS from Aug 2005 –
Mar 2006.
 WEEKLY YOGA COLUMN in Tamil magazine DEVI July –August 2006.
 TATTVALOKA. Journal of Sri Sringeri Sharadha Peetham, India.
 COMPILED BULLETIN OF ACYTER, JIPMER –2009 (July and October editions),
2010 (January, April, July and Oct editions), 2011 (January, April, July and Oct
editions).
PHD GUIDE / CO-GUIDE /EXAMINER:

1. Invited to be examiner for Doctor of Philosophy thesis on “Understanding Modern
Yoga Pedagogy and Curriculum: An Interpretive Study Exploring Sense-Making by
Senior Western Yoga Teacher-Trainers” at University of Southern
Queensland (USQ), Toowoomba, Queensland, Australia in 2016.
2. Invited to be an examiner for Doctor of Philosophy thesis on “Effect of yoga based
lifestyle intervention on cardiovascular variables, psychopathologies and cognitive
functions in hypertension patients” at the Swami Vivekananda Yoga Anusandhana
Samsthana (Deemed University), Bengaluru, India in 2017.
3. Member of the KHYF Therapy Evaluation Board since April 2017. Evaluating Yoga
therapy project submissions from students of the Yoga therapy certification through
KHYF International.
4. Guide for following candidates:
1. Dr R Balaji- MPhil Yoga therapy 2016, SBV
2. Mr Archudane- MPhil Yoga therapy 2016, SBV
3. Mr G Dayanidy-PhD Yoga Therapy 2017, SBV
4. Mr Kiaan Gupta - MPhil Yoga therapy 2018, SBV
5. Ms Garima Setia -PhD Yoga Therapy 2018, SBV
6. Mrs Priya Felix Philip -PhD Yoga Therapy 2018, SBV
5. Co-guide for following candidates:
1. Dr. Rajeswari A -DM (Neuro) – JIPMER -2012- The effect of a yogic relaxation
technique (pranava yoga) on cerebrovascular circulation as measured by
TCD in patients with recent ischemic stroke
2. Dr. Vasanthan S- (PhD)-SBV-2013-17: A comparative study on the effect of
yogic relaxing asans and pranayams on heart rate variability and perceived
stress in healthy young volunteers.
3. Dr. Anirban Dutta - (MD General medicine)-SBV (2015)- Assessment of
fasting lipid profile in chronic kidney disease and the effect of yoga therapy.
4. Mr. Uthiravelu P- (PhD)-SBV (2016)- Effect of yoga therapy on autonomic
function and biochemical parameters in patients with newly diagnosed
essential hypertension: A randomized controlled trial.
5. Dr. Selvakumar S- (PhD)-SBV (2016)- Effect of yogic intervention on
oxidative stress and cellular aging in elderly volunteers.
6. Abishek K. (MBBS Student-ICMR-2016). The efficacy of bhramari
pranayama in relieving symptoms of chronic rhinosinusitis - a randomized
study.
7. Rahul S. (MBBS Student-ICMR-2016). Effect of overnight sleep deprivation
on autonomic function test and perceived stress in young healthy
volunteers.
8. Mrs Mangala Gowri - (PhD)-SBV (2016)- Yoga in DM.
9. Dr. Suriyakumar- (MD Psychiatry)-SBV (2016)- Yoga in depression.
10. Dr Venkatesh Kumar- (MD General Medicine) SBV (2017)- Yoga in COPD
11. Dr R Balaji PhD-SBV-2017
12. Dr Vasundhara-MPhil -SBV2017-18
13. Mr Artchudane S-PhD Yoga Therapy 2018, SBV
14. Dr B Rajalakshmi -PhD Yoga Therapy 2018, SBV
BHARATA NATYAM ARTISTE, TEACHER AND CHOREOGRAPHER:

 He was a performer of Bharatanatyam and has performed all over India and notably
at the ABHAI National Dance Festival in 1992. Following his father's Maha
Samadhi on Dec. 29-1993 he has stopped his dance performances and instead,
focused his attention on Dance Choreography, especially in the rhythmic aspect for
Yoganjali Natyalayam.
 He has helped to choreograph 12 Major Dance Dramas and 13 Mini Dance Dramas
for Yoganjali Natyalayam in the last 15 years. His students who have completed
Nine Year Diplomas & Seven Year Certificates from Yoganjali Natyalayam and
performed their Bharatanatyam Arangetram include V Renukadevi (2001), Padma
M Prashanthini (2002), D Lakshmi (2005), Shreya Agrawal (2008), R Sruti (2008),
Shilpa Balaji (2009), T Tamilarasan (2009), G Kanimozhi (2009), U Kokila (2009), G
Charulatha (2009), N Ponghuzhali (2011), J Sangavi (2014) and I Krishnaveni (2016).
 In the last few years he has CO-DIRECTED the “Ramavathara” (2003), “Pancha
Maha Bhuta” (2004), “Jayadeva’s Dasavathara” (2005) , “Navagraha Vazhipaadu:
A homage to the Navagrahas” (2006), “Karna Charitram” (2007), Namashivaya
Vazhga – The Story of Thiru Gnana Sambandar (2008), Panchali Sabadam (2009),
Muruga Muruga (2010), Shakunthala (2011), Thamizh Moothatti Avvai (2012),
Iyarkaiyai Vanangiduvom– Homage to Mother Nature (2013), Lingashtakam
(2014), Navarasam (2015), Pancha Maha Devigal (2016), and Trishakti (2018).
 He has also recently composed the music as well as choreographed five complete
Bharatanatyam Margams (the classical performing repertoire) with more than five
dozen compositions that could be called an “Ananda Nartana Margam”. He has
composed the lyrics and music and choreographed many Bharatanatyam items
including Ganeshanjali, Alarippu, Kouthvams, Pushpanjalis, Jathiswarams,
Shabdams, Varnams, Keerthanam, Padams, Thillanas and Mangalams.
 He has composed more than 100 songs in various ragas and talas with deep spiritual
insights set to melody and rhythm. He has also composed several songs in English
and Italian (with Dr Sangeeta Laura Biagi).
YOGA AND YOGA THERAPY RESEARCH EXPERIENCE:

 DIRECTOR: Centre for Yoga Therapy Education and Research (CYTER),
MGMC&RI, Pondicherry under Sri Balaji Vidyapeeth from 3.5.2017 onwards.
 DEPUTY DIRECTOR: Centre for Yoga Therapy Education and Research
(CYTER), MGMC&RI, Pondicherry under Sri Balaji Vidyapeeth from 11.7.2013 to
2.5.2017.
 PROGRAMME COORDINATOR ACYTER (Advanced Centre for Yoga Therapy,
Education and Research), JIPMER from 4.3.2009 to 10.7.2013.
 SENIOR RESEARCH FELLOW in CCRYN (Union Health Ministry, New Delhi)
sponsored Yoga Project in Department of Physiology, JIPMER from November 2000
to February 2004.
 SENIOR RESEARCH FELLOW in DIPAS (Union Defense Ministry, New Delhi)
sponsored Yoga Project in Department of Physiology, JIPMER- April to December
2004.
 Associated with the Pondicherry Govt. Sponsored DSTE Yoga project in the
Physiology Department at JIPMER during 2001-02.
 Associated with the Pranayama and cardiac function study conducted by Dr K
Udupa in JIPMER during 2001-02.
 Conducted the Effect of direction of head on heart rate and blood pressure study
at JIPMER during 2001.
 Conducted the Pranayama and reaction time study conducted in JIPMER during
2002.
 Associated with the Hypertension and Yoga study conducted by Dr Vijayalakshmi
in JIPMER during 2002. JIPMER Intramural Research Project.
 Associated with the Heart Rate Variability and Shavasan study conducted in
JIPMER during 2002. ICMR student project.
 Associated with the Slow and Fast Pranayama Study conducted in JIPMER during
2002. ICMR student project.
 Conducted studies of the
 Pattern of nasal dominance with reference to different phases of the lunar
cycle at ICYER, Pondicherry during December 2003-January 2004.
 Acute effect of mukha bhastrika on children with mental retardation,
Pondicherry during June-August 2010.
 Immediate effects of suryanamaskar on reaction time and heart rate in
female volunteers, Pondicherry during 2011-12.
 Immediate effect of forced uni-nostril / alternate nostril breathing on heart
rate, blood pressure and reaction time, Pondicherry during 2011-12.
 Immediate effect of savitri pranayama in sitting and supine positions,
Pondicherry during 2011-12.
Coordinated Yoga & Yoga Therapy Research Studies (ACYTER, JIPMER 2009-13):
 Patient Feedback Survey and Retrospective Wellness Questionnaire was completed
for 100 patients in June 2011 and published in ACYTER bulletin of July2011
 Immediate effect of sukha pranayama on heart rate and blood pressure of patients
with hypertension
 Immediate cardiovascular effects of kaya kriya in normal healthy volunteers
 Immediate effect of shavasana and savitri pranayama on heart rate and blood
pressure of hypertensive patients
 Immediate effect of chandra nadi pranayama on heart rate and blood pressure of
hypertensive patients
 Immediate cardiovascular effects of shavasana and pranava pranayama on heart
rate and blood pressure of hypertensive patients
 Immediate effects of yoga nidra on heart rate and blood pressure
 Immediate effect of pranava pranayama in patients of hypertension
 Effect of yoga training on reaction time, blood glucose and lipid profile of female
diabetes mellitus patients.
 Effect of yoga training on heart rate, blood pressure and lipid profile of patients
with essential hypertension
 Effect of yoga therapy on cardiac autonomic functions and oxidative stress in
prehypertensive subjects: a randomized controlled study.
 Effect of yoga therapy on cardiac function, response to exercise, oxidative stress
and quality of life in heart failure patients: a randomized controlled trial.
 Effect of 12 week yoga therapy as a lifestyle intervention in patients of type 2
diabetes mellitus with distal symmetric polyneuropathy – A randomized
controlled study.
 Effect of yoga therapy on cardiac autonomic function in patients of essential
hypertension – A randomized controlled study.
 Effects of slow and fast pranayams on pulmonary function, handgrip strength and
endurance in young healthy volunteers – A randomized controlled trial.
 Effect of yoga training on autonomic functions and reaction time in young healthy
females during different phases of menstrual cycle.
 Effect of pranayam on maximal exercise performance, pulmonary function,
recovery heart rate and blood pressure in healthy adults.
 A pilot study on immediate effect of chandranadi and suryanadi pranayam on
heart rate variability in healthy volunteers.
 A pilot study on acute effect of anulom vilom pranayam on heart rate variability in
healthy volunteers.
 A pilot study on effect of respiratory rate on heart rate variability in healthy
volunteers.
 Immediate effect of 5 minutes chandranadi pranayam on heart rate variability in
hypertensive patients.
 Immediate effect of 5 minutes chandranadi pranayam on heart rate variability in
Diabetes mellitus patients.
 Acute effect of 5 minutes chandranadi pranayam on heart rate variability in
patients with diabetes mellitus and hypertension.
 Immediate effect of suryanadi pranayam on heart rate and blood pressure of
hypertensive patients.
 Effect of yoganidra on short term HRV in heart failure patients.
 Effect of mid trimester yoga on the incidence of preeclampsia in high risk women.
 Effect of slow and fast pranayams on cognitive and autonomic parameters in young
healthy subjects.
 CASE STUDIES:
a) Effect of yoga on sub clinical hypothyroidism.
b) Effect of yoga in newly diagnosed hypertension.
c) Effect of yoga in a patient of long standing diabetes and hypertension.
d) Case report on COAD in an adult.
e) Case report on bronchial asthma in a 4 year old child.
f) Case report on Obesity
g) Case report on DM with ketoacidosis
MAJOR PAPER PRESENTATIONS (YOGA AND YOGA THERAPY) AT

CONFERENCES:
1. Presented a paper entitled “Effect of Mukh Bhastrika (a Yogic bellows type breathing)
on reaction time” at the 23rd Annual Conference of the Indian Association of Biomedical
Scientists, JIPMER, Pondicherry, Oct 2002.
2. Presented a paper entitled “Integral Psychology of Yoga” at the International Seminar
on Integral Yoga Psychology conducted by the Pondicherry Psychology Association in
collaboration with the Indian Academy of Applied Psychology, Pondicherry, June 2004.
3. Presented a paper entitled, “Application of Integral Yoga Psychology in teacher
education curriculum” in Plenary Session of the 2nd International Seminar on Integral
Yoga Psychology and 6th National Conference on Integral Education conducted by
Pondicherry Psychology Association in collaboration with All India Association for
Educational Research, Pondicherry, January 2005.
4. Presented a paper entitled, “Therapeutic Aspects of Yogic Pranayama” in the
International CME on Yoga Therapy in the Current Millennium and Annual Meet of
Indian Academy of Yoga organised by the Indian Academy of Yoga, Yoga Sadhana
Kendra and Institute of Medical Sciences, BHU, Varanasi, India in March 2005.
5. Presented a paper entitled, “Yoga and Modern Medicine: Possible meeting points” in
the International CME on Yoga Therapy in the Current Millennium and Annual Meet
of the Indian Academy of Yoga organised by the Indian Academy of Yoga, Yoga
Sadhana Kendra and Institute of Medical Sciences, BHU, Varanasi, India in March 2005.
6. Presented a guest lecture entitled, “Yoga for Health in Children” in the International
CME on Yoga Therapy in the Current Millennium and Annual Meet of the Indian
Academy of Yoga organised by the Indian Academy of Yoga, Yoga Sadhana Kendra
and Institute of Medical Sciences, BHU, Varanasi, India in March 2005.
7. Chaired a session on “Benefits of Asana” at the 13th International Yoga festival by
Tourism Department, Govt of Pondicherry in January 2006.
8. Presented a paper entitled, “Introduction of Integral Yoga education in the teacher
training curriculum” in the Concluding Valedictory Session of the 7th National
Conference on Integral Education conducted by the Pondicherry Psychology
Association, Pondicherry, January 2006.
9. Invited guest speaker at 5th International Yoga Conference held from December 28-31
2007 at Kaivalyadhama in Lonavla, Maharasthra. Was co-chairperson for session on
Yoga Therapy, Jury Member for the Best Paper Presentation Session and presented a
paper on “Yoga research –where are we?” as part of the Panel Discussion on Recent
Trends and Advancements in Yoga Research.
10. Chaired paper presentation session at 14th International Yoga festival by Tourism
Department, Govt of Puducherry -Jan 2007.
11. Invited guest of honour at the NATIONAL YOGA WEEK 2007 conducted by the
Morarji Desai National Institute of Yoga, New Delhi from 12th to 16th March 2007.
Presented keynote address on Yoga and modern medicine: possible meeting points.
Presented invited talk on Yoga for health in children. He was Master of Ceremonies for
inaugural function and moderator at other sessions. Member of the consultation
meetings held to discuss Yoga accreditation procedures and policies.
12. Invited guest of honour at the MILANO YOGA FESTIVAL 2007 in Milan, Italy in
October 2007. Presented 2 workshops and a musical concert.
13. Chaired the paper presentation session at the 15th International Yoga festival by
Tourism Department, Govt of Puducherry in January 2008.
14. Invited guest of honour at the NATIONAL YOGA WEEK 2008 conducted by the
Morarji Desai National Institute of Yoga, New Delhi from 25th to 29th February 2008.
Presented invited talk on Using BMI and waist circumference to preempt the
complications of obesity. He was the Master of Ceremonies for the inaugural function
and moderator at other sessions. Presented an invited talk on obesity for the workshop
being conducted during the week.
15. As resource person, presented paper entitled, “Yoga and sinusitis” in National
Seminar on Yoga for Respiratory Disorders organised by Vallabhai Patel Chest Institute,
Delhi University -April 2008.
16. Invited to present a daylong workshop at Cornwall on the 7th of September 2008.
17. Invited to present a three day intensive retreat at South Wales, UK from the 12 th to
14th September 2008.
18. Invited to present a three day intensive Seminar on Pranayama at Monte Verita,
Locarno, Switzerland, September 2008.
19. Invited to present a talk on Mudras and Pranayama at INDIAN EMBASSY -Tagore
Cultural centre, Berlin, Germany, Sept 2008.
20. Invited to present a three day intensive Seminar on Hatha Yoga at the Finnish Centre
in Berlin -September 2008.
21. Invited to present a two day intensive Seminar on Yantra at the Gitananda Yoga
Society in Berlin -September 2008.
22. Invited guest of honour at the INTERNATIONAL YOGA THERPY CONFERENCE
in San RAFAEL, California, USA from October 4-6, 2008. Gave Keynote address, 3
workshops, 3 practical classes and participated in 3 panel presentations along with
eminent Yoga masters of North America.
23. Invited guest of honour: presented 2 workshops at the MILANO YOGA FESTIVAL
2008 in Milan, Italy in October 2008.
24. Invited to present talks, concerts, dance lessons, seminars and classes at the
Gitananda Ashram in Savona, Italy - October 2008.
25. Invited guest speaker at National Workshop on role of Yoga in Geriatrics in December
2008 at CCRYN, New Delhi. Presented a paper on “Rheumatological and
immunological aspects of aging and importance of integrated approach of Yoga in
senior citizens” and Panel discussion.
26. Invited guest speaker at the 29th National Conference of the IABMS in December 2008
at Ragas Dental College and Hospital, Chennai and presented a paper on “Yoga for
positive health”.
27. Chaired the paper presentation session at 16th International Yoga festival by Tourism
Department, Govt of Puducherry in January 2009.
28. Invited guest speaker and presented an invited talk entitled, “Indian approaches to
school psychology” in the Plenary Session of the 11th National Conference on School
Psychology organized by Pondicherry Psychology Association at Pondicherry, 10th and
11th of January 2009.
29. Invited guest of honour at the NATIONAL YOGA WEEK 2009 conducted by Morarji
Desai National Institute of Yoga, New Delhi in February 2009. Presented invited talk on
“Indian approaches to school psychology”. He was Master of Ceremonies for
inaugural function & participated in Brainstorming session with Secretary AYUSH &
eminent Yoga experts.
30. Presented an invited talk on “Lifestyle modification of psychosomatic disorders
through Yoga” at the National Workshop on “Fitness to Overcome Lifestyle Diseases”
conducted by the Department of Physical Education and Sports, Pondicherry
University, Pondicherry. February 2009.
31. Resource Person and panelist at the National Workshop on Introducing Yoga in the
Medical Curriculum. ACTYER, JIPMER, Pondicherry. March, 2009.
32. Invited Guest of Honour & Inaugural Address on Yoga and Holistic Health at UGC
sponsored National Seminar on Yoga & Holistic health by Nabira Mahavidyalaya,
Katol, RTM Nagpur University-April 2009.
33. Invited to present a 3- day Intensive Seminar at Augustine Centre in Melbourne
(April 2009); hosted by National Institute of Integrative Medicine & Vibrational
Breath Therapy, Australia.
34. Invited to present an intensive workshop for International Yoga Teachers
Association (IYTA) in Sydney in April 2009.
35. Invited to conduct a series of Intensive Retreats coordinated by the Gitananda Yoga
Association at Geelong, the Gold Coast, Sydney and Brisbane in Australia in April
2009.
36. Invited to conduct an Intensive Retreat at the Lotus Yoga Centre in Paraparaumu,
New Zealand in April 2009.
37. Presented an invited talk on, “Therapeutic potential of Yoga” in the first Clinical
Society meeting of the Mahatma Gandhi Post Graduate Institute of Dental Studies,
Pondicherry–Aug 2009.
38. Invited to present a Seminar on Yoga Therapy at the Gitananda Yoga Society in Berlin
–August 2009.
39. Invited to present a 3-day retreat with talks, concerts, dance lessons, seminars and
classes at the Gitananda Ashram in Savona, Italy – August 2009. He was accompanied
by his wife Devasena Bhavanani who conducted classes on Yoga, Samskrit and
Indian Classical Dance. They also gave numerous dance and music performances.
40. Invited Plenary Speaker at 6th International Yoga Conference, at Kaivalyadhama,
Lonavla, Maharashtra-Dec 27 - 30, 2009. Presented the Plenary Address in the Plenary
Session on “Yoga and Cultural Synthesis”. Was Chairperson for the paper session on
Applied Aspects of Yoga and was a panelist in the Panel Discussion on Ethical decline
in Yoga Research and Yoga Teaching.
41. Chaired a paper presentation session, conducted a workshop on Gitananda Yoga and
coordinated the Yoga Sport event at 17th International Yoga festival by Tourism
Department, Govt of Puducherry in January 2010.
42. Invited guest speaker and presented an invited talk entitled, “Culturing one’s self
through Yoga” in the Plenary Session of the 12th National Conference on Developing
School Psychology in India organized by Pondicherry Psychology Association at
Pondicherry, 10th January 2010.
43. Resource Person-cum-Organizer: presented talks on, “Yoga and stress: a perspective”
and “Culturing one’s self though Yoga” and participated in the Panel Discussion in
Workshop on Yoga for Stress Management & Personality Development organized by
ANANDITA and Gautam Buddha Health Care Foundation and sponsored by CCRYN
at Pondicherry in January 2010.
44. Resource Person-cum-Organizer: moderated panel discussion and conducted practical
training in Workshop-cum-Seminar on Yoga and CAM therapies for HIV/AIDS
organized by ACYTER and PACS at JIPMER, Pondicherry on January 30th 2010.
45. Invited guest of honour at the NATIONAL YOGA WEEK 2010 conducted by MDNIY,
New Delhi from 12th to 18th February 2010. Chaired the Free Paper Presentation Session
and Conducted a WORKSHOP ON YOGA FOR TECHNOSTRESS along with faculty of
MDNIY.
46. Presented an invited talk on “Yoga: A boon for maternal and child health” at the State
Level Champaign conducted by the Directorate of Indian Systems of Medicine and
Homeopathy, Government of Pondicherry -February 2010.
47. Invited Speaker, Workshop Presenter and open session panelist at the National
Workshop cum Seminar on Role of Yoga in Prevention and Management of
Hypertension. ACTYER, JIPMER, Pondicherry. March 18-19, 2010.
48. Invited Keynote Speaker, Workshop Presenter and open session panelist at the 1st
National Seminar cum Workshop on Role of Yoga in Geriatric Care. ACYER, Gujarat
Ayurved University, Jamnagar. March 28-29, 2010.
49. Invited to present an intensive One Day Workshop on Yoga for Doctors during the
month long training program on Yoga for doctors organized by Dep’t of physiology,
JNMC, Datta Meghe Medical University at Wardha on 31, March 2010.
50. Invited guest speaker at the World Health Day celebrations and CME organized by the
Indian Association of Preventive Dentistry at Ragas Dental College, Chennai and
presented a lecture cum demonstration on “Healthy Living through Yoga”. April 5,
2010.
51. Invited to present a three day intensive retreat along with public talks, classes and
workshops at Cape Town in April 2010. Hosted by Anjali School of Yoga, South
Africa.
52. Invited to present intensive retreats, workshops, seminars, book presentations and
musical performances in Italy (Milan, Genova, Liverno, and Savona) and Germany
(Berlin) in June-July 2010. Hosted by the Gitananda Ashram and Italian Gitananda
Yoga Federation in Italy and the Gitananda Society In Germany.
53. As a resource person, presented an invited paper entitled, “Rheumatological and
immunological aspects of aging and importance of integrated approach of Yoga in
senior citizens” in “SYNERGIES IN HEALING” an international conference organized
by the Krishnamacharya Yoga Mandiram (KYM), Chennai at GRT Convention Centre,
Chennai on 18 July 2010.
54. Invited to present Keynote address at the 3rd International Seminar on Integral Yoga
Psychology organized by Indian School Psychology Association (New Delhi),
Pondicherry Psychology Association and RICE foundations (Netherlands) at
Pondicherry, 7th August 2010.
55. Invited to be the MAJOR PRESENTER at the “REUNION IN YOGA”- IYTA WORLD
YOGA CONVENTION held at Sydney, Australia from 16 to 19 September 2010. More
than 180 delegates attended the WORLD CONVENTION that was held after a gap of
13 years. It is notable that previous special invitees have been Swami Satyananada
Saraswathi, Swami Gitananda Giri, Swami Satchitananda, BKS Iyengar, Andre Van
Lysbeth, Lilias Folan, Howard Kent, Mansukh Patel and Swami Maheshwarananda.
56. Invited to conduct an Intensive Retreat on “DISTRESS TO DE-STRESS” organized
by the Gitananda Yoga Association at Brisbane, Australia in September 2010.
57. Presented an INVITED TALK on “Yoga: A boon for maternal and child health” during
the 8th National Conference of the Society of Midwives of India on 12.11. 2010 at JIPMER,
Puducherry.
58. Chaired paper presentation sessions, presented invited talks and coordinated the
Yoga Sport event at 18th International Yoga festival by Tourism Department, Govt of
Puducherry in January 2011. Also conducted the performance of the dance drama
MURUGA MURUGA by Yognat on the occasion with 80 dancers and musicians.
59. Invited Keynote Speaker, Workshop Presenter and open session panelist at Golden
Jubilee National Seminar cum Workshop on Role of Yoga in Respiratory Tract Disorders
with Special Reference to Bronchial Asthma. ACYER, Gujarat Ayurved University,
Jamnagar. Jan 20-21, 2011.
60. Invited Speaker on Yogic therapy: A physiological perspective” at the Yoga Update 2011
organised by ICYHC Kaivalyadhama, Mumbai. January 29-30, 2011.
61. Invited Keynote Speaker at the NATIONAL YOGA WEEK 2011 conducted by the
Morarji Desai National Institute of Yoga, New Delhi from 12th to 18th February 2011.
62. Co-ordinator and Workshop Presenter at National Workshop cum Seminar on Role of
Yoga in Prevention & Management of Diabetes Mellitus. ACTYER, JIPMER. March 1-2,
2011.
63. Invited to present a day long Yoga Day workshop on Stress at Milan on the 10th April
2011.
64. Invited to present a 5-Day Intensive Retreat at South Wales, UK from the 15-19th April
2011 and a Special Cultural Evening on 14th April at the Indian Cultural Centre,
Cardiff, UK.
65. Invited to present a workshop at Cornwall, UK on the 21st April 2011.
66. Invited Guest Speaker at CME on Obesity organized by Woman Doctors Association
(TN) at Sri Lakshminarayanan Institute of Medical Studies, Pondicherry and presented
am interactive talk and lecture cum demonstration session on “Dealing with obesity
the Yoga way”. August 7, 2011.
67. Invited to present talks, concerts, dance lessons, seminars and classes at the
Gitananda Ashram in Savona, Italy – August 2011. He was accompanied by his wife
Devasena Bhavanani who conducted classes on Yoga, Samskrit and Indian Classical
Dance. They also gave numerous dance and music performances for Ganesh
Chaturthi Celebrations.
68. Resource Person for the workshop on “Tourism-Linking Cultures” organized by
Department of Tourism Studies, Pondicherry University on occasion of World Tourism
Day, 27.9 2011.
69. Invited Speaker on Yoga & Education during 19th International conference on frontiers
in yoga research and its applications. Organized by the VYASA, Bengaluru, India. 21
December 2011.
70. Invited Keynote Speaker on “The Yoga of interpersonal relationships” at National
Yoga Week 2012 conducted by Morarji Desai National Institute of Yoga, New Delhi
from 12 to 18 Feb 2012.
71. Invited to present intensive retreats, workshops, seminars, book presentations and
musical performances in Italy (Merano, Cuneo and Savona) and Germany (Berlin) in
April 2012. Hosted by the Gitananda Ashram and Italian Gitananda Yoga Federation
in Italy and the Gitananda Society in Germany.
72. Resource Person for the CME–cum- Workshop on “Heart rate variability: a diagnostic
and research tool” organised by Deptt of Physiology, MGMCRI, Puducherry on 12th
June 2012.
73. Invited to present an intensive 2-day workshop on Yoga therapy for the International
Yoga Teachers Association (IYTA) in Sydney -10,11th November 2012.
74. Invited to present a 2 day Intensive Seminar on Yoga Therapy at Augustine Centre in
Melbourne in Nov 2012. Hosted by National Institute of Integrative Medicine &
Vibrational Breath Therapy, Australia.
75. Invited to conduct a series of Intensive Retreats and talks coordinated by the
Gitananda Yoga Association at Brisbane, Melbourne, Geelong and Toowomba -
Australia in Nov 2012.
76. Invited to conduct a talk on Yoga at Integral Yoga Academy of Australasia, Adelaide
-Australia in Nov 2012.
77. Invited to present a talk on “Yoga in Healthcare” during the “Patient First – A Joint
International Conference on Quality Assurance and Patient Safety” organized by Sri
Balaji Vidyapeeth and Royal College of Physicians & Surgeons (Glasgow) at Puducherry
on 29.11. 2012.
78. Invited to present a talk on “Psychosomatic Mechanisms of Yoga” during National
Conference on Mind Body Medicine. Department of Physiology, JNMC, DMIMSDU,
Wardha on 21.12. 2012.
79. Invited Guest Speaker at the 7th International Yoga Conference held from December 27
to 30, 2012 at Kaivalyadhama in Lonavla, Maharasthra.
80. Chief Guest and Invited Speaker at the International Conference on Health and Wealth
held from December 28 to 30, 2012 at Lexicon Educational Institute, Pune.
81. Chaired paper presentation sessions, presented invited talks and coordinated Yoga
Sport event at 19th International Yoga festival by Tourism Department, Govt of
Puducherry in January 2013. Conducted performance of dance drama AVVAIYAR by
Yognat with 75 dancers and musicians.
82. Presented invited talk and lec-dem on “Role of Yoga therapy in prevention & treatment
of diabetes & hypertension” at Vinayaka Mission’s Kirupananda Variayar Medical
College, Salem – 2.3. 2013.
83. Invited to present talk on Yoga for Hypertension during World Health Day 2013 CME
at Mother Theresa PG & Research Institute of Health Sciences (MTPG&RIHS),
Pondicherry on 8.4.2013.
84. Invited to present a Yoga Day at Cornwall, UK on the 13th April 2013.
85. Invited to present a Yoga Day with musical concert at Yoga Satsanga Ashram, Wales,
UK on 15th April 2013.
86. Invited to present many classes, talks and a 3-Day Intensive Retreat at Yoga Wales
(Gitananda Yoga Society), Cardiff, South Wales, UK from 16-25th April 2013.
87. Invited to present Special Address at the 3rd National Conference on School Psychology
Services to Multiple Disabled Children, held 22-24 November 2013 at NIEPMD,
Muttukadu, Tamil Nadu.
88. Presented a Workshop on Yoga Therapy on behalf of CYTER at 20th International Yoga
festival by Tourism Department, Govt of Puducherry in January 2014. Also conducted
the performance of the dance drama Pancha Maha Bhutam by Yognat on the occasion
with 70 dancers and musicians.
89. Invited to conduct an Intensive Retreat by the Gitananda Yoga Association from
March 28th to 30th 2014 at Tatum park, Paraparaumu, New Zealand.
90. Invited to conduct a talk on Yoga for wellness at the Lotus Yoga Centre, Paraparaumu,
New Zealand on April 1st 2014.
91. Invited to conduct a talk on Yoga for longevity at IYTA, Wellington, New Zealand on
2.4.2014.
92. Invited to present a 3-day Intensive Retreat on Yoga by the Integral Yoga Academy of
Australasia at Woodhouse in Adelaide, Australia from 4th to 6th April 2014.
93. Invited to conduct a talk on the Science of Yoga for longevity at the Anand Yoga
Academy, Adelaide, Australia on April 7th 2014.
94. Invited to present an intensive 2-day workshop on “Understanding the Psychic
Energies of Yoga” for the International Yoga Teachers Association (IYTA) in Sydney -
12th and 13th April 2014.
95. Invited Resource Person for the National Seminar on "Dimensions of Yoga and its
dynamics" on 4th July 2014 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.
96. Conducted workshop on Yoga Therapy on behalf of CYTER at 21st International Yoga
festival by Tourism Department, Govt of Puducherry in January 2015.
97. Resource person for the CME on “Therapeutic Potential of Yoga” organized on
20.1.2015 by Department of Physiology, Sri Venkateshwaraa Medical College Hospital
& Research Center, Ariyur, Pondicherry.
98. Invited Guest Speaker for the International ONLINE MEDIATION SUMMIT
organised by the Ananda Sanga Educational Institute (ASEI) of South Africa in January
2015.
99. Invited Speaker on “Role of Yoga in Non Communicable Diseases” at National Yoga
Week 2015 conducted by Morarji Desai National Institute of Yoga, New Delhi from 12
to 18 Feb 2015.
100. Invited Panelist in 8th International Conference on Yoga & Education at Kaivalydhama,
Lonavla, India from 27th - 30th December 2015. Also presented a paper in the theme
"Experiential Paradigm of Yoga in Education" for which he received Best Paper Award
from the hands of Swami Maheshanandaji (Chairman Kaivalydhama) in the august
presence of Dr BM Hegde and Sri DR Karthikeyan.
101. Chaired paper presentation session on “Empowering society through Yoga” at 22nd
International Yoga festival by Tourism Department, Govt of Puducherry -Jan 2016.
102. Conducted workshop on Yoga Therapy on behalf of CYTER at 22nd International
Yoga festival by Tourism Department, Govt of Puducherry in January 2016.
103. Resource person for CME on “Memory: Mind to Molecules” organized on 5.3.2016 by
Department of Physiology, Danalakshmi Srinivasan Medical College & Hospital,
Perambalur, Tamil Nadu.
104. Resource person for the Integrated CME & Workshop on “Introduction of Yoga in
Medical Curriculum” organized on 9.3.2016 by Department of Anatomy, Physiology
and Biochemistry, Sri Satya Sai Medical College & Research Institute, Ammapettai,
Kancheepuram Dist, Tamil Nadu.
105. Resource person for National Conference on Chronobiology and Health organized on
18-19 March 2016 by Department of Physiology, MGMCRI, Pondicherry.
106. Chief Guest for ARENA 16, the Annual Sports Meet of Indira Gandhi Institute of
Dental Sciences at Sri Balaji Vidyapeeth, Pondicherry on 14 March 2016.
107. Chief Guest for Annual Day celebrations and Sports Day Tagore Arts College, Lawspet,
Pondicherry on 31 March 2016.
108. Invited to present a 3-day Intensive Retreat on Yoga by the Gitananda Yoga Association
of Canada at Montreal, Quebec from April 22 - 24 2016. He also gave invited talks for
120 students of the Vanier College and 30 Yoga teachers and enthusiasts at the YogaNat
Studio in Montreal.
109. Invited Consultant and Principal Faculty for the Integrative Yoga Therapy (IYT)
training program, "YOGA THERAPY APPLIED IN MEDICAL SETTINGS", held at
Kripalu Center for Yoga & Health, USA from April 24 – May 1, 2016. He presented half-
day sessions covering the main focus areas of Yoga Therapy, including the
cardiovascular, respiratory, nervous and immune systems. He detailed Yoga Therapy
approaches to each, with a focus on the Gitananda tradition. Other eminent experts who
taught in the program included Joseph Le Page, Amrita Sandra Mc Lanahan, Susi
Amendola, Sat Bir Khalsa, Allen Wilkens, Terry Roth, Deb Jenson, and Karen O'Donnell
Clarke.
110. Resource Person for International Conference on "Yoga for the Body and Beyond"
organized at Vigyan Bhawan, New Delhi from 22-23 June 2016 by Ministry of AYUSH,
Govt of India. The grand event was inaugurated by Hon'ble Vice President of India, Shri
M Hamid Ansari with participation from more than 34 countries and all states of India.
Dr Ananda presented an invited talk in the first technical session on "Power of
Pranayama" and participated in the concluding Panel Discussion that fielded pertinent
questions from the enthusiastic global audience. He also participated in the executive
committee meetings of the Indian Yoga Association of which he is Director of
Publications.
111. Presented a paper entitled, “Restoring human values in medicine: Role of Yoga" in the
National Conference on Changing Trends in Health Professions Education (NC-CTHPE
2016) at Sri Balaji Vidyapeeth, Pondicherry. 18-21 Aug 2016.
112. Invited Guest Speaker and Co-chairperson for Keynote session of the National Seminar
on Emerging Trends of Research in Yoga and Naturopathy organised by CCRYN,
Ministry of AYUSH, GOI at Adhyatma Sadhana Kendra, New Delhi from 16-18
September 2016.
113. Invited Plenary Guest Speaker and Symposium Chairperson at 6th InSPA International
Conference and 3rdInternational Conference of the Department of Applied Psychology
of Pondicherry University. Pondicherry, 13-15 October 2016.
114. Invited resource person for CME on ‘Translational Medicine in the Diagnosis and
Management of Diabetes Mellitus’, organized by Dept of Biochemistry, MGMCRI,
Pondicherry. He gave a presentation on Enhancing Management of Type 2 Diabetes
through Yoga in the event on 10 November 2016.
115. Invited to be Chief Guest and present a talk on Yoga for Health Professionals during
the Annual Scientific Society Meet of Sri Manakula Vinayagar Medical College and
Hospital Kalitheerthalkuppam, Madagadipet, Pondicherry on 16 December 2016.
116. Invited Resource Person for Capacity Building Workshop at WHO Collaborating
Centre for Traditional Medicine (Yoga), MDNIY, Delhi from 28th - 30th November,
2016.
117. Invited to be a Resource Person and give a presentation on “Managing stress through
yoga: concepts and methods” during PONCON 2016, the 7th Annual Pondicherry State
Conference of the Indian Society of Anesthesiologists at MGMCRI, Pondicherry on 7th
January 2017.
118. Invited to be a Resource Person and give presentation on “Yoga and respiratory
disorders” during Bhopal Yoga Fest 2017 organized by Sant Hirdaram Medical College
of Naturopathy and Yogic Sciences, sponsored by Ministry of AYUSH, Govt of India
and coordinated by the CCRYN from 25-27 February 2017 at Bhopal, MP, India.
119. Invited guest speaker and guest of honur for the valedictory function of the 3-day
International Yoga Fest held from 8th-10th March 2017 at Talkatora Indoor Stadium,
New Delhi. The event was organized as a Curtain Raiser for International Day of Yoga
(IDY) 2017 by MDNIY on behalf of the Ministry of AYUSH, Govt of India.
120. Invited to be a Resource Person and give workshops at Phoenix 2017, International
Medical Students Conference organized by AJ Institute of Medical Sciences, Mangalore
from 24-26 March 2017.
121. Invited talk on “Yoga for dental professionals” at the Scientific Academic Forum of
IGIDS on 4th April 2017.
122. Invited panelist for panel discussion “Let’s talk about the Black Dog” organized by
Dept of Community medicine and Scientific Academic Forum commemorating World
health Day, 7th April 2017 at MGMCRI.
123. Invited to present a 4-day Intensive Retreat on Yoga by the Integral Yoga Academy
of Australasia at Woodhouse in Adelaide, Australia from 12-15 October 2017. Co-
hosted by Gitananda Yoga Association of Australia and New Zealand.
124. Invited to be KEY NOTE PRESENTER at the Golden Jubilee, 50th Anniversary World
Yoga Conference of the IYTA held at Sydney, Australia from 20-22 October 2017.
More than 250 delegates attended the international event.
125. Coordinator-cum-resource person for the Yoga therapy in India study program for 20
scholars from Loyola Marymount University Yoga Studies, California, USA from 12-
15 December 2017.
126. Invited Guest Speaker at the International Yog Festival organized by Garhwal Mandal
Vikas Nigam, Govt of Uttarakhand at Rishikesh from March 1 to 7, 2018.
127. Invited to present Yoga workshops with musical concert at Yoga Satsanga Ashram,
Wales, UK on 18 and 19 April 2018.
128. Invited to present numerous workshops and a 3-Day Intensive Retreat organized by
Om Yoga Studio, Cardiff, South Wales, UK from 12-16 April 2018.
129. Invited to present an invited talk for Yoga enthusiasts at the YogaNat Studio in
Montreal on 21 April 2018 organised by the Gitananda Yoga Association of Canada.
130. Invited Consultant and Principal Faculty for the Integrative Yoga Therapy (IYT)
training program, "YOGA THERAPY APPLIED IN MEDICAL SETTINGS", held at
Kripalu Center for Yoga & Health, USA from April 22 – 29, 2018. He presented half-day
sessions covering the main focus areas of Yoga Therapy, including the cardiovascular,
respiratory, nervous and immune systems. He detailed Yoga Therapy approaches to
each, with a focus on the Gitananda tradition. Other eminent experts who taught in the
program included Joseph Le Page, Susi Amendola, Baxter Bell, Deb Jenson, and Karen
O'Donnell Clarke.
131. Invited to conduct the Annual Retreat Hosted by South Okanagan Yoga Academy
(SOYA) from 1-3 June 2018 at Sorrento Centre Retreat & Conference Centre, Sorrento
Canada with more than 120 participants from all over North America.
132. Invited KEY NOTE PRESENTER at SYTAR 2018: Symposium on Yoga Therapy and
Research organised by the IAYT at Reston, USA from 14-17 June 2018. More than 300
delegates attended the international event.
YOGA AND YOGA THERAPY TEACHING EXPERIENCE:

1. Yoganjali Natyalayam- Theory & practical classes - 25 years. Has trained thousands in
classes on Yoga Theory, Practicals, Shat Kriyas, Yoga Psychology, Yoga Therapy, Yoga
Anatomy & Physiology and Yoga Research.
2. International Centre for Yoga Education and Research (ICYER) – Trained nearly 100
teacher trainees in classes in Yoga Theory, Practicals, Shat Kriyas, Mantra Yoga, Laya
Yoga, Yoga Psychology, Yoga Therapy, Yoga Anatomy & Physiology, Yantra and Yoga
Research.- 19 Years.
3. Yoga instructor:
 Tagore Arts College- Dept of Philosophy. Theory & practical classes in Yoga
for more than 250 BA students -30 hours every year- 9 years.
 Refresher courses for Pondicherry Govt. Physical Education teachers though the
Education Department. 2002.
 Coordinated the “Feel of Yoga” classes at several venues in Pondicherry during
the International Yoga Festivals conducted by Tourism Department, Govt of
Pondicherry- 2006, 2007 & 2008.
4. Guest lecturer:
 Pondicherry Central University- Centre for Yoga Studies. Theory lectures for
more than 30 PG Diploma in Yoga students-15 hours – 2002, 2003.
 Pondicherry University- Community College. For more than 25 Certificate in
Yoga teaching (CYT) course students-2001, 2002.
 Annamalai University, Chidambaram. Conducted theory classes in scientific
basics of Yoga and Yoga therapy for more than 250 Diploma and PG Diploma
Yoga course students-June 2007.
 Annamalai University, Chidambaram. Conducted theory classes in Yoga
therapy for more than 250 MSc Yoga and PG Diploma Yoga course students-
March 2008.
 JIPMER (ACYTER) Pondicherry. Conducted theory lecture on, “Therapeutic
potential of Yoga” and participated in question answer panel session, for nearly
100 medical students in the Orientation course for Professionals. –Aug 2008.
 MDNIY (Morarji Desai National Institute For Yoga), New Delhi. Conducted
15 hours of theory lectures on Yoga therapy modules for cardiovascular
conditions and musculo-skeletal conditions for students of the DYT course from
17th to 21st November 2008.
 Pondicherry Dental College- Presented an invited talk on, “Therapeutic
potential of Yoga” in the Clinical Society meeting of the Mahatma Gandhi Post
Graduate Institute of Dental Studies, Pondicherry–9 Aug 2009.
 Presented Invited Talks on, “Complementary and alternative therapies in
HIV/AIDS” for the Workshop for Nursing professionals at JIPMER Nursing
College, in Sept-October 2009.
 Presented invited talks on Yoga Research and Bridging Yoga and Modern
Medicine at the Yoga Seminar for Doctors conducted by Kaivalyadhama at
Lonavla- February 2010.
5. Paper setting and valuation:
 Pondicherry Central University- Community College. Paper setting and
valuation for final exam (CYT) in the subjects ‘Scientific basis of Yoga Education’
and ‘History and fundamentals of Yoga’- Jan and May 2003.
 Member of the CENTRAL EVALUATION COMMITTEE of DYT and DYS
courses at Morarji Desai National Institute for Yoga, New Delhi-August 2007.
Appointed paper setter for the DYT course examination in 2008.
 Morarji Desai National Institute for Yoga, New Delhi. Paper setting and
valuation for DYT and DYS courses since 2008.
6. Yoga Therapy Consultation – offered to more than 1500 patients of various medical
conditions in the last 10 years at Yoganjali Natyalayam twice weekly on OPD basis.
More than 15,000 patients have benefited from personal consultation at ACYTER,
JIPMER (2009-13) and in CYTER, MGMCRI since July 2013.
7. CHAIRMAN, BOARD OF STUDIES in “Anatomy & Physiology of Human Body in
the context of Yoga”- Gordhandas Seksaria College of Yoga and Cultural Synthesis,
Kaivalyadhama, Lonavla, Pune. Nomination for the tenure 2013-16.
8. Member, Board of Studies KGNC, SBV for “Foundation in Yoga Therapy” course for
BSc Nursing students-20, July 2016.
9. CONSULTANT YOGA EXPERT:
 NATIONAL BOARD for the Promotion and Development of Yoga and
Naturopathy, Ministry of AYUSH, Govt of India. 2017
 SCIENTIFIC ADVISORY COMMITTEE of the Central Council for Research in Yoga
and Naturopathy (CCRYN), Ministry of AYUSH, Govt of India. 2015-2018.
 STANDING FINANCE COMMITTEE of the Central Council for Research in Yoga
and Naturopathy (CCRYN), Ministry of AYUSH, Govt of India. 2018-2021.
 INTER-MINISTERIAL COMMITTEE of Ministry of AYUSH, Govt of India, New
Delhi for the International Day of Yoga in 2017 and 2018
 COMMITTEE OF EXPERTS FOR YOGA & DIABETES. Ministry of AYUSH, Govt of
India, New Delhi. August 2016
 COMMITTEE OF YOGA EXPERTS FOR THE CELEBRATION OF
INTERNATIONAL DAY OF YOGA 2015. Ministry of AYUSH, Govt of India, New
Delhi.
 SEARCH CUM PEER REVIEW COMMITTEE of the Central Council for Research in
Yoga and Naturopathy (CCRYN), Ministry of AYUSH, Govt of India. July 2015
 Invited expert for consultative meeting chaired by Secretary AYUSH at the Ministry
of AYUSH, Govt of India on 18.11.2016 to firm the views for articulating during the
Inter-Governmental Committee on Intangible Cultural Heritage (IGC-ICH) to be
held 28 November to 2 December 2016 at Addis Ababa, Ethiopia to defend India’s
interest for inscription of “Yoga” in Representative List of the UNESCO as
Intangible Cultural Heritage. On 1 December 2016, Yoga was inscribed in the
UNESCO's list of ICH.
 COUNCIL FOR YOGA ACCREDITATION INTERNATIONAL, USA since 2012.
ICYER is a founding charter member and Dr Ananda is Member, Board of Directors.
 INDIAN YOGA ASSOCIATION (IYA), a self-regulatory body for Yoga formed by
eminent Yoga Schools in India supported by Ministry of AYUSH, Govt. of India.
ICYER is a founding member and Dr Ananda is a member of the Executive Council
and was Director Publications and on 27.11.2016 nominated Director of the Standing
Research Committee of the IYA.
 Member Technical Committee of QCI (Quality Council of India) for Yoga Schemes
(2017).
 YOGA ACCREDITATION AND SYLLABUS COMMITTEES-Dept of AYUSH,
Ministry of Health, Govt of India, New Delhi-2007
 Consultative meeting of the WORLD HEALTH ORGANISATION
COLLABORATING CENTRE IN TRADITIONAL MEDICINE (YOGA) at the
Morarji Desai National Institute of Yoga, New Delhi, India-September and
November 2014.
 Member of the Research Advisory Committee for Scientific Research Department of
Kaivalyadhama Yoga Institute, Lonavla. (October 2016-2018).
 YOGA BRAINSTORMING SESSION -Dept of AYUSH, Ministry of Health, Govt of
India, New Delhi-7th April 2008
 SYLLABUS COMMITTEE MEETING FOR YOGA IN SCHOOLS-MDNIY, Dept of
AYUSH, Ministry of Health, Govt of India, New Delhi-8th and 9th July 2009
 INTERNATIONAL YOGA FESTIVAL, Tourism Directorate, Govt of Pondicherry.
Since 2001 onwards.
 MEMBER EDITORIAL BOARD:
o Yoga- Teacher’s Manual for School Teachers. MDNIY, Dept of AYUSH,
Ministry of Health, Govt of India, New Delhi.2010
o International Scientific Yoga Journal SENSE , Belgrade, Serbia-since 2010
o YOGA MIMAMSA journal of Kaivalyadhama, Lonavla, India-since 2010
o SM Journal of Cardiovascular Disorders, USA since April 2015.
o International Journal of Physiatry, USA since June 2015.
o Yoga and Natural Therapy Journal, USA since February 2016.
o Journal of Alternative Medical Research, New Jersey, USA since March 2016.
o Jacobs Journal of Yoga, Austin, Texas, USA since April 2016.
o Annals of Yoga and Physical Therapy, New Jersey, USA since May 2016.
o Journal of Yoga and Physiotherapy, California, USA since July 2016.
o MED ONE, Qingres Ltd, London, U.K since December 2016
o Section Editor (AYUSH) of the Journal of Basic, Clinical and Applied Health
Sciences, Sri Balaji Vidyapeeth since 2017.
o Editorial Board of the MOJ Yoga & Physical Therapy since May 2018
 Member, Selection Committee, INDIAN COUNCIL FOR CULTURAL RELATIONS

(ICCR), Government of India, New Dehi-2010.
 SADAY School for Special Children, Pondicherry since 2005.
 SUPER AUDIO (Madras) Pvt Ltd since 2005.
 COAST GUARD, Pondicherry-2013 October
 PEER REVIEWER:
o Yoga Mimamsa journal of Kaivalyadhama, Lonavla, Maharashtra-since 2007
o International Journal of Yoga from SVYASA, Bengaluru- since May 2009.
o International Journal of Yoga Therapy, IAYT, USA-since 2010
o International Scientific Yoga Journal SENSE , Belgrade, Serbia-since 2010
o Journal of Clinical and Diagnostic Research (JCDR) - since January 2012.
o Biomedical Human Kinetics-since January 2012
o Indian Journal of Traditional Knowledge, New Delhi -since March 2012
o Indian Journal of Physiology and Pharmacology- since June 2012
o Journal of Ayurveda and Integrative Medicine - since July 2013.
o Journal of BioPsycho Social Medicine - since July 2014.
o Saudi Journal of Sports Medicine- since January 2015.
o Indian Journal of Medical Research- since August 2015.
o SM Journal of Cardiovascular Disorders - since September 2015,.
o Alternative & Integrative Medicine: Open Access- since October 2015.
o Med One by Qingres Ltd, London, U.K- since December 2016.
o Complementary Therapies in Medicine -since May 2017.
o MOJ Yoga & Physical Therapy -since May 2018.
 Member SCIENTIFIC PANEL OF EXAMINERS for evaluation of Yoga Therapy or
evaluation of the Yoga Therapy Training projects, Krishnamacharya Healing and
Yoga Foundation, Chennai. Since 2012
 Honorary Member of the Scientific Board, INTERNATIONAL SOCIETY FOR
INTERDISCIPLINARY YOGA RESEARCH, Belgrade, Serbia
 Honorary Member of the Scientific Board, INTERNATIONAL ACADEMY FOR
YOGA TEACHERS EDUCATION, Belgrade, Serbia
 Member of the Consultative Meetings for Discussion of Yoga Accreditation- Policies
and Procedures conducted by Dept of AYUSH, Ministry of Health and FW, Govt of
India during National Yoga Week 2007 at New Delhi, March 2007 and at sVYASA,
Bangalore in June 2007.
 Member of the INSTITUTIONAL ANIMAL ETHICS COMMITTEE of the
Pondicherry University (Central University) from 2007-12.
 OBL Ltd, Pondicherry. 2000.
 ACER India (Pvt) Ltd, Pondicherry. 2004.
 Interactive TV programme (Sky Sat) on Yoga for Sleep disorders in collaboration
with the Yoga Research Project, Dept of Pharmacology, JIPMER, Pondicherry. 2004.
 Pondicherry Vetinary College, Guest Lecture on Yoga at Faculty Club. 2004
 Bharatidasan Women’s College, Pondicherry. Guest Lecture on Yoga at Dept of
English—2005
 Rotary Club of Pondicherry Central, Guest Lecture on Yoga, 29.3.2005 at Anandha
Inn.
 Suicide Prevention Awareness Campaign, Community Service Scheme, Govt HSS,
Karayanmbuthur, Pondicherry- Guest Lecture on Yoga on 8.5.2005.
 Nominated to the committee to examine the proposal of starting “PG Diploma
Course in Yoga Therapy” at Pondicherry University by the Vice Chancellor in June
2005.
 Interactive programme on Yoga (All India Radio-Pondicherry Kendra) in the
URAVU PALAM- a live phone in programme on 25th October 2005
 E-THINK. An academy that aims to provide training programmes in various aspects
in a professional manner for kids. Trichy, South India (2006).
 Workshop on stress reduction for Airtel executives at Hotel Pondicherry Ashoka-
3.3. 2007.
 Member of the AD-HOC ACADEMIC COMMITTEE of MDNIY, New Delhi-August
2007.
 Interactive programme on Yoga (All India Radio-Pondicherry Kendra) in the
URAVU PALAM- a live phone in programme on 18th September 2007
 Interactive programme on Yoga (Deepam TV Channel) - a live phone in
programme on 2.6 2008
 Talk on Yoga (All India Radio-Pondicherry Kendra) in the Vilayattu Arangam – in
April 2009
 Special 15 day Yoga workshop for ZEST Beach Resort, Pondicherry-April and
August 2009
 Yoga for stress management programme at SHASUN Chemicals, Pondicherry-2010
 Interactive programme on Yoga (Right TV Channel) - live “phone in” prog on 5.8.
2010
 Rotary Club of Pondicherry Aurocity, Chief Guest and Lecture on Yoga for special
children on 4 September 2010 at Mother Rehabilitation School, Pondicherry.
 Chairperson for Special Programme on Complementary and Alternative Medicine
organised by IMA, Cuddalore and Scientific and Academic Forum, Sri Balaji
Vidyapeeth at MGMCRI, Pondicherry on 5 April 2011
 Yoga Awareness Programme for Harmoney Corporate group. Pondicherry. Jan
2012.
 Holistic Health and Humour Association. Jothi Eye Care Centre, Pondicherry. 1.4.
2012.
 Interactive live phone in session on Yoga and medical science (Doordarshan).
6.2.2013.
 Invited presentations on Yoga research during the OTP programme for AYUSH and
modern professionals at Kaivalyadhama- Feb 14th 2013.
 Yoga awareness programs for Pondicherry Doordarshan on 20 & 27 April 2017.
10. RESOURCE PERSON IN YOGA AND YOGA THERAPY:

 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.
 Member EXPERT COMMITTEE of SZCC to select “Young Talented Artistes
awardees for 2013-14. Held on December 5th 2013.
 Member Technical Committee of QCI for Yoga Schemes (2017).
 Centre for Cultural Resources and Training (CCRT), Ministry of Culture, Govt of
India, New Delhi: Guru in vocal music for R Shalini (since 2007) and Shreya
Agrawal in Bharatanatyam (since 2008) in their Scholarships from CCRT
 Pondicherry Central University- Community College. For more than 60 Certificate
in Yoga teaching (CYT) course students during 2003-04 and 2004-05 in “Scientific
Basis of Yoga”.
 Pondicherry Central University- Community College. For more than 100 Diploma
in Yoga Education (DYEd) course students since 2005 till date in the subject of
Scientific Basis of Yoga and Principles of Yoga Therapy.
 Pondicherry Central University- Community College. For more than 75 PG
Diploma in Yoga Education (PGDY) course students from 2007 till date in the
subject of Scientific Basis of Yoga and Principles of Yoga Therapy.
 Pondicherry Central University- Study India Programme – Yoga Course and
Bharatanatyam Course. From 2004-2013.
 Paper setter and examiner for DYT course conducted by the Morarji Desai
National Institute for Yoga, New Delhi- 2007-08.
 Hemophilia Society Camp, Pondicherry. 2001-02 and 2006
 Dr MGR Educational & Research Institute (Dr MGR Deemed University), Chennai
for Certificate, Diploma, PG Diploma and BSc Yoga course students during 2004-
05 in the subject of Scientific Basis of Yoga and Yoga Therapy.
 International CME on Yoga Therapy in the New Millennium. Organised by the
Indian Academy of Yoga, BHU, Varanasi, UP. March 2005.
 National Workshop on Yogic Management of Stress. Organised by Dept of
Physiology, JIPMER, Pondicherry. March, 2005
 National Conference on Yoga and Naturopathy for common man. Organised by
the Indian Yoga Federation, Chandigarh -March 19th and 20th 2005
 2ndInternational Conference, Yoga & Psychotherapy Association of India (YPAI)
organised by Dept. of Human Consciousness and Yogic Science, GK University
Haridwar, November 2005.
 Coordinator and faculty member for the National Workshop on “Pranayama:
techniques, physiological basis and therapeutic potential” organised by the Dept
of Physiology, JIPMER, Pondicherry during the 51st Annual Conference of the
Association of Physiologists and Pharmacologists of India (APPICON December
2005)
 Invited Faculty member and Panelist for the Symposium on “Yoga in
contemporary medicine”. Organised by the Dept of Physiology, JIPMER,
Pondicherry during 51st Annual Conference of the Association of Physiologists
and Pharmacologists of India (APPICON December 2005)
 Invited to present 2 workshops on Meditation at MILAN YOGA FESTIVAL 2007
in Milan, Italy from 19th to 21st October 2007.
 Invited to present a workshop and talk on YOGA AND MODERN MEDICINE at
LOCARNO HOSPITAL in Switzerland, 23rd Oct 2007.
 Invited to present a talk on YOGA AND MODERN MEDICINE at the INDIAN
EMBASSY -Tagore Cultural Centre in Berlin, Germany on the 25th October 2007.
 National Seminar on Social Relevance of Sanskrit organised by School of
Humanities, Dept. of Sanskrit, Pondicherry University, Feb 2008.
 National Seminar on Yoga for respiratory problems organised by Vallabhai Patel
Chest Institute, University of Delhi, 5th - 6th April 2008.
 Invited to present a daylong workshop at Cornwall on the 7th of September 2008.
 Invited to present a 3- day intensive retreat at South Wales, UK from 12-14
September 2008.
 Invited to present a 3-day Seminar on Pranayama at Monte Verita, Switzerland-
Sept 2008.
 Invited to present a talk on Mudras and Pranayama at INDIAN EMBASSY -Tagore
Cultural centre, Berlin, Germany, Sept 2008.
 Invited to present a 3-day Seminar on Hatha Yoga at Finnish Centre, Berlin –Sept
2008.
 Invited to present a two day intensive Seminar on Yantra at the Gitananda Yoga
Society in Berlin -September 2008.
 Invited to present talks, concerts, dance lessons, seminars and classes at the
Gitananda Ashram in Savona, Italy - October 2008.
 National Workshop on “Fitness to combat lifestyle disorders”. Organised by Dept
of Physical Education and Sports, Pondicherry University, Pondicherry. February
2009.
 Invited to present a three day intensive retreat at Geelong, Victoria by Gitananda
Yoga Association of Australia. April 2009
 Invited to present an intensive seminar on YOGA at Augustine Centre in
Melbourne on 16-17th April 2009. Hosted by National Institute of Integrative
Medicine & Vibrational Breath Therapy, Australia.
 Invited to present an intensive workshop for the International Yoga Teachers
Association (IYTA) in Sydney on April 19th 2009.
 Invited to present a three day intensive retreat at Paraparaumu, New Zealand by
the Lotus Yoga Centre. April 22-24th 2009
 Invited to present an intensive workshop for the Gitananda Yoga Centre of Sydney
at YWCA, Sydney on April 26th 2009.
 Invited to present talks, concerts and classes at the Annual Get together of the
Gitananda Yoga Sadhakas at the Gold Coast, Australia from 27th to 30th April 2009.
 Invited to present a three day intensive retreat at Brisbane, Australia -May 2009.
 Invited to present a Seminar on Yoga Therapy at Gitananda Yoga Society, Berlin –
Aug 2009.
 Invited to present a 3-day retreat with talks, concerts, dance lessons, seminars and
classes at the Gitananda Ashram in Savona, Italy – August 2009. He was
accompanied by his wife Devasena Bhavanani who conducted classes on Yoga,
Samskrit and Indian Classical Dance. They also gave numerous dance and music
performances.
 RESOURCE PERSON for the workshop on YOGA FOR STRESS MANAGEMENT
AND PERSONALITY DEVELOPMENT organized by ANANDITA and Gautam
Buddha Health Care Foundation and sponsored by CCRYN, New Delhi at
Pondicherry in January 2010.
 Invited to present a workshop on YOGA FOR TECHNOSTRESS at MDNIY, New
Delhi during the National Yoga Week 2010.
 Invited to present workshop on YOGA FOR NECK PAIN at ACYER, Gujarat
Ayurved Uni, Jamnagar during National Seminar cum Workshop on Yoga for
Geriatric Care. March, 2010.
 Invited to present a three day intensive retreat along with public talks, classes and
workshops at Cape Town in April 2010. Hosted by Anjali School of Yoga, South
Africa.
 Invited to present intensive retreats, workshops, seminars, book presentations and
musical performances in Italy (Milan, Genova, Liverno, and Savona) and Germany
(Berlin) in June-July 2010. Hosted by the Gitananda Ashram and Italian Gitananda
Yoga Federation in Italy and the Gitananda Society In Germany.
 Invited to be MAJOR PRESENTER at the “REUNION IN YOGA”- IYTA
WORLD YOGA CONVENTION held at Sydney, Australia from 16 to 19
September 2010.
 Invited to conduct an Intensive Retreat on “Distress to De-Stress” organized by
the Gitananda Yoga Association at Brisbane, Australia in September 2010.
 Invited to present a talk on “Therapeutic Potential of Yoga” during a CME on
Physiological Benefits of Yoga. Organised by Shri Sathya Sai medical College and
Research institute, Kancheepuram on 17th January 2011.
 RESOURCE PERSON for the Capacity Building Programme for the senior TGT’s
in high schools organised by State Training Centre, Directorate of School
Education, Govt of Pondicherry. 26 & 28- Feb2014.
 Invited as Chairman, Board of Studies in “Anatomy & Physiology of Human
Body in the context of Yoga” to the meeting held at Gordhandas Seksaria College
of Yoga and Cultural Synthesis, Kaivalyadhama, Lonavla on 14-15th June 2014.
Also chief guest at the inauguration of the Foundation Course in Yoga and
Ayurveda at Kaivalyadhama on 15th June 2014.
 Resource Person for Capacity Building Workshop at WHO Collaborating Centre
for Traditional Medicine (Yoga), MDNIY, Delhi from 28th - 30th November, 2016.
11. JIPMER CCRYN YOGA PROJECT (2000-04) –4 years- Planned and implemented
Practical Yoga training for more than 250 JIPMER Staff, Students and Patients, 100
Kendriya Vidyalaya students,160 Pondicherry Police trainees, 150 Pondicherry Police
Constables, 110 Tagore Arts College students and 150 Indira Nagar school students
12. ACYTER (JIPMER YOGA PROJECT) – from March 4, 2009 to July 10, 2013.
Yoga Therapy OPD in Super Specialty Block of JIPMER with Yoga therapy consultations
Monday to Friday. Yoga therapy sessions for diabetes and cardiovascular diseases
conducted at ACYTER Yoga Hall. A senior citizen clinic conducted every Thursday. More
than 36,000 patients benefited from OPD consultations and therapy sessions. Regular Yoga
classes conducted on Monday, Wednesday and Friday at the ACYTER Yoga Hall. More
than 3000 persons benefited from these classes.
ACYTER conducted Yoga training for medical students, a mass awareness programme in
48 schools of Puducherry and a National Workshop on “Introducing Yoga in Medical
Curriculum” in March 2009, on “Role of Yoga in prevention and management of
hypertension” in March 2010 and on “Role of Yoga in prevention and management of
diabetes mellitus” in March 2011. Regular academic programmes held and six foreign
delegations from Italy, Germany, Australia, New Zealand, Poland and South Africa visited
ACYTER and participated in activities during 2009-13. Yoga awareness programmes
conducted for staff and students of JIPMER, Government Dental College, Mother Theresa
Institute of Health Sciences, Satya Sai Medical College, MGMCRI, and JIPMER Nursing
College. ACYTER also conducted Yoga and healthy lifestyle consultations for delegates
attending Regional Official Language Conference -South and South Western Zone, at
JIPMER in October 2009 and the International Yoga Festival at Pondicherry in 2010 and
2011. ACYTER also organized a Workshop-cum-Seminar on Yoga and CAM therapies for
HIV/AIDS in collaboration with the Pondicherry AIDS Control Society in January 2010.
13. CYTER, MGMCRI, SBV– from July 2013 till date.

Yoga Therapy OPD in MGMCRI with Yoga therapy consultations Monday to Friday. More
than 50,000 patients benefited from OPD consultations and therapy sessions. Yoga training
imparted to nursing students of Kasturba Gandhi Nursing College and efforts made to
include Yoga component in the MBBS curriculum and PG Diploma in Yoga Therapy is
running successfully. Regular Yoga awareness programmes are being held in the MRD of
MGMCRI and Yoga consultations given in Master Health Checkup daily. Regular talks are
being conducted as part of Arthritis, Obesity, back pain, diabetes awareness programmes
organized by various departments. Capsule talks and lecture demonstrations have been
given during SAF meetings to create awareness of Yoga and its potential, amongst the
faculty and PG students of SBVU. The CYTER team has also participated in outreach
programmes in educational institutions and other social organizations to create awareness
of Yoga and the functioning of CYTER at SBV.
CMEs have been organised on Yoga & Lifestyle Disorders (2013), Sleep, Consciousness and
Meditation (2014), Therapeutic potential of Yoga (2015), Introducing Yoga in health
professions Education (2016), Yoga in chronic diseases (2017) and Swastha Manas (2018)
with more than 250 participants in each event.
TRADITIONAL YOGA EXPERIENCE:

Dr Ananda has been trained in Rishiculture Ashtanga (Gitananda) Yoga from the tender
age of four when he was nominated as the successor to his father Yogamaharishi Dr Swami
Gitananda Giri at Sri Kambaliswamy Madam. He grew up in a Gurukula atmosphere where
the Yoga Vidya (Knowledge of the Art and Science of Yoga) was imbibed as a 24 hour a day
Sadhana and not just a few classes now and then. He has from that tender age assisted his
parents in the Yoga training imparted at Ananda Ashram, Sri Kambaliswamy Madam and
ICYER.
Yoga for him is not just the performance of a few Asanas or Pranayamas but is a means for
evolution of the human mind in to further states of consciousness and awareness.
He has attended various national and international Yoga Conferences all over the world
and assisted in the conduct of three International Yoga Conferences under the guidance of
his Guru-Parents Dr. Swami Gitananda and Smt Meenakshi Devi Bhavanani. He has been
a Featured Speaker and Chairman at many sessions in the 24 International Yoga Festivals
conducted by the Pondicherry Government Tourism Department since 1993. He has had
197 scientific and Yoga papers and 76 abstracts on Yoga and Yoga research published. He
has also scripted and presented 19 DVDs on Yoga and 5 Dance drama productions in
addition to 23 books and 29 notes compilations.
EXPERIENCE in YOGA SPORT COMPETITIONS:

1. COORDINATED:
 Yoga Sport Championships in the International Yoga Festivals conducted by
the Pondicherry Government Tourism Directorate from 2001 onwards.
 Pondy State HIMALAYA Yoga Olympiad in October 2001 at ICYER in
collaboration with Vivekananda Kendra Yogas, Bangalore.
 Pondicherry Team to Bangalore for the National HIMALAYA Yoga Olympiad
in November 2001 where Pondicherry team placed a commendable SECOND
OVERALL.
 SWAMI GITANANDA BEST YOGA YOUTH AWARD competitions every
year since 2000.
 17th - 18th Pondicherry State Yogasana Championship in November 2002 and
2003 at ICYER on behalf of Pondicherry Yogasana Association.
 Pondicherry Team to Kovilpatti for the 15th Tamil Nadu State Yogasana
Championship conducted by the Tamil Nadu State Yoga Association and
Sports Development Authority of Tamil Nadu (Tuticorin) on 9th and 10th
August 2003.
 Pondicherry Team to Kancheepuram for the 2nd National Open Yogasana
Championship conducted by the Narayana Guru Sevashram under auspices of
Indian Yoga Federation and Tamil Nadu State Yoga Association on 24th and
25th July 2004.
 19th to 34th Pondicherry State Yoga Sport Championships in 2004-2018 at
Pondicherry on behalf of Pondicherry Yogasana Association.
 1st, 2nd, 3rd and 4th Tamil Nadu State Invitation Yoga Sport Championship in
2004, 2005 , 2006 and 2007 at Pondicherry on behalf of Pondicherry Yogasana
Association.
 It is notable that two of his students trained at YOGNAT have won the
CHAMPIONSHIP awards in the Pondicherry Government sponsored
International Yoga Festival in 1999 (M NIRAIMATHI) and 2011 (AS
ANIRUDH). Many others have also won first prizes in the event.
2. EXECUTIVE COMMITTEE MEMBER of the INDIAN YOGA FEDERATION,
Kolkata since 2006 onwards.
3. JURY at numerous National and International Yoga Competitions since 1993.
Member, Executive Committee of INDIAN YOGA FEDERATION and State
Coordinator for HIMALAYA YOGA OLYMPIAD.
4. PARTICIPATED in numerous Yoga Sport events from age of 6 to 15 and won
numerous First Prizes in the Pondy State Yogasana Competitions. Stopped
participating in competitions from the age of 15 as he felt the urge to take up the
responsibility of organizing competitions.
LANGUAGES KNOWN:
 TAMIL (read, write and speak)
 ENGLISH (read, write and speak)
 HINDI (read and speak)
 SANSKRIT (read and write)
CLASSICAL ARTIST:
 MRIDUNGAM (All India Radio Artist Grade “B”)
 CARNATIC VOCAL (Vocalist and Composer)
 BHARATA NATYAM (Performer and Choreographer)
 NATUVANGAM
TITLE AWARDS :
Yogacharya, Palkalai Chemmal, Sagala Kala Vallavan, Isai Sevagan, Puduvai Mannin
Maindhan, Jnana Vruddha, Outstanding Young Person 2002, Yoga Vibhushan, Achiever
Award 2003, Yoga Bishmacharya, Yoga Chakravarthy, Muthaizh Suvaignar, Mattala
Vittaga Mamani, Sevai Thilagam, Shiva Yoga Chudar, Yoga Kalaimamani, Yoga Thilagam,
Saivaneri Isai Chemmal, Sri Aurobindo Award, School Psychology- Best Performance
Award 2013 and 2016, Biodiversity Award 2014, Sigaram Award, Bharat Excellence Award,
Mahatma Gandhi Award, Shining Achievers of India 2015 Award, Best Indian Personalities
Award 2016 and ‘Lifetime Achievement Award in Yoga’.
PRESENT OCCUPATION :
1. CHAIRMAN
a. International Centre for Yoga Education and Research (ICYER), Mettu St,
Chinnamudaliarchavady, Tamil Nadu, India.
b. Yoganjali Natyalayam, 25, Iyyanar Nagar, Pondicherry.
c. Vishwa Yoga Samaj, Ananda Ashram, Pondicherry-9.
2. DIRECTOR: Centre for Yoga Therapy Education and Research (CYTER) at
MGMC&RI, Pondicherry under auspices of Sri Balaji Vidyapeeth. Member of the
SBV Academic Council and Research Advisory Boards.
3. ADJUNCT PROFESSOR, Kaivalyadhama, Lonavla from June 2015 onwards.
4. Visiting Faculty for Integrative Yoga Therapy at Kripalu Centre for Yoga and
health, Massachusetts, USA from 2016 onwards.
5. PROGRAMME COORDINATOR: Advanced Centre for Yoga Therapy,
Education and Research (ACYTER), JIPMER, Puducherry from 4th March 2009 to
10th July 2013.
6. GENERAL SECRETARY: Pondicherry Yogasana Association, Pondicherry Music
and Dance Artistes Association
7. SENIOR RESEARCH FELLOW, Yoga Research Project,
Department of Physiology, JIPMER, Pondicherry - 6. (From 2000 to 2004)
8. MANAGING PARTNER, DHIVYANANDA CREATIONS (Spiritual
Publications, Multimedia Creations and Event Management), Iyyanar Nagar,
Puducherry-13.
9. HEREDITARY TRUSTEE and MADATHIPATHI of Sri Kambliswamy
Madam (Samadhi), Thattanchavady, Pondicherry - 9.
10. VICE-PRESIDENT: Yoga Jivana Satsangha (International), Pondicherry
11. REGISTERED MEDICAL DOCTOR (T.N.M.C. No.: 62838)
12. MEDICAL OFFICER: Village Health Programme and Child to Child Health
Education Programme, Auroville Health Centre, Auroville, South India.(From 1999
till June 2008)
13. CONSULTANT YOGA THERAPIST -International Advisory Member
International Association of Yoga Therapists, (IYAT) U.S.A and Australian
Association of Yoga therapists.
14. Honorary President: PONDICHERRY YOGA TEACHERS WELFARE
ASSOCIATION
15. PROFESSIONAL CARNATIC VOCALIST AND COMPOSER
16. PROFESSIONAL MRIDUNGIST
17. BHARATA NATYAM CHOREOGRAPHER
18. STAFF ARTIST and contributor, YOGA LIFE, International Monthly Journal of
Yoga Jivana Satsangha (International), Pondicherry, India.
19. EXECUTIVE COMMITTEE MEMBER of Indian Yoga Federation, Kolkata. 2006-
2010.
20. Member, Board of Trustees, Sri Aurobindo Siddha Research Foundation Trust,
Pondicherry-1.
21. HONORARY ADVISOR:
a. International Association of Yoga Therapists (IAYT), U.S.A
b. Gitananda Yoga Societies/ Associations of Australia, USA, Italy,
Switzerland, Germany and UK
c. Sanatana Dharma Sangha, Italy
d. Australian Association of Yoga Therapists, Australia
e. World Yoga Foundation, Kolkota, India
f. Scientific Research Department, Kaivalyadhama, India.
g. Anjali School of Yoga, South Africa
h. Vijeya School of Yoga, Switzerland
i. Yoga Alliance International, New Delhi
j. Puduchery Yoga and Naturopathy Association, Pondicherry-4
k. Gitanjali Yoga Centre, Vennila Nagar, Pondicherry-8
l. Sadagopan Yoga Centre, Puducherry-4
LIFE MEMBER :
 IMA (Indian Medical Association), New Delhi, India
 IAYT (International Association of Yoga Therapists) U.S.A
 APPI (Association of Physiologists and Pharmacologists of India)
 Pondicherry Psychology Association, Pondicherry, India
 ABHAI (Association of Bharata Natyam Artists of India), Chennai
 INDIAN ACADEMY OF YOGA, Banaras Hindu University, UP.
Life Sketch
LIFE SKETCH OF PALKALAI CHEMMAL
YOGACHARYA DR. ANANDA BALAYOGI BHAVANANI
Yogacharya Dr. Ananda Balayogi Bhavanani was born to the world famous Yoga team of
Yogamaharishi Dr. Swami Gitananda Giri Guru Maharaj and Puduvai Kalaimamani,
Yogamani, Yogacharini, Smt. Meenakshi Devi Bhavanani on April 16, 1972, at
Pondicherry, South India.
He was reared in the 'Gurukula' atmosphere of Ananda Ashram, first at Lawspet and then
at Sri Kambliswamy Madam in Thattanchavady, Pondicherry where the Yoga Vidya
(Knowledge of the Art and Science of Yoga) was imbibed as a 24 hour a day Sadhana and
not just a few classes now and then. Nominated as his Guru Father's successor on his fourth
birthday itself as Madathiapathy of Sri Kambaliswamy Madam (an ancient Samadhi site),
Ananda took great interest in the Hindu Rites and Rituals, Mantra, Yoga and the Carnatic
Fine Arts from a young and tender age. He has been trained in Rishiculture Ashtanga
(Gitananda) Yoga from that tender age. He has assisted his parents in the Yoga training
imparted at Ananda Ashram, Sri Kambaliswamy Madam and ICYER from that time
onwards.
He began his studies of classical Carnatic Vocal Music at the age of four years under
Puduvai Kalaimamani Shri V Manikannan performing Vocal Music Arangetram at the
age of 12 years at Marie Hall, Podicherry on August 11, 1984. At the age of seven years he
began arduous training in Carnatic Music under the tutorage of Kalaimamani Srirengam
R. Ranganathan of Pondicherry, one of the most famous Carnatic Vocalists of South India.
He continued his training for twenty years until his Guru’s death in 2002. He has studied
Mridungam since the age of five, beginning with world-famous Master Shri K M
Vaidhyanathan in 1977. Later, Thiruvarur Shri R. Krishnamurthy, one of the most
respected classical Mridungists of modern times, accepted him as a disciple. He completed
his Mridungam Arangetram in 1987. He began the study of Bharata Natyam under his
mother Puduvai Kalaimamani Smt Meenakshi Devi Bhavanani in the Kalakshetra
tradition of Rukmani Arundale when he was five years of age. At the age of eight, world-
famous Bharata Natyam master Padmasri Adyar K. Lakshmanan of Chennai accepted him
as a disciple and he performed many performances under the guidance of Lakshman Sir.
For the past decade he has shared a special Manasika Guru-Sishya relationship with Padma
Bhushan Sri TV Sankaranarayanan, one of India’s greatest vocalists. He treasures all these
blessed relations with his illustrious Gurus that the Divine has bestowed upon him in his
artistic evolution.
His initial training in scholastic work was in the Ashram itself and only when he was
thirteen was he sent to Bhavan's Gandhi Vidyashram, Kodaikanal, to do his formal
schooling. At school in addition to his academic proficiency, he was also one of the cricket
team's major stars and the all-round Athletic Champion. At school he was awarded the
"K.S. Jayarama Iyer Award for Best Instrumentalist" for three successive years. In his final
year he served as the School Captain.
He has written a book on Yoga For Children at the age of 12 years itself and has written
and edited 22 other books including ‘Yoga And Modern Man’ that takes a look at various
Yogic concepts with humorous cartoons and line drawings and “A Yogic Approach To
Stress” that deals with the Yogic explanations and management of stress. The 2nd edition of
the Stress Book was released recently. His “A Primer of Yoga Theory” that has also been
published in Tamil as “Yoga Vina Vidai Thoguppu” has become a standard textbook for
Yoga Sport events and is also prescribed in many academic Yoga courses. It is now in its 3rd
edition. “Yoga: 1 to 10” explains numerous concepts of Yoga and Indian Culture through a
numerical codification using the numbers 1 to 10. It has been translated and published in
Italian in 2009. He coauthored a Tamil book on Basic Hatha Yoga Lessons of Gitananda
Yoga as well as Yoga for Weight Loss. In the past few years he has authored, “Yoga for
Health and Healing”, “Yoga for Weight Reduction”, Chakras, Hatha Yoga of the
Gitananda Tradition, Meditation the inner Yoga, Yoga and Wellness, Suryanamaskar
and Understanding the Yoga Darshan (an exploration of the Yoga Sutra of Maharishi
Patanjali). He is currently working on a text book on “Yoga Chikitsa: The Application of
Yoga as a Therapy” as well as “Saraswati’s Pearls” a book on Yoga and Music coauthored
with Yogacharini Dr. Sangeeta Laura Biagi of Italy.
He has also edited and revised the new editions of Dr Swami Gitananda Giri’s Correction
of Breathing Disorders through Rishiculture Ashtanga Yoga and also Pujya Swamiji’s
books on Mudras, Surya Namaskar and Pranayama in the Gitananda Tradition. He has
had 197 scientific and Yoga papers and 76 scientific abstracts on Yoga and Yoga research
published along with 29 notes compilations on Yogic education and therapy.
He has also scripted and presented 19 DVDs on Yoga that are being marketed for a
worldwide audience in different languages by the famous Super Audio Company in
Chennai.
He undertook the Diploma and Advanced Diploma courses in Yoga at ICYER under the
guidance of his Guru-father Yogamaharishi Dr. Swami Gitananda Giri in 1991 and
following this joined medical college in order to combine the best of eastern wisdom with
the best of modern medical science.
During his Medical Studies at J.N.M.C Wardha (Nagpur University), he was the top student
in a class of hundred. He secured Distinction in Surgery and a Gold Medal in Community
Medicine in his final year, topping about 500 students from the five Medical Colleges
affiliated to Nagpur University. He was also the Student Representative at Medical
College. Later he completed his internship at JIPMER Hospital, Pondicherry, India.
He has completed with distinction Post Graduate Diploma in Family Health (PGDFH)
from Sri Ramachandra Medical College (Deemed University), Chennai (2003). He has also
completed a Diploma in Psychological Counseling as well as a Diploma in Stress
Management from the Institute for Health Care Administration, Chennai in 2001 and a
Certificate in Pediatrics from IMA Sinha Institute, New Delhi. He was awarded MD
(Alternative Medicine) by the Indian Council of Alternative Medicines, Kolkata, West
Bengal in 2013.
He was one of the Star performers in the television serial YOGA FOR YOUTH that was
first broadcast over New Delhi Doordarshan in November 1989. This series of twenty-five
episodes is regularly re-broadcast on the National Doordarshan Channel even to date. His
musical concerts and Mridungam have been regularly broadcast over Pondicherry
television. He has presented five Yoga programmes on NDTV in February 2008 with re-
broadcasts numerous times. His Yoga DVDs are regularly played on Shatabdi Express train
services and are also now available through Tata Sky TV network.
He was a performer of Bharata Natyam and has performed all over India and notably at the
ABHAI National Dance Festival in 1992. Following his father's Maha Samadhi on Dec.
29-1993 he has stopped his dance performances and instead, focused his attention on Dance
Choreography, especially in the rhythmic aspect for Yoganjali Natyalayam. He has helped
to choreograph 16 Major Dance Dramas and 15 Mini Dance Dramas for Yoganjali
Natyalayam. He CO-DIRECTED “Ramavathara” (2003), “Pancha Maha Bhuta” (2004),
“Jayadeva’s Dasavathara” (2005) , “Navagraha Vazhipaadu: A homage to the
Navagrahas” (2006), “Karna Charitram” (2007), “Namashivaya Vazhga”- The story of
Thiru Gnana Sambandar (2008), Panchali Sabadam (2009) , Muruga Muruga (2010),
Shakuntala (2011), Thamizh Moothatti Avvai (2012), Lingasthakam (2013), Pancha Maha
Bhuta (2014), Navarasa (2015),Pancha Maha Devigal (2016), and Trishakti (2018). He has
also recently composed the music as well as choreographed four complete Bharatanatyam
Margams (the classical performing repertoire) with more than four dozen compositions that
could be called “Ananda Nartana Margam”
As a Carnatic Vocalist and instrumentalist he has released many albums of which "THE
YOGA OF SOUND" has the unique blend of English lyrics with Carnatic Raga and Tala in
an attempt, to bridge the gap between East and the West. The second Album 'TAMIL
INBAM' is a collection of Tamil Compositions in Carnatic Music. He is a regular performer
at programmes in and around Pondy and has performed at the International Yoga Festival,
Government Music Festival, Millennium Sunrise Festival, Thiagaraja Festival, Puduvai
Tamil Isai Sangam and Eswaran Koil Kumbabhishekam amongst many others in
Pondicherry. He is well known for his spontaneous imagination in the concerts and for his
explanations on the Yogic aspects of Carnatic Music. He has performed innumerable vocal
and instrumental recitals all over India including in Bombay, Dehra Dun, Chennai,
Cochin, Lonavla (Pune), Chidambaram, Bangalore and Pondicherry. It is notable that he
has performed five times in the Isai Vizha (Music Festival) conducted by the Govt of
Pondicherry in 1998, 2000, 2003, 2008 and 2012. He has also performed in Italy,
Switzerland, Germany, UK, South Africa, USA, Australia and New Zealand in recent
times.
He has been a featured speaker at many Yoga conferences and is a regular featured speaker
at the International Yoga Festival conducted by the Government of Pondicherry each year
in January since 1993. He has also been the Co-ordinator and Jury at the International
Yogasana Competition held at the International Yoga Festival – Pondicherry annually and
is responsible for organizing the more than 800 contestants who come from all over India
to participate. He has also organised Himalaya Yoga Olympiad in Pondicherry (2001) in
his capacity as Himalaya State Coordinator and led the Pondy team to the National
Himalaya Yoga Olympiad at Bangalore in November 2001.
He is responsible for reviving the Pondicherry Yogasana Association (2000) founded by
Yogamaharishi Dr Swami Gitananda Giri in 1975. He is currently the General Secretary of
the Pondicherry Yogasana Association and a member of the Executive Committee of
Indian Yoga Federation, Kolkata. The PYA has been active in conducting Yoga Sport events
such 34 Pondicherry State Level Yoga Sport Championships and 21 Swami Gitananda Best
Youth and Child Award Competitions.
It is notable that two of his students trained at YOGNAT have won the
CHAMPIONSHIP awards in the Pondicherry Government sponsored International Yoga
Festival in 1999 (M NIRAIMATHI) and 2011 (AS ANIRUDH).
Yoga for him is not just the performance of a few Asanas or Pranayamas but is a means for
evolution of the human mind in to further states of consciousness and awareness. He has
been instrumental in developing the concept of “Yoga Tableaus” as a performing art and
has trained hundreds of young people in the difficult art of acrobatic Yoga Asanas. The
Yoga-Asana Tableau Concept has been developed by Dr. Ananda a vital tool in inculcating
the sense of “team spirit and mutual cooperation” into youngsters. His pioneering efforts
in this field have been widely applauded. As well, Dr. Ananda has been a pioneer in the
revival of the use of the acrobatic Natya Karanas (difficult, athletic and acrobatic postures
of Bharatanatyam) into the modern dance repertoire. With his finely developed aesthetic
sense, he tastefully weaves these acrobatic poses into his classical dance choreography and
productions.
As chairperson of Yoganjali Natyalayam he has coordinated programmes at Bangalore
(sVYASA), Chennai (Arkaya Foundation), Alangudi (Guru Stalam), Kodaikanal (Bhavan’s
Gandhi Vidyashram), Tanjore (Salangai Natham 2004 for the South Zone Cultural Centre)
and Mahe (Varnam 2004 for the Dept of Art and Culture). He also coordinated the Yognat
team’s performance during the Cultural Procession marking the 50th year of Pondicherry
Independence in August 2004. He has also coordinated the spectacular annual day
celebrations of Yognat for the past 25 years along with the annual full length dance dramas
productions by Yognat. He has also coordinated many programmes for the Pondicherry
Music and Dance Artistes Association in the past decade.
Even in his formative years, he attended various Yoga Conferences and seminars at New
Delhi, Bombay, Lonavla, Bhopal, Bangalore, Chennai, Kancheepuram, Madurai and other
places along with his parents. He also assisted in the conduct of three International Yoga
Conferences conducted at Pondicherry by Ananda Ashram under Dr. Swami Gitananda
and Smt Meenakshi Devi Bhavanani and has been ex-officio advisor to the International
Yoga Festival of the Pondicherry Government since 1993.
He has had the good fortune of meeting and receiving the blessings of numerous Great
Yoga Masters such as Swami Chidanada, Swami Chinmayananda, Swami Satchidananada,
Swami Dayananda, Swami Digambarji, Padmabhushan BKS Iyengar, Sri Yogendra Desai,
Yogacharya Sri TKV Desikachar, Sant Keshav Das, Yogi Amrit Desai, Yogic Direndra
Brahmachari and Sri Yogeshwar. He has also been privileged to receive the blessings of
eminent Scientist Yogis such as Shri RR Diwakar, Dr K Arunachalam, Dr B Ramamurthy,
Prof TR Anantaraman, Dr W Selvamurthy, Dr RL Bijlani, Dr Nagendra, Dr Nagaratna, Dr
MV Bhole, Dr SV Rao, Dr RP Pandey, Dr Khapre, Dr SR Joharapurkar and Dr Madanmohan.
As a Mridungist he has accompanied great artists like Padma Bhushan T.V.
Sankaranaarayanan, Kalaimamani Srirengam Ranganathan, Kalaimamani Kulikkarai S.P.
Vishvalingam, Vidushi Radha Kalyanaraman, Kalaimamani S Matangi, Shri B
Govindarajan, Kumbakonam MR Gopinath, Kalaimamani SV Jagadeesan and others on the
Mridungam and is a 'B' Grade Mridangist recognized by All India Radio. He regularly
plays for Yoganjali Natyalayam dance performances. He has played Mridungam for
“Sendhen Tamilisai”, a Music Album by Kalaimamani Pulavar I Pattabiramane in 2002 as
well as “Bhakti Mani Mala”, a music album sung by Smt Jyothirmayi (2003). He has also
played Mridungam in the Music Therapy Albums of Dr Hariharan PhD.
He shares a special relationship with Mutthamizmamani Kalaimamani Pulavar I
PATTABHIRAMAN, the illustrious Tamil Scholar and poet of Pondicherry who has
composed the lyrics for all dance drama of Yognat in the past 25 years. Dr Ananda values
this relationship that has stimulated an inner growth manifesting as a deep love for the
Tamil language and that has motivated his skill in Tamil composition.
He is a life member of INDIAN MEDICAL ASSOCIATION; ABHAI (Association of Bharata
Natyam Artists of India); Chennai, IAYT (International Association of Yoga Therapists,
based in USA); APPI (Association of Physiologists and Pharmacologists of India), INDIAN
ACADEMY OF YOGA, BHU, Varanasi and the PONDICHERRY PSYCHOLOGY
ASSOCIATION. He is Honorary International Advisor to International Association of Yoga
Therapists (IAYT) in the USA, the Australian Association of Yoga Therapists and on
Editorial Board for Yoga Mimansa journal of Kaivalyadhama, Lonavla, India.
He is Hon Chairman of Sanathana Dharma Sangha, the Hindu Movement in Italy and
Europe as well as more than a hundred Rishiculture Ashtanga (Gitananda) Yoga centres
worldwide. He is Patron of Gitananda Yoga Associations of Australia, Germany, UK,
Czech Republic, North America and Italy.
He has traveled abroad 18 TIMES and given workshops, classes, lectures, performances
and talks in USA (San Francisco and Kripalu in Massachusetts), Canada (Montreal), UK
(Cornwall and Wales), Italy (Rome, Milan, Merano, Liverno, Genova and Savona),
Switzerland (Locarno), Germany (Berlin), Australia (Sydney, Brisbane, Melbourne,
Adelaide, Gold Coast and Victoria), New Zealand (Wellington, Paraparaumu), South
Africa (Cape Town). He was a featured Guest at the MILAN YOGA FESITVAL 2007 and
2008 and Merano Yoga Festival 2012 where he gave successful workshops and performed
concerts of South Indian Music for an appreciative audience. He was a featured guest
presenter at the International Yoga therapy conference in San Rafael, USA where he lectured
and taught in October 2008. He has given invited talks at the Tagore centre of the Indian
Embassy in Berlin in 2007 and 2008. He was invited guest of the National Institute of
Integrative Medicine, Melbourne in April 2009. He has taught and performed at the
GITANANDA ASHRAM in Italy on all his visits to the “Mini India” created near Savona
by Svami Yogananda Giri.
He was invited to be MAJOR PRESENTER at the “REUNION IN YOGA”- IYTA WORLD
YOGA CONVENTION held at Sydney, Australia from 16 to 19 September 2010. Nearly 200
delegates attended the WORLD CONVENTION that was held after a gap of 13 years. It is
to be noted that previous such invitees have been Swami Satyananada Saraswathi, Swami
Gitananda Giri, Swami Satchitananda, BKS Iyengar, Andre Van Lysbeth, Lilias Folan,
Howard Kent, Mansukh Patel and Swami Maheshwarananda. He has conducted successful
Yoga workshops for IYTA in Sydney in 2008 and 2012. He was invited to be a Keynote
Speaker at the Golden Jubilee 50th anniversary of IYTA in October 2017 at Sydney and
SYTAR the annual conference of the International Association of Yoga Therapists in
Reston, Virginia in June 2018.
Dr. Ananda is a Senior Lecturer in Mantra, Yantra, Yoga History and Philosophy and Yoga
Physiology and Anatomy for the fully residential Yoga Teachers Training Courses at the
International Centre for Yoga Education and Research (ICYER) in Kottakuppam, Tamil
Nadu. These full time residential courses, the 6- Month International Yoga Teachers
Training Course and the One Year Yoga Teachers Diploma Courses are well established
and presented to an international professional standard. These courses have been held
annually since 1968 and students from all over the world attend these Yoga Teachers
Training courses.
Dr. Ananda is Chairman of the International Centre for Yoga Education and Research
(ICYER), the internationally acclaimed Yoga Institute established as “Ananda Ashram” in
1968. He is Chairman of Yoganjali Natyalayam, a world famous Institute of Yoga, Bharata
Natyam, and Carnatic Music established in Pondicherry in 1993. He is also Director of
studies for both these institutes
He has received the Marudha Ramalinganar OUTSTANDING YOUNG PERSON
AWARD and Rolling Shield for the year 2002 from the Youth Peace Centre, Pondicherry
and received the title award of “Yoga Vibhushan” from Tamil Nadu State Yoga Association
and Sports Development Authority of Tamil Nadu (Tuticorin) in August 2003.
He received the title award of “Yoga Bishmacharya” from the Tirumoolar Yoga and Natural
Diet Trust, Chennai and Tamil Nadu State Yoga Association in November 2004. He has been
honoured with the “Yoga Chakravarthy” title awarded by Gitanjali Yoga Centre in
September 2005.Other titles and awards received by him are “Palkalai Chemmal”, “Sagala
Kala Vallavan”, “Isai Sevagan”, “Puduvai Mannin Maindhan”, “Achiever Award 2003”,
“Jnana Vruddha”, “Muthaizh Suvaignar”, “Mattala Vittaga Mamani”, “Sevai Thilagam”
,“Shiva Yoga Chudar”, “Yoga Kalaimamani”,“Yoga Thilagam”,“ Saivneri Isai Chemmal”,
“Sri Aurobindo Award”, “ Palkalaisudar Mamani”, and “Biodiversity Award 2014”. He
was awarded the SCHOOL PSYCHOLOGY: BEST PERFORMANCE AWARD 2013 by
Indian School Psychology Association (InSPA), during 3rd National Conference on School
Psychology Services to Multiple Disabled Children, in November 2013 at NIEPMD,
Muttukadu, Tamil Nadu, India.
He was honoured for his Yoga Seva by Kumari Selja Union Minister for Tourism
during the 18th international Yoga Festival 2011 in the presence of Sri V
Narayanasamy, Union Minister for Culture, Lt Governor of Pondicherry Dr Iqbal
Singh, Chief Minister Sri Vaithiyalingam, Home Minister Sri Valsaraj, Tourism
Minister Sri Malladi Krishna Roa and Social Welfare Minster Sri Kandasamy. He
was also awarded the “LIFETIME ACHIEVEMENT AWARD IN FIELD OF YOGA” on
January 7th 2011 by Department of Tourism, Govt of Pondicherry during the 18th
International Yoga Festival. He 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 worked for four years from 2000 to 2004 as a SENIOR RESEARCH FELLOW in the
Yoga Research Project conducted by Department of Physiology, JIPMER under auspices of
Union Ministry of Health and Family Welfare as well as Ministry of Defense, Govt. of India,
New Delhi. He involved in various research studies at JIPMER and published numerous
scientific papers on these findings.
He worked as MEDICAL OFFICER in the Village Health Programme and the Child to
Child Health Education Programme run by the AUROVILLE HEALTH CENTRE in the
International Township of Auroville, Tamil Nadu from 1999 to 2000 and 2004 to 2008.
He worked as PROGRAMME COORDINATOR in the Advanced Centre for Yoga
Therapy, Education and Research (ACYTER), JIPMER, Puducherry from March 2009 to
July 2013. Many research studies were completed and scientific papers published from this
centre established by a MOU between JIPMER and MDNIY in June 2008. The centre focused
on the role of Yoga in the prevention and management of cardiovascular disorders and
diabetes mellitus and 36,000 patients benefited from Yoga therapy consultations and
practical sessions. The centre also popularized the science of Yoga among medical
professionals and general public and conducted three national workshops on Yoga in
medical education, Yoga and hypertension, Yoga and diabetes as well as workshops on
Yoga and HIV etc with excellent response from all over the country.
Dr Ananda is currently DIRECTOR of the Centre for Yoga Therapy Education and
Research (CYTER), MGMC&RI, Pondicherry under auspices of Sri Balaji Vidyapeeth.
More than 50,000 patients have benefited from Yoga therapy at this centre and 86 papers
and 30 abstracts published along with the conduct of six successful National CMEs on
“Yoga and lifestyle disorders”, “Sleep, consciousness and meditation: neurological
correlates”, “Therapeutic Potential of Yoga”, “Integrating Yoga in Health Professions
Education”, “Role of Yoga in Chronic Diseases”, “Swastha Manas” from 2013 to 2018, as
well as International Symposiums on “Yoga and Wellbeing” in 2016 and “ Yoga Therapy”
in 2017. He is extremely proud of his illustrious and dear student Yoga Chemmal Dr Meena
Ramanathan who is working as Coordinator and Yoga Therapy Consultant for this centre
that is serving thousands through Yoga.
He finds pride of place in many reference biographies such as Reference Asia, Emerald
Who’s Who in Asia, Biography, Asia Pacific Who’s Who, Famous India: Nation’s Who’s
Who, Asia: Men & Women of Achievement, Kohinoor Personalities, Asian Admirable
Achievers And Asian American Who’s Who. He has received the Best Personalities of India
Award and Shining Achievers of India Award from Friendship Forum, New Delhi in 2015
and 16 for his excellent contribution towards welfare of people.
He was recognized as PhD Guide (Yoga Therapy and Inter Disciplinary Research) by Sri
Balaji Vidyapeeth, Pondicherry in August 2016 and was the first Indian to be recognized as
IAYT Certified Yoga Therapist by the International Association of Yoga Therapists, USA in
September 2016. He was honored with the InSPA PK Subbaraja Trust Best Performance
Award by the CM of Puducherry Sri V Narayanasamy during 6th InSPA International
Conference and 3rd International Conference of the Department of Applied Psychology of
Pondicherry University at Convention Centre of the Pondicherry University on 13 Oct 2016.
In recent years he has travelled abroad 18 times and conducted invited talks, public events,
workshops and retreats and been major presenter at Yoga conferences in the UK, USA, Italy,
South Africa, Germany, Switzerland, Canada, Australia and New Zealand. He is an
Honorary International Advisor to the International Association of Yoga Therapists
(www.iayt.org), the Australasian Association of Yoga Therapists
(www.yogatherapy.org.au), the World Yoga Foundation (www.worldyogafoundation.in)
and Gitananda Yoga Associations worldwide (www.rishiculture.in).
He is currently Member of the National Board for Yoga and Naturopathy of AYUSH,
Standing Finance Committee of the CCRYN, Ministry of AYUSH, Govt of India as well as
the Expert Committee of AYUSH for Celebration of International Yoga Day and the Yoga
& Diabetes program. He is also member of the Executive Council of the Indian Yoga
Association (www.yogaiya.in) and Board of Directors of the Council for Yoga Accreditation
International (www.cyai.org) as well as Technical Committee of the Yoga Certification
Board at MDNIY, Ministry of AYUSH.
He is married to Yogacharini Devasena Bhavanani who has a Masters degree in Sanskrit
in addition to being an eminent Yoga Expert, Carnatic Vocalist and Bharatanatyam Dancer,
teacher and choreographer. They have a talented daughter Dhivya Priya Bhavanani and
son Anandraj Bhavanani.
Selected Published
Research Papers
Indian J Physiol Pharmacol 2003; 47 (4) : 387–392
EFFECT OF YOGA TRAINING ON HANDGRIP, RESPIRATORY

PRESSURES AND PULMONARY FUNCTION
MANDANMOHAN*, LAKSHMI JATIYA, KAVIRAJA UDUPA

AND ANANDA BALAYOGI BHAVANANI
Department of Physiology,
Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER),
Pondicherry – 605 006
( Received on February 5, 2003 )
Abstract : Although there are a number of reports on the effect of yoga

training on pulmonary functions, very few studies have been undertaken
on the effect of yoga training on respiratory pressures and handgrip
endurance. Hence the present work was planned to study the effect of
yoga training on hand grip strength (HGS), hand grip endurance (HGE),
maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP),
forced expiratory volume (FEV), forced expiratory volume in first second
(FEV 1 ) and peak expiratory flow rate (PEFR). 20 school children in the
age group of 12 to 15 years were given yoga training ( asans and pranayams)
for 6 months. 20 age and gender-matched students formed the control
group. Yoga training produced statistically significant (P<0.05) increase
in HGS and HGE. MEP, MIP, FEV, FEV 1 and PEFR also increased
significantly (P<0.001) after the yoga training. In contrast, the increase in
these parameters in the control group was statistically insignificant. Our
study shows that yoga training for 6 months improves lung function,
strength of inspiratory and expiratory muscles as well as skeletal muscle
strength and endurance. It is suggested that yoga be introduced at school
level in order to improve physiological functions, overall health and
performance of students.
Key words : yoga training pulmonary functions

respiratory muscle strength muscle endurance
INTRODUCTION (PEFR) (1, 2, 3, 4, 5). However, very few

workers have studied the effect of yoga
There are a number of reports on the training on respiratory pressures i.e.
effect of yoga training on pulmonary maximum expiratory pressure (MEP) and
functions like forced expiratory volume maximum inspiratory pressure (MIP).
(FEV), forced expiratory volume in 1st Respiratory pressures are easily measured,
second (FEV 1) and peak expiratory flow rate objective and sensitive indices of respiratory
* Corresponding Author
388 Madanmohan et al Indian J Physiol Pharmacol 2003; 47(4)
muscle strength and can be altered in had no previous exposure to yoga training
disease states even when other commonly and none of the subjects had a history
measured pulmonary function tests show of substance abuse. Respiratory and
little abnormality (6). In an earlier work, cardiovascular diseases were ruled out by
we have found that yoga training for 12 their history and clinical examination. Their
weeks results in a significant improvement age was 12 to 15 (13.21 ± 0.10, SEM) years,
in MEP and MIP in normal young weight 20 to 57 (34.97 ± 1.24, SEM) kilograms,
volunteers (7). In the same study, we also height 1.3 to 1.66 (1.48 ± 0.01, SEM) meters
observed a significant increase in handgrip and body mass index (BMI) 8.33 to 23.30
strength (HGS) after yoga training and this (15.90 ± 0.44, SEM) units. After briefing
is in agreement with the findings of other about the study protocol, informed consent
workers (8, 9, 10). However, the effect of was obtained from them as well as their
yoga training on handgrip endurance (HGE) parents. The subjects were divided randomly
has been studied by only a few workers. into two groups of 20 each.
While Tran et al (10) have reported a
significant increase in muscular endurance Group I (yoga group) : Group I
after 8 weeks yoga training program, Dash subjects were taught the following asans
and Telles (11) have concluded that yoga and pranayams : talasan, utkatasan,
training does not increase muscle trikonasan, ardhamatsyendrasan, bakasan,
endurance. Handgrip dynamometry is an pavanmuktasan, navasan, noukasan,
indicator of muscle function and nutritional matsyasan, pashchimottanasan, halasan,
status. As an objective and accurate bhujangasan, shalabhasan, sarvangasan,
physiological test that is easy to perform, it shavasan, mukh-bhastrika, mahat yoga
can be used as a bedside test to predict pre- pranayam, nadi shuddhi and savitri
operative nutritional status and post- pranayam. Each pose was held for 30
operative complications (12). Keeping this seconds and a short period of rest was given
in mind, we planned to study the effect of between the poses. Each pranayam was
yoga training on these parameters. Since performed nine times. Shavasan was
most of the studies on the effect of yoga performed at the end for ten minutes.
training on pulmonary functions have been Detailed description of these techniques is
conducted on subjects above 18 yr in age, given in standard texts on yoga (13, 14).
the present study was carried out on school
going children from younger age (12–15 yr) The subjects underwent yoga training
group. over a period of 2 weeks. After the training
period, 45 minute practice sessions were
METHODS held regularly, Monday through Saturday,
for a total duration of 6 months under our
Subjects and T 40 student volunteers
raining :
Training direct supervision.
of either gender studying in 8th standard
at Government Higher Secondary School, Group II (control group) : Group II
Indira Nagar, Pondicherry were motivated subjects did not receive any yoga training.
and recruited for the present study. They They were asked to study in a classroom
Indian J Physiol Pharmacol 2003; 47(4) Yoga on Handgrip, Respiratory Pressures and PFT 389
while Group I subjects were undergoing the subjects did not use oral muscles to
yoga training. develop pressure or tongue to block the
tubing.
Parameters :2–3 days prior to pre-training
recordings, the subjects were familiarized Spirometry : FEV, FEV 1 and PEFR were
with the laboratory environment and their measured by computerized spirometer
anthropometric measurements were taken. (Spirocheck, Morgan, England). The subject
They were given instructions about the was instructed to take maximum inspiration
experimental procedures and practice trials and blow into the mouthpiece as rapidly,
were administered until we were satisfied forcefully and completely as possible. It was
that the subjects performed the test as ensured that a tight seal was maintained
required of them. Pre and post training between the lips and the mouthpiece of the
measurements were taken about 2 hours spirometer.
after a light breakfast.
The above mentioned parameters were
Handgrip strength and endurance : HGS measured before and after the 6 months
(mm Hg) was measured with the dominant study period in both the groups. For each
hand gripping an inflated cuff of a mercury parameter, three trials at three minute
manometer while the subject was sitting intervals were given and highest of the
c o m f o r t a b l y i n a c h a i r. T h e a r m w a s three values was used for statistical
extended in front at the shoulder level and analysis.
kept horizontal to the ground. For
determining HGE, the subject was asked to
Statistical analysis
maintain 1/3rd of HGS in a sustained
squeeze for as long as possible and the time The data was analyzed using Student’s
(sec) was noted. In all our subjects, right paired ‘t’ test to compare the pre and post
hand was dominant hand. Dash and Telles training values of both the groups. P value
(8) have reported that hand grip strength of less than 0.05 was accepted as indicating
of right hand is greater than that of left significant difference between the compared
hand. values.
Respiratory pressures : MEP was

RESULTS
determined by asking the subject to blow
against mercury column of a manometer
Yoga training of six months produced a
after taking in a full breath. The maximum
significant (P<0.05) increase in HGS and
level at which the mercury column could be
maintained for about 3 sec was noted. MIP HGE in our group I subjects (Table I). It
was determined by asking the subject to also produced a highly significant (P<0.001)
perform maximum inspiratory effort against increase in MEP, MIP, FEV, FEV 1 and PEFR.
the mercury column after breathing out In contrast, the changes in these parameters
fully. MIP that could be maintained for in the control group subjects were
about 3 sec was noted. It was ensured that statistically insignificant.
TABLE I : Handgrip strength (HGS), handgrip endurance (HGE), maximum expiratory pressure (MEP), maximum
inspiratory pressure (MIP), forced expiratory volume (FEV), forced expiratory volume in 1st second (FEV 1)
and peak expiratory flow rate (PEFR) before and after the 6 months study period.
Yoga group Control group

Parameters
Before After Before After
HGS (mm Hg) 129.53± 8.96 147.37± 9.57* 133.30± 7.54 133.00± 8.53
HGE (sec) 46.21± 4.38 57.16± 5.86* 45.05± 2.87 50.90± 4.99
MEP (mm Hg) 29.32± 4.63 46.05± 5.5** 29.75± 4.31 36.00± 3.93
MIP (mm Hg) 30.26± 3.07 65.53± 5.86** 34.75± 3.11 38.00± 3.31
FEV (L) 1.85± 0.07 2.21± 0.09** 1.98± 0.06 2.11± 0.07
FEV 1 (L) 1.84± 0.07 2.12± 0.09** 1.90± 0.05 2.03± 0.07
PEFR (L/min) 271.21± 14.82 336.16± 19.04** 270.40± 10.28 287.05± 12.69
Values are Mean ± SEM for 20 subjects in each group. *P<0.05, **P<0.001.
DISCUSSION involve sustained isometric contraction of

t h e s h o u l d e r, c h e s t a n d a r m m u s c l e s .
In the present study, HGS and HGE Consequent improvement in the strength
increased significantly after six months of and endurance of these muscles can explain
yoga training. This is consistent with our the significant increase in HGS and HGE.
earlier finding that yoga training produces Although HGS and HGE are simple methods
a significant increase in HGS (7). Raghuraj to assess skeletal muscle strength and
et al (9) have reported that pranayam nutritional status, normative data on these
training results in significant increase in parameters is limited. These tests can be
the HGS of both hands. On the other hand, used to determine the effectiveness of
Dash and Telles (11) have concluded that health-promoting programs like yoga
yoga training produces an increase in motor training. They can also be used as objective
speed for repetitive finger movements, but clinical measures for determining the
not in strength or endurance. The increase severity of the disease process and
in HGS and HGE in our yoga group is effectiveness of rehabilitation programs.
consistent with the findings of Tran et al Hence, there is a need to carry out further
(10) who have reported that eight week studies on these parameters in normal
hatha yoga training results in a significant subjects and patients with neuromuscular
increase in isokinetic muscular strength and and nutritional disorders.
isometric muscular endurance. Raju et al
(15) have also reported that yoga training In the present study MEP and MIP
results in a significant increase in maximal increased significantly following six months
work output with a significant reduced level of yoga training in our group I subjects.
of oxygen consumption per unit work. Some Our results do not agree with those of Gopal
of the yogic postures in our study like et al (16) who have reported a lower MEP
bakasan , bhujangasan and shalabhasan in yoga trained subjects as compared to
Indian J Physiol Pharmacol 2003; 47(4) Yoga on Handgrip, Respiratory Pressures and PFT 391
u n t r a i n e d o n e s . H o w e v e r, t h e p r e s e n t (both men and women), Birkel and Edgren

findings are consistent with those of our (2) found that yoga training produced a
earlier work (7). Chen and Kuo (17) have significant improvement in vital capacity
reported that inspiratory muscle endurance across all categories of subjects that
is greater in physically active men than included smokers, asthmatics as well as
sedentary men. The increase in MEP and those with no known lung disease. Joshi et
MIP in our yoga group indicates that yoga al (5) have reported that pranayam training
training improves the strength of the improves ventilatory functions in the form
expiratory as well as inspiratory muscles. o f i n c r e a s e i n F E V, F E V 1 a n d P E F R .
Mukh-bhastrika included in our present Makwana et al (3) and Yadav and Das (4)
training program involves powerful strokes also found a significant increase in these
of exhalation, which trains the subject to parameters after yoga training. Thus our
make full use of diaphragm and abdominal results are consistent with the findings of
muscles. Slow, deep and full exhalation other workers who have reported beneficial
and inhalation during mahat yoga and effects of yoga training on pulmonary
savitri pranayams also train the respiratory function as measured by spirometry. Vital
muscles. Respiratory muscles are vital and capacity is a critical component of good
evaluation of their performance is health and its determination is important
important. Respiratory pressures are for normal subjects, smokers and patients
specific and sensitive indices of respiratory with respiratory and cardiovascular
muscle strength and they are easy to conditions. PEFR is an inexpensive, accurate
measure and reproducible. Black and Hyatt and simple test for measuring airway
(6) have demonstrated that their values are resistance and strength of expiratory
altered before there is alteration in other muscles.
commonly used pulmonary function tests.
Hence, evaluation of respiratory muscle The baseline values of our subjects are
strength is important from physiological as lower than those reported in the literature.
well as clinical point of view. Since the The values for European subjects are known
highest MEP is obtained at lung volumes of to be higher than the age and sex matched
more than 70% of total lung capacity and Indian subjects and this has been attributed
the highest MIP is obtained at lung volumes to racial background and nutritional status.
of less than 50% of total lung capacity (16), Our subjects were sedentary, from low socio-
we measured MEP after full inspiration and economic background and had low weight
MIP after full expiration. and BMI. Hence their baseline values were
lower than the values reported in the
Our present findings that pulmonary l i t e r a t u r e . Yo g a t r a i n i n g r e s u l t e d i n
function tests such as FEV, FEV 1 and PEFR appreciable and statistically significant
increased significantly after yoga training improvement in all the parameters
is consistent with earlier studies. Bhole et measured in this study. In conclusion, the
al (1) have reported a significant increase present study shows that six month yoga
in vital capacity after three weeks of yoga training produces a significant improvement
training. In a study on 287 college students in handgrip strength and endurance,
respiratory pressures and spirometric values of Science and Technology, Government of

and this improvement is appreciable in Pondicherry and Central Council for Research
underweight children. in Yoga and Naturopathy (CCRYN), New
Delhi for funding this research project. We
ACKNOWLEDGEMENTS also thank Mr. G. Kumaran for assisting in
the yoga training and Miss R. Lalithambiga
The authors wish to thank Department for her technical assistance.
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MODULATION OF STRESS INDUCED BY ISOMETRIC HANDGRIP

TEST IN HYPERTENSIVE PATIENTS FOLLOWING YOGIC
RELAXATION TRAINING
VIJAYALAKSHMI P.*, MADANMOHAN, BHAVANANI A. B.,

ASMITA PATIL AND KUMAR BABU P. †
Department of Physiology and † Staff & Students’ Health Centre,

Jawaharlal Institute of Post-graduate Medical Education and Research,
( Received on February 15, 2003 )
Abstract : 13 essential hypertensive patients aged 41 to 60 years were

given yoga training for 60 min daily, Monday through Saturday, for a
total duration of 4 weeks. Blood pressure and heart rate (HR) were
measured with non-invasive semi-automatic blood pressure monitor.
Measurements were recorded before the training and at weekly intervals
during the 4 week training period. Results of our study show a significant
(P<0.001) reduction in resting HR and rate-pressure-product (RPP) after
2 weeks of yoga training. Systolic pressure (SP), diastolic pressure (DP)
(P<0.001) and mean pressure (MP) (P<0.05) showed a significant reduction
at 3 weeks of training period. After 4 weeks of training, there was further
fall in SP, DP, pulse pressure (PP) (P<0.05), MP (P<0.001), HR and RPP.
Isometric handgrip test before yoga training produced a significant rise in
SP and MP and insignificant rise in DP, HR and RPP. After yoga training,
there was a significant rise in all these parameters. Our results show that
yoga training optimises the sympathetic response to stressful stimuli like
isometric handgrip test and restores the autonomic regulatory reflex
mechanisms in hypertensive patients.
Key words : yoga training blood pressure heart rate

rate-pressure-product isometric handgrip
INTRODUCTION yoga is effective for prevention as well as

management of bronchial asthma (1), stress
Modern man has become a victim of due to exams (2), anxiety and depression
daily stress and stress related disorders like (3), stress in hypertensive patients (4) and
essential hypertension, angina, insomnia in the cure/control of essential hypertension
a n d i m p o t e n c y. B e i n g h o l i s t i c i n t h e i r (5). Yoga is also known to improve the
approach, yogic techniques are ideal for subjective well being (3, 6). Non-
improving one's ability to withstand pharmacological control of essential
stressful stimuli. There is evidence that hypertension with relaxation methodologies
* Corresponding Author
60 Vijayalakshmi et al Indian J Physiol Pharmacol 2004; 48(1)
in the form of yoga (7, 8, 9), transcendental uncomplicated essential hypertension for 3
meditation (10) and progressive muscular to 17 (6.84 ± 1.39 SEM) years and were
relaxation (11) has become more popular under treatment with Atenolol. Their age
recently, though these techniques have been was 41 to 60 (50 ± 1.84 SEM) years, height
practised in the past (12). Most of these 160 to 170 (163.84 ± 1.01 SEM) cm and
techniques produce long-lasting changes in weight 62 to 76 (71.07 ± 1.13 SEM) kg. After
the blood pressure (BP) and heart rate (HR) explaining purpose and design of the study,
if they are practised regularly (8, 12). informed consent was obtained from them.
Earlier studies by Selvamurthy et al (5) They were taught yogasans and pranayams
have shown that some yogic postural and practised the same under our direct
exercises can control essential hypertension. supervision daily for one hour, Monday
Many references are available on non- through Saturday for a total duration of four
pharmacological control of essential weeks. The yogasans and pranayams taught
hypertension (11, 13, 14) and a number of were :
workers have used shavasan and other yogic
techniques for the control of essential Asans : naukasan, vipareetakarani, matsyasan,
hypertension (7, 15, 16). shashasan, shavasan with kayakriya
Pranayams : pranava, chandra anuloma and

Rate-pressure-product (RPP) is a reliable
savitri pranayams.
index of myocardial oxygen consumption and
cardiac work and it correlates well with the Basal recordings were taken in sitting
myocardial oxygen consumption of normal posture after 10 min of rest in a chair.
subjects as well as patients with angina Systolic pressure (SP), diastolic pressure
pectoris (17). Yogasans may influence RPP (DP), mean pressure (MP) and HR were
by altering pre-load and or after-load. recorded by non-invasive semi-automatic
However, there is paucity of literature on blood pressure monitor (Press-Mate 8800,
the effect of yogasans on RPP in essential Colin Corporation, Japan). Pulse pressure
hypertension. In view of this, the present (PP = SP-DP) and RPP (RPP=HR × SP × 10–2)
work was planned to study the effect of yoga were calculated. HR and BP response to
training on BP, HR and RPP. Since vascular isometric handgrip was determined by
reactivity response can readily be detected asking the subject to sustain the handgrip
by isometric stress (18), we extended our for 2–3 min using partially inflated
work to study the cardiovascular response sphygmomanometer cuff so as to maintain
to stress with isometric hand-grip (IHG) test the mercury column at a level corresponding
before and after yoga training. to 1/3 of maximum voluntary contraction
pressure (19). In our pilot study we found
METHODS that our hypertensive patients could
maintain the handgrip for 2–3 min as
Thirteen male patients attending compared to 3–4 min in normal young
JIPMER staff clinic for essential subjects. Hence in the present study the
hypertension volunteered to be subjects for duration of isometric handgrip exercise was
this study. All the patients were having kept at 2–3 min.
Indian J Physiol Pharmacol 2004; 48(1) Handgrip Test in Hypertensive Patients After Yoga Training 61
HR and BP were recorded before the the 1st week, after which it decreased
yoga training and at weekly intervals during progressively. This decrease was statistically
the four week training period. The response significant at 3rd and 4th week of the
to IHG test was measured before and at the training period (P<0.001). DP also showed
end of four week study period. Results were a marginal increase in the 1st week and a
expressed as mean ± SEM. Data were subsequent progressive decrease. This
analysed by repeated measures analysis of decrease was statistically significant at 3rd
v a r i a n c e ( A N O VA ) , f o l l o w e d b y Tu k e y - and 4th week (P<0.001). PP decreased
Krammer multiple comparison test. significantly at 4th week (P<0.05). MP
Students paired ‘t’ test was used to compare increased insignificantly at 1st week after
the parameters after the handgrip exercise w h i c h i t d e c r e a s e d p r o g r e s s i v e l y, t h e
and resting values and also for percentage decrease being statistically significant at
(delta) changes before and after yoga 3 r d and 4th week (P<0.05 and P<0.001
training. For all comparisons, P<0.05 was respectively). An insignificant decrease in
considered statistically significant. HR was found at 1st week. Subsequently it
showed progressive and statistically significant
RESULTS (P<0.001) decrease at 2nd, 3rd and 4th
week. The pattern of changes in RPP was
SP showed an insignificant increase in similar to that of the HR (Table I).
TABLE I : Systolic pressure (SP), diastolic (DP), pulse pressure (PP), mean pressure (MP),
heart rate (HR) and rate-pressure product (RPP) before yoga training (control) and
at 1, 2, 3 and 4th week of the training. Data are expressed as mean ± SEM. Results
of post-hoc test (Tukey-Kramer multiple comparison test) are given in the footnote.
Parameter Control 1st week 2nd week 3rd week 4th week F ratio P value
SP (mm Hg) 141.69± 3.42 145.15± 3.51 136.69± 2.29 127.92± 3.72 120.69± 2.28 27.50 <0.0001
DP (mm Hg) 87.85± 1.58 88.31± 1.63 82.46± 1.62 77.92± 2.30 75.77± 2.24 13.62 <0.0001
PP (mm Hg) 53.85± 3.55 56.85± 2.59 54.23± 2.71 50.00± 3.07 44.92± 3.00 5.29 <0.0001
MP (mm Hg) 105.23± 2.54 109.62± 2.31 101.31± 1.60 97.15± 2.96 92.77± 2.21 11.47 <0.0001
HR (bpm) 84.38± 3.51 79.15± 3.87 73.15± 3.16 73.54± 3.01 74.23± 3.04 9.15 <0.0001
RPP (units) 119.77± 6.23 115.57± 7.52 99.90± 4.42 94.04± 4.75 89.40± 3.69 18.47 <0.0001
Comparison P value Comparison P value

SP: control Vs 3rd t week <0.001 MP: control Vs 3rd week <0.05
SP: control Vs 4th week <0.001 MP: control Vs 4th week <0.001
SP: 1st week Vs 2nd week <0.05 MP: 1st week Vs 2nd week <0.05
SP: 1st week Vs 3rd week <0.001 MP: 1st week Vs 3rd week <0.001
SP: 1st week Vs 4th week <0.001 MP: 1st week Vs 4th week <0.001
SP: 2nd week Vs 3rd week <0.05 MP: 2nd week Vs 4th week <0.05
SP: 2nd week Vs 4th week <0.001 HR: control Vs 2nd week <0.001
DP: control Vs 3rd week <0.001 HR: control Vs 3rd week <0.001
DP: control Vs 4th week <0.001 HR: control Vs 4th week <0.001
DP: 1st week Vs 3rd week <0.001 RPP: control Vs 2nd week <0.001
DP: 1st week Vs 4th week <0.001 RPP: control Vs 3rd week <0.001
DP: 2nd week Vs 4th week <0.05 RPP: control Vs 4th week <0.001
PP: control Vs 4th week <0.05 RPP: 1st week Vs 2nd week <0.01
PP: 1st week Vs 4th week <0.01 RPP: 1st week Vs 3rd week <0.001
PP: 2nd week Vs 4th week <0.05 RPP: 1st week Vs 4th week <0.001
For all other comparisons, P>0.05.
TABLE II : Cardiovascular response to isometric handgrip (IHG) test before and after yoga training for 4 weeks.
Before yoga training After yoga training

Parameter Rest IHG % change Rest IHG % change
SP (mm Hg) 141.69± 3.42 160.46± 7.90* 13.12± 4.87 120.69± 2.28 145.00± 4.40**** 20.08± 2.93
DP (mm Hg) 87.85± 1.58 95.69± 5.93 8.68± 6.24 75.77± 2.24 93.15± 3.64*** 24.32± 6.00
PP (mm Hg) 53.85± 3.55 64.77± 5.06 26.52± 12.09 44.92± 3.00 53.54± 2.98 24.50± 8.66
MP (mm Hg) 105.23± 2.54 131.46± 4.78**** 24.91± 3.63 92.77± 2.21 118.69± 2.95**** 28.42± 3.78*
HR (bpm) 84.38± 3.51 90.46± 3.92 8.84± 5.77 74.23± 3.04 87.00± 3.78** 18.33± 5.07
RPP (units) 119.77± 6.23 147.11± 11.68 24.95± 10.78 89.40± 3.69 126.44± 7.14** 42.51± 7.57
SP : systolic pressure; DP : diastolic pressure; PP : pulse pressure; MP : mean pressure; HR : heart rate;
RPP : rate pressure product.
Values are means ± SEM for 13 subjects.
*P<0.05, **P<0.02, ***P<0.01, ****P<0.001 compared to the rest value.
Before yoga training IHG test produced reduction in BP. Sunder et al (7) also have
an increase in all the parameters mentioned demonstrated that shavasan therapy results
above. However, the increase was significant in statistically significant fall in both mean
in SP and MP (P<0.05 and P<0.001 systolic and diastolic pressures as well as
respectively) (Table II). After four week yoga requirement of anti-hypertensive drugs.
training, IHG test produced more Shavasan is known to produce psychosomatic
pronounced and statistically significant relaxation. In an earlier work from our
increase in all the parameters. The laboratories, we have demonstrated that
percentage (delta) changes in the shavasan produces a consistent and
parameters before and after yoga training significant reduction in oxygen consumption
were found insignificant. and this is associated with a feeling of
psychosomatic relaxation (20). Stress
DISCUSSION reduction with behavioural procedures like
yoga is known to benefit hypertensive
In the present study, we have recorded patients by lowering their BP (13). Bera et
time course of the effect of yoga training on al (21) also have reported that the effects
BP and HR in essential hypertensive of stress are reversed in significantly
patients. The marginal and insignificant shorter time in shavasan. Blackwell et
increase in BP at the end of the first week al (10) have also demonstrated that
is likely to be due to adjustment of the transcendental meditation reduces anxiety
subjects to the study environment. From level and blood pressure. Malathi and
second week onwards there was a significant Damodaran have demonstrated the
and progressive decrease in HR and RPP beneficial role of yoga in not only causing
and from 3rd week onwards in SP, DP and reduction in basal anxiety level but also
MP as well. Our results are in agreement attenuating the increase in anxiety score
with the findings of Patel and North (16) in stressful states like examination (2). The
who have reported that six weeks treatment early and significant reduction in BP and
with yoga relaxation produces a significant HR in our subjects might be due to our
Indian J Physiol Pharmacol 2004; 48(1) Handgrip Test in Hypertensive Patients After Yoga Training 63
training schedule consisting of shavasan as and HR by 6 beats/min before yoga training.

well as relaxing postures (asans) and Both these changes were insufficient and
breathing exercises (pranayams). A statistically insignificant. After yoga
significant reduction in RPP indicates a training, HR as well as DP increased
decrease in myocardial oxygen consumption significantly in response to IHG test. Here,
and load on heart (17). This can be explained it is interesting to note that Selvamurthy
on the basis of decrease in sympathetic drive et al have concluded that yoga training
to the heart. Our findings are consistent results in an improvement of baroreflex
with those of Selvamurthy et al (5) who have sensitivity (5). Our results are different
reported that yogic training produces a from earlier studies reporting that
significant decrease in BP associated with sympathetic reactivity is reduced following
improvement of baroreflex sensitivity and yoga training (25) and the pressor response
attenuation of sympathetic and renin- to emotional and physical stimuli becomes
angiotensin activity. less exaggerated and less protracted
after yoga training (4). Our results suggest
IHG test provides pressor stimuli to that the vasoconstrictor and cardiac
cardiovascular system through efferent acceleratory responses to IHG test are
sympathetic pathways with a resultant subnormal in hypertensive patients and
increase in HR and BP (19). BP response to yoga training improves these reflex
IHG in our study is in agreement with the regulatory mechanisms. This is an interesting
observation of other workers who have observation and needs further study and
reported a rise in BP with IHG in essential confirmation.
hypertensive patients (22, 23). A blunted BP
response to IHG may be due to insufficient ACKNOWLEDGEMENTS
sympathetic response in our hypertensive
patients. Normally, IHG test increases DP The authors wish to express their
by 16 mm Hg or more and a rise of 10 mm gratitude to the Central Council for
Hg or less indicates abnormal cardiovascular Research in Yoga and Naturopathy (CCRYN)
reflex regulation (24). In our subjects, IHG and Director, JIPMER, Pondicherry, for
test increased the mean DP by 8 mm Hg funding the Research Project.
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Indian
370 Letter
J Physiol
to the
Pharmacol
Editor 2004; 48 (3) : 370–373 Indian J Physiol Pharmacol 2004; 48(3)
LETTER TO THE EDITOR
EFFECT OF SIX WEEKS OF SHAVASAN TRAINING ON SPECTRAL

MEASURES OF SHORT-TERM HEART RATE VARIABILITY
IN YOUNG HEALTHY VOLUNTEERS
Sir,
( Received on September 17, 2003 )
In an earlier work from our laboratory, v a r i a b i l i t y ( 7 ) . T h e e f f e c t o f shavasan

we have demonstrated the effectiveness of training on HRV has not been studied so far.
shavasan, a yogic relaxation technique, in Hence, we planned to determine whether
producing psychosomatic relaxation (1). The shavasan training of short duration has any
blood pressure (BP) lowering effect of effect on the low frequency and high frequency
shavasan has been demonstrated previously components of heart rate variability.
in subjects with hypertension (2). The
cardiovascular effects of shavasan may at 26 healthy subjects (13 boys and 13 girls)
least in part be due to its effects on aged 16.1 ± 0.2 (mean ± SD) years were
autonomic regulation of heart rate and blood recruited to the shavasan group and 17 age
pressure. Heart rate variability (HRV) and gender matched healthy subjects (9 boys
analysis has come to be increasingly used and 8 girls) aged 15.8 ± 0.6 years to the
in physiologic research studies as a control group (P=0.07). The BMI of the
noninvasive tool to examine the autonomic shavasan a n d t h e c o n t r o l g r o u p s w e r e
regulation of cardiovascular function. It 20.8 ± 2.8 kg/m 2 (mean ± SD) and 19.3 ± 3.5
describes the variability in instantaneous respectively (P=0.16). ECG (a bipolar chest
heart rates and assesses modulation lead) was continuously acquired at a rate of
of cardiac cycle time by intrinsic 1000 samples per second for five minutes
biological rhythms (3, 4, 5). Oscillations in u s i n g t h e B I O PA C ® M P 1 0 0 h a r d w a r e
instantaneous heart rates occur at high ( B I O PA C S y s t e m s I n c . , U S A ) a n d t h e
frequencies (0.15–0.40 Hz), low frequencies Acq Knowledge ® 3.7.1 software (BIOPAC
(0.04–0.15 Hz) and at very low frequencies Systems Inc., USA) and a Microsoft
(0.003–0.04 Hz) due to different physiologic Windows-based PC. Blood pressure was
mechanisms and these have been inferred measured by an automated non-invasive
from pharmacologic studies (3, 4, 5, 6). For blood pressure monitor (Colins Press-Mate
a detailed discussion of the physiologic BP 8800, Colin® Corporation, Japan).
foundations of HRV, consult Akselrod (3, 4), Recordings were obtained in the Polygraph
Eckberg (5) and Pagani et al (6). Time- laboratory, between 10.00 am and 12.00 pm,
domain analysis is a simple method to 3 h after a light breakfast. The environment
quantify overall HRV whereas power was quiet, the laboratory temperature 25°C,
spectral analysis provides a means of and the lighting subdued. After familiarizing
studying different mechanisms responsible the subject with the procedure and at least
for variability in instantaneous heart rates. 10 minutes of rest in the supine position,
Raghuraj et al have studied the effect of ECG was recorded with subjects in the
two yogic breathing techniques on heart rate supine position. They were instructed to
Indian J Physiol Pharmacol 2004; 48(3) Letter to the Editor. 371
breathe quietly at about 12 breaths per than 0.05 was taken as indicating a
minute during the recording. None of the statistically significant difference between
subjects were taking any medication the compared means.
influencing autonomic function. Under
similar conditions, we determined the Results are given in Table I. We could
obtain HRV data only for 20 subjects in the
resting BP, heart rate (HR) and HRV, before
shavasan group and 14 subjects in the
and within 5 days after 6 weeks of shavasan
control group. HRV could not be reliably
training. Shavasan group was taught
determined from ECG with excessive noise,
shavasan by a trained yoga teacher and
artifacts and these were not used for
subjects practised the same for 15 minutes
analysis. At baseline, the shavasan and the
a day, four days a week for a total duration
control groups were comparable in terms of
of six weeks. The control group did their resting HR, systolic pressure (SP),
not receive any shavasan training. The diastolic pressure (DP), rate-pressure
technique of shavasan is given elsewhere product (RPP), LF power, HF power and
(8). The local ethics committee approved the total RR spectral power (P>0.2). Even after
study protocol. Written informed consent the six weeks training period, there were
was taken from the parents of all subjects. no significant differences between the
shavasan and the control groups in terms
HRV analysis was done conforming to
of the above-mentioned parameters (P>0.05).
established standards (9) using the
A c q K n o w l e d g e 3 . 7 . 1 s o f t w a r e . B r i e f l y, In the shavasan group, we noted a
ectopics and artifacts in the ECG were significant decrease in resting HR following
edited and a 256-second long RR interval training (P=0.01). As noted in Table I, there
tachogram obtained by using a rate- was a decrease in SP (P=0.05), DP (P=0.03)
detection algorithm. The RR interval and RPP (P=0.012) following shavasan
tachogram was resampled at 4 Hz, its mean training. In the control group, there was an
and trend removed, a Hanning window insignificant decrease in resting HR
applied and transformed by fast Fourier (P=0.023) and the mean SP and mean DP
algorithm to obtain a power spectrum of RR did not change in this group after the six-
intervals. Low frequency power (LF power) week period. An insignificant decrease in
and high frequency power (HF power) were RPP was noted in this group (P=0.035). In
obtained by integrating the spectrum from the shavasan as well as the control groups,
0.04–0.15 Hz and 0.15–0.40 Hz respectively changes in LF power, HF power, and total
(9). Total power was calculated as the sum spectral powers after the six-week period
of LF and HF powers (5). were not significant (P>0.25).
The shavasan and control groups were RR interval fluctuations occurring at

compared by unpaired ‘t’ test. After the respiratory frequencies are vagally mediated
training period, the spectral powers of the and have been shown to be nearly abolished
two groups did not follow a normal by large-dose atropine (5). Baseline HF
distribution and these were compared using power expressed in absolute units of power
a non-parametric test (Mann-Whitney test). quantifies vagally mediated fluctuations
Changes within the shavasan and control in instantaneous heart rates due to
groups after the training period were respiration. LF power expressed in absolute
analyzed by paired ‘t’ test A P value less units of power quantifies RR interval
372 Letter to the Editor Indian J Physiol Pharmacol 2004; 48(3)
TABLE I : Resting heart rate, blood pressure and heart rate variability indices at baseline and at the
end of the six-week training period in the shavasan and control groups. Data are expressed
as mean ±SD. HR: heart rate in beats per minute, SP: systolic pressure in mm Hg, DP: diastolic
pressure in mm Hg, RPP: rate-pressure product in mm Hg × beats per minute × 10–2, LF power:
Low frequency spectral power of RR intervals in ms2, HF power : high frequency spectral power
of RR intervals in ms 2, total power : total spectral power of RR intervals in ms 2 .
Baseline After 6 weeks

Shavasan group Control group Shavasan group Control group
HR 73± 10 71± 11 68± 10*** 68± 11

SP 114± 10 112± 8 109± 10* 112± 9
DP 62± 5 59± 7 58± 5** 59± 5
RPP 84± 15 79± 14 75± 10*** 77± 14
LF power 1518± 1434 2148± 1916 1635± 1058 2376± 1818
HF power 2742± 2626 3090± 2748 2751± 1492 4742± 5265
Total power 4260± 3741 5238± 4146 4385± 2225 7119± 6637
For HR, SP, DP and RPP, number of subjects in shavasan and control groups was 26 and 17 respectively. For
LF power, HF power and total power, number of subjects in shavasan and control groups was 20 and 14
respectively. For all comparisons between shavasan and control groups at baseline and after six weeks,
P>0.25.
*P=0.05, **P=0.03, ***P=0.01 with respect to baseline values.
fluctuations due to baroreflex-mediated changes in vagal nerve traffic to the heart.

changes in vagal nerve traffic to the heart Singh et al have demonstrated that a
( 5 ) . To t a l p o w e r q u a n t i f i e s h e a r t r a t e substantial proportion of the variance
variability due to LF and HF components. in HRV noted in a population is due to
The ratio of low frequency to high frequency genetic factors (10). Goldberger at al have
spectral powers has been used as an index postulated that HRV initially increases with
of sympathovagal balance (5). However, in increasing vagal nerve traffic to the heart
healthy subjects in the supine position, and then decreases with further increase
power in both the LF and HF ranges is i n v a g a l t o n e ( 11 ) . T h e a b s e n c e o f a
nearly abolished by large dose atropine (5). significant change in LF and HF powers in
Therefore, the assumption that LF/HF ratio our subjects may have been due to the fact
signifies sympathovagal balance, especially that their baseline HRV was saturatingly
in the supine position, is problematic (5). high. Secondly, the intensity of training may
This is why we have only analyzed changes not have been adequate to produce a
in absolute powers of the LF and HF quantifiable change in HRV.
components of HRV. We have not attempted
to analyze overall HRV or quantitate In conclusion, the present study shows
sympathovagal balance. that shavasan training for 15 minutes a day,
4 days a week, for six weeks does not
I n t h i s s t u d y, w e h a v e n o t e d l a r g e significantly affect heart rate variability in
variations in spectral measures of HRV in young healthy subjects. Further studies may
both the groups, at baseline as well as be undertaken to determine the effect
immediately after the study period. This of longer duration of shavasan training
could possibly be due to interindividual o n h e a r t r a t e v a r i a b i l i t y. T h i s s t u d y
variations in cardiac responsiveness to demonstrates a useful method of examining
Indian J Physiol Pharmacol 2004; 48(3) Letter to the Editor. 373
the effects of yogic techniques on autonomic from the Central Council for Research in
modulation of cardiovascular function. Since Yoga and Naturopathy (CCRYN), New Delhi.
the BP and HR lowering effects of shavasan J. Amudhan, currently third year medical
have been previously demonstrated in student in JIPMER, was on an Indian
subjects with hypertension, it follows that Council of Medical Research (ICMR)
the effects of shavasan and other relaxation s t u d e n t s h i p d u r i n g t h i s s t u d y. We a r e
techniques may be more apparent in grateful to yoga therapist and teacher Mr.
s u b j e c t s w i t h r e d u c e d b a s e l i n e H RV. G. Kumaran for training the students.
Controlled studies done on subjects with We thank Miss R. Lalithambiga, B.Sc.,
reduced baseline HRV may provide us with for providing secretarial and technical
more useful information of clinical significance.
assistance. We thank Dr. Kaviraja Udupa,
ACKNOWLEDGEMENTS Senior Resident, Department of Physiology,
JIPMER, for his critical comments on the
This study was supported by a grant manuscript.
MADANMOHAN*, A. B. BHAVANANI, E. S. PRAKASH,

M. G. KAMATH AND J. AMUDHAN
Jawaharlal Institute of Postgraduate Medical
Education and Research (JIPMER)
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Swami Gitananda. Cardiorespiratory changes man and conscious dog. Circ Res 1986; 59: 178–
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critical appraisal. Circulation 1997; 96: 3224– Study. Circulation 1999; 99: 2251–2254.
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11. Goldberger JJ, Challapalli S, Tung R, Parker MA,
6. P a g a n i M , L o m b a r d i F, G u z z e t t i S . P o w e r Kadish AH. Relationship of heart rate variability
spectral analysis of heart rate and arterial to parasympathetic effect. Circulation 2001; 103:
pressure variabilities as a marker of sympatho- 1977–1983.
*Corresponding Author : E-mail : madanmohan@jipmer.edu, dresprakash@yahoo.com. Phone : (0413) 2271314

MODULATION OF CARDIOVASCULAR RESPONSE TO

EXERCISE BY YOGA TRAINING
MADANMOHAN*, KAVIRAJA UDUPA,

ANANDA BALAYOGI BHAVANANI,
CHETAN CHINMAYA SHATAPATHY
AND AJIT SAHAI**
* * Department of Social and Preventive Medicine,
Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER),
Pondicherry – 605 006, India
( Received on July 1, 2004 )

Abstract : This study reports the effects of yoga training on cardiovascular
response to exercise and the time course of recovery after the exercise.
Cardiovascular response to exercise was determined by Harvard step test
using a platform of 45 cm height. The subjects were asked to step up and
down the platform at a rate of 30/min for a total duration of 5 min or until
fatigue, whichever was earlier. Heart rate (HR) and blood pressure response
to exercise were measured in supine position before exercise and at 1, 2,
3, 4, 5, 7 and 10 minutes after the exercise. Rate-pressure product [RPP
= (HR × SP)/100] and double product (Do P = HR × MP), which are indices
of w ork done by the hear t wer e also c al c ul ate d . Ex e rc is e pro d uc e d a
significant increase in HR, systolic pressure, RPP & DoP and a significant
decrease in diastolic pressure. After two months of yoga training, exercise-
induced changes in these parameters were significantly reduced. It is
concluded that after yoga training a given level of exercise leads to a
milder cardiovascular response, suggesting better exercise tolerance.
K e y w o r d s : yoga training Harvard step test
rate-pressure product double product
INTRODUCTION Muralidhara & Ranganathan (2) have

reported an improvement in cardiac
Yogic techniques are known to improve recovery index after 10 week yoga training
one’s overall performance and work programme. Raju et al (3) have found a
capacity. Following the study of significant increase in maximal work output
Bhattacharya & Krishnaswami (1) in which and a significant increase in oxygen
they observed that yoga exercises do not consumption per unit work after yoga
produce marked effect on physical and training. Bera & Rajapurkar (4) have
physiological performance, there have been reported a significant improvement in
several reports on the beneficial effects of cardiovascular endurance and anaerobic
yoga training on physiological functions. power as a result of yoga training. However,
*Corresponding Author
Balasubramanian & Pansare (5) have (Press-Mate BP 8800, Colin Corporation,

reported that yoga training produces a Japan). Pulse pressure (PP = SP – DP),
significant decrease in anaerobic power. mean pressure (MP = DP + PP/3) and rate-
Exercise stress testing is a valuable tool for pressure product [RPP = (HR × SP)/100] and
evaluating physical fitness and cardio- double product (Do P = HR × MP) were
respiratory status. The effect of physical calculated for each recording. Three BP
training on exercise tolerance is well known. recordings at one-minute intervals were
However, there are limited studies on the taken and the lowest of these values was
effect of yoga training on cardiovascular included for calculation. Cardiovascular
response to stress. Moreover, there is paucity response to exercise was determined by
of information on the effect of yoga training Harvard step test using a platform of 45 cm
on the time course of the cardiovascular height (6). The subjects were asked to step
response following exercise. In view of this, up and down the platform at a rate of 30/
min for a total duration of 5 min or until
the present study was planned with the
fatigue, whichever was earlier. HR and BP
objective of determining the effect of yoga
response to exercise was measured in supine
training on the cardiovascular response to
position before exercise and at 1, 2, 3, 4, 5,
step test and its time course after the
7 and 10 minutes after the exercise.
exercise in normal young volunteers.
The subjects were taught yogasans and
METHODS
pranayams for two weeks. Then they
Twenty one normal boys (age : 17–19 practised the same under our direct
years) were recruited for the present study. supervision, daily for 45 minutes, for a total
Those having a history of active sports duration of 2 months. The yogasans and
training or yoga practice, medical illness pranayams taught were: talasan, utkatasan,
such as tuberculosis, hypertension, diabetes trikonasan, ardha-matsyendrasan, bakasan,
mellitus, bronchial asthma or major surgery pavanmuktasan, navasan, noukasan,
in the recent past were excluded from the matsyasan, pashchimottanasan, halasan,
study. After explaining the design and bhujangasan, shalabhasan, sarvangasan,
purpose of the study, informed consent was shavasan, mukh-bhastrika, mahat-yoga
obtained from them. Clearance was obtained pranayam, nadi shuddhi and savitri
from Institute Ethical Committee. pranayam.
A few days before actual recording, the The cardiovascular response to exercise
subjects were familiarized with the was measured before the training and again
laboratory environment and experimental at the end of the 2 months of study period.
procedure. On the day of the test, the The data was analysed using Student’s
subjects reported at our laboratory in the paired ‘t’ test to compare the pre and post-
morning, two hours after a light breakfast. training values. A p value of less than 0.05
The laboratory temperature was maintained was accepted as indicating significant
at 27 ± 1°C. After 15 minutes of supine rest, difference between the compared values.
heart rate (HR) and right brachial blood
pressure (BP) was recorded with non- RESULTS
invasive semi-automatic blood pressure
monitor using the oscillometric method Results are given in Table I. Yoga
TABLE I : Effect of yoga training on cardiovascular response to exercise and post – exercise recovery.
HR (beats/min) SP (mmHg) DP (mmHg) PP (mmHg) MP (mmHg) RPP (units) Do P (units)
Before After Before After Before After Before After Before After Before After Before After
Basal 71.33 65.71 116.14 113.19 68.76 62.57 47.38 47.86 84.19 78.24 82.62 71.48 6010.67 5147.52
± 1.11 ± 1.13** ± 1.27 ± 1.34** ± 0.97 ± 1.02*** ± 1.29 ± 1.04 ± 0.90 ± 0.94*** ± 1.84 ± 1.34*** ± 123.78 ± 120.20***
After step test

Indian J Physiol Pharmacol 2004; 48(4)
1 min 141.67 116.19 168.43 151.14 61.43 59.90 107.00 90.95 96.76 89.81 238.19 175.14 13729.52 10445.43
± 2.47‡ ± 2.46***‡ ± 2.52‡ ± 2.62***‡ ± 0.95‡ ± 1.06*† ± 2.37‡ ± 2.67‡ ± 1.20‡ ± 1.27‡ ± 5.92‡ ± 4.62***‡ ± 349.3‡ ± 278.05***‡
2 min 118.38 105.67 156.57 143.10 61.62 57.81 92.95 85.29 92.14 85.90 184.43 150.95 10941.43 9079.71
± 1.83 ± 1.66*** ± 2.54 ± 2.29*** ± 0.81 ± 0.83** ± 2.91 ± 2.76* ± 1.42 ± 0.71*** ± 5.27 ± 3.47*** ± 310.22 ± 166.11***
3 min 110.29 102.14 146.00 134.38 62.19 58.19 82.95 75.90 89.50 83.10 161.24 136.86 9922.76 8492.38
± 2.33 ± 1.49** ± 2.66 ± 1.57*** ± 0.92 ± 0.66*** ± 2.47 ± 1.69** ± 0.63 ± 0.70*** ± 5.92 ± 2.83*** ± 341.43 ± 157.14***
4 min 107.81 100.00 138.00 129.62 60.19 58.95 77.81 70.67 85.67 82.10 149.05 129.29 9268.76 8217.10
± 1.90 ± 1.62** ± 2.98 ± 1.58* ± 1.43 ± 0.55 ± 2.66 ± 1.66* ± 1.64 ± 0.64* ± 5.37 ± 2.81** ± 304.38 ± 166.31**
5 min 105.90 99.19 132.57 122.38 62.38 62.10 70.19 60.29 85.43 81.95 140.62 121.19 9082.05 8133.10
± 1.89 ± 1.78** ± 2.47 ± 1.52*** ± 1.07 ± 0.56 ± 2.06 ± 1.54*** ± 1.32 ± 0.66* ± 4.86 ± 2.97** ± 281.71 ± 169.22**
7 min 103.00 96.00 125.24 115.14 64.95 62.67 60.29 52.48 84.76 79.76 129.10 110.24 8753.67 7669.81
± 1.58 ± 1.43*** ± 2.08 ± 1.52*** ± 0.64 ± 0.89 ± 1.71 ± 1.55** ± 1.04 ± 0.90*** ± 3.82 ± 2.56*** ± 223.39 ± 169.51***
10 min 101.57 92.57 120.00 110.95 67.24 63.43 52.76 47.52 84.48 78.81 121.62 102.43 8594.14 7310.10
± 1.65‡ ± 1.45***‡ ± 1.47‡ ± 1.02*** ± 0.56+ ± 0.83*** ± 1.28† ± 0.98** ± 0.74 ± 0.76*** ± 3.06‡ ± 2.17***‡ ± 192.3‡ ± 165.86***‡
Basal: before step test; Before: before yoga training; After: after yoga training; HR: heart rate; SP: systolic pressure; DP: diastolic
pressure; PP: pulse pressure; MP: mean pressure; RPP: rate-pressure product; Do P: double product.
Values are expressed as mean ± SEM for 21 subjects.
*P<0.05; **P<0.01; ***P<0.001 by paired ‘t’ test between pre and post training values.
+ P<0.05; †P<0.01; ‡P<0.001 by paired ‘t’ test between basal and post-exercise values.
Yoga Training and Exercise
463
training produced a significant reduction in induced changes (i.e. decrease in DP and

basal HR, SP, DP, MP, RPP and Do P. increase in other parameters) were
Before yoga training, step test produced a significantly reduced. It is interesting to
marked and significant rise in all these note that before yoga training only MP had
parameters except DP which showed a returned to pre-exercise value at the end of
significant decrease following the exercise. 10 minutes study period. After yoga
All these parameters showed subsequent training, SP, DP and PP also returned to
progressive recovery throughout the ten the pre-exercise basal values indicating
minute study period. After 2 months of yoga faster recovery of cariovascular parameters
training, the exercise-induced change in after yoga training. Our results are similar
these parameters was significantly less as to the recent findings of O’ Sullivan and
compared to their pre-training response. Bell (9) who have reported that physical
Before yoga training, only MP returned to training blunts the pressor, tachycardiac
pre-exercise basal value whereas other and vasodilator responses and attributed
parameters continued to be significantly this to blunting of sympathetic vasodilator
different from their basal values at the end activation. Although Bhattacharya &
of 10 min post-exercise period. After yoga Krishnaswami (1) concluded that yoga
training, in addition to MP, SP, DP and PP training does not produce any marked effect
also returned to their pre-exercise basal on the physiological parameters of the
values by the end of 10 min study period. subjects, there are several reports of
beneficial effects of yoga training on
DISCUSSION physiological functions. Bera & Rajapurkar
(4) have reported that yoga training results
The purpose of this study was to in significant improvement in cardiovascular
determine if yoga training modulates the endurance and anaerobic threshold. This is
cardiovascular response to exercise and its consistent with the findings of Muralidhara
time course after the exercise. Yoga training & Ranganathan (2) that yoga training
for two months resulted in a significant improves physical efficiency as indicated by
decrease in basal HR and BP. Calculated significant increase in cardiac recovery
RPP and Do P also decreased significantly. index measured by Harvard step test. Our
Since RPP is an index of myocardial oxygen findings of lesser increase in BP, HR and
consumption and load on the heart (7), our RPP after yoga training are consistent with
results indicate that after yoga training, a the findings of Ray et al (8, 10) that yoga
given level of exercise is less taxing for the training increases muscular endurance,
heart. A decrease in DP after yoga training delays onset of fatigue and enables one to
has also been reported by Ray et al (8) who perform work at lesser V O 2 max. Palatini
attributed this to a reduction in sympathetic (11) has reported that in comparison
activity. Exercise produced a marked and to normotensives, the increase in DP
significant increase in the parameters in response to isometric exercise is
measured except DP which showed a substantially more in hypertensives. An
significant decrease in response to exercise exaggerated cardiovascular reactivity to the
stress. After yoga training, these exercise- stressors is known to be a risk factor for
Indian J Physiol Pharmacol 2004; 48(4) Yoga Training and Exercise 465
cardiovascular diseases whereas reduced ACKNOWLEDGEMENTS

reactivity is an indicator of fitness.
Therefore a reduction in exercise-induced We gratefully acknowledge the financial
stress on cardiovascular system by yoga support from the Director, Central Council
training has physiological significance as for Research in Yoga & Naturopathy
well as clinical applications. (CCRYN), New Delhi.
REFERENCES
1. Bhattacharyya KS and Krishnaswami P. Trial 7. Gobel FL, Nordstrom LA, Nelson RR, Jorgenson
of yogic exercise. Armed Forces Med J 1960; 16: CR, Wang Y. The rate-pressure-product as an index
222–228. of myocardial oxygen consumption during exercise
2. Muralidhara DV and Ranganathan KV. Effect of
57: 549–556.
yoga practice on cardiac recovery index. Indian J
Physiol Pharmacol 1982; 26: 279–283. 8. Ray US, Mukhopadhyaya S, Purkayastha SS,
Asnani V, Tomer OS, Prashad R, Thakur L
3. Raju PS, Prasad KV, Venkata RY, Murthy KJ and
and Selvamurthy W. Effect of exercises on
Reddy MV. Influence of intensive yoga training on
physical and mental health of young fellowship
physiological changes in 6 adult women: a case
course trainees. Indian J Physiol Pharmacol 2001;
report. J Altern Complement Med 1997; 3: 291–
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295.
4. Bera TK and Rajapurkar MV. Body composition, 9. O’Sullivan and Bell C. Training reduce autonomic
cardiovascular endurance and anaerobic power of cardiovascular responses to both exercise-
yogic practitioner. Indian J Physiol Pharmacol dependent and independent stimuli in humans.
1993; 37(3): 225–228. Auton Neurosci 2001; 91: 76–84.
5. Balasubramanian B and Pansare MS. Effect of yoga 10. R a y U S , H e g d e K S a n d S e l v a m u r t h y W .

on aerobic and anaerobic power of muscles. Indian Improvement in muscular efficiency as related to
J Physiol Pharmacol 1991; 35: 281–282. a standard task after yogic exercises in middle aged
men. Indian J Med Res 1986; 83: 343–348.
6. Ganeriwal SK, Sen SC, and Khandare SS. Test of
physical fitness (Harvard Step Test) in Indian 11. Palatini P. Blood pressure behavior during physical
females. Indian Jour Med Res 1968; 56: 845–849. activity. Sports Med 1988; 5: 353–374.
CORRIGENDUM
Letter to the Editor : “Effect of six weeks of Shavasan training on spectral measures
of short-term heart rate variability in young healthy volunteers.” Volume 48: 3;
line 8, 2004 :
(1) Page 371, Column 2, para 3, line 8, please read P = 0.23 instead of P = 0.023.
(2) Page 371, Column 2, para 3, line 11, please read P = 0.35 instead of P = 0.035.
Indian
132 Madanmohan
J Physiol Pharmacol
et al 2005; 49 (2) : 132–138 Indian J Physiol Pharmacol 2005; 49(2)
CORRELATION BETWEEN SHORT-TERM HEART RATE VARIABILITY

INDICES AND HEART RATE, BLOOD PRESSURE INDICES,
PRESSOR REACTIVITY TO ISOMETRIC HANDGRIP IN
HEALTHY YOUNG MALE SUBJECTS
MADANMOHAN*, E. S. PRAKASH AND A. B. BHAVANANI
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
( Received on November 1, 2004 )
Abstract : The purpose of the present study was to determine whether
readily measured blood pressure (BP) indices and responses to autonomic
reflex tests could be used as surrogates of short-term heart rate variability
(HRV), which is an established marker of autonomic regulation of SA
node. Therefore, we examined the correlation between short-term HRV
and heart rate (HR), BP indices viz. systolic pressure, diastolic pressure,
pulse pressure (PP), and rate-pressure product (RPP), during supine rest
and head-up tilt in 17 young healthy normotensive subjects, aged 19.8 ± 1
yr (mean ± SD). Three classic autonomic indices viz. Valsalva ratio, HR
response to deep breathing and pressor response to isometric handgrip
were also determined. We noted two interesting and statistically significant
(P<0.05 in both cases) correlations viz. i) a positive correlation (r = 0.6)
between change in RPP during tilt and change in low frequency (LF) RR
spectral power expressed in normalized units (LF nu) during tilt, and ii)
a negative correlation (r = –0.6) between change in PP during isometric
handgrip and LF nu during tilt. The possible physiologic significance of
these and other correlations is discussed in this paper. In conclusion, the
presence of a statistically significant correlation between RPP, PP and
spectral measures of short-term HRV supports a simplistic approach to
autonomic assessment, in that, easily measurable BP indices could be used
as surrogates of HRV when it is not feasible to determine HRV indices
directly. However, the same have to be tested in healthy subjects belonging
to various age groups and in patients with conditions known to be
associated with autonomic dysregulation.
Key words : autonomic function RR variability

rate-pressure product isometric handgrip
INTRODUCTION domain measures of short-term heart rate

variability (HRV) because it reflects the
Cardiovascular autonomic function is frequency specific modulation of SA node
increasingly evaluated with frequency- by the two limbs of the autonomic nervous
*Corresponding Author :
Indian J Physiol Pharmacol 2005; 49(2) Correlation between HRV and BP, HR, Pressor Reactivity 133
system (1–3). Studies of baroreflex had a significant medical history and

physiology (4) and HRV in hypertensives (5) their physical examination was normal.
suggest that HRV is inversely correlated Autonomic reflex tests were carried out in
with blood pressure (BP). The purpose of the mornings, 1–2 h after a light breakfast
this study was to test whether readily and after familiarizing the subjects with the
measured BP indices and responses to testing procedures. Subjects refrained from
classic autonomic reflex tests could be used smoking and caffeinated drinks on the
as surrogates of short-term HRV. Therefore, morning of the tests. None of the subjects
we examined the correlation between were taking any medication at the time of
measures of short-term HRV and heart rate testing. The Institute Ethics Committee
(HR), BP indices viz. systolic pressure (SP), approved the study protocol. All subjects
diastolic pressure (DP), pulse pressure (PP), gave written informed consent.
mean pressure (MP), and rate-pressure
product (RPP), during supine rest and head- Baseline BP and HR were measured
up tilt in 17 young healthy normotensive after 5 min of rest in the supine position on
subjects. Apart from spectral indices of the tilt table. BP was measured with an
HRV, we determined the correlation oscillometric device (Colin Press-Mate,
between Valsalva ratio (VR) – a complex Model BP 8800, Colin Corporation Inc.,
global index of sympathetic and Japan). For assessing the response to tilt,
parasympathetic effects (6, 7) and heart we used a manually operated tilt table with
rate response to deep breathing (I - E HR footplate support and the subject was
difference) – a reliable index of vagal strapped to the tilt table by safety
modulation of RR intervals (6–8), with HR restraints. After 5 min rest in the supine
and BP indices. The pressor response to position, subjects were tilted 80° head-up
sustained isometric handgrip (IHG) was for 5 min. BP was recorded immediately, 2
taken as an index of sympathetic modulation min and 5 min after tilt. The subject was
of BP (6–8). We report here some interesting then made to lie down comfortably on a
and statistically significant correlations that couch, rest for 5 min and after that,
exist between short-term HRV indices and instructed to breathe slowly and deeply, at
autonomic responses to head-up tilt and IHG six breaths per min. The HR response to
in the group of subjects examined in the deep breathing (I – E HR difference) was
present study. expressed as the average of the differences
between the maximum HR and the
MATERIALS AND METHODS minimum HR during deep breathing at six
breaths per minute for one minute (6–8).
Twenty seven male subjects aged The subjects were asked to perform the
19.8 ± 1 yr (mean ± SD) were recruited for Valsalva maneuver in the sitting position
the study after a brief history and physical by blowing into a mouthpiece attached to a
examination. The mean ± SD weight, height manometer and maintaining an expiratory
and body mass index (BMI) of the subjects pressure of 40 mm Hg for 15 seconds.
were 53.8 ± 8.2 Kg, 1.67 ± 0.05 m, and Valsalva ratio (VR) was calculated as the
19.7 ± 2.5 Kg/m 2 respectively. None of them maximum RR interval immediately following
the strain divided by minimum RR interval were determined by integrating the power
during the strain (6–8). IHG was done spectrum between 0.04 and 0.15 Hz and 0.15
by asking subjects to maintain 30% of and 0.4 Hz respectively. Total power was
maximum voluntary contraction pressure calculated by integrating the spectrum
using a handgrip dynamometer for one and between 0.004 and 0.4 Hz and includes very
a half minutes. The difference between DP low frequency, LF and HF components.
just before the release of handgrip and the Spectral powers are expressed in absolute
baseline DP was noted as the pressor units of milliseconds squared. LF and HF
response to the test (7). RPP was calculated powers are also expressed in normalized
as SP × HR × 10 –2 and expressed in units of units as described previously (3).
mm Hg × beats per min × 10 –2 .
Unless otherwise noted,
Statistical analysis :
A chest lead
Heart rate variability analysis) : data are expressed as mean ± SD. Since
ECG was recorded throughout supine rest, correlation was tested, the range of values
head-up tilt, deep breathing and Valsalva of various parameters that were used is
maneuver using the BIOPAC MP 100 mentioned in Table I. Spectral powers are
system (BIOPAC Inc., USA). Beat-to-beat presented as median (interquartile range).
variations in instantaneous HR were derived Changes in parameters during tilt or
offline using a rate-detector algorithm handgrip were compared using Student’s
(Acknowledge 3.7.3 software, BIOPAC Inc., paired t-test for normally distributed data
USA). For computing HRV indices during and Wilcoxon-matched pairs test for
supine rest and tilt, recommendations of the skewed data. Correlation between normally
Task Force on HRV were followed (3). distributed indices was determined using
Briefly, a 5-min ECG was acquired at a the Pearson correlation coefficient.
sampling rate of 1000 Hz during supine rest Correlation between various indices and RR
and during tilt, with the subjects breathing interval spectral powers was tested using
normally at 12–18 per min. RR intervals Spearman’s rank correlation test. A two
were plotted using the BIOPAC tailed P value less than 0.05 was considered
Acknowledge 3.7.1 software. An RR series significant.
was extracted using a rate-detector
algorithm after exclusion of artifacts and RESULTS
ectopics. A stationary 256 second RR series
was chosen for analysis. In the time domain, Results are given in Tables I – IV.
the standard deviation of normal-to-normal Resting BP, HR, I – E HR difference, VR
RR intervals (SDNN) was taken as an index and pressor response to IHG, are given in
of overall HRV. The RR series was Table I. The mean RR and HRV indices at
resampled at 4 Hz, the mean and trend rest and during head-up tilt are given in
removed, a Hann window applied and the Table II. HRV data during supine rest as
1024 data point series transformed by fast well as head-up tilt were available only for
Fourier transformation. Low frequency (LF) 17 subjects. Thus, the correlations between
and high frequency (HF) spectral powers resting HR, BP indices and HRV indices
TABLE I : Resting cardiovascular parameters, TABLE III : Correlation matrix showing correlations
Valsalva ratio, heart rate (HR) response to between resting heart rate, blood pressure
deep breathing (I – E HR difference), and indices and short-term heart rate
pressor response to isometric handgrip variability indices.
(IHG).
Mean HR SP DP PP MP RPP
Range
Parameter Mean ± SD (min – max) SDNN –0.6* 0.2 0 0.4 0.1 –0.5*
Systolic pressure (mm Hg) 115± 8 106 – 127 LF power –0.4 0 0.1 0.5* 0.3 –0.3
Diastolic pressure (mm Hg) 63± 6 54 – 71 HF power –0.5* 0 –0.1 0.3 0 –0.4
Pulse pressure (mm Hg) 51± 5 40 – 61 LF+HF powers –0.5* 0 –0.1 0.4 0.2 –0.4
Heart rate (beats per minute) 67± 7 60 – 88 Total power –0.6* 0 –0.1 0.4 0.2 –0.5*
Rate-pressure product 77± 10 62 – 105 LF nu 0.3 0.3 0.4 0.1 0.4 0.5*
(SP×HR×10 –2 )
Valsalva ratio 0.1 –0.3 –0.3 –0.5 –0.3 –0.1
Valsalva ratio 2.1± 0.5 1.3 – 3.25
I – E HR difference –0.2 0.1 0.2 –0.1 0.3 –0.2
I – E HR difference 29± 7 15 – 36
Increase in diastolic pressure 31± 14 2 – 64
during IHG (mm Hg) Data (n = 17) are expressed as Pearson or
Change in pulse pressure 6 ± 15 -27 – 40 Spearman correlation coefficient, whichever is
during IHG (mm Hg) appropriate.
*P<0.05
Data are for 27 subjects. HR: heart rate; SP: systolic pressure; DP: diastolic
pressure; PP: pulse pressure; MP: mean pressure;
RPP: rate-pressure product; SDNN: standard
deviation of normal-to-normal RR intervals; LF and
T A B L E I I : Mean RR and heart rate variability indices HF powers: low frequency and high frequency RR
during supine rest and head-up tilt.
spectral powers; LF nu: low frequency RR spectral
power expressed in normalized units; I – E HR
Parameter Supine Head-up-tilt P value difference: Inspiration – expiration HR difference.
Mean RR (ms) 817±100 721±92 <0.001

T A B L E I V : Summary of other interesting correlations.
SDNN (ms) 48±20 50±13 NS
LF power (ms2 ) 108 (52–236) 249 (166–513) NS
HF power (ms 2 ) 157 (37–460) 54 (38–120) <0.05 Pearson’s P
Parameter 1 Parameter 2 correlation value
Total power (ms2) 556 (189–1187) 563 (421–847) NS coefficient
LF nu 46±18 79±16 <0.0001
MP during Tilt LF nu – –0.4 0.09
supine rest rest LF nu
Data from 17 subjects are expressed as mean±SD MP after 5 min tilt LF power at rest 0.4 0.08
or median (interquartile range) whichever is
appropriate. MP ater 5 min tilt LF nu at rest 0.4 0.08
SDNN: standard deviation of normal-to-normal RR MP ater 5 min tilt Tilt LF nu – rest LF nu –0.5 0.03
intervals; LF and HF power : low frequency and ∆ RPP during tilt Tilt LF nu – rest LF nu 0.6 0.01
high frequency RR spectral power respectively; LF
nu : low frequency RR spectral power expressed in ∆ DP during IHG LF nu tilt 0.4 0.1
normalized units; NS : not significant. ∆ PP during IHG LF nu tilt –0.6 0.01
Valsalva ratio Body mass index –0.6 0.02
given in Table III, and some interesting

Data are given for 17 subjects.
correlations given in Table IV were derived
∆: change; MP: mean pressure; RPP: rate-pressure
from 17 subjects. The correlation between product; DP: diastolic pressure; IHG: isometric
handgrip; LF power: low frequency spectral power;
HRV indices and BP and HR during supine LF nu: low frequency spectral power in normalized
rest is presented in the form of a correlation units.
matrix in Table III. Change in RPP during reflects parasympathetic modulation of RR

tilt (Table IV) was derived as the difference intervals at respiratory frequency (1–3, 9–
between RPP after 2 minutes of tilt and 11). LF power in absolute units of power
resting RPP. Similarly, change in PP during quantifies baroreflex-mediated modulation
IHG (Table IV) was derived as the difference of RR intervals in the 0.04–0.15 Hz range.
between PP after one and a half minutes Changes in sympathetic as well as vagal
IHG and resting PP. nerve traffic to the heart are thought to
contribute to LF power (2, 3, 11). Total
There was a statistically significant power, calculated as the sum of LF and HF
decrease in mean RR (P<0.001), HF power powers is also an index of overall HRV (2).
(P<0.05), and an increase in LF nu At least in physiologic states characterized
(P<0.0001) during head-up tilt (Table II). by sympathetic excitation, low frequency
Statistically significant inverse correlations spectral power expressed in normalized
(P<0.05) were observed between SDNN, HF units of power (LF nu) has been shown
power, sum of LF and HF powers, total to be a useful noninvasive index of
power, and mean HR at rest (Table III). sympathovagal balance (2, 12).
There was no significant correlation
between SP, DP and any of the HRV indices. The decrease in mean RR, increase in
There was no correlation between VR, I – E LF nu, and decrease in HF power during
HR difference and HR or BP indices at rest head-up tilt (Table II) are well known
or during tilt. We observed statistically concomitants of sympathetic excitation (2,
significant (P<0.05) positive correlations 3, 12). Sympathetic excitation, which is
between PP at rest and LF power, and associated with an increase in mean HR,
between MP and LF power, LF nu at rest reduces the magnitude of respiratory sinus
(Table III). A significant inverse correlation arrhythmia (13). Also, greater the number
was noted between RPP and SDNN, and of normal sinus beats in a given time period,
RPP and total power (P<0.05 for both) at lesser is the scope for modulation of RR
rest (Table III). intervals. RPP, which increases in states
associated with sympathetic excitation, has
DISCUSSION been shown to correlate with myocardial
oxygen consumption (14). Thus, the
It is worth noting that Valsalva ratio inverse correlation between RPP and
and I – E HR difference did not correlate SDNN, as well as RPP and total power is
with HR and BP indices whereas there were not surprising since sympathetic activation
significant correlations between some HRV is known to result in an increase in
indices and HR, RPP as well as between HR, RPP and a decrease in overall HRV (3,
HRV indices and autonomic responses to tilt 11, 13).
and IHG. SDNN, which encompasses all
components responsible for RR variability, For a greater PP, loading of high-
is a simple time domain measure of overall pressure baroreceptor afferents is greater
HRV (3, 6). High frequency spectral power and consequently, the reflex modulation of
RR interval is also higher. This is the basis expected to be associated with higher LF
for the positive correlation between PP and nu. A significant negative correlation
LF power during supine rest (Table III). between VR, an index of sympathetic as well
However, the correlation between MP at rest as parasympathetic modulation (6, 7) and
and LF power was weak. This indicates that BMI is not surprising since BMI and overall
LF power is more closely related to stretch HRV are known to be inversely correlated
induced changes in firing of baroreceptor (15).
afferents rather than the tonic discharge in
baroreceptor afferents in response to the In conclusion, the presence of a
prevailing MP. significant correlation between mean HR,
pulse pressure, mean pressure, rate-
LF nu is a widely used index of
pressure product changes during tilt, pulse
sympathovagal balance during head-up tilt
pressure changes during isometric handgrip
(2, 12). A significant positive correlation
and spectral measures of short-term HRV,
between RPP during tilt and the change in
during the physiologic states examined,
LF nu (i.e. LF nu during tilt – LF nu during
supports a simplistic approach to autonomic
supine rest), given in Table IV, is possibly
assessment, in that, mean HR and rate-
because of sympathetic excitation during
pressure product could be used as
head-up tilt. The physiologic significance of
surrogates of overall HRV and the pulse
the positive correlation between the pressor
pressure change during isometric handgrip
response to isometric handgrip and LF nu
could be used as surrogate of LF nu when
during tilt, although not statistically
it is not feasible to determine HRV indices
significant (P = 0.1), may be the same. The
directly. However, observations need to be
pressor response to IHG is an index of
made in healthy subjects belonging to
sympathetic activation and vascular
various age groups and in patients with
responsiveness to pressor stimuli (7). The
conditions known to be associated with
inverse correlation between the increase in
autonomic dysregulation.
PP during IHG and LF nu during tilt has
the same significance. The prominent
ACKNOWLEDGEMENTS
increase in DP due to sympathetic
augmentation of total peripheral resistance
and accompanied by a baroreflex-mediated The authors wish to thank Director,
lowering of cardiac output causes PP to Defense Institute of Physiology and Allied
decrease during IHG. Thus, a greater Sciences (DIPAS), Delhi for financial
decrement in PP during IHG would be support.
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Original Article
A comparative study of slow and fast suryanamaskar on

physiological function
Ananda Balayogi Bhavanani, Kaviraja Udupa1, Madanmohan2, PN Ravindra3
Programme Co-ordinator, Advanced Centre for Yoga Therapy, Education, and Research (ACYTER), JIPMER, Pondicherry, India,
1
Department of Medicine, University of Toronto, MP 13-301, Toronto Western Research Institute, Toronto, Ontario, Canada, 2Department
of Physiology and Programme Director, Advanced Centre for Yoga Therapy, Education, and Research (ACYTER), JIPMER, Pondicherry,
3
Department of Physiology, Sri Siddartha Medical College and Hospital, Agalakote, Tumkur, Karnataka, India
Address for correspondence: Dr. Ananda Balayogi Bhavanani,

Programme Co-ordinator, Advanced Centre for Yoga Therapy, Education,
and Research (ACYTER), JIPMER, Pondicherry – 605 006, India.
E-mail: yognat@gmail.com
ABSTRACT
Background: Numerous scientific studies have reported beneficial physiological changes after short- and long-term yoga
training. Suryanamaskar (SN) is an integral part of modern yoga training and may be performed either in a slow or rapid
manner. As there are few studies on SN, we conducted this study to determine the differential effect of 6 months training in
the fast and slow versions.
Materials and Methods: 42 school children in the age group of 12–16 years were randomly divided into two groups of 21
each. Group I and Group II received 6 months training in performance of slow suryanamaskar (SSN) and fast suryanamaskar
(FSN), respectively.
Results: Training in SSN produced a significant decrease in diastolic pressure. In contrast, training in FSN produced a
significant increase in systolic pressure. Although there was a highly significant increase in isometric hand grip (IHG) strength
and hand grip endurance (HGE) in both the groups, the increase in HGE in FSN group was significantly more than in SSN
group. Pulmonary function tests showed improvements in both the groups though intergroup comparison showed no significance
difference. Maximum inspiratory pressure (MIP) and maximum expiratory pressure increased significantly in both the groups
with increase of MIP in FSN group being more significant than in SSN.
Conclusion: The present study reports that SN has positive physiological benefits as evidenced by improvement of pulmonary
function, respiratory pressures, hand grip strength and endurance, and resting cardiovascular parameters. It also demonstrates
the differences between SN training when performed in a slow and fast manner, concluding that the effects of FSN are similar
to physical aerobic exercises, whereas the effects of SSN are similar to those of yoga training.
Key words: Physical aerobic exercise; suryanamaskar; yoga training.
INTRODUCTION cardiovascular parameters,[8-10] scientific literature is

deficient on the physiological effects of SN that is an
Suryanamaskar (SN) is a sequential combination of yogic integral part of modern yoga training. For many years,
postures performed dynamically in synchrony with the there was only one scientific study[11] on this practice
breath. Although there are a number of reports on the effect and even that study was performed on only two
of yoga training on pulmonary functions,[1,2] respiratory subjects. In recent times, studies have been conducted
pressures,[3,4] handgrip strength and endurance,[3-7] and by Sinha and colleagues[12] who studied energy cost and
cardiorespiratory changes during the practice, as well as
Access this article online Bhutkar and colleagues[13] who conducted a pilot study
Quick Response Code on 6 months of SN practice on cardiorespiratory fitness
Website: parameters. Sinha and colleagues had concluded that
www.ijoy.org.in
SN is an ideal form of aerobic exercise having static,
stretching and dynamic muscular movements involving
DOI: all major joints.[12]
10.4103/0973-6131.85489
Various schools of yoga differ in the practice of SN. Some

International Journal of Yoga  Vol. 4  Jul-Dec-2011 71
Bhavanani, et al.: Suryanamaskar on physiological function
schools advocate performance in a slow manner in tune Group I (FSN group)

with slow breathing, while others advocate a rapid method
of performing multiple rounds in a fast manner similar to The subjects were trained to perform SN in a rapid manner
physical exercise. It has been suggested that SN at different so that all 12 postures were completed in 2 minutes. Fifteen
speeds provides different benefits and that when it is rounds were performed in 30–40 minutes. After 2 weeks of
done rapidly it warms up the body and acts as a cardio training, they practiced the same under direct supervision
tonic, whereas when done slowly it strengthens and tones of the instructor for a total duration of 6 months.
the musculature and enhances functioning of internal
organs.[14] It has also been suggested that one can drive Group II (SSN group)
away depression through fast rounds or cool down
hyperactivity with slow rounds.[15] The subjects were trained to perform SN in a slow manner
so that each of the 12 postures was held for 30 seconds.
This study was planned based on our hypothesis that these Each round took 6 minutes to complete and five rounds
two methods of performance based on different speeds were performed in 30–40 minutes. After 2 weeks of
would have different physiological effects. training, they practiced the same under direct supervision
of the instructor for a total duration of 6 months.
The objectives of this study were:
1. to determine the effect of SN on pulmonary function, Two to three days before the actual recording, the subjects
respiratory pressures, handgrip strength and endurance were familiarized with the laboratory environment and
and resting cardiovascular parameters and their anthropometric measurements were taken. On
2. to compare the effects of 6 months training in slow the day of the test, subjects reported at our polygraph
suryanamaskar (SSN) and fast suryanamaskar (FSN). laboratory 2 hours after a light breakfast. Recordings were
taken at laboratory temperature of 27 ± 1°C.
MATERIALS AND METHODS
Parameters
Subjects
Hand grip strength and endurance
Forty-two healthy student volunteers (21 males and 21
females) studying 8th standard at Government Higher Isometric hand grip strength (IHG) was measured with
Secondary School, Indira Nagar, Pondicherry, were the dominant hand gripping the inflated cuff of a mercury
recruited. Subjects with history of active sports training, manometer while the subject was sitting comfortably in
previous experience of yoga training, history of major a chair. The arm was extended in front at the shoulder
medical illness such as tuberculosis, hypertension, level and kept horizontal to the ground. Endurance time
diabetes mellitus, bronchial asthma in the past and history for 33% of IHG was calculated as the duration for which
of major surgery in the recent past were excluded from 33% of IHG could be sustained and noted as hand grip
the study. The mean age of the subjects was 13.45 ± 0.18 endurance (HGE).
years, mean height 1.47 ± 0.01 m, mean weight 34.79 ±
1.34 kg and mean body mass index (BMI) was 15.89 ± 0.42 Respiratory pressures
units. They were briefed about the study and informed
consent was obtained from them along with permission Maximum inspiratory pressure (MIP) and maximum
from their parents and head of the institution. This study expiratory pressure (MEP) were recoded as follows.
was conducted within the purview of a larger study on MIP was determined by asking the subject to perform
the physiological effects of yoga, and ethical approval maximum inspiratory effort against the mercury
was obtained from institutional ethics committee for the column of a manometer after breathing out fully. The
entire study. maximum level at which the mercury column could be
maintained for about 3 seconds was noted. MEP was
Training schedule determined by asking the subject to blow against the
mercury column after taking in a full breath. MEP that
Subjects of either gender were randomly divided into the could be maintained for about 3 seconds was noted. It
two groups of 21 (10 girls and 11 boys) each and trained was ensured that the subjects did not use oral muscles
to perform SN by a qualified instructor. SN consists of a to develop pressure or use their tongue to block the
sequence of 12 postures performed in a rhythmic manner tubing.
starting in an upright standing position and then moving
into alternate forward and backward bending movements Pulmonary function tests
interspaced with movements involving all four limbs before
ending the practice in an erect standing position.[16,17] Forced vital capacity (FVC), forced expiratory volume in 1st
72 International Journal of Yoga  Vol. 4  Jul-Dec-2011

second (FEV1), and peak expiratory flow rate (PEFR) were Table 1: Effect of training in slow suryanamaskar (SSN)
measured using a computerized spirometer (Spirocheck, and fast suryanamaskar (FSN) on isometric hand grip
Morgan, England). The subject was instructed to take (IHG), hand grip endurance (HGE), maximum inspiratory
pressure (MIP), maximum expiratory pressure (MEP),
maximum inspiration and blow into the mouthpiece as
forced vital capacity (FVC), forced expiratory vital volume
rapidly, forcefully and completely as possible. It was ensured in 1st second (FEV1), peak expiratory flow rate (PEFR),
that a tight seal was maintained between the lips and the heart rate (HR), systolic pressure (SP), diastolic pressure
mouthpiece of the spirometer. (DP), mean pressure (MP), pulse pressure (PP), rate
pressure product (RPP) and double product (Do P) before
Resting cardiovascular parameters (B) and after (A) the 6-month study period
SSN (n = 21) FSN (n = 21)
After 10 minutes of supine rest, right brachial systolic B A B A
(SP) and diastolic (DP) blood pressure as well as heart IHG (mm Hg) 122.25 144.25 135.05 153.64
rate (HR) were recorded with non-invasive semi-automatic ± 6.29 ± 5.92*** ± 7.48 ± 9.11***
HGE (seconds) 41.65 54.10 43.05 78.05
blood pressure (BP) monitor (Press-Mate BP 8800, Colin ± 3.20 ± 4.10*** ± 3.52 ±
Corporation, Komaki, Japan). Pulse pressure (PP = SP 9.67***+
– DP), mean pressure (MP = DP + PP/3), rate pressure MIP (mm Hg) 27.00 40.25 33.64 54.55
product [RPP = (HR × SP)/100] and double product ± 1.79 ± 2.91*** ± 2.83 ±
3.71***+
(Do P = HR × MP) were calculated for each recording.
MEP (mm Hg) 23.50 35.75 27.50 34.09
Three BP and HR recordings at 1-minute intervals were ± 2.57 ± 3.27*** ± 2.65 ± 3.51
taken and the lowest of these values was included for the FVC (L) 1.88 2.05 1.96 2.16
present study. ± 0.08 ± 0.09** ± 0.11 ± 0.10**
FEV1 (L) 1.84 2.00 1.91 2.13
± 0.08 ± 0.08** ± 0.10 ± 0.10**
The above-mentioned parameters were measured before PEFR (L/min) 268.55 307.20 271.32 331.77
and after the 6-month study period in both the groups. ± 14.45 ± 12.36*** ± 12.28 ± 13.00***
For each parameter, three trials at 3-minute intervals HR (beats/min) 86.15 82.35 80.00 79.36
± 2.38 ± 2.08 ± 2.52 ± 2.67
were given and highest of the three values was used for SP (mm Hg) 100.20 101.20 97.14 102.27
statistical analysis. ± 1.57 ± 2.98 ± 2.16 ± 2.64*
DP (mm Hg) 66.15 61.10 63.82 65.00
± 1.84 ± 1.25* ± 1.84 ± 1.83
Analysis of data
MP (mm Hg) 77.50 74.47 74.92 77.42
± 1.57 ± 1.65 ± 1.82 ± 1.89
In both the groups, all the above parameters were measured
PP (mm Hg) 34.05 40.10 33.32 37.27
at the beginning and again at the end of the 6-month ± 1.67 ± 2.41* ± 1.48 ± 2.11
study period. The data were assessed for normality RPP (units) 86.48 83.52 77.39 80.82
using GraphPad InStat and passed normality testing by ± 3.17 ± 3.35 ± 2.47 ± 2.97
Do P (units) 6663.60 6145.72 5984.59 6110.53
Kolmogorov–Smirnov Test. The data were then analyzed
± 215.99 ± 224.05 ± 220.25 ± 206.63
using Student’s (paired) t test to compare pre- and post- Values are Mean ± SEM for 21 subjects in each group;
training values of each group. Student’s (unpaired) t *P < 0.05, **P < 0.01, ***P < 0.001 paired “‘t” test between post- and
pre-training values; +P < 0.05 unpaired “t” test between SSN and FSN
test was used to compare the values between the groups
before and after training. A P value of less than 0.05 was
accepted as indicating significant difference between the It was found that FSN training also produced a significant
compared values. (P < 0.001) increase in IHG, HGE, MIP and PEFR, along
with a significant (P < 0.01) increase in FVC and FEV1.
There was a substantial, though statistically insignificant,
RESULTS
increase in MEP. There was a significant (P < 0.05) rise in
The results are given in Table 1. Both the groups were SP following 6 months training in FSN group, along with
comparable before training as no statistically significant an appreciable, yet statistically insignificant, rise in DP,
difference was found between them with respect to MP, PP, RPP and Do P.
baseline data of all parameters. The post-training analysis
revealed the following findings. SSN training produced a Intergroup comparisons showed no statistically significant
significant (P < 0.001) increase in IHG, HGE, MIP, MEP difference between the groups with respect to pre-training
and PEFR, along with a significant (P < 0.01) increase in baseline values. Post-training analysis showed that changes
FVC and FEV1. There was also a significant (P < 0.05) fall in all the parameters were statistically comparable between
in DP and rise in PP following SSN training along with FSN and SSN groups, except in the case of HGE and MIP
an appreciable, yet statistically insignificant, fall in HR, that had a statistically significant (P < 0.05) rise in the
MP, RPP and Do P. FSN group as compared to the SSN group.

An interesting difference between the groups in the post- controlled inspiration and expiration, as practiced in
training analysis, which was apparent but not statistically SSN, contributed to significant increase in both pressures,
significant, was the fall in cardiovascular parameters such whereas FSN, being performed rapidly, had no such
as DP, MP RPP, Do P in SSN group with a converse rise in controlled expiration phase and hence resulted in increase
the same parameters in FSN. in MIP alone.
DISCUSSION Pulmonary functions
Isometric handgrip strength and endurance FVC and FEV1 increased significantly (P < 0.001) in both
FSN and SSN groups. PEFR also increased significantly in
There was a statistically significant increase (P < 0.001) both the groups, the increase being statistically significant
in IHG and HGE in both the groups. The increase in FSN (P < 0.001). Bhutkar and colleagues have reported an
was significant (P < 0.05) as compared to the increase in increase in MVV and FEV1 following 6 months of SN
SSN group. Our results are similar to those of previous training and practice.[13]
studies on yoga that have reported an increase in hand
grip strength following yoga training.[5,6] In earlier works In our study, there was a significant improvement in
from our laboratories, we have found a significant increase FVC, FEV1 and PEFR. This is similar to earlier studies
in IHG and HGE time after 3 months of yoga training.[3,4] on yoga that have reported significant improvement
This increase in muscle strength and endurance time can in vital capacity (VC), FVC, FEV1 and PEFR following
be explained on the basis of stimulation of skeletal muscles training.[2,19,20] This can be attributed to the increase in the
during the isometric contraction maintained during the strength of the major respiratory muscles following SN
steady state of the different postures in SN. This may be practice. It is important to note that in spite of differences
also because of the delayed onset in muscular fatigue. in the method of performance, both FSN and SSN have
Our study gives evidence that both SSN and FSN improve produced similar results. On the basis of this study, SN
muscle strength like yoga practices and that it is more may be recommended for improving respiratory function
apparent in the case of FSN. in children and adolescents.
Respiratory pressures Resting cardiovascular parameters

MIP increased significantly in both FSN and SSN groups Resting HR decreased in both the groups, and though this
(P < 0.001) and this increase in FSN group was more was statistically insignificant, it was more apparent in
significant (P < 0.05) as compared to that in SSN group. SSN. Six-month practice of FSN produced a significant
MEP increased significantly in SSN group (P < 0.001). This increase in SP and relatively no change in either HR or DP.
increase in MIP and MEP after SN training is similar to FSN is a fast rhythmic sequential performance of various
our earlier observations that yoga training increases MIP postures and all the large muscle groups are subjected to
and MEP.[3,4] This suggests that SN training improves the rhythmic contraction and relaxation, which is analogous
strength of both expiratory and inspiratory muscles. The to any exercise involving large muscle groups. This may
different postures of SN involve isometric contraction and be bringing about increase in venous return causing rise in
chest wall expansion which may be improving strength of stroke volume and SP. The increase in SP in FSN group can
the intercostal muscles. be thus attributed to adaptive physiological changes and
this is consistent with the report of Udupa and colleagues
Maximum respiratory pressures are simple, yet specific, which showed a fall in HR and rise in SP following SN
indices of respiratory muscle strength and highest MIP is training.[11] It is possible that the SN done by their subjects
obtained at lung volumes of less than 50% of total lung was of the FSN variety but this is not clear from their paper.
capacity and highest MEP is obtained at lung volumes of
more than 70% of total lung capacity.[17,18] Earlier studies The DP was significantly lower in SSN group at the
from our laboratory have reported improvement in the end of training period. The main determinant of DP is
strength of inspiratory and as well expiratory muscles peripheral vascular resistance/tone, which is modulated
following yoga training. [3] In the present study, SSN by sympathetic tone. An earlier study from our laboratory
produced a significant improvement in both MIP and MEP has shown that 3 months of pranayam training modulates
while FSN had a significant effect only on MIP though ventricular performance by increasing parasympathetic
a statistically insignificant yet appreciable increase in activity and decreasing sympathetic activity as evidenced
MEP was noted. Intergroup comparison showed that by changes in systolic time intervals.[21] The SN study by
FSN has a more significant effect on MIP than on MEP. Bhutkar and colleagues reported a fall in both SP and DP
This can be attributed to the pattern of breathing and after 6 months of training and practice.[13] In our study, the
type of SN practiced. It is plausible that the slow and significant decrease of DP and statistically insignificant

5% decrease in resting heart rate in SSN group may be pilot study done by Bhutkar et al.[13] They had however
attributed to a decrease in peripheral resistance due to not given adequate description of the type of SN used in
decrease in sympathetic tone. These changes evidenced the training and both these studies (our study as well as
in our study also contributed to the significant increase their study) suffer a lack of a control group. Further studies
in pulse pressure among SSN subjects, indicating better with control group and in different age groups can help
tissue perfusion. us understand the inherent mechanisms resulting in such
differential beneficial effects.
RPP and Do P are indirect measures of cardiac oxygen
consumption and work done by the heart and both showed ACKNOWLEDGMENTS
a trend of increase in FSN and decrease in SSN. This
The authors wish to thank Department of Science and Technology,
implies that the practice of FSN and SSN for a period of 6
Government of Pondicherry, and Central Council for Research
months may increase and decrease resting cardiac oxygen
in Yoga and Naturopathy (CCRYN), New Delhi, for funding this
consumption, respectively. In their study, Bhutkar and research project. We also thank Mr. G. Kumaran for assisting in
colleagues reported an increase in VO2 max, indicating the yoga training and Miss. R. Lalithambiga for her technical
improved aerobic capacity after training in SN.[13] An assistance.
earlier study on the component steps of the SN had also
concluded that SN exerts only a moderate stress on the
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2. Yadav RK, Das S. Effect of yogic practice on pulmonary functions in young
One of the interesting differences which was apparent females. Indian J Physiol Pharmacol 2001;45:493-6.
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the post-training analysis was the fall in cardiovascular S, Krishnamurthy N, et al. Effect of yoga training on reaction time,
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mind leading to a decrease in peripheral resistance due Pharmacol 2003;47:387-92.
to decrease in sympathetic tone as illustrated by fall in 5. Dash M, Telles S. Improvement in handgrip strength in normal volunteers
DP and MP coupled with a reduced load on the heart as and rheumatoid arthritis patients following yoga training. Indian J Physiol
illustrated by changes in RPP and Do P. Pharmacol 2001;45:355-60.
6. Raghuraj P, Telles S. Muscle power, dexterity skill and visual perception in
community home girls trained in yoga or sports and in regular school girls.
CONCLUSION Indian J Physiol Pharmacol 1997;41:409-15.
7. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of hatha
The present study shows that SN has positive physiological
yoga practice on health related aspects of physical fitness. Prev Cardiol
benefits as evidenced by changes in pulmonary function, 2001;4:165-70.
respiratory pressures, handgrip strength and endurance, 8. Gopal KS, Bhatnagar OP, Subramanian N, Nishith SD. Effect of yogasanas
and resting cardiovascular parameters. It also demonstrates and pranayamas on BP, pulse rate and some respiratory functions. Indian J
the comparative differential effects of training in SN when Physiol Pharmacol 1973;17:273-6.
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On the basis of the present study it is recommended that 11. Udupa KN, Singh H, Settiwar RM. Physiological and biochemical studies
SN be introduced to school children to improve their on the effect of yogic and certain other exercises. Indian J Med Res
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physical fitness.
12. Sinha B, Ray US, Pathak A, Selvamurthy W. Energy cost and cardiorespiratory
changes during the practice of surya namaskar. Indian J Physiol Pharmacol
The strength of this study is that it is the first study 2004;48:184-90.
comparing physiological effects of 6 months training and 13. Bhutkar MP, Bhutkar VM, Taware BG, Doijad V, Doddamani BR. Effect
performance of SN in a slow and fast manner. Even though of suryanamaskar practice on cardio-respiratory fitness parameters: A Pilot
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Yoga M¢m¡Æs¡, Vol. XLIII No. 2 : 102-107 July, 2011
EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM :

A CASE REPORT
BHAVANANI, ANANDA BALAYOGI1; ZEENA SANJAY2 AND MADANMOHAN3
ABSTRACT
Complementary and Alternative Medical (CAM) therapies such as yoga are being increasingly
used as adjuncts to modern medicine. Though it has been suggested that yoga may have a role in
revitalizing thyroid function there are few studies on the effects of yoga on thyroid disorders.
Case history: A 36 year old female with elevated TSH level (9.39 IU/ml) and low normal T4
levels (12.57 pmol/L) was diagnosed as having primary sub-clinical hypothyroidism and advised
to start replacement therapy. She came for consultation to the ACYTER Yoga OPD at JIPMER,
Pondicherry and was given appropriate yogic counseling and taught a series of techniques
potentially beneficial to patients of thyroid conditions. She continued the practices for a year and
reported back at the end of the year with her biochemical investigations. Results: After one year
of therapy, there was a fall in TSH (2.66 mIU/L) and a normalization of free T4 values (8.98
pmol/L). A third biochemical analysis three months later showed that TSH further stabilized 2
mIU/L and FT4 at 9.78 pmol/L. As the anti TPO antibodies were positive both before and after
the yoga intervention, the patient was advised to continue the yoga practices on a regular basis as
long as possible with regular six-monthly follow up. Conclusion: it is suggested that yoga can be
an effective adjunct therapy in thyroid conditions and further studies in larger samples are needed
to confirm these findings and to better understand the mechanisms behind such beneficial effects
in patients of thyroid disorders.
Key words: Subclinical hypothyroidism, yoga therapy, psycho-neuro-endocrinology
Introduction
In recent times there is a shift in paradigm and Complementary and Alternative Medical
(CAM) therapies such as yoga are being increasingly used as adjuncts to modern medicine. It
has been suggested that yoga may have a role in revitalizing thyroid function as well as improving
psycho-neuro-endocrine function on the whole (James Funderburk 1977, Singh RH 1982). Though
1. Programme Co-ordinator, ACYTER, JIPMER, Puducherry, India. Email: ananda@icyer.com

2. Senior Research Fellow, ACYTER, JIPMER, Puducherry, India.
3. Professor and Head, Physiology and Programme Director , ACYTER, JIPMER, Puducherry, India.
YM, Vol. XLIII No. 2 102 Bhavanani, et al. (2011)

EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM : A CASE REPORT
numerous studies have shown the psycho-physiological benefits and therapeutic potential of
Yoga (Khalsa 2004) there are few studies on the effects of yoga on thyroid disorders.
Hypothyroidism refers to a condition where the thyroid gland is not producing sufficient
amounts of hormones. As there are intricate feedback mechanisms between the thyroid and
anterior pituitary, hypothyroidism is classified as primary when thyroxin (T4) and triiodothyronine
(T3) levels are low but levels of thyroid stimulating hormone (TSH) secreted by anterior pituitary
high. It is classified as secondary when TSH is low and T4 and T3 levels are high.
Sub-clinical hypothyroidism is a condition where TSH levels are elevated but T4 and T3
levels are usually found to be in the normal laboratory reference ranges. Prevalence in the US
adult population ranges from 4 to 8.5% with an increase with age. It is also more common in
women. Sub-clinical hypothyroidism may manifest without any major thyroid related symptoms
as cellular metabolic rates may not be affected in many cases. Approximately 2 to 5 % of these
patients will progress to overt hypothyroidism per year (Martin I Surks 2004). Opinion is divided
on the biochemical and symptomatic point at which to start replacement therapy with
levothyroxine that is the usual management of clinical hypothyroidism. One needs to be cautious
as there is always the risk of iatrogenic hyperthyroidism.
Case Report
History
A 36 year old female, working in Kuwait presented to her clinician with the complaints of
hair fall and a feeling of general lethargy. There were no other major thyroid related symptoms
through she was anxious about her condition. As her blood tests revealed an elevated TSH level
and low normal T4 levels she was diagnosed as having primary hypothyroidism and advised to
start replacement therapy with levothyroxine as she tested positive for anti TPO antibodies. The
patient put off starting the medication as she was visiting Pondicherry to visit her father for a
short holiday with family. As she wished to avoid lifelong replacement therapy, on the suggestion
of her father who is a YOGA enthusiast she came for consultation to the ACYTER Yoga OPD
that is functioning since June 2009 at JIPMER, Pondicherry. She had no apparent thyroid
enlargement and her vitals were within normal limits. However she was anxious about her
condition and the necessity of taking levothyroxine life long. She was given appropriate yogic
counseling and dietary advice and taught a series of techniques that are potentially beneficial to
patients of thyroid conditions. She continued the practices for one year and reported back at the
end of the year with her biochemical investigations. Her biochemical results showed a fall in
TSH and a normalization of free T4 values. She also reported less hair fall and a sense of well
being. In fact she commented that many of her colleagues at work had noticed the positive
changes in her attitude and day to day activities and were interested in what she has doing so that
they could benefit themselves. As the anti TPO antibodies were positive both before and after
the yoga intervention, the patient has been advised to continue the yoga practices on a regular
basis as long as possible with regular six-monthly follow up.
Investigations
The initial biochemical investigations detected that her TSH was 9.39 IU/ml (normal range
for the laboratory is given as 0.27 to 4.20 mIU/L) and FT4 value was 12.57 pmol/L which is at
the lower normal level of the range for that laboratory (12 to 22 pmol/L). Following 6 months of
Yoga therapy, TSH fell to 2.66 mIU/L (normal range for the laboratory is given as 0.37 to 4
mIU/L) while FT4 was 8.98 pmol/L which is mid normal of the range for that laboratory (7.5 to
21 pmol/L). A third biochemical analysis three months later showed that TSH was 2 (normal
range for the laboratory 0.27 to 4.20 mIU/L) and FT4 was 9.78 (normal range for the laboratory
7.86 to 14.4 pmol/L). Anti TPO antibodies were positive both before and after the yoga
intervention.
Yoga therapy
The patient was given appropriate yogic counseling and dietary advice and taught the following
techniques that may be potentially beneficial to patients of thyroid conditions. The techniques
included s£rya namask¡ra, j¡landharabandha, vipar¢takara¸i and brahmamudr¡ in addition to
¡sanas such as triko¸a, vakra, ardha matsyendra, pawanamukta and sarva´g¡sana. She also
received training in s£ryan¡·i, pra¸ava, ujj¡yi and bhr¡mari pr¡¸¡yama and relaxation techniques
done in ¿av¡sana.
Discussion
The consensus report generated by the Consensus Development Conference (2002)
cosponsored by the American Association of Clinical Endocrinologists (AACE), the American
Thyroid Association (ATA), and The Endocrine Society (TES), has suggested that the upper
limit of TSH should be considered as 4.5 mIU/L. It also states that since available data do not
convincingly show clear-cut benefit from early thyroxine therapy, routine T4 treatment for patients
with TSH between 4.5 and 10 mIU/L is not warranted. Martin I Surks et al (2004) concluded that
data supporting associations of sub-clinical thyroid disease with symptoms or adverse clinical

outcomes or benefits of treatment are few. They have recommended against routine treatment
of patients with TSH levels ranging from 4.5-10 mIU/L. as the consequences of sub-
clinical thyroid disease are minimal.
However the AACE Clinical Practice Guidelines for the Evaluation and Treatment of
Hyperthyroidism and Hypothyroidism (2002 Update) suggests that thyroid antibodies should be
measured in patients having sub-clinical hypothyroidism and used as a clinical tool in deciding
upon treatment. AACE guidelines also recommend treatment of patients with TSH > 5mIU/L if
the patient has a goiter or if thyroid antibodies are present.
Two randomized controlled trials in patients with TSH values less than 10mIU/L found no
symptomatic improvement following treatment with thyroxine (Meier C 2001 and Kong WM
2002). However caution is advised as there is a risk of progression to overt hypothyroidism. A
20 year follow up study showed a correlation of this with TSH levels and anti TPO antibodies
(Bijay 2008).
Yoga has great potential as an adjunct therapy as it is cost effective and may not have any
complications when practiced in a proper manner and under expert guidance. Many patients are
nowadays also opting to try out yoga either before starting medications, or in combination with
medication. The position statement of the AACE on Sub-clinical Thyroid Disease clearly states
that until adequate data are available, best practice combines clinical judgment with patient
preferences. In this case, the patient's preference was to use yoga as a method to prevent her sub-
clinical hypothyroidism from developing into full blown hypothyroidism and to avoid taking the
replacement therapy as long as possible.
Yoga therapy imparted to this patient included techniques that may stimulate the thyroid
such as viparitakara¸i, sarva´g¡sana and j¡landhara bandha. One of the pioneers of reach in
Yoga, K. N. Udupa (1985) of the BHU, Varanasi reported that head-low posture reduced levels
of circulating catecholamine, improved tolerance to stress hence may act as a tranquilizer. These
practices may help normalize thyroid function and also improve neuro-endocrine feedback
mechanisms. This may also be accentuated by the pr¡¸¡y¡ma practices like bhr¡mari and pra¸ava
that may bring about such benefit through central action on either the hypothalamus or the limbic
cortex.
Forfar et al (1982) reported a reduction in left ventricular ejection fraction and myocardial
contractile performance in hypothyroid patients. A study of systolic time intervals in hypothyroid
patients by William F. Crowley et al (1977) reported that pretreatment systolic time intervals

were characterized by prolongation of the pre-ejection period and reduction of left ventricular
ejection period. A previous study from our laboratory has demonstrated that three months of
pr¡¸¡y¡ma training modulates ventricular performance by increasing parasympathetic activity
and decreasing sympathetic activity (Udupa 2003).
The practice of yoga is known to educe a sense of subjective well (Malathi) and a study done
at the Integral Health Clinic of AIIMS, New Delhi reported that state and trait anxiety scores
were significantly reduced following a comprehensive but brief lifestyle intervention based on
yoga. Subjects in that study included patients of thyroid disorders (Gupta N 2006). Yogic
relaxation techniques may be producing psycho-somatic harmonization and inducing a sense of
calm due to hypo-metabolic activity as has been described in meditation by RK Wallace (1971).
A reduction in metabolic activity could be indirectly reducing the bodily demand for thyroxin as
demonstrated by S. B. Rawal and colleagues (1994).
Further studies in larger samples are needed to confirm these findings and to better understand
the mechanisms behind such beneficial effects of yoga in patients of thyroid disorders.
References
Vaidya, Bijay; Pearce, Simon H S (2008) Management of hypothyroidism in adults: Clinical
review. BMJ 337:a801
Funderburk, James. (1977) Science Studies Yoga: A Review of Physiological Data. Honesdale,
Penn.: Himalayan International Institute of Yoga Science & Philosophy.
Gupta N.; Khera S,; Vempati R.P, Sharma R.; Bijlani, R.L. (2006) Effect of yoga based lifestyle
intervention on state and trait anxiety. Indian J Physiol Pharmacol., 50(1):41-7.
Hossein Gharib, Rhoda H Cobin, H Jack Baskin. (2010). Position statement of the AACE on
Subclinical Thyroid Disease. www.aace.com / pub / positionstatements / subclinical.php.
Forfar , J.C.; Muir, A.L.; Toft, A.D. (1982). Left ventricular function in hypothyroidism:
Responses to exercise and beta adrenoceptor blockade. Br Heart J. 48: 278-84
Khalsa, S.B.S. (2004) Yoga as a therapeutic intervention: a bibliometric analysis of published
research studies. Indian J Physiol Pharmacol; 48 (3): 269-285.
Kong, W.M.; Sheikh, M.H.; Lumb, P.J. et al. (2002) A 6-month randomized trial of thyroxine
treatment in women with mild subclinical hypothyroidism. Am J Med;112:348-354

Malathi, A.; Asha, D.; Shah, N. et al. ( 2000) Effect of yoga practices on subjective well being.
Indian J Physiol Pharmacol; 44 (2) : 202-206.
Martin, I.; Surks, Eduardo Ortiz, Gilbert H Daniels et al. (2004) Subclinical Thyroid Disease:
Scientific Review and Guidelines for Diagnosis and Management. JAMA. 291: 228-238.
Meier, C.; Staub, J.J.; Roth, C.B. et al. (2001) TSH-controlled L-thyroxine therapy reduces
cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double-blind,
placebo-controlled trial. J Clin Endo Metab;86:4860-4866
Rawal, S.B.; Singh, M.V.; Tyagi, A.K.; Selvamurthy, W.; Chaudhuri, B.N. (1994) Effect of
yogic exercises on thyroid function in subjects resident at sea level upon exposure to high
altitude. Int J Biometeorol.; 38(1):44-7.
Singh, R.H..; Shettiwar, R. M.; Udupa, K.N. (1982) Physiological and therapeutic studies on
yoga. The Yoga Review, 2(4):185-209.
Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishnamurthy N. (2003) Effect of
pranayam training on cardiac function in normal young volunteers. Indian J Physiol
Pharmacol; 47(1):27-33.
Udupa K.N, (1985). Stress and Its Management by Yoga, Motilal Banarsidass, Delhi - pp. 146-
161
Wallace R. K,; Benson H,; Wilson A.F. (1971) A wakeful hypometabolic physiologic state. Am
J Physiol;221 (3):795-9.
William F Crowley, E Chester Ridgway, Edward W Bough, Gary S Francis, Gilbert H Daniels,
Ione A Kourides, Gordon S Myers, Farahe Maloof. (1977). Noninvasive Evaluation of
Cardiac Function in Hypothyroidism -Response to Gradual Thyroxine Replacement. N Engl
J Med; 296:1-6
Authors' Note
The authors thank Mrs. Lalitha Shanmugam for imparting the Yoga Therapy at the Yoganjali
Natyalayam city centre of ICYER, Pondicherry. We also thank the Director, MDNIY and Director,
JIPMER for their support as this study was possible only 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 in the Ministry of Health and
Family Welfare, Government of India.

INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011) 73
Research
Immediate Effect of Sukha Pranayama on
Cardiovascular Variables in Patients of Hypertension
Ananda Balayogi Bhavanani, MBBS, ADY, Zeena Sanjay, BNYS,
Madanmohan MD, MSc
The Advanced Centre for Yoga Therapy, Education and Research, Jawaharlal Institute of Postgraduate Medical
Education & Research, Puducherry, India
Abstract: Hypertension is one of the most common health disorders, and yoga has been shown to be an effective
adjunct therapy in its management. Earlier studies have reported blood pressure (BP)-lowering effects of slow,
deep breathing after 3 weeks and 3 months of training and beneficial immediate effects of slow, deep breathing
in reducing premature ventricular complexes and lowering blood pressure. None of these immediate studies used
the concept of pranayama, involving conscious internal awareness of the whole breathing process. This study
was undertaken to determine the immediate cardiovascular effects of sukha pranayama in hypertensive patients.
Methods: Twenty-three hypertensive patients attending the Yoga OPD at JIPMER were recruited for the study
and instructed to perform sukha pranayama for 5 minutes at the rate of 6 breaths/min. This pranayama involves
conscious, slow and deep breathing with equal duration for inhalation and exhalation. Heart rate (HR) and BP
were recorded before and immediately after the intervention. Results: Post-intervention statistical analysis revealed
a significant (p < .05) reduction in HR and a highly significant (p < .001) reduction in systolic pressure, pulse
pressure, mean arterial pressure, rate-pressure product, and double product with an insignificant fall in diastolic
pressure. Discussion: It is concluded that sukha pranayama at the rate of 6 breaths/minute can reduce HR and BP
in hypertensive patients within 5 minutes of practice. This may be due to a normalization of autonomic cardio-
vascular rhythms as a result of increased vagal modulation and/or decreased sympathetic activity and improved
baroreflex sensitivity. Further studies are required to understand possible mechanisms underlying this beneficial
immediate effect and to determine how long such a beneficial effect persists.
Key words: hypertension, pranayama, yoga, breathing, blood pressure, cardiovascular disease, vagal tone
Correspondence: Ananda Balayogi Bhavanani at 25, 2nd Cross, Iyyanar Nagar, Pondicherry, India 605013.
ananda@icyer.com.
Acknowledgments: The authors thank ACYTER yoga instructor Selvi L. Vithiyalakshmi for her assistance during the
study. We also thank the directors of MDNIY and JIPMER for their support. This study was possible only 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 the Department of AYUSH in the Ministry of Health and Family
Welfare, Government of India.
74 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011)
Background patients attending the Yoga Out Patient Department at

JIPMER, Puducherry, India.
One of the most common health disorders today is hy-
pertension, or high blood pressure (BP). This health chal- Methods
lenge affects millions of people all over the world and is a
major risk factor for stroke, coronary artery disease, and This study was conducted at the Advanced Centre
organ failure. Lifestyle modifications are universally accept- for Yoga Therapy Education and Research (ACYTER).
ed not only as the first step in the management of hyperten- ACYTER is a collaborative venture between Morarji Desai
sion but also as a way to prevent hypertension.1 Lifestyle National Institute of Yoga in New Delhi and the Jawaharlal
modifications may eliminate the need for drug therapy in Institute of Postgraduate Medical Education & Research
borderline hypertension and decrease the dosage and/or in Puducherry, with funding from the Department of
reduce the number of drugs need in established hyperten- Ayurveda, Yoga & Naturopathy, Unani, Siddha and
sion. It may also decrease the risk of cardiovascular diseases Homeopathy (AYUSH) in the Ministry of Health and
directly and indirectly. Family Welfare, Government of India. Ethical approval
Yoga has been found to be an effective adjunct therapy was obtained by ACYTER from the Institutional Ethics
for hypertension. Yoga is a true lifestyle intervention that Committee for studies on the effect of yoga therapy on hy-
may include practices such as asana (postures), pranayama pertension and diabetes. The present study was conducted
(breathing), meditation, relaxation, dietary changes, and as a pilot study as part of this larger study on the effects of
other techniques that have been shown to aid in reducing yoga therapy in patients with hypertension.
cardiovascular risk and high blood pressure.2 Breathing
techniques are increasingly being used for therapeutic pur- Participants
poses, and research suggests that pranayama may be espe- Twenty-three patients (11 men) with essential hyper-
cially helpful in managing hypertension. tension attending the Yoga Out Patient Department (OPD)
For example, a recent study by Pramanik and colleagues run by ACYTER were selected for this study by nonran-
has reported reduction in heart rate and blood pressure dom sampling. The Yoga OPD is a facility of ACYTER
following 5 minutes of slow-paced bhastrika pranayama.3 where patients are referred from various departments of the
Earlier studies from our laboratory have shown the heart hospital to be given yoga consultation. Individualized and
rate- and blood pressure-lowering effects of practicing slow, group-based yoga therapy schedules are determined based
deep breathing on a regular basis for 3 weeks and 3 months.4, 5 on their condition. These schedules are then completed at
Deep breathing has also been reported to reduce premature the ACYTER Yoga Hall. Regular follow-up is done on a
ventricular complexes.6 Joseph and colleagues demonstrated periodic basis at the Yoga OPD, and required changes made
a decrease in blood pressure after 3 minutes of slow breath- in the schedule as appropriate. Participant age ranged from
ing at the rate of 6 breaths/min, while Kaushika and col- 45 to 70 (M = 55.13 , SEM = 1.54) years. All of the partici-
leagues demonstrated that even a single 10-minute session pants had experienced hypertension for more than 5 years
of slow breathing could produce a temporary fall in blood and were under regular medical management with one or
pressure.7,8 Grossman and colleagues reported a clinically more antihypertensive medications at the Medicine OPD
significant reduction in blood pressure after 8 weeks of slow in JIPMER. Patients of secondary hypertension and those
deep breathing for 10 minutes a day using a Breathe with with history, signs and symptoms, or laboratory reports
Interactive Music (BIM) apparatus.9 suggestive of nephrologic, neurologic, and ophthalmologic
However, none of these studies on timed deep complications were excluded from the study. None of the
breathing have used the yogic concept of pranayama as a participants had any previous experience of yoga training
conscious internal awareness of the whole breathing pro- before attending the Yoga OPD. Informed consent was ob-
cess. Further, most research on the immediate effects of tained by one of the investigators.
pranayama has used a nonclinical, healthy sample, while
research on the therapeutic benefits of pranayama has fo- Pranayama Intervention
cused on long-term benefits from regular practice. This Participants were taught to perform sukha pranayama in
study was undertaken to determine the immediate ef- an individual manner by a qualified yoga teacher working as
fects of 5 minutes of a classic pranayama technique, sukha a yoga instructor in ACYTER. Sukha pranayama is a simple
pranayama, on cardiovascular parameters in hypertensive type of yogic breathing that is done by consciously regulating
PRANAYAMA AND HYPERTENSION 75
the inhalation and exhalation to an equal ratio, with internal According to the Seventh Report of the Joint National
awareness of the complete breathing process involving all Committee on Prevention, Detection, Evaluation, and
sections of the lungs.10 This pranayama can be done at the Treatment of High Blood Pressure, normal systolic pressure
rate of 6 breaths/min by using a timed count of 5 for inhal- (SP) and diastolic pressure (DP) are expected to be less than
ing and exhaling. The study was done in the third session of 120 mm Hg and 80 mm Hg, respectively. SP between 120–
attendance at ACYTER, after the practice had been taught 139 mm Hg and DP between 80–89 mm Hg is labelled as
in the first two sessions. In these preliminary sessions, partici- prehypertension, while SP values above 140 mm Hg and
pants were also introduced to simple breath–body coordina- DP above 90 mm Hg are considered stage I hypertension.
tion and loosening practices, along with savasana relaxation. SP more than 160 mm Hg and DP more than 100 mm Hg
An overview of the practice was given to the patients, is considered stage II hypertension (JNC VII).11
and then they were instructed to sit upright, resting their
palms on their thighs. They were asked to keep their eyes Discussion
closed to facilitate the development of an internal aware-
ness. The pranayama was done through both nostrils in a In the present study, the practice of sukha pranayama for
calm and regular manner with a conscious effort to use the 5 minutes at a rate of 6 breaths/min was found to reduce the
lower, middle, and upper parts of the lungs in a sequential heart rate and blood pressure in patients with hypertension.
manner for both inhalation and exhalation. Participants Although both systolic and diastolic pressure dropped, only
were instructed to breathe in and out for an equal count of the reduction in systolic pressure was significant. This may
5 that was given by the instructor using a stopwatch. The be because systolic values were initially already higher than
instructor called out counts at the rate of 6 breaths/min for is considered healthy. On the other hand, diastolic pres-
the entire duration of 5 minutes. sure was already within the normal range. Because sukha
pranayama aims to produce a balanced state, further drops
Measurements would not be expected. The cardiovascular effects were more
Heart rate (HR) and blood pressure (BP) were mea- pronounced with regard to the MAP, RPP, and Do P. RPP
sured using a noninvasive semi-automatic blood pressure and Do P are especially significant because they are indi-
monitor. Baseline measurements of HR and BP were taken cators of myocardial oxygen consumption and load on the
after 5 minutes of rest in a seated posture. HR and BP were heart.12 The decrease observed following sukha pranayama
measured again after the 5 minutes of sukha pranayama. implies a lowering of strain on the heart itself. The observed
Pulse pressure (PP) was calculated as SP-DP, mean arte- changes may in part be due to an increase in parasympa-
rial pressure (MAP) as DP + 1/3 PP, rate-pressure product thetic activity and decrease in sympathetic activity, which
(RPP) as HR × SP/100, and double product (Do P) as HR has been previously reported in a study of pranayama’s ef-
× MAP/100. Statistical analysis was done using a student’s t- fects on ventricular performance.13
test for paired samples. P values less than .05 were accepted The beneficial cardiovascular effects seen in this study
as indicating significant differences between the baseline may also be due to the rate of breathing. Studies by Prakash
and post-pranayama means. and colleagues and Ravindra and colleagues have shown the
therapeutic benefits of deep breathing at the rate of 6 breaths/
Results min on reducing premature ventricular complexes.6,14 The
authors suggested that this was possibly due to the increased
All values are given as mean ± SEM. Immediately fol- vagal modulation of sinoatrial (SA) and atrioventricular (AV)
lowing 5 minutes of deep breathing, there was a statistically nodes. The increase in vagal modulation may be responsible
significant (p < .05) fall in HR from 79.3 ±2.86 to 76.57 for the reduction in heart rate and blood pressure seen in
±2.69 beats /min. The SP fell from 136.13 ± 3.32 to 126.96 this study. It has been previously suggested that breathing
± 2.54 mm Hg (p < 0.001), MAP from 97.26 ± 1.78 to at 6 breaths/min has the effect of entraining all RR interval
92.81±1.49 mm Hg (p < .001), RPP from 108.50 ± 5.25 to fluctuations, thereby causing them to merge at the rate of res-
97.82 ±4.58 units (p < .001), and Do P from 77.34 ± 3.31 piration and to increase greatly in amplitude. This increase in
to 71.34 ± 3.04 units (p < .001). PP showed a significant fall RR interval fluctuations enhances baroreflex efficiency and
from 58.3 ± 2.95 to 51.22 ± 2.22 mm Hg (p < .01), while may have contributed toward lowering blood pressure.7
there was a statistically insignificant fall in DP from 77.83 The slow, deep, conscious breathing done in sukha
±1.48 to 75.74 ±1.32. pranayama may also help normalize autonomic cardiovas-
76 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011)
cular rhythms that were described by Mayer more than a Surendiran A. Effect of slow and fast pranayams on reaction time
century ago.15 These rhythms occur as a 10-second cycle in and cardiorespiratory variables. Indian Journal of Physiology and
Pharmacology. 2005;49(3):313-8.
blood pressure that is related to both vagal and sympathetic
5. Pal GK, Velkumari S, Madanmohan. Effect of short-term practice
activity. Luciano Bernardi and colleagues have shown ben- of breathing exercieses on automonic funtions in normal human volun-
eficial effects of rosary prayer and yoga mantras in restoring teers. Indian Journal of Medical Research. 2004;120:115-121.
these autonomic cardiovascular rhythms.16 They reported 6. Prakash ES, Ravindra PN, Madanmohan, Anilkumar R,
an increase in baroreflex sensitivity following such chanting Balachander J. Effect of deep breathing at six breaths per minute on the
and concluded that rhythm formulas that involve breathing frequency of premature ventricular complexes. International Journal of
Cardiology. 2006; 111(3):450-2.
at six breaths/min induce favorable psychological and pos- 7. Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi
sibly physiological effects. A previous study by Joseph and M, Bernardi L. Slow breathing improves arterial baroreflex sensitivity
colleagues reported a normalization of baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension.
in hypertensive patients following just 2 minutes of breath- 2005;46(4):714-8.
ing at the rate of 6 breaths/min.7 8. Kaushika RM, Kaushika R, Mahajana SK, Rajesh V. Effects
of mental relaxation and slow breathing in essential hypertension.
We conclude that sukha pranayama when performed
Complementary Therapies in Medicine. 2006;4(2):120-6.
at the rate of 6 breaths/min is effective in reducing heart 9. Grossman E, Grossman A, Schein MH, Zimlichman R, Gavish B.
rate and blood pressure in hypertensive patients after just Breathing-control lowers blood pressure. Journal of Human Hypertension.
5 minutes of practice. This finding has potential therapeu- 2001;15(4):263-9.
tic applications in day-to-day as well as clinical situations 10. Gitananda Giri Swami. Sukha Pranayama: pleasant or easy breath. In
where blood pressure needs to be brought down quickly. Correction of Breathing Difficulties by Rishiculture Ashtanga Yoga. 2nd
Ed. Pudicherry: Satya Press; 2006, 84-85.
It is simple, cost-effective, and may be added to the man- 11. Seventh Report of the Joint National Committee on Prevention,
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the regular medical management of such situations. Further Department of Health and Human Services. NIH Publication No.
studies are required to enable a deeper understanding of the 04-5230. 2004.
mechanisms involved. We plan to further investigate how 12. Madanmohan, Udupa K, Bhavanani AB, Shatapathy CC, Sahai
A. Modulation of cardiovascular response to exercise by yoga training.
long the cardiovascular effects persist, as this will provide
Indian Journal of Physiology and Pharmacology. 2004;48(4):461-65.
more information about its usefulness in the long-term 13. Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P,
management of hypertension. Krishnamurthy N. Effect of pranayam training on cardiac function in
normal young volunteers. Indian Journal of Physiology and Pharmacology.
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1. Sharma R, Gupta N, Bijlani RL. Effect of yoga based lifestyle (yogic breathing) and shavasan (relaxation training) on the frequency
intervention on subjective well-being. Indian Journal of Physiology and of benign ventricular ectopics in two patients with palpitations.
Pharmacology. 2008;52(2):123-31. International Journal of Cardiology. 2006;108:124-125.
2. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Babu K. 15. Mayer S. Studien zur Physiologie des Herzens und der Blutgefaesse
Modulation of stress induced by isometric handgrip test in hypertensive 6. Abhandlung: ueber spontane Blutdruckschwenkungen. (Studies on
patients following yogic relaxation training. Indian Journal of Physiology the physiology of the heart and the blood vessels 6. Discourse on fluc-
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3. Pramanik T, Sharma HO, Mishra S, Mishra A, Prajapati R, Singh Kl Anat 1876;74:281–307.
S. Immediate effect of slow pace bhastrika pranayama on blood pressure 16. Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini L,
and heart rate. Journal of Alternative and Complementary Medicine. Wdowczyc-Szulc J, Lagi A. Effect of rosary prayer and yoga mantras on
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Indian J Physiol Pharmacol 2012; 56(3) : 273–278
SHORT COMMUNICATION
IMMEDIATE CARDIOVASCULAR EFFECTS OF PRANAVA

PRANAYAMA IN HYPERTENSIVE PATIENTS
ANANDA BALAYOGI BHAVANANI 1*, MADANMOHAN 1,

ZEENA SANJAY 1 AND ISHWAR V. BASAVARADDI 2
1
ACYTER, JIPMER, Puducherry – 605 006
3
Director, Morarji Desai National Institute of Yoga (MDNIY), New Delhi
( Received on August 18, 2011 )
Abstract : Slow, deep, pranayama - based breathing training has been

shown to be effective in reducing blood pressure (BP). The present study
was undertaken to determine immediate effects of performing pranava
pranayama on cardiovascular parameters in hypertensive patients. 29
hypertensive patients who were on medical treatment and also attending
yoga sessions were recruited for the present study. Supine heart rate (HR)
and BP were recorded before and after performance of pranava pranayama
for five minutes. Post intervention statistical analysis revealed a significant
(P<0.05) reduction in systolic pressure (SP) and a more significant (P<0.01)
reduction in HR, pulse pressure and double product (Do P). The reduction
in rate-pressure product (RPP) was highly significant (P<0.001). Pranava
pranayama is effective in reducing HR and SP in hypertensive patients
within five minutes of the practice. This may be due to a normalization of
autonomic cardiovascular rhythms as a result of increased vagal modulation
and/or decreased sympathetic activity and improved baroreflex sensitivity
along with an augmentation of endogenous nitric oxide production. Our
findings have potential therapeutic applications in day-to-day as well as
clinical situations where blood pressure needs to be brought down at the
earliest. The significant fall in RPP and Do P signifies a reduction in
oxygen consumption and work done by the heart. It is concluded that
pranava pranayama, a simple and cost effective technique can be used in
the management of hypertensive patients in addition to the regular medical
management. Further studies are required to enable a deeper understanding
of the mechanisms involved and its usefulness in the long- term management
of hypertension.
Key words : yoga therapy hypertension pranava pranayama
INTRODUCTION health disorders prevalent worldwide and is

a major risk factor for stroke, coronary
Hypertension is one of the most common artery disease and organ failure. Yoga has
*Corresponding Author : Dr. Ananda Balayogi Bhavanani, Programme Co-ordinator, ACYTER, JIPMER,
Puducherry – 605 006; Email : ananda@icyer.com
274 Bhavanani et al Indian J Physiol Pharmacol 2012; 56(3)
been shown to be an effective adjunct involves slow and deep inhalation with
therapy in hypertension and many studies conscious use of complete yogic breathing
have demonstrated the scientific basis of (mahat yoga pranayama) followed by the
using it as a therapy and also as an effective audible vibratory resonance of a prolonged
lifestyle modification measure (1, 2). AUM chant. This technique is one of the
practices taught in the comprehensive yoga
Yoga as a therapy is simple and therapy schedule used for hypertensive
inexpensive and can be easily adopted in patients at ACYTER, JIPMER, Puducherry,
most patients without any complications (3). India. Keeping this in mind, the present
Yoga therapy encompasses the use of asana, study was undertaken to determine
pranayama and relaxation techniques along immediate effects of performing pranava
with dietary advice and yogic counselling that pranayama on cardiovascular parameters in
attempts to address the root cause of the hypertensive patients.
problem rather than merely providing a
symptomatic relief (4). MATERIALS AND METHODS
Pranayama is an integral component of This study was conducted as part of a

holistic yoga therapy schedule and involves larger study on the effects of yoga therapy
slowing down of the normal breathing rate on hypertensive patients that had been
along with an awareness based, conscious accorded permission by the research and
inner focus on respiration. Slow, deep, ethics councils of the institute. 29 subjects
pranayama based breathing training has been (16 male and 13 female, 49.34±2.36 y)
shown to be effective in reducing blood attending yoga therapy sessions at ACYTER
and able to perform pranava pranayama in a
pressure (BP) after 3 weeks and 3 months
competent manner were recruited and
(5, 6).
informed consent obtained from them. All of
them were receiving medical treatment for
Jerath et al have reported that slow deep
their hypertension at the Medicine OPD. Sub
breathing in pranayama results in decreased
classification of the subjects according to
oxygen consumption, heart rate (HR) and BP JNC VII revealed that based on systolic
(7). They postulated that the performance of pressure (SP) values, 11 of them were in
voluntary slow breathing functionally resets the normal range, 14 in the prehypertensive
the autonomic nervous system via stretch - range, two in stage I hypertension and two
induced inhibitory signals coupled with in stage II hypertension. Based on diastolic
synchronization of neural elements in limbic pressure (DP) values, 24 were in normal
system and cortex. range, four in prehypertensive range and one
in stage II hypertension. Patients of
Pranava pranayama is an important secondary hypertension and those with
technique of the Gitananda Yoga tradition history, signs and symptoms or laboratory
and Vibrational Breath Therapy (VBT) reports suggestive of nephrologic, neurologic
modules propounded by Sri Bala Rathnam of and ophthalmologic complications were
Melbourne, Australia (www.vbt.com.au). It excluded from the study.
Indian J Physiol Pharmacol 2012; 56(3) Pranava Pranayama in Hypertensive Patients 275
HR and BP were recorded in the supine Statistical analysis was done using Students
position using a digital BP monitor, (CH – t (paired) test and p values less than 0.05
432, Citizen Systems, Tokyo, Japan). The were accepted as indicating significant
pre-intervention recording was done after 5 differences between pre and post
minutes of supine rest. Post-intervention intervention data.
recording was also done in the supine
position immediately after the performance RESULTS
of 3 rounds of pranava pranayama in sitting
position that took approximately 5 minutes. The values are given as mean±SEM. Post
Rate-pressure product (RPP) was calculated intervention statistical analysis revealed a
as HR × SP/100 and double product (Do P) as significant (P<0.05) reduction in SP from
HR × mean arterial pressure (MAP)/100. 126.86±3.03 to 124.07±3.09 mmHg and a
more significant (P<0.01) reduction in HR
The technique of pranava pranayama is from 75.24±2.34 to 72.96±2.22 beats/min,
as follows. The subject sits in a comfortable pulse pressure (PP) from 52.79±2.24 to
sitting position such as sukhasana, ardha 50.06±2.23 mm Hg, and Do P from
padmasana or vajarasana. He/she then 69.07±2.75 to 66.26±2.65 units. The reduction
performs three rounds of slow and deep yogic in RPP from 95.31±3.66 to 90.43±3.49 units
breathing into low chest, mid chest and upper was statistically highly significant (P<0.001).
chest followed by the prolonged audible
rendition of the akara, ukara and makara Upon analysis of subgroups based on JNC
nada (Aaa, Uuu and Mmm sounds) VII (12) criteria, the maximum % decrease
respectively during exhalation phase. in HR (5.1%) and Do P (6%) was in patients
Following this, he/she performs three rounds who were in the normotensive range while
of the complete yogic breathing (mahat yoga maximum % decrease in SP (3.4%), PP
pranayama) technique with an audible (10.2%) and RPP (7.21%) was in those who
rendition of omkara nada (AUM sound) were in the range of stage I and II
during exhalation phase. Appropriate hasta hypertension. The least % fall in HR (1.31%),
mudras (hand gestures) are used during each SP (1.85%), PP (3.6%), RPP (3.3%) and Do P
part of the four-part practice. The time taken (2.6%) was in patients in the prehypertensive
for the exhalation with nada is approximately range.
three times the time taken for each
inhalation, thus maintaining a ratio of 1:3. DISCUSSION
After completing the performance of pranava
pranayama that took approximately 5 Our finding that pranava pranayama
minutes, the subject lay down in the supine produces an immediate decrease in HR and
position and post intervention HR and BP SP is similar to earlier studies that have
were recorded. reported on the immediate effects of slow
and deep breathing (8, 9). In a recent study,
Data was assessed for normality using we have reported that sukha pranayama
GraphPad InStat and passed normality involving equal periods of inhalation and
testing by Kolmogorov-Smirnov Test. exhalation at the rate of 6 breaths/min can
reduce HR and BP in hypertensive patients cardiovascular rhythms. These rhythms first

within five minutes. We have postulated that described by Mayer more than a century ago
this could be attributed to normalization of occur as a 10 second cycle in BP and are co-
autonomic cardiovascular rhythms due to related to both vagal and sympathetic
either improved vagal modulation, and/or activity. Bernardi et al have reported the
decreased sympathetic activity and improved beneficial effects of rosary prayer and yoga
baroreflex sensitivity (10). mantras in restoring these autonomic
cardiovascular rhythms (11). They reported
In one of our pilot studies on 19 an increase in baroreflex sensitivity
hypertensive patients, we have found that following such chanting and concluded that
15 minutes of shavasana with pranava rhythm formulas involving breathing at 6
pranayama reduces SP, DP, PP and MAP in breaths/min induce favourable psychological
hypertensive patients. There was also a and possibly physiological effects. The
significant fall in RPP and Do P signifying a audible chanting of the pranava in the
reduction in O 2 consumption and work done present study may be having a similar effect
by the heart. However, as that study was on baroreflex sensitivity as Joseph et al
done in shavasana, the cardiovascular effects reported a fall in BP and normalisation of
of pranava pranayama may have been baroreflex sensitivity in hypertensive
influenced by the supine position. There are patients following just 2 minutes of slow
two major differences between these two breathing at 6 breaths/min (12).
studies. The first is that the decrease in HR
was not statistically significant when pranava Pramanik et al studied the immediate
pranayama was performed in the supine effect of 5 minutes of bhramari pranayama
position in our earlier study whereas in the using 1:3 ratio, similar to the time cycle
present study it is highly significant. The used in our present study (13). They reported
second major difference is that the decrease a decrease in SP, DP, MP and HR that was
in DP was significant in our earlier pilot significant with respect to DP and MP and
study whereas there is no change in DP in concluded that bhramari pranayama induced
the present study. This may be attributed to parasympathetic dominance. Pranava
a reduction in perceived stress, peripheral pranayama like bhramari, is also a nada
vasodilatation as a result of decrease in pranayama employing audible sounds during
sympathetic tone and the normalization of exhalation, hence these findings are
cardiac autonomic regulatory processes. comparable with our findings.
These may be more apparent in the supine
position as compared to the sitting postures It has been postulated that pranayama
that may be preventing a fall in peripheral increases frequency and duration of
resistance. inhibitory neural impulses by activating
pulmonary stretch receptors as in Hering
Conscious deep breathing with prolonged Bruer reflex (8). Withdrawal of sympathetic
exhalation and audible chanting during tone to skeletal muscle blood vessels leads
pranava pranayama may be contributing to widespread vasodilatation decreasing
towards the normalization of autonomic peripheral resistance, hence reducing DP.
Indian J Physiol Pharmacol 2012; 56(3) Pranava Pranayama in Hypertensive Patients 277
This could be a mechanism by which DP and Do P are especially significant as they

decreased in our earlier pilot study when are indicators of myocardial oxygen
pranava was done in shavasana and that the consumption and load on the heart and
sitting position adopted by the subjects in therefore imply a lowering of strain on the
the present study was a confounding factor heart (5).
in this regard.
Conclusion
Valsalva manoeuvre produces an
increased intrathoracic pressure and It is concluded that the practice of
decreased pre-load to the heart. Humming pranava pranayama is effective in reducing
shares many physiological similarities to HR and SP in hypertensive patients. This
Valsalva and is equally effective for may be due to a normalization of autonomic
distending the jugular and common femoral cardiovascular rhythms as a result of
veins (14). The prolonged exhalation phase increased vagal modulation and/or decreased
of pranava pranayama mimicked Valsalva sympathetic activity and improved baroreflex
manoeuvre resulting in a decrease in venous sensitivity along with an augmentation of
return, cardiac output and SP. The absence endogenous NO production. Our findings have
of reflex tachycardia may be due to a potential therapeutic applications in day-to-
simultaneous blunting of the sympathetic day as well as clinical situations where BP
component by pranava -induced relaxation. needs to be brought down at the earliest.
This simple and cost effective technique may
It has been reported that the stimulation be added to the management protocol of
of endogenous Nitric Oxide (NO) pathways hypertension in addition to regular medical
might enhance parasympathetic protection management. Further studies are required
against adverse influences of cardiac to enable a deeper understanding of the
sympathetic over activity (15). NO appears mechanisms involved. We plan to further
to play a tonic facilitatory role in baroreflex investigate how long such a BP lowering
control of cardiac parasympathetic activity effect persists as this will provide more
and acts at a postsynaptic level to facilitate information about its usefulness in the long-
cardiac responses to muscarinic stimulation term management of hypertension.
when background levels of adrenergic
activity are high. As low pitch humming ACKNOWLEDGEMENTS
increases tissue nasal NO production, it is
possible that pranava pranayama is We thank L Vithiyalakshmi and G
stimulating endogenous production of NO and Dayanidy, yoga instructors at ACYTER
thus producing a cardio protective benefit for their assistance during the study. We
(16). are also grateful to the Department of
AYUSH, Ministry of Health and Family
The effects in our study were more Welfare, Government of India for
pronounced with regard to RPP and Do P establishing ACYTER as a collaborative
due to cumulative benefits occurring as venture between the MDNIY, New Delhi and
result of reduction in HR, SP and MAP. RPP JIPMER, Puducherry.
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Original Paper. Biomedical Human Kinetics, 4, 66 – 69, 2012
DOI: 10.2478/v10101-012-0012-2
Immediate cardiovascular effects of pranava relaxation in patients

with hypertension and diabetes
Ananda Balayogi Bhavanani, Madanmohan, Zeena Sanjay, Selvi L Vithiyalakshmi
Advanced Centre for Yoga Therapy Education and Research (ACYTER), JIPMER, Puducherry, India
Summary
Study aim: To assess immediate cardiovascular effect of pranava pranayama in the supine position in patients with
concomitant hypertension and diabetes.
Material and methods: Twenty-nine established patients having both hypertension and type 2 diabetes and attending
regular therapy sessions were recruited and randomly allotted to pranava or control groups. Heart rate (HR) and blood
pressure (BP) were recorded before and after 10 minutes of “sham relaxation” in the control group and 10 minutes of
pranava pranayama in the study group.
Results: Significant (p<0.05) decreases of blood pressure and heart rate were observed. However, responses in the
pranava and control groups were different: systolic pressure, pulse pressure, as well as mean pressure significantly
decreased in the pranava group and this was not observed in the control group.
Conclusions: Pranava pranayam in the supine posture produces an integrated relaxation response, clinically valuable in
patients with hypertension and diabetes.
Key words: Yoga relaxation – Pranava pranayama – Hypertension – Diabetes
Introduction tices taught in the comprehensive yoga therapy schedules

imparted for HT and DM patients at ACYTER, JIPMER,
Comprehensive reviews have reported that Yoga is in Puducherry, India. As the supine position is normally
potentially beneficial for patients with hypertension (HT) used for relaxation, the present study was designed to de-
and diabetes mellitus (DM), and that it reduces the risk termine the immediate cardiovascular effects of pranava
profile in such populations [7,8]. Another review of relaxa- pranayama while resting in the supine position.
tion therapy concluded that relaxation therapy is useful
in the clinical management of HT, especially for those Material and Methods
individuals with high BP despite pharmacological treat-
ment [9]. Earlier studies from our laboratories have dem- The present study was conducted at the Advanced Cen-
onstrated that shavasan, a yogic relaxation technique, re- tre for Yoga Therapy Education and Research (ACYTER),
duces load on the heart in normal subjects by blunting established in JIPMER, Puducherry, India. Ethical approval
sympathetic responses with enhanced parasympathetic has been obtained by ACYTER from the Institutional
activity [11], while yogic relaxation training for a month Ethics Committee for studies on the effect of yoga ther-
reduces blood pressure (BP) and restores autonomic regu- apy on HT and DM. The present pilot study was conducted
latory reflex mechanisms in hypertensive patients [20]. as part of this larger study on the effects of yoga therapy
We have recently reported immediate beneficial effects in patients with HT and DM.
of sukha pranayama on cardiovascular parameters in pa- Twenty-nine patients receiving standard medical care
tients with HT after just 5 minutes of the technique [4]. for both essential HT and type 2 DM, and who were attend-
Pranava pranayama is an important technique of the ing regular yoga therapy sessions for more than a month
Gitananda tradition, involving slow and deep inhalation at ACYTER, were selected for this study by random sam-
with conscious use of complete yogic breathing (mahat pling. Patients with secondary HT and those with history
yoga pranayama), followed by an audible vibratory re- / signs and symptoms / laboratory reports suggestive of
sonance of a prolonged AUM chant. This technique is nephrological, neurologic, and ophthalmologic compli-
usually done in the sitting position and is one of the prac- cations due to HT or DM were excluded from the study.
Author’s address Dr Ananda Balayogi Bhavanani, Advanced Centre for Yoga Therapy, Education and Research (ACYTER),
JIPMER, Pondicherry - 605006, India yognat@gmail.com
Cardiovascular effects of pranava relaxation 67
For this study, 15 of the patients were male and 14 of the sounds), respectively, during exhalation phase. Following
patients were female; the average age was 56.66 ± 10.9 this, subject performs 3 rounds of the complete yogic breath-
years, the average BMI was 25.99 ± 3.5. All subjects were ing (mahat yoga pranayama) technique with an audible
receiving standard medical management for more than 3 rendition of omkara nada (AUM sound) during exhala-
years with antihypertensive and oral antidiabetic medication phase. The time taken for the exhalation with nada is
tions under the supervision of consultants in the depart- approximately 3 times the time taken for each inhalation,
ment of medicine at JIPMER. Patients on medication were thus maintaining a ratio of 1:3. After completing pranava
selected, as it has been previously suggested that the com- pranayama, which took approximately 6 minutes, the sub-
bination of relaxation and medication has the maximum ject continued to rest in the supine position for another 2
effect [6]. minutes, before post-intervention HR and BP were re-
Subclassification of the subjects according to JNC corded. Pulse pressure (PP) was calculated as the differ-
VII [17] revealed that based on either systolic pressure ence between systolic pressure (SP) and diastolic pressure
(SP) or diastolic pressure (DP) values, 16 were in the (DP), mean pressure (MP) as DP + 1/3 PP, rate-pressure
prehypertensive range, 7 in Stage I HT, and one in Stage product (RPP) as HR × SP / 100, and double product (Do P)
II HT, even with regular medication. This is pertinent, as as HR × MP / 100.
a previous review had concluded that relaxation therapy All data passed normality testing by Kolmogorov-
is useful in the clinical management of HT, especially Smirnov Test and was therefore analyzed using ANOVA
for individuals with high BP despite pharmacological for repeated measures followed by Tukey’s test (post hoc).
treatment [9]. Effects of Group (pranava, control) and Measurement
Informed consent was obtained by one of the inves- (pre, post) as well as their interaction were assessed. Statis-
tigators and the subjects were then randomly allotted to tical analysis was done using STATISTICA 9.1 (StatSoft,
either the pranava or control groups. There were 8 males USA). The level of α=0.05 was considered significant.
and 7 females in the pranava group with an average age
of 53.47 ± 12.5 years. The control group consisted of 7 Results
males and 7 females with an average age of 60.07 ± 7.9
years. The difference in age between groups was statis- The mean ± SE values of cardiovascular variables
tically insignificant (p = 0.103) before and after performance of pranava pranayama and
Subjects were familiarized with the study protocol and “sham relaxation” control are presented in Table 1. Sig-
then given 5 minutes of supine rest. Heart rate (HR) and BP nificant changes of means (Measurement effect) were
were then recorded from their left upper arm in the supine observed for all variables tested except DP, while the ef-
position using a non-invasive semi-automatic BP monitor fects of Group were not found. Significant interactions
(CH-432, Citizen Systems, Tokyo, Japan) with an instru- of Group×Measurement occurred for SP (F1,27 = 17.69,
mental accuracy of ± 5% for HR and ± 3 mm Hg for BP. p<0.001), PP (F1,27 = 26.06, p<0.001) and MP (F1,27 = 6.63,
It has previously been suggested that one needs a sham p<0.05). Interactions revealed differential responses in
treatment group rather than a mere nonspecific relaxation the pranava and control groups. Post-hoc tests showed
or “no treatment” control group when studying and com- that SP, PP, as well as MP decreased significantly in the
paring effects of psycho-physiologic therapies [5]. Hence, pranava group; this was not observed in the control group.
in the present study we have used a “sham relaxation”
control group that performed 10 minutes of simple supine Discussion
resting for the first and last 2 minutes; they were given
verbal commands suggesting relaxation of different body Enhanced cardiac parasympathetic tone is postulated
parts from feet to head for the intervening 6 minutes. HR to be an important mechanism underlying the beneficial
and BP were recorded again at the end of the 10 minutes effects of the relaxation response [15]. It has also been
of “sham relaxation.” The pranava group, on the other suggested that a holistic and complete sympathovagal
hand, performed 10 minutes of supine rest that included homeostatic development is possible only by the practice
simple conscious resting in shavasana for the first and of yoga in its true form and spirit [13]. A previous study
last 2 minutes with a performance of pranava pranayama conducted by our laboratories reported significant blunt-
for the intervening 6 minutes. The technique of pranava ing of cold pressor-induced increase in HR, BP, and RPP
pranayama involves the performance of 3 rounds of slow following the practice of shavasan, thus giving evidence
and deep yogic breathing into low chest, mid chest and that shavasan reduces the load on the heart by blunting
upper chest, followed by the prolonged audible rendition the sympathetic response along with an enhanced para-
of the akara, ukara, and makara nada (Aaa, Uuu, and Mmm sympathetic activity [11].
68 A.B. Bhavanani et al.
Table 1. Immediate effect of pranava pranayama in supine position on cardiovascular variables in patients having
concomitant hypertension and diabetes (mean ± SE)
Pranava Control
Group (n=15) Group (n=14) Pre-post
Variable Int.
changes
Pre Post Pre Post
HR (beats/min) 77.5 ± 3.3 75.3 ± 3.1 84.8 ± 3.5 80.0 ± 3.5 *** –
SP (mm Hg) 134.3 ± 3.8 124.7 ± 3.2 ººº 136.3 ± 4.1 138.3 ± 4.2 * ***
DP (mm Hg) 77.2 ± 1.3 74.9 ± 1.2 77.4 ± 2.2 76.9 ± 1.6 – –
PP (mm Hg) 57.1 ± 3.7 49.9 ± 3.0 ººº 58.9 ± 3.2 61.4 ± 3.5 * ***
MP (mm Hg) 96.2 ± 1.7 91.5 ± 1.5 ºº 97.0 ± 2.6 97.4 ± 2.2 * *
RPP 104.5 ± 5.9 94.2 ± 4.9 116.3 ± 6.9 111.3 ± 6.7 *** –
Do P 74.8 ± 3.7 69.1 ± 3.2 82.7 ± 4.7 78.3 ± 4.5 ** –
Legend: HR - Heart rate; SP - Systolic pressure; DP - Diastolic pressure; MP - Mean pressure; PP - Pulse pressure; RPP - Rate-
pressure-product; Do P - Double product; Int. - Group×Measurement interaction; Significantly different from pre-test: ºº p<0.01,
ººº p<0.001; Significant effect: ** p<0.05, ** p<0.01; *** p<0.001. All baseline comparisons between groups were insignificant
with p>0.05.
A review of relaxation therapy in the treatment of HT We have previously suggested that conscious deep
reported that task awareness adds to the treatment effect breathing with prolonged exhalation and audible chant-
and suggested that relaxation therapy is useful in the clinical ing during pranava pranayama may contribute towards
management of HT, especially for individuals whose BP a normalization of autonomic cardiovascular rhythms [3].
remains high despite pharmacological treatment [9]. Most The beneficial effect of audible chanting in restoring these
yogic relaxation practices have a task awareness element autonomic cardiovascular rhythms has been reported earlier
associated with them: as the performance of pranava [2]. It is plausible that the prolonged, audible chanting of
pranayama while relaxing in the supine position is done the pranava in the present study may be producing a simi-
with conscious awareness, it may be producing its bene- lar improvement in baroreflex sensitivity resulting in the
ficial effects in a similar manner to those of task awareness. normalizing of such autonomic cardiovascular rhythms.
A study by Goldstein et al. [6] concluded that relaxa- The effects of interaction between group and meas-
tion without drugs, although somewhat more effective urement were not observed for RPP and Do P. However,
than self monitoring alone, did not reduce BP as much the actual difference in Do P was greater in the pranava
as the combination of relaxation and medication. Inter- group (7.2%) as opposed to the control group (4.7%). This
estingly, just as with our present study, they also found shows a trend that suggests further statistical significance
no significant changes in HR between groups. The sig- of interaction could be achieved with a larger sample size.
nificant decrease of HR in our control group may have RPP and Do P are especially important in patient care, as
been due to a reduction in physiological arousal that had they are indirect indicators of myocardial oxygen con-
been previously reported to occur from both guided relaxa- sumption and load on the heart, thereby signifying a low-
tion and supine rest in a previous study [19]. ering of strain on the heart [12]. RPP also provides a simple
Analysis of variance revealed significant interaction measure of overall heart rate variability (HRV) in hyper-
between group and measurement for SP, PP, and MP. The tensive patients and is a surrogate marker in situations
decreases of mean values of these variables were signifi- where HRV analysis is not available [14]. Reduction in
cantly greater in the pranava group as compared to the RPP is thus representative of enhanced HRV power, im-
control group. This may be due to a decrease in venous plying better cardiac autonomic regulation in our subjects
return and resultant decrease in cardiac output occurring having concomitant DM and HT that are both major risk
as a result of the prolonged exhalation phase in pranava factors implicated in the causation of cerebrovascular
pranayama producing a mild Valsalva-like effect due to accidents as well as other cardiovascular and neurological
the increased intrathoracic pressure and decreased pre- complications. Hence, this technique can be considered
load to the heart. A previous study from our laboratories a means of primary prevention in this high-risk population,
also reported that pranayama training of 3-month dura- as we may be preventing the occurrence of future unto-
tion modulated ventricular performance by increasing ward and adverse events of high mortality and morbidity.
parasympathetic activity and simultaneously decreasing Pranava pranayama involves the audible chanting of
sympathetic activity [18]. the aaa, uuu, and mmm sounds and when performed in the
Cardiovascular effects of pranava relaxation 69
supine position is strikingly similar to the deep relaxation 7. Innes K.E., C.Bourguignon, A.G.Taylor (2005) Risk in-
dices associated with the insulin resistance syndrome, cardio-
technique (DRT) popularized by SVYASA University,
vascular disease, and possible protection with yoga: a system-
Bangalore [19]. A previous study from SVYASA reported atic review. J.Am.Board Fam.Pract., 18:491-519.
that DRT improves sustained attention and reduces the 8. Innes K.E., H.K.Vincent (2007) The influence of yoga-based
state of anxiety [10], while another reported a decrease programs on risk profiles in adults with type 2 diabetes mellitus:
in sympathetic activity with significant reduction in O2 a systematic review. Evid.Based Complement.Alternat.Med.,
4(4):469-486.
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effects of two relaxation techniques on healthy volunteers. In-
trum along with a decreased LF band and LF/HF ratio dian J.Physiol.Pharmacol., 53:67-72.
during and after a guided relaxation period in pregnant 11. Madanmohan, K.Udupa, A.B.Bhavanani, N.Krishnamurthy,
women indicating improved sympathovagal balance. This G.K.Pal (2002) Modulation of cold pressor-induced stress by
improvement in sympathovagal balance following simi- shavasan in normal adult volunteers. Indian J.Physiol.Pharmacol.,
46: 307-312.
lar yogic relaxation techniques such as DRT is possibly 12. Madanmohan, K.Udupa, A.B.Bhavanani, C.C.Shatapathy,
one of the mechanisms behind the positive changes seen A.Sahai (2004) Modulation of cardiovascular response to exercise
in our subjects. Hence, the reduction in RPP in our sub- by yoga training. Indian J.Physiol.Pharmacol., 48: 461-465.
jects having concomitant HT and DM implies a better 13. Pal G.K. (2008) Role of sympathovagal balance in achieving
an effective homeostasis. Biomedicine, 28:67-68.
autonomic regulation of the heart that is clinically valu- 14. Prakash E.S., Madanmohan, K.R.Sethuraman, S.K.Narayan
able from both a qualitative and quantitative perspective. (2005) Cardiovascular autonomic regulation in subjects with
Performance of pranava pranayama in the supine po- normal blood pressure, high-normal blood pressure and recent-
sition may induce an integrated relaxation response similar onset hypertension. Clin.Exp.Pharmacol.Physiol., 32:488-494.
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is useful in the management of hypertensive subjects who NIH Publication No. 04-5230.
http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf
are already on drug therapy. Based on our findings we 18. Udupa K., Madanmohan, A.B.Bhavanani, P.Vijayalakshmi,
suggest that pranava pranayama in the supine position N.Krishnamurthy (2003) Effect of pranayam training on cardiac
can achieve the same benefits in those having concomi- function in normal young volunteers. Indian J.Physiol.Pharmacol.,
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tion reduces sympathetic activity in subjects based on baseline
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1. Benson H, B.R.Marzetta, B.A.Rosner, H.M.Klemchuk (1974) K.Babu (2004) Modulation of stress induced by isometric hand-
Decreased blood-pressure in pharmacologically treated hyper- grip test in hypertensive patients following yogic relaxation train-
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J.Wdowczyc-Szulc, A.Lagi (2001) Effect of rosary prayer and Received 31.03.2012
yoga mantras on autonomic cardiovascular rhythms: comparative Accepted 04.06.2012
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(2012) Immediate cardiovascular effects of pranava pranayama Acknowledgements
in hypertensive patients. Indian J.Physiol.Pharmacol., (in press)
4. Bhavanani A.B., Madanmohan, S.Zeena (2011) Immediate The authors thank the Director, MDNIY and Director, JIPMER
effect of sukha pranayama on cardiovascular variables in pa- for their support. This study was possible because ACYTER
tients of hypertension. Int.J.Yoga Ther., 21:73-76. has been established as a collaborative venture between
5. Frankel B.L., D.J.Patel, D.Horwitz, W.T.Friedewald, Morarji Desai National Institute of Yoga (MDNIY), New Delhi
K.R.Gaarder (1978) Treatment of hypertension with biofeedback and JIPMER, Puducherry with funding from Department of
and relaxation techniques. Psychosom.Med., 40(4):276-293. AYUSH, Ministry of Health and Family Welfare, Government
6. Goldstein I.B., D.Shapiro, C.Thananopavaran (1984) Home of India.
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46: 398-414. © University of Physical Education, Warsaw, Poland
Bhavanani et al., J Yoga Phys Ther 2012, 2:4
http://dx.doi.org/10.4172/2157-7595.1000118
Yoga & Physical Therapy

Research
Research Article
Article Open
OpenAccess
Access
Suryanadi Pranayama (Right Unilateral Nostril Breathing) May be Safe for

Hypertensives
Ananda Balayogi Bhavanani1*, Madanmohan2 and Zeena Sanjay3
1
Programme Co-ordinator, ACYTER, JIPMER, Puducherry, India
2
Programme Director, ACYTER, JIPMER, Puducherry, India
3
Senior Research Fellow, ACYTER, JIPMER, Puducherry, India
Abstract
Background: Previous studies have suggested that exclusive right uni-nostril breathing known as suryanadi
pranayama (SNP) has sympathomimetic effects and hence, the present study was designed to determine immediate
effects of 27 rounds of SNP on cardiovascular parameters in patients of essential hypertension (HT). This has
clinical significance in determining whether such a potentially sympathomimetic practice is safe in such a population.
Materials and methods: Twenty hypertensive patients on standard medical management were taught to
perform SNP by qualified yoga instructors. Heart rate (HR) and blood pressure (BP) were recorded after 5 minutes
of rest in sitting posture and after 27 rounds of SNP. All data passed normality testing and hence was analyzed using
Students t test for paired data.
Results: Statistical analysis revealed no statistically significant changes in any of the parameters following
SNP. Gender based sub analysis of ∆% following SNP revealed no significant differences between male and female
subjects.
Discussion: The absence of any significant increase in HR or BP following SNP goes against earlier theories
that it may be dangerous for hypertensive patients due to its sympathomimetic nature. SNP may not be increasing
HR and BP in our subjects because they already had reached a certain threshold of reactivity. The goal of yoga is
to restore homeostasis. Hence, if sympathetic reactivity of a subject is already higher than normal, yogic techniques
will not further increase such a hyper reactivity but rather bring it back to normal. The small 1-2% decrease in most
parameters in our study gives a hint of this possibility. In conclusion, our study offers evidence that exclusive right
nostril breathing as performed in SNP may be safe in patients of HT. We also conclude that the cardiovascular
effects of SNP in hypertensives are different than those reported by previous studies done in normal subjects.
Further studies may throw light on possible mechanisms involved and also whether there is any difference produced
by long term training in SNP.
Keywords: Yoga; Suryanadi pranayama; Nasika mudra; parameters in patients of essential HT. This has clinical significance in
Shivaswarodaya; Hypertensives determining whether such a potentially sympathomimetic practice is
safe in such a population.
Introduction
Materials and Methods
Ancient Rishis of India have intuitively analyzed all aspects of
human life and one such example is swarodaya vijnan, the ultradian Twenty patients of essential HT attending the Yoga OPD run
nasal cycle as codified in the Shivaswarodaya [1]. This has captured by ACYTER at JIPMER, Pondicherry were selected for this study by
the imagination of scientists in recent times with numerous reports on accidental sampling. Patients of secondary HT and those with history/
differential physiological and psychological effects of exclusive right or signs and symptoms/laboratory reports suggestive of nephrologic,
left nostril breathing [2-8]. However, these studies have evaluated only neurologic and ophthalmologic complications were excluded from
the physiological effects on normal subjects and although potential the study. Ten patients were male and 10 female with an average age
health benefits of unilateral forced nostril breathing (UFNB) have of 57.10 ± 2.47 (SEM) years. All of the subjects were under standard
been postulated, clinical research is required to prove immediate and medical management and taking antihypertensive medications for
sustained efficacy of these techniques in psychosomatic conditions like more than five years. Sub classification of the subjects based on JNC
hypertension (HT) and diabetes mellitus (DM). VII guidelines [9] revealed that 10 of them were in stage I HT range,
Previous studies have suggested that exclusive right uni-nostril
breathing known as suryanadi pranayama (SNP) or surya anuloma
viloma pranayama (SAVP) has sympathomimetic effects including *Corresponding author: Ananda Balayogi Bhavanani, Programme Co-ordinator,
increase in metabolism, baseline oxygen consumption, systolic pressure ACYTER, JIPMER, Puducherry-605006, India, E-mail: ananda@icyer.com
(SP) and heart rate (HR) [6]. These effects have been demonstrated after Received July 13, 2012; Accepted August 27, 2012; Published August 29, 2012
a month -long training [3] as well as immediately after 45 minutes of
Citation: Bhavanani AB, Madanmohan, Sanjay Z (2012) Suryanadi Pranayama
the practice [4]. A recent study also has reported significant increase in (Right Unilateral Nostril Breathing) May be Safe for Hypertensives. J Yoga Phys
SP, diastolic pressure (DP) and mean pressure (MP) after 30 minutes Ther 2:118. doi:10.4172/2157-7595.1000118
of the practice [8]. Copyright: © 2012 Bhavanani AB, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
With the above in mind, the present study was designed to unrestricted use, distribution, and reproduction in any medium, provided the
determine immediate effects of 27 rounds of SNP on cardiovascular original author and source are credited.
J Yoga Phys Ther

ISSN: 2157-7595 JYPT, an open access journal Volume 2 • Issue 4 • 1000118
Citation: Bhavanani AB, Madanmohan, Sanjay Z (2012) Suryanadi Pranayama (Right Unilateral Nostril Breathing) May be Safe for Hypertensives. J
Yoga Phys Ther 2:118. doi:10.4172/2157-7595.1000118
Page 2 of 3
7 in prehypertensive range and three had blood pressure (BP) in B A % Change p Value
normotensive range even though they were on regular medication.
None of them had any previous experience of yoga training. Informed 76.15 75.25
HR (beats/min) - 1.18 0.453
consent was obtained by one of the investigators. Pre-intervention HR ± 3.31 ± 3.11
and BP were recorded after 5 minutes of rest in sitting posture using SP (mmHg)
128.10 127.20
- 0.70 0.472
non-invasive semi-automatic BP monitor (CH–432, Citizen Systems, ± 2.52 ± 3.02
Tokyo, Japan). DP (mmHg)
73.35 73.60
+ 0.34 0.837
± 1.89 ± 1.65
The subjects were individually taught to perform SNP by a qualified 54.75 53.60
PP (mmHg) - 2.10 0.602
yoga instructor. An overview of the practice was given to the patients ± 2.26 ± 3.29
and then they were instructed to take up an erect sitting position 91.60 91.47
MP (mmHg) - 0.15 0.838
with palms on their thighs. They were asked to keep their eyes closed ± 1.83 ± 1.56
to facilitate the development of inner awareness. The subject was 97.13 95.31
RPP (units) - 1.87 0.339
instructed to perform nasika mudra with their right hand by touching ± 4.06 ± 3.90
the tip of their index finger to the base of their thumb. The right ring DoP (units)
69.80 68.81
- 1.42 0.364
finger was then used to close their left nostril with gentle pressure. The ± 3.29 ± 3.00
pranayama was then performed though the unblocked right nostril in Values are M ± SEM for 20 subjects with p values obtained from Students t test
for paired data.
a calm and regular manner with a conscious effort to use low, mid and
Table 1: Immediate effect of suryanadi pranayama on heart rate (HR), systolic
upper parts of the lungs in a sequential manner during inspiration as pressure (SP), diastolic pressure (DP), pulse pressure (PP), mean pressure
well as expiration. Subjects were instructed to breathe in and out for an (MP), rate-pressure product (RPP) and double product (Do P) in patients of
equal count of 5 that was given by the instructor with the help of a stop essential hypertension. B: before and A: after five minutes of the practice.
watch. A regularity of counts at the rate of 6 breaths/minute (BPM) was

of reactivity. The goal of yoga is to restore homeostasis. Hence, if
maintained by the instructor for the entire duration of nearly 5 minutes
sympathetic reactivity of a subject is already higher than normal, yogic
taken to complete 27 rounds of SNP.
techniques will not further increase such a hyper reactivity but rather
Post intervention HR and BP measurements were recorded again bring it back to normal. The small 1-2% decrease in most parameters in
at the end of the 27 rounds of SNP. Pulse pressure (PP) was calculated our study gives a hint of this possibility.
as SP-DP, mean pressure (MP) as DP+1/3 PP, rate-pressure product
In earlier studies we have report that both sukha pranayama and
(RPP) as HR×SP/100 and double product (Do P) as HR×MP/100. chandra nadi pranayama (CNP) at the rate of 6 BPM reduces HR and
Statistical analysis of pre and post intervention data was done using BP in hypertensive patients within five minutes of practice [11,12]. We
GraphPad InStat version 3.06 for Windows 95 (GraphPad Software, San have suggested that this may be due to a normalization of autonomic
Diego California USA, www.graphpad.com). All data passed normality cardiovascular rhythms as a result of increased vagal modulation and/
testing by Kolmogorov-Smirnov Test and hence was analyzed using or decreased sympathetic activity and improved baroreflex sensitivity.
Students t test for paired data. P values less than 0.05 were accepted It is possible that in our present study, a similar effect due to breathing
as indicating significant differences between pre and post intervention at the rate of 6 BPM is overriding the sympathomimetic effect of
data. SNP and hence HR and BP did not change. Jain et al. have suggested
that sympathetic activation produced by right nostril breathing may
Results be masked by vagally mediated lung bar receptor activity that is
enhanced by voluntary breathing efforts [7]. As an earlier study [2]
Results of the pre and post SNP comparisons are given in Table 1.
on normal subjects reported increased HR following right UFNB
Statistical analysis revealed no statistically significant changes in any of
at 6 BPM, it is possible that this difference is due to the fact that
the parameters following 27 rounds of SNP though there was a trend of
cardiovascular regulatory mechanisms are altered in hypertensives.
1-2% reduction in HR, SP, PP, MP, RPP and Do P with a slight rise of This is substantiated by an earlier study from JIPMER reporting
0.34% in DP. Gender based sub analysis of ∆% following SNP revealed that vasoconstrictor and cardiac acceleratory responses to isometric
no significant differences between male and female subjects. handgrip test are subnormal in hypertensive patients and that yoga
Discussion training improves these reflex regulatory mechanisms [13]. The above
may explain the differential effects of SNP in normal subjects and in
The absence of any significant increase in HR or BP following SNP hypertensive patients.
goes against earlier theories that it may be dangerous for hypertensive
patients due to its sympathomimetic nature. Though earlier studies in Upon gender based sub analysis of the ∆% changes of HR and BPs,
normal subjects [2-4,6] have reported significant increase in HR and/ we found no differences between male and female subjects following
or BP following exclusive right nostril breathing, our study shows that the practice of SNP. Again, this is in contradiction to an earlier report
of gender differences in HR and BP responses to UFNB in healthy
such a rise doesn’t occur in patients of essential HT. Our findings are in
subjects [5]. They have suggested a nostril laterality affecting the
agreement with those of Jain et al who reported no significant change
autonomic nervous system differentially in males and females. Though
in HR and a significant reduction in BP in healthy male subjects with
we found this to be true in our recent study on exclusive left nostril
no significant changes in female subjects after 15 minutes of SNP [7].
breathing of CNP in hypertensive patients [12], this is not found to be
Enhanced sympathetic activity has been reported in essential HT true in our present study on SNP. Even the study by Jain et al. has not
[10]. Hence it is plausible that SNP may not be increasing HR and BP reported any significant gender differences between healthy male and
in our subjects because they already had reached a certain threshold female subjects after 15 minutes of SNP [7].
J Yoga Phys Ther

Citation: Bhavanani AB, Madanmohan, Sanjay Z (2012) Suryanadi Pranayama (Right Unilateral Nostril Breathing) May be Safe for Hypertensives. J
Yoga Phys Ther 2:118. doi:10.4172/2157-7595.1000118
Page 3 of 3
In conclusion, our study offers evidence that exclusive right nostril 5. Dane S, Calişkan E, Karaşen M, Oztaşan N (2002) Effects of unilateral nostril
breathing as performed in SNP may be safe in patients of HT. We breathing on blood pressure and heart rate in right-handed healthy subjects. Int
J Neurosci 112: 97-102.
also conclude that the cardiovascular effects of SNP in hypertensives
are different than those reported by previous studies done in normal 6. Raghuraj P, Telles S (2003) Effect of yoga-based and forced uni-nostril
subjects. Further studies may throw light on possible mechanisms breathing on the autonomic nervous system. Percept Mot Skills 96: 79-80.
involved and also whether there is any difference produced by long 7. Jain N, Srivastava RD, Singhal A (2005) The effects of right and left nostril
term training in SNP. breathing on cardiorespiratory and autonomic parameters. Indian J Physiol
Pharmacol 49: 469-474.
Acknowledgements
8. Raghuraj P, Telles S (2008) Immediate effect of specific nostril manipulating
The authors thank Sri G Dayanidy and Selvi L Vithiyalakshmi, yoga instructors yoga breathing practices on autonomic and respiratory variables. Appl
at ACYTER for their assistance during the study. We also thank the Director, Psychophysiol Biofeedback 33: 65-75.
MDNIY and Director, JIPMER for their support as this study was possible because
ACYTER has been established as a collaborative venture between the Morarji 9. Seventh Report of the Joint National Committee on Prevention, Detection,
Desai National Institute of Yoga, New Delhi and JIPMER, Puducherry with funding Evaluation, and Treatment of High Blood Pressure. US Department of Health
from Department of AYUSH, Ministry of Health and Family Welfare, Government and Human Services. NIH Publication No. 04-5230. Aug 2004.
of India.
10. Tuck ML (1992) Obesity, the sympathetic nervous system and essential
References hypertension. Hypertension 19: 167-177.
1. Bhavanani AB (2007) Swarodaya vigjnan- a scientific study of the nasal cycle. 11. Bhavanani AB, Sanjay Z, Madanmohan (2011) Immediate effect of sukha
Yoga Mimamsa 39: 32-38. pranayama on cardiovascular variables in patients of hypertension. Int J Yoga
Therap 21: 73-76.
2. Shannahoff-Khalsa DS, Kennedy B (1993) The effects of unilateral forced
nostril breathing on the heart. Int J Neurosci 73: 47-60. 12. Bhavanani AB, Madanmohan, Sanjay Z (2012) Immediate effect of chandra
nadi pranayama (left unilateral forced nostril breathing) on cardiovascular
3. Telles S, Nagarathna R, Nagendra HR (1994) Breathing through a particular parameters in hypertensive patients. Int J Yoga 2012: 108-111.
nostril can alter metabolism and autonomic activities. Indian J Physiol
Pharmacol 38: 133-137. 13. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Babu K (2004)
Modulation of stress induced by isometric handgrip test in hypertensive patients
4. Telles S, Nagarathna R, Nagendra HR (1996) Physiological measures of right following yogic relaxation training. Indian J Physiol Pharmacol 48: 59-64.
nostril breathing. J Altern Complement Med 2: 479-484.
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J Yoga Phys Ther

Yoga M¢m¡Æs¡, Vol. XLIV No. 2 : 101-112, July, 2012
IMMEDIATE CARDIOVASCULAR EFFECTS OF SËVITRÌ PRËÛËYËMA IN

SITTING AND SUPINE POSITIONS IN FEMALE VOLUNTEERS
Bhavanani, Ananda Balayogi*, Ramanathan, Meena**
ABSTRACT
This study was planned to determine the cardiovascular effects of s¡vitr¢ pr¡¸¡y¡ma, a
rhythmical, slow and deep breathing technique done in sitting and supine positions. Heart rate,
systolic and diastolic blood pressure were recorded in 11 female subjects before and after 5
minutes of normal breathing and s¡vitr¢ in sitting and supine positions. Overall comparisons of
∆ % changes following s¡vitr¢ and normal breathing in both sitting and supine positions revealed
significant difference between groups with regard to heart rate, diastolic, mean pressure, rate-
pressure product and double product. In sitting positions the ∆ % was lower following s¡vitr¢
whereas in supine position the ∆ % was higher following s¡vitr¢. It is concluded that the practice
of s¡vitr¢ in sitting position has beneficial cardiovascular effects.
Key words : yoga, s¡vitr¢ pr¡¸¡yama, cardio-respiratory physiology
Introduction
Pr¡¸¡y¡ma, the fourth limb of classical aÀ¶¡´ga yoga is increasingly being used as a therapeutic
tool in different psychosomatic ailments. Earlier studies have reported beneficial physiological
effects of pr¡¸¡y¡ma both immediate after the practice (Rai 1982, Madanmohan 1983,
Madanmohan 1986, Telles 1992, Pramanik 2009, Bhavanani 2011) as well as after short and
long term training (Udupa 2003, Madanmohan 2005).
S¡vitr¢ pr¡¸¡y¡ma is one of the unique pr¡¸¡y¡ma techniques taught in the Rishiculture
AÀ¶¡´ga Yoga Parampara of Yogamaharishi Dr. Swami Gitananda Giri. It involves slow,
rhythmic, and deep breathing in a 2:1:2:1 pattern incorporating a safer and milder form of breath
holding. The duration of the breath held in (kumbhaka) and held out (¿£nyaka) phases is only for
* Chairman, International Centre for Yoga, Education and Research (ICYER), Bommayapalaam Post,
(Pondicherry), TN - 605 104, India. Email: yognat@gmail.com
Corresponding author
** Coordinator Outreach Programmes, ICYER and Yoganjali Natyalayam, Pondicherry - 605 104, India.
Email: saineema@yahoo.com
Running head: cardiovascular effects of s¡vitr¢ pr¡¸¡y¡ma
YM, Vol. XLIV No. 2 101 Bhavanani et al., (2012)

IMMEDIATE CARDIOVASCULAR EFFECTS OF SËVITRÌ PRËÛËYËMA IN SITTING
AND SUPINE POSITIONS IN FEMALE VOLUNTEERS
half that of the inspiration (p£raka) and exhalation (recaka) phases. This pr¡¸¡y¡ma is usually
taught as a relaxative and rejuvenative practice and may be done from either sitting or supine
position. It can also be used along with nature walks as the speed of walking may be timed to the
breath cycles. It then becomes a cardio-respiratory exercise. It is claimed that each of the different
rhythms (tala) of s¡vitr¢ from the 2:1, 4:2, 6:3, 8:4 up to the 32:16 siddha rhythms have their own
additional physiological, psychological and spiritual benefits (Gitananda 1978).
Earlier studies have reported the beneficial effects of s¡vitr¢ in healthy volunteers following
three weeks of training (Madanmohan 2005). These physiological effects included a significant
increase in respiratory pressures and respiratory endurance with decrease in heart rate (HR),
rate-pressure product (RPP) and double product (Do P).
One of the earliest reports on yoga research from JIPMER, Puducherry was the pioneering
study on s¡vitr¢ done by Madanmohan et al who studied the immediate effects of s¡vitr¢ in
supine position (Madanmohan 1983). They reported a significant decrease in oxygen consumption
in trained subjects and attributed it to an ability to achieve a state of deep psychosomatic relaxation.
As s¡vitr¢ can be done both in sitting and supine positions, this study was undertaken to determine
differential immediate effects of five minutes of the pr¡¸¡y¡ma in sitting and supine positions
on cardiovascular parameters. We have also included a period of normal breathing in both positions
as a control in order to compare and contrast the effects of the pr¡¸¡y¡ma better.
Materials and Method
This study was conducted as a part of the Outreach Programmes of Yog¡µjali N¡¶y¡layam in
the local community in and around Pondicherry. 11 female subjects (aged 34.00 - 2.03, with
BMI 26.66 - 1.25) attending regular thrice weekly yoga sessions for 2 to 3 months and able to
perform s¡vitr¢ in a competent manner were recruited and informed consent obtained from them.
Of the subjects, one was hypertensive, another hypothyroid but both were on regular medication.
Four of the subjects complained of occasional sinusitis and headaches while three of them were
overweight. Informed consent was obtained by one of the investigators and procedure of the
study was explained to them.
Baseline HR and blood pressure (BP) were recorded in the sitting position at the start of their
regular yoga practice session on the first day of the study. Mean - SEM baseline value of HR,
systolic (SP) and diastolic (DP) pressures were 82.18 - 2.02, 113.45 - 3.48 and 70.55 - 2.25
respectively. They then participated in their regular yoga session of 45 minutes following which
they took part in the study.
HR and BP recorded after 5 minutes of quiet sitting using a digital BP monitor, (CH - 432,
Citizen Systems, Tokyo, Japan). They were then asked to do 5 minutes of normal, quiet breathing
in the sitting position following which HR and BP were once again recorded. Similarly pre and
post recordings were done after 5 minutes of s¡vitr¢ in sitting position. On the second day, the
HR and BP were recorded similarly before and after a period of 5 minutes of normal quiet
breathing and s¡vitr¢ performed in the supine position. RPP was calculated as HR × SP / 100
and Do P as HR × mean pressure (MP) / 100.
The technique of s¡vitr¢, the rhythmic breath, is as follows. (Gitananda 1978) While breathing
in, awareness is placed on filling and emptying the lungs from low, mid and upper sections as in
mahat yoga pr¡¸¡y¡ma. A held in and a held out breath are added to the breath technique so that
the incoming and the outgoing breath are done for an equal count, while the held in and the held
out breath are for only half of that duration. In this study, we have used a six count for inspiration
and expiration and a three count for the retained and held out breaths (6:3:6:3).
Data was assessed for normality using GraphPad InStat and passed normality testing by
Kolmogorov-Smirnov Test. Statistical analysis was done using ANOVA with Tukey-Kramer
Multiple Comparisons Test for data with identical SDs and Kruskal Wallis (nonparametric
ANOVA) with Dunn's Multiple Comparisons Test for data with non identical SDs. Students t
(paired) test and p values less than 0.05 were accepted as indicating significant differences in
intra and inter group comparisons.
Results
Results are given in Tables 1, 2, 3, 4 and 5. All values are given as mean - SEM. Overall
comparisons of ∆ % changes following s¡vitr¢ and normal breathing in both sitting and supine
positions revealed significant difference between groups with regard to HR, DP, MP, RPP and
DOP (Table 1). The differences between s¡vitr¢ and normal breathing were significant in sitting
position for RPP and DoP and in supine position for DP, MP and DoP. In sitting positions the
∆ % was lower following s¡vitr¢ whereas in supine position the ∆ % was higher following
s¡vitr¢. ∆ % of HR, DP, MP, RPP and DoP were significantly lower following s¡vitr¢ in sitting
as compared to s¡vitr¢ in supine position. In the sitting position, ∆ % of HR, SP, DP, MP, RPP
and DoP were significantly lower following s¡vitr¢ as compared to normal breathing (Table 2)
and actual values were significantly lower with regard to HR, SP, RPP and DoP (Table 4). In
supine position, ∆ % of DP, MP and DoP were significantly higher after s¡vitr¢ (Table 3) while
actual values were significantly higher with regard to DP and MP (Table 5).

Discussion
Our findings of an increased HR following s¡vitr¢ in supine position are in agreement with
previous reports. (Madanmohan 1983, 1986) In those studies, s¡vitr¢ produced significant
cardioacceleration in healthy untrained subjects with an increase in QRS axis during inspiratory
phase, as compared to eupnoea. The changes in HR and QRS axis during inspiratory and expiratory
phases of s¡vitr¢ were similar to changes observed during corresponding phases of deep breathing.
(Madanmohan 1986).
Telles and Desiraju (Telles and Desiraju 1992) have however reported an insignificant rise in
mean HR following s¡vitr¢ in sukh¡sana that is contradictory to our finding of a significant
reduction in HR following s¡vitr¢ in the same sitting position. They also reported increased HR
during inspiratory phase of s¡vitr¢ that was significantly more than eupnoea or deep breathing.
The contradiction between both studies can be explained by the fact that they only studied one
male subject who had 5 years of experience whereas we have studied 11 female subjects who
had only been practising yoga on a thrice weekly basis for 2 to 3 months.
Madanmohan et al., (1983) had reported insignificant rise in HR, SP with insignificant fall in
DP in trained subjects following s¡vitr¢ in supine position. In the same study, they reported an
increase in HR, SP and DP in untrained subjects. As suggested by them, the increase HR and SP
can be explained by an increase in venous return as a result of deep breathing in supine posture,
afferents from vagal stretch receptors and irradiation of impulses to cardiovascular centers from
respiratory centers. They also studied oxygen consumption in s¡vitr¢ in both trained and untrained
subjects and concluded that oxygen consumption decreased significantly in trained but not in
untrained subjects. It is possible that the level of expertise attained by our subjects with 3 months
of training was insufficient to decrease HR and BP in supine position though they achieved it in
the sitting position. The excursions of the diaphragm, important in pr¡¸¡y¡mic deep breathing
may also be easier and more comfortable in a sitting position as opposed to a supine position.
This may also be contributing to a sense of uneasiness, resulting in sympathetic arousal,
manifesting as an increase in HR and DP.
The decrease of all HR and BP indices in sitting position (Table 3, 4) is similar to previous
reports that slow deep breathing in a sitting position results in decreased oxygen consumption,
HR and BP (Joseph 2005, Jerath 2006, Pramanik 2009, Bhavanani 2011). It was postulated that
voluntary slow breathing functionally resets the autonomic nervous system via stretch - induced
inhibitory signals coupled with synchronization of neural elements in limbic system and cortex.

As s¡vitr¢ is a slow, rhythmic, deep breathing technique, the above mechanism may explain its
effects too.
A pilot study from ACYTER, JIPMER, Puducherry reported significant reductions in HR,
SP, DP, MP, RPP and Do P following 10 minutes of áav¡sana with s¡vitr¢ in 6 hypertensive
patients (Madanmohan 2010). This was attributed to a normalization of cardiovascular autonomic
regulatory mechanisms with increased vagal modulation and / or decreased sympathetic activity.
Reduction in RPP and Do P signifies reduction in oxygen consumption and work done by the
heart and hence beneficial for hypertensives. We need to consider that psycho-physiological
effects of various yoga techniques may be different in normal, healthy volunteers as opposed to
established patients of hypertension on medication. As all HR and BP indices were on a higher
side in that pilot study, the technique may have resulted in the lowering them to normal. As
opposed to this, in the present study, all pre values were already in the lower normal range and
hence the mechanisms may have worked differently in raising them towards a higher normalcy.
Conscious deep, slow and rhythmic breathing may normalize autonomic cardiovascular
rhythms co-related to both vagal and sympathetic activity. Bhavanani et al., have reported
significant reductions in HR and BP indices in hypertensives following 5 minutes of sukha
pr¡¸¡y¡ma utilizing slow, deep and rhythmic breathing (Bhavanani 2011). Bernardi et al., (2001)
reported beneficial effects of rosary prayer and yoga mantras in restoring these rhythms with an
increase in baroreflex sensitivity and concluded that rhythm formulas involving breathing at 6
breaths / min induce favorable psychological and possibly physiological effects. Joseph et al.,
(2005) reported a fall in BP and normalization of baroreflex sensitivity in hypertensive patients
following just 2 minutes of slow breathing at 6 breaths /min. The significant differences between
normal breathing and s¡vitr¢ in the sitting position can be explained on the basis of the above
(Table 1, 2 and 4).
Cardiovascular effects in the present study were more pronounced with regard to RPP and
DoP due to cumulative benefits occurring as result of changes in HR, SP, and MAP. RPP and Do
P are especially significant as they are indicators of myocardial oxygen consumption and load
on the heart and therefore an indirect indicator of strain on the heart (Madanmohan 2004). Our
results give direct evidence of the cardiovascular benefits of performing s¡vitr¢ in a sitting position.
The rise of the same in supine position may be understood as a mere restoration of normalcy that
had been lowered by the previous practices.

Table 1. Overall comparison of ∆ % changes in 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 11 subjects following 5 minutes of normal breathing
and s¡vitr¢ pr¡¸¡y¡ma in sitting and supine positions.
Sitting Position Supine Position
∆ % after ∆ % after ∆ % after ∆ % after ρ value
normal s¡vitr¢ normal s¡vitr¢
breathing pr¡¸¡y¡ma breathing pr¡¸¡y¡ma
HR (%) -0.93 -6.91 -3.29 3.39 0.0101
± 1.71 ± 1.63 ± 1.84 ± 2.89 **
SP (%) 1.89 -6.47 -2.67 0.61 0.0895
± 3.02 ± 2.65 ± 2.23 ± 1.55
DP (%) 6.12 -5.58 -3.69 7.11 0.0045
± 4.78 ± 3.76 ± 2.43 ± 1.76 * ψ ψ
PP (%) -6.27 -4.11 -0.01 -7.84 0.7325
± 2.36 ± 6.67 ± 5.07 ± 5.29
MP (%) 4.29 -6.16 -3.28 4.07 0.0063
± 4.00 ± 2.86 ± 2.11 ± 1.03** ψ
RPP (%) 0.72 -12.82 -5.89 4.22 0.0027
± 2.66 ± 3.30* ± 2.72 ± 3.89 ψ ψ
Do P (%) 2.99 -12.53 -6.36 7.72
± 3.29 ± 3.42* ± 3.03 ± 3.55 ψ ψ ψF 0.0004
Values are given as mean - SEM
P values are given for intergroup compassions done by ANOVA with Tukey-Kramer Multiple
Comparisons Test (TKMCT) for HR, SP, RPP and DoP while Kruskal Wallis (nonparametric
ANOVA) with Dunn's Multiple Comparisons Test (DMCT) was done for DP, PP and MP.
** p < 0.01 for HR between s¡vitr¢ in sitting vs s¡vitr¢ in supine by TKMCT
* p < 0.05 for DP between s¡vitr¢ in sitting vs s¡vitr¢ in supine by DMCT
ψ ψp < 0.01 for DP between normal breathing vs s¡vitr¢ in supine by DMCT
** p < 0.01 for MP between s¡vitr¢ in sitting vs s¡vitr¢ in supine by DMCT
ψp< 0.05MP between normal breathing vs s¡vitr¢ in supine by DMCT
*p < 0.05 for RPP between normal breathing and s¡vitr¢ in sitting by TKMCT
ψ ψp < 0.01 for RPP between s¡vitr¢ in sitting and s¡vitr¢ in supine by TKMCT
* p < 0.05 for DoP between normal breathing and s¡vitr¢ in sitting by TKMCT
ψ ψ ψp < 0.001 DoP between s¡vitr¢ in sitting and s¡vitr¢ in supine by TKMCT
F p < 0.05 for DoP between normal breathing and s¡vitr¢ in supine by TKMCT
For all other comparisons, p > 0.05.
Table 2: Comparison of ∆ % changes in 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 11 subjects following 5 minutes of normal breathing versus
s¡vitr¢ pr¡¸¡y¡ma in sitting position.
Sitting position
∆ % after ∆ % after P value
normal breathing s¡vitr¢ pr¡¸¡y¡ma
HR (%) -0.93 -6.91 0.046
± 1.71 ± 1.63
SP (%) 1.89 -6.47 0.029
± 3.02 ± 2.65
DP (%) 6.12 -5.58 0.022
± 4.78 ± 3.76
PP (%) -6.27 -4.11 0.777
± 2.36 ± 6.67
MP (%) 4.29 -6.16 0.012
± 4.00 ± 2.86
RPP (%) 0.72 -12.82 0.004
± 2.66 ± 3.30
Do P (%) 2.99 -12.53 0.001
± 3.29 ± 3.42
Values are given as mean ± SEM.

Table 3: Comparison of ∆ % changes in 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 11 subjects following 5 minutes of normal breathing versus
s¡vitr¢ pr¡¸¡y¡ma in supine position.
Supine position
∆ % after ∆ % after P value
normal breathing s¡vitr¢ pr¡¸¡y¡ma
HR (%) -3.29 3.39 0.141
± 1.84 ± 2.89
SP (%) -2.67 0.61 0.316
± 2.23 ± 1.55
DP (%) -3.69 7.11 0.011
± 2.43 ± 1.76
PP (%) -0.01 -7.84 0.409
± 5.07 ± 5.29
MP (%) -3.28 4.07 0.018
± 2.11 ± 1.03
RPP (%) -5.89 4.22 0.103
± 2.72 ± 3.89
Do P (%) -6.36 7.72 0.031
± 3.03 ± 3.55

Table 4: 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 11
subjects before (B) and after (A) 5 minutes of normal breathing and s¡vitr¢ pr¡¸¡y¡ma
in sitting position.
SITTING POSITION
Normal breathing s¡vitr¢ pr¡¸¡y¡ma
B A p value B A p value
HR 81.82 80.91 81.27 75.55
(beats/min) 0.518 0.002
± 2.58 ± 2.52 ± 2.92 ± 2.77
SP 109.18 110.64 114.36 106.18
(mmHg) 0.650 0.044
± 3.48 ± 3.02 ± 3.82 ± 2.16
DP 72.64 76.45 74.36 69.45
(mmHg) 0.233 0.135
± 3.38 ± 3.65 ± 3.06 ± 2.34
PP 36.55 34.18 40.00 36.73
(mmHg) 0.026 0.281
± 1.06 ± 1.13 ± 2.83 ± 1.48
MP 84.82 87.85 87.70 81.70
(mmHg) 0.338 0.066
± 3.38 ± 3.41 ± 3.06 ± 2.17
RPP 89.14 89.80 92.68 80.30
(units) 0.789 0.005
± 3.49 ± 4.39 ± 3.80 ± 3.55
Do P 69.23 71.35 71.13 61.76
(units) 0.377 0.008
± 3.17 ± 4.16 ± 3.18 ± 2.84

(PP), mean pressure (MP), rate-pressure product (RPP) and double product (Do P) in 11
subjects before (B) and after (A) 5 minutes of normal breathing and s¡vitr¢ pr¡¸¡y¡ma
in supine position.
SITTING POSITION
Normal breathing s¡vitr¢ pr¡¸¡y¡ma
B A p value B A p value
HR 73.36 71.09 71.27 73.18
(beats/min) 0.110 0.376
± 2.04 ± 2.71 ± 2.84 ± 2.36
SP 107.55 104.45 106.45 107.00
(mmHg) 0.250 0.740
± 2.97 ± 3.14 ± 2.78 ± 2.98
DP 68.91 66.45 65.55 69.91
(mmHg) 0.175 0.002
± 2.41 ± 3.07 ± 2.77 ± 2.42
PP 38.64 38.00 40.91 37.09
(mmHg) 0.758 0.113
± 1.95 ± 1.66 ± 1.49 ± 1.36
MP 81.79 79.12 79.18 82.27
(mmHg) 0.162 0.002
± 2.44 ± 2.99 ± 2.68 ± 2.54
RPP 78.88 73.97 75.75 78.03
(units) 0.056 0.442
± 3.16 ± 2.90 ± 3.26 ± 2.66
Do P 59.95 56.11 56.31 60.01
(units) 0.053 0.078
± 2.37 ± 2.65 ± 2.59 ± 2.20

Conclusion
It is concluded that the practice of s¡vitr¢ pr¡¸¡y¡ma in sitting position has beneficial
cardiovascular effects. This may be due to a normalization of autonomic cardiovascular rhythms
as a result of increased vagal modulation and / or decreased sympathetic activity and improved
baroreflex sensitivity. Our study gives evidence that the sitting position may be preferred over
the supine position for performing s¡vitr¢. Our findings have potential therapeutic applications
in day-to-day as well as clinical situations where HR and BP need to be brought down at the
earliest. Further studies in larger groups of healthy volunteers as well as in patients of hypertension
and other psychosomatic disorders is required to enable a deeper understanding of the mechanisms
involved.
Acknowledgments
The authors are grateful to Yogacharini Meenakshi Devi Bhavanani, Director ICYER and
Yog¡µjali N¡¶y¡layam for her constant motivation, encouragement and supportive guidance.
We thank Dr. R. Balaji, Miss D. Pushpa and Miss Subashana for their valuable assistance during
the recording sessions and data entry.
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174 Bhavanani
Indian J Physiol etPharmacol
al 2012; 56(2) : 174–180 Indian J Physiol Pharmacol 2012; 56(2)
SHORT COMMUNICATION
IMMEDIATE EFFECT OF MUKHA BHASTRIKA (A BELLOWS TYPE

PRANAYAMA) ON REACTION TIME IN MENTALLY
CHALLENGED ADOLESCENTS
ANANDA BALAYOGI BHAVANANI 1*, MEENA RAMANATHAN 2

AND HARICHANDRAKUMAR KT 3
1
Chairman, International Centre for Yoga, Education and Research (ICYER),
Bommayapalaam Post, (Pondicherry), TN – 605 104, India, Email: yognat@gmail.com
2
Coordinator Outreach Programmes, ICYER and Yoganjali Natyalayam,
Pondicherry – 605 104, India, Email: saineema@yahoo.com
3
Lecturer, Division of Biostatistics, JIPMER,
Pondicherry – 605 006, India, Email: hckumar2001@gmail.com
( Received on July 10, 2010 )
Abstract : Mentally challenged individuals are known to have slower

speed of reaction. As a previous study has shown immediate improvement
in reaction time (RT) following mukha bhastrika, a bellows type of
pranayama, we planned to study the effect of this pranayama in mentally
challenged adolescents. 34 mentally challenged adolescents (15.1±0.806 y)
studying in a school for Special Needs were recruited as they have been
receiving yoga training once a week for more than 3 years. Exclusion
criteria were inability to either perform mukha bhastrika or to understand
procedure for testing RT. Visual (VRT) and auditory reaction time (ART)
was measured using RT apparatus before and after nine rounds of mukha
bhastrika and a control period of ten minutes of normal activities to rule
out any test-retest practice effect. Analysis of non-intervention period
values showed that the reliability in terms of reproducibility of the
observation for both VRT (r=0.87) and ART (r=0.95) was excellent. Mukha
bhastrika produced an immediate and significant decrease in both VRT and
ART. There was a statistically significant decrease in VRT (P<0.0001) from
296.15 ms±13.49 to 263.59 ms±12.53 and ART (P<0.0001) from
247.88 ms±14.33 to 217.35 ms±11.36 following mukha bhastrika. Decrease
in RT signifies improved central neuronal processing ability. This may be
due to greater arousal and faster rate of information processing, improved
concentration and/or ability to ignore or inhibit extraneous stimuli. Mukha
bhastrika may be altering afferent inputs from abdominal and thoracic
regions, in turn modulating activity at ascending reticular activating system
and thalamo-cortical levels. It is suggested that yogic breathing techniques
like mukha bhastrika be used as an effective means of improving neuro-
muscular abilities in special children.
Key words : reaction time mukha bhastrika
mental retardation central processing
*Corresponding Author :
Indian J Physiol Pharmacol 2012; 56(2) Mukha Bhastrika on Reaction Time in Mentally Challenged 175
INTRODUCTION neuronal processing and is a simple means

of determining sensory-motor association,
Yoga has been found to be an effective performance and cortical arousal. Decrease
adjunct therapeutic modality in numerous in RT indicates an improved sensory-motor
health conditions and is being widely used performance and an enhanced processing
all over the world. The diverse applications ability of the central nervous system. It is a
of yoga in rehabilitation of mentally and sensitive and reproducible test that can be
physically handicapped as well as visually measured with a simple apparatus and setup.
impaired children have been demonstrated
earlier with significant decrease in their It has been found that changes in
abnormal anxiety levels (1). breathing period produced by voluntary
control of inspiration are significantly
Mental retardation is one of the correlated to changes in RT (7). Some studies
conditions in which yoga may have great on yoga have shown that regular practice of
potential. Though there are some yoga over a period of a few weeks to a few
documented reports (2), very few have months can significantly decrease VRT and
scientifically studied this effect and hence ART (4, 5). Not many have however studied
more studies are required to streamline the the acute and immediate effects of yoga
use of yoga as an adjunct therapy in such techniques on RT.
children.
A previous study from our laboratories
Uma et al (3) have reported that yoga reported a significant and immediate
improved IQ in MR children and that the decrease in RT following the practice of nine
Binet Kamath (BK) test scores for general rounds of mukha bhastrika, a bellows type
mental ability improved significantly in the of pranayama in normal school children (8).
yoga group. They suggested that the breath It has been previously reported that
control obtained through yoga increases mentally challenged individuals show specific
psycho-motor coordination. They concluded motor performance deficits on measures of
that yoga improves concentration, attention- RT, aiming, dexterity and that their motor
span and enhances IQ and memory power by performance measures are considerably
gaining conscious control over the mind. longer compared to the non retarded (9).
The neurological benefits of yoga have Mukha bhastrika is a yogic technique in

interested scientists all over the world. It which the breath is actively blasted out in
has been reported to be beneficial in both multiple ‘whooshes’ with forced abdominal
peripheral nerve function as well as central contractions. After taking up Vajra Asana, a
neuronal processing (4, 5, 6). One of the straight back sitting position, a deep
simple and effective methods of studying the inhalation is performed with awareness of
central neuronal processing is the RT that the sequential expansion of the lungs. The
is the interval between the onset of a signal mouth is then puckered up into Kaki Mudra,
(stimulus) and the initiation of a movement the crow beak gesture and the breath is
response. It is an indirect index of central blasted out in multiple, forceful expulsions
while simultaneously bringing the head down Exclusion criteria were the inability to
to the ground. Then, with a deep inhalation, either perform mukha bhastrika or to
the head is raised slowly and the subject understand the procedure for testing RT. Of
comes back to the sting position. This the 63 students studying in the school, only
constitutes one round of mukha bhastrika 34 of those children who could perform
that is one of the practices being taught on mukha bhastrika in the proper manner, as
a regular basis in all pranayama classes in well as understand the procedure of testing
the Gitananda tradition. This is also one of RT were recruited for this study. Informed
the techniques taught in regular yoga consent for the study was obtained from the
training imparted for special children in head of the institution on behalf of the
Pondicherry as part of the outreach special children and ethical clearance
programmes of ICYER and Yoganjali obtained from that institution as well as
Natyalayam, Pondicherry, India. ICYER.
Keeping all of this in mind, this study RT apparatus manufactured by Anand

was planned to investigate the acute effects Agencies, Pune, was used for the study. The
of mukha bhastrika on VRT and ART in instrument has a built in 4 digit chronoscope
mentally challenged children. Since the study with a display accuracy of 1 ms. It features
was done on mentally challenged subjects four stimuli, two response keys and a ready
and as we wanted to rule out potential signal. Switches for selecting right or left
practice effects on the readings, we included response key for any stimulus is provided.
a non-intervention period and performed test- In the present study simple ART was
retest analysis to ensure reliability and recorded for auditory beep sound stimulus
reproducibility of the readings. and simple VRT for red light stimulus. The
subjects were instructed to release the
MATERIALS AND METHODS response key as soon as they perceived the
stimulus. The signals were given from the
Thirty four children (21 male, 13 female) front of the subjects to avoid the effect of
with MR studying in SADAY School for lateralised stimulus and they used their
Special Needs, Pondicherry, were recruited dominant hand while responding to the signal
for this study by accidental sampling method (10). All subjects were given adequate
as they have been receiving yoga training exposure to the equipment on 2 different
once a week for 2-3 years. Their mean age occasions to familiarize them with the
was 15.1±0.806 and mean IQ was 54.88±2.51. procedure of RT measurement.
two of the children belonged to the severe
mental retardation category (IQ 20-34), 10 RT measurements were done before and
to the moderate mental retardation category after a non-intervention period of 10 minutes
(IQ 35-49), 19 to the mild mental retardation where the subjects continued their normal
category (IQ 50-69) and 3 were in the activities between the recordings. Test-retest
borderline intellectual functioning category study was done on these values to assess
(IQ 70-84) according to the International reliability and reproducibility of the
Classification of Diseases-10. observations and to rule out any changes
that could be resulting from ‘practice effect’. RESULTS

RT was then recorded before and after the
practice of nine rounds of mukha bhastrika. The results are given in Table I. Mean
To avoid any extraneous influences due to VRT score at baseline was 296.15±13.49 ms
the recording on different days, one half of and there was no significant difference
the subjects performed non-intervention between male and female subjects though
period recordings on day-1, while the other mean score of male subjects (301.5±18.42 ms)
half did the mukha bhastrika recordings. This was marginally higher than that of the
was then reversed on day-2. More than 8-10 female (287.46±19.62 ms) subjects. The mean
trials were recorded and the average of the ART score at baseline was 247.88±14.33 ms
lowest three similar observations was taken and there was no significant difference between
as a single value for statistical analysis (10). male and female subjects though mean score
of the female subjects (250.54±26.67 ms) was
Data are expressed as mean±SEM. All marginally higher than that of the male
statistical analysis was carried out using (246.2±16.85 ms) subjects.
SPSS 13.0. The reliability and reproducibility
of the observations of VRT and ART in the Test-Retest analysis of the non-
non-intervention period were assessed by intervention period values showed that the
using Test-Retest study using correlation reliability in terms of reproducibility of the
analysis. The distribution of both VRT and observations was excellent for both VRT (r
ART was assessed by using Kolmogrov =0.87) and ART (r=0.95). On the other hand,
Smirnov (KS) test. The immediate effect of Mukha bhastrika produced an immediate and
mukha bhastrika on RT was assessed by significant decrease in VRT and ART. There
using Students t (paired) test. Correlation was a statistically significant (P<0.0001)
Analysis (Karl Pearson Coefficient of decrease in VRT from 296.15±13.49 ms to
Correlation) was carried out to assess the 263.59±12.53 ms. There was also a statistically
test retest reliability of the observations in significant (p < 0.0001) decrease in ART from
the non-intervention period to rule out 247.88±14.33 ms to 217.35±11.36 ms
‘practice effect”. All statistical analysis was following mukha bhastrika. There was an
carried out at 5% level of significance and a overall reduction of 33 ms and 30.5 ms
P value <0.05 was taken to indicate (10.99% and 12.31% reduction) in mean
significant differences between groups of scores of VRT and ART respectively after
data. mukha bhastrika.
TABLE I : Visual reaction time (VRT) and auditory reaction time (ART) of mentally challenged adolescents
before (B) and immediately after (A) performance of nine rounds of mukha bhastrika.
B A % Change P Value
VRT (ms) 296.15±13.49 263.59±12.53 – 10.99% <0.0001

ART (ms) 247.88±14.33 217.35±11.36 – 12.31% <0.0001
Values are mean±SEM for 34 subjects.

DISCUSSION information processing (ii) improved

concentration and/or (iii) ability to ignore or
In our subjects, ART values were inhibit extraneous stimuli.
significantly shorter than VRT and this is in
agreement with previous reports (4, 5, 10). Studies done in the erstwhile Czechoslovakia
All pre and post values obtained in the have demonstrated EEC changes around
present study showed slower RT than somato-sensory and parietal areas of the
expected values for a normal population. A cerebral cortex suggesting an affective
literature review by Kosinski gives normal arousal following agnisara, nauli and
values of ART as 140-160 ms and VRT as bhastrika (12). It was suggested that these
180-200 ms (11). In the present study the practices bring about such changes through
mean value of ART and VRT before mukha strong stimulation of somatic and splanchnic
bhastrika was 247.88±14.33 ms and receptors. As mukha bhastrika utilizes similar
296.15±13.49 ms respectively. This difference forceful abdominal contractions, it may be
between the expected normal values and the shortening RT through similar mechanisms.
values in our study can be explained by the
well documented delay in the processing It has been reported that moderate
speed in children with MR (9). muscular tension shortened pre-contraction
RT (13) and that isometric contraction allows
Performance of nine rounds of mukha the brain to work faster (14). It is possible
bhastrika produced an immediate and that the vigorous abdomino-thoracic muscular
statistically significant decrease in both VRT contractions in mukha bhastrika influenced
and ART. The faster reactivity seen post the RT in a manner similar to isometric
mukha bhastrika, both in the present study muscular exercise. However the post mukha
as well as in our earlier study (8) may be bhastrika shortening of RT shows that this
due to a generalized alteration in information effect differs, as unlike muscular exercise it
processing at the primary thalamo-cortical is carried over into the post mukha bhastrika
level that occurs during pranayama as period too.
postulated by Telles et al (6). According to
the traditional wisdom of yoga, pranayama The level of intelligence has been
is the key to bringing about psychosomatic correlated with RT and it has been found
integration and harmony. A calm mind will that serious MR produces slower and more
be able to process information much better variable RT (15). In our study we have
than an agitated one. A previous study from focused primarily on the mild and moderately
our laboratory has also reported a reduction retarded subjects with a mean IQ of
in RT following three weeks of training in 54.88±2.51. Uma et al (3) reported significant
slow and fast pranayamas (10). improvement of BK scores in the group
having a moderate degree of MR signifying
Decrease in RT signifies an improvement an improved IQ after yoga training. They
in central neuronal processing ability of also suggested that yoga techniques help MR
the special children. This may be due to children in improving their locomotor skills
(i) greater arousal and faster rate of as well as their psycho-motor coordination.
Improved concentration and attention-span children. Further studies are required to

may result in improved IQ and memory understand the underlying mechanisms
power too. involved in bringing about such an immediate
benefit.
RT has been found to be faster when the
stimulus occurred during expiration as ACKNOWLEDGEMENTS
compared to inspiration (16). As mukha
bhastrika involves multiple forceful The authors thank Dr. Madanmohan,
expirations done rapidly and consecutively, Professor and Head, Department of
this may be having a prolonged and residual Physiology and Programme Director,
neuro-muscular effect that is also influencing ACYTER, JIPMER for his support at all
the RT. Mukha bhastrika may be altering stages of the study. We thank Yogacharini
afferent inputs from abdominal and thoracic Meenakshi Devi Bhavanani, Director ICYER
regions, in turn modulating activity at for her constant motivation, encouragement
ascending reticular activating system and and supportive guidance for this work as well
thalamo-cortical levels. This is quite as yoga training for special children.
plausible as kapalbhathi, a yogic technique We thank Dr. M Sugatham, Consultant
with similar bellows type breathing has been psychologist and Director SADAY School for
reported to increase mental activity and Special Needs permitting us to do this study
induce a calm and alert state (17). and for encouraging the yoga therapy
sessions for the children for the past 5 years.
In conclusions on the basis of the present We also thank the staff members of SADAY
study, we suggest that yogic breathing for their cooperation and assistance and Dr.
techniques like mukha bhastrika may be R Balaji, Junior Faculty member of Yoganjali
used as an effective means of training to Natyalayam for his valuable assistance in
improve neuromuscular abilities in special the recordings.
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IJOY_49_11R5 EP Done 18th Jun
Original Article
1 1
2 2
3
Immediate effect of chandra nadi pranayama (left unilateral 3
4 forced nostril breathing) on cardiovascular parameters in 4
5 5
6 hypertensive patients 6
7 7
8 Ananda Balayogi Bhavanani, Madanmohan1, Zeena Sanjay2 8
9 Program Co-ordinator, 1Professor and Head, Department of Physiology and Program Director, 2Senior Research Fellow, ACYTER, JIPMER, 9
10 Puducherry, India 10
11 11
12 Programme Co-ordinator, Advanced Centre for Yoga Therapy, 12
13 Education and Research (ACYTER), JIPMER, 13
14 Pondicherry - 605 006, India. 14
E-mail: ananda@icyer.com
15 15
16 16
17 ABSTRACT 17
18 Introduction: Recent studies have reported differential physiological and psychological effects produced by exclusive right
18
19 and left nostril breathing and clinical research is required to prove immediate and sustained efficacy of these techniques in
19
20 various psychosomatic conditions such as hypertension (HT). The present study was designed to determine immediate effects
20
21 of 27 rounds of exclusive left nostril breathing, a yogic pranayama technique known as chandra nadi pranayama (CNP) on
21
22 cardiovascular parameters in patients of essential HT.
22
23 23
Materials and Methods: Twenty two patients of essential HT under regular standard medical management were individually
24 24
taught to perform CNP by a qualified yoga instructor with a regularity of 6 breaths/min throughout a performance of 27 rounds
25 25
of CNP. Pre and post intervention heart rate (HR) and blood pressure (BP) measurements were recorded using non-invasive
26 26
semi-automatic BP monitor and Students t test for paired data used to determine significant differences.
27 27
28 Results: Twenty seven rounds of CNP produced an immediate decrease in all the measured cardiovascular parameters with the decrease 28
29 in HR, systolic pressure (SP), pulse pressure, rate-pressure product and double product being statistically significant. Further, gender- 29
30 based sub-analysis of our data revealed that our male participants evidenced significant reductions in HR and SP with an insignificant 30
31 decrease in diastolic pressure, while in female participants only HR decreased significantly with an insignificant decrease in SP. 31
32 Discussion and Conclusion: It is concluded that CNP is effective in reducing HR and SP in hypertensive patients on regular 32
33 standard medical management. To the best of our knowledge, there are no previously published reports on immediate effects of 33
34 left UFNB in patients of HT and ours is the first to report on this beneficial clinical effect. This may be due to a normalization of 34
35 autonomic cardiovascular rhythms with increased vagal modulation and/or decreased sympathetic activity along with improvement in 35
36 baroreflex sensitivity. Further studies are required to enable a deeper understanding of the mechanisms involved as well as determine 36
37 how long such a BP lowering effect persists. We recommend that this simple and cost effective technique be added to the regular 37
38 management protocol of HT and utilized when immediate reduction of BP is required in day-to-day as well as clinical situations. 38
39 Key words: Blood pressure, chandra nadi pranayama, hypertension, yoga therapy. 39
40 40
41 41
42 42
43 INTRODUCTION interest of scientists all over the world, had been analyzed
43
44 extensively by Indian yogis of lore. Though they lacked 44
45 The science of swara (nasal cycle) that has recently caught the equipment available to modern science, these yogis 45
46 through their dedicated practice (abhyasa), inner vision 46
47 Access this article online (antar drishti) and self-analysis (swadhyaya) had made 47
48 Quick Response Code
extensive observations on this concept. The Vedic science 48
49 Website:
of understanding the function of the nasal cycle is known 49
www.ijoy.org.in
50 as Swarodaya Vigjnan (swara = sonorous sound produced 50
51 by the airflow through the nostrils in the nasal cycle, 51
52 DOI: udaya = functioning state, and vigjnan = knowledge).[1] The 52
53 *** Shivaswarodaya, an ancient treatise advises quieter, passive 53
54 activities (soumya karya) when left nostril (ida/chandra 54

Bhavanani, et al.: Chandra nadi pranayama on hypertensives
1 swara) is dominant and engage in challenging and exertional pressure (DP) values, 16 were in the prehypertensive range, 1
2 activities (roudra karya) when right nostril (pingala/surya 4 in stage I HT and 2 in stage II HT even with regular 2
3 swara) is dominant and to relax or meditate when flow medication. None of them had any previous experience of 3
4 through both nostrils is equal (sushumna swara).[1] yoga training. Informed consent was obtained by one of the 4
5 investigators. Pre intervention heart rate (HR) and blood 5
6 The nasal cycle is dependent upon tonic activity of the pressure (BP) were recorded after 5 min of rest in sitting 6
7 limbic autonomic nervous system with hypothalamus posture using non-invasive semi-automatic BP monitor 7
8 as the control centre, as well as levels of circulating (CH – 432, Citizen Systems, Tokyo, Japan). 8
9 catecholamines and other neuro-hormones.[2,3] Recent 9
10 studies have reported differential physiological and The subjects were individually taught to perform CNP by 10
11 psychological effects produced by exclusive right and a qualified yoga instructor. An overview of the practice 11
12 left nostril breathing.[4-7] However, these studies have only was given to the patients and then they were instructed 12
13 evaluated the effects on normal subjects. Though potential to take up an erect sitting position with palms on their 13
14 health benefits of unilateral forced nostril breathing thighs. They were asked to keep their eyes closed to 14
15 (UFNB) have been postulated, further clinical research is facilitate the development of inner awareness. The subjects 15
16 required to prove immediate and sustained efficacy of these were instructed to perform nasika mudra with their right 16
17 techniques in various psychosomatic conditions such as hand, by touching the tip of their index finger to the base 17
18 hypertension (HT) and diabetes mellitus (DM). of their thumb. The right thumb was then used to close 18
19 their right nostril with gentle pressure. The pranayama 19
20 With the above in mind, the present study was designed was then performed through the unblocked left nostril 20
21 to determine immediate effects of 27 rounds of exclusive in a calm and regular manner with a conscious effort to 21
22 left nostril breathing, a yogic UFNB pranayama technique use low, mid and upper parts of the lungs in a sequential 22
23 known as chandra nadi pranayama (CNP) on cardiovascular manner for both inspiration and expiration. Subjects were 23
24 parameters in patients of essential HT. instructed to breathe in and out for an equal count of 5 that 24
was given by the instructor throughout the period in tune
25 25
with a stop watch. A regularity of counts at the rate of 6
26 MATERIALS AND METHODS 26
breaths/min (BPM) was maintained by the instructor for
27 27
This study was conducted at the Advanced Centre for the entire duration of nearly 5min taken to complete 27
28 28
Yoga Therapy Education and Research (ACYTER) that has rounds of CNP.
29 29
been established as a collaborative venture between the
30 30
Morarji Desai National Institute of Yoga, New Delhi and Post intervention HR and BP measurements were recorded
31 31
Jawaharlal Institute of Post Graduate Medical Education again at the end of the 27 rounds of CNP. Pulse pressure
32 32
and Research (JIPMER), Puducherry with funding from (PP) was calculated as SP-DP, mean pressure (MP) as
33 33
Department of AYUSH (Ayurveda, Yoga and Naturopathy, DP + 1/3 PP, rate-pressure product (RPP) as HR × SP/100
34 34
Unani, Siddha and Homeopathy) in the Ministry of Health and double product (Do P) as HR × MP/100.
35 and Family Welfare, Government of India. Ethical approval
35
36 has been obtained by ACYTER from the Institutional Ethics
36
Statistical analysis of pre and post intervention data was
37 Committee for studies on the effect of yoga therapy on HT 37
done using GraphPad InStat version 3.06 for Windows
38 and DM. The present study was conducted as a pilot study 38
95, GraphPad Software, San Diego California USA, www.
39 as part of this larger study on the effects of yoga therapy 39
graphpad.com. All data passed normality testing by
40 in patients of HT. 40
Kolmogorov-Smirnov test and hence was analyzed using
41 41
Students t test for paired data. P values less than 0.05 were
42 Twenty two patients of essential HT attending the Yoga OPD
42
accepted as indicating significant differences between pre
43 run by ACYTER were selected for this study by accidental and post intervention data.
43
44 sampling. Patients whose SP was less than 120 mm Hg 44
45 with medication, patients of secondary HT, and those with 45
46 RESULTS 46
history/signs and symptoms/laboratory reports suggestive of
47 nephrologic, neurologic and ophthalmologic complications Results of the pre and post intervention comparisons are 47
48 were excluded from the study. Twelve of the patients given in [Table 1]. All values are given as mean ± SEM. 48
49 were males and 10 were females with an average age of 27 rounds of CNP produced an immediate decrease 49
50 58.14 ± 1.69 (SEM) years. All of the subjects were under in all the measured cardiovascular parameters with 50
51 regular standard medical management for more than five the decrease in HR, SP, PP, MP, RPP and Do P being 51
52 years with antihypertensive medications at JIPMER. Sub statistically significant while the fall in DP missed 52
53 classification of the subjects according to JNC VII[8] revealed statistical significance. Students paired t test showed 53
54 that based on either systolic pressure (SP) or diastolic significant reductions in HR, t (21) = 4.23, P <0.001, SP, 54
1 Table 1: Immediate effect of chandra nadi pranayama in SP values that were on the higher side despite regular 1
2 on heart rate (HR), systolic pressure (SP), diastolic medication. However we have found in both studies that 2
3 pressure (DP), pulse pressure (PP), mean pressure (MP), DP didn’t change much and this may be attributed to the 3
4 rate-pressure product (RPP) and double product (Do P) 4
fact it was already stabilized within the normal range with
in patients of essential hypertension. B: before and A:
5 after the intervention
medication. 5
6 B A % t value P value
6
7 change The cardiovascular effects in the present study as well as 7
8 HR (beats/ 75.77± 73.45 ± -3.06 4.23 (21) <0.001 our previous one are more pronounced with regard to the 8
9 min) 3.15 3.12 RPP and Do P due to the cumulative benefits occurring as 9
SP (mmHg) 134.68 ± 130.27 ± -3.27 3.61 (21) 0.0016
10 3.17 3.16
a result of reduction in HR as well as BP. RPP and Do P are 10
11 DP (mmHg) 78.77 ± 78.05 ± -0.91 0.74 (21) 0.467 especially important in patient care as they are indirect 11
12 1.74 1.89 indicators of myocardial oxygen consumption and load 12
13 PP (mmHg) 55.91 ± 52.23 ± -6.58 2.95 (21) 0.0076 on the heart, thereby signifying a lowering of strain on 13
2.99 2.56
14 the heart.[10] The RPP also provides a simple measure 14
MP (mmHg) 97.41 ± 95.45 ± -2.01 2.20 (21) 0.0395
15 1.84 2.06
of overall heart rate variability (HRV) in hypertensive 15
16 RPP (units) 101.87 ± 95.58 ± -6.17 5.07 (21) <0.001 patients and is a surrogate marker in situations where 16
17 4.66 4.59 HRV analysis is not available.[11] Hence, the reduction in 17
DoP (units) 73.94 ± 70.35 ± -4.85 4.55 (21) <0.001 RPP in our study implies better autonomic regulation of
18 18
3.56 3.69
19 the heart in hypertensive patients. A previous study from 19
Values are mean ± SEM for 22 subjects. t and P values as obtained from
20 Students t test for paired data. our laboratories reported that pranayama training of three 20
21 months duration modulates ventricular performance by 21
22 increasing parasympathetic activity and simultaneously 22
t (21) = 3.61, P = 0.002, PP t (21) = 2.59, P = 0.0076, MP decreasing sympathetic activity.[12] This may explain
23 23
t (21) = 2.20, P = 0.039, RPP, t (21) = 5. 07, P <0.001, significant decreases in HR and BP observed in the present
24 Do P, t (21) = 4.55, P <0.001.
24
25 study with pronounced effects on the heart. 25
26 26
Further, gender based sub-analysis of our data revealed Our findings are in agreement with those of a previous
27 27
that the male participants evidenced significant reductions report that left UFNB at the rate of 6 BPM lowers HR with
28 in HR, t (11) = 2.48, P = 0.03 and SP, t (11) = 2.97,
28
29 compensatory increase in stroke volume and end diastolic 29
P=0.013 from 73.17 ± 3.78 to 71.25 ± 3.70 beats/min and volume.[4] Another study done on normal volunteers
30 132.75 ± 4.55 to 128.08 ± 4.71 mm HG respectively. The 30
31 reported a significant decrease in SP and MP following 31
decrease in DP from 77.91 ± 3.04 to 75.58 ± 2.99 mm 30 min of exclusive left nostril breathing while the small
32 HG just missed significance t (11) = 2.09, P = 0.06. On 32
reduction in DP in that study also missed significance as
33 the other hand in female participants, only HR decreased 33
in ours.[6] This shows that similar beneficial effects can
34 significantly from 78.90 ± 5.28 to 76.10 ± 5.31 beats/ 34
be obtained in hypertensive patients even after less than
35 min, t (9) = 3.56, P = 0.006 while the decrease in SP 35
5 min of pranayama practice. Interestingly Raghuraj and
36 from 137.00± 4.46 to 132.90± 4.14 mm HG just missed 36
Telles reported a significant increase in HR whereas we
37 significance, t (9) = 2.05, P = 0.07. There was a statistically 37
have found a significant decrease in HR in the present
38 insignificant rise in DP in female participants 79.80 ± 1.33 38
study. They suggested that the fall in SP may have been
39 to 81.00 ± 1.87 mm HG. 39
influenced by changes in cardiac output (CO), peripheral
40 vascular resistance and humoral factors.[6] However the
40
41 DISCUSSION rise in HR in their study doesn’t support the contention
41
42 of changes in CO and if there was change in peripheral 42
43 The immediate decrease in all cardiovascular parameters vascular resistance, it should have been reflected in the DP 43
44 in our patients can be explained by changes in the changes. As the HR reduced significantly in our study, it 44
45 autonomic balance as it has been previously reported is more plausible that the fall is SP is related to CO. They 45
46 that sympathetic activity is lower during left nostril had not used timed breathing rates in their study whereas 46
47 breathing. [5] It has also been reported that exclusive left our subjects were breathing at the rate of 6 BPM and this 47
48 nostril breathing, repeated 4 times a day for a month may have harmonized respiratory and cardiovascular 48
49 reduced sympathetic activity.[7] Meyer rhythms, resulting in changes in HR as well as BP. 49
50 Breathing at the rate of 6 BPM increases vagal modulation 50
51 We have earlier reported that the practice of sukha of sinoatrial (SA) and atrioventricular (AV) nodes[13] and 51
52 pranayama for 5 min at a rate of 6 BPM reduces HR and enhances baroreceptor sensitivity[14] by entraining all RR 52
53 BP in patients of hypertension.[9] In both that study as well interval fluctuations, thereby causing them to merge at the 53
54 as the present study we have found significant reduction rate of respiration and to increase greatly in amplitude. This 54

1 increase in RR interval fluctuations enhances baroreflex of Yoga, New Delhi and JIPMER, Puducherry with funding from 1
2 efficiency and may have contributed towards lowering Department of AYUSH, Ministry of Health and Family Welfare, 2
3 the BP.[15] Increase vagal modulation of SA and AV nodes Government of India. 3
4 along with enhancement of baroreceptor sensitivity may 4
5 be responsible for reduction in HR and subsequent fall in REFERENCES 5
6 SP evidenced in our study.
1. Bhavanani AB, Swarodaya Vigjnan- A Scientific Study of the Nasal Cycle.
6
7 Yoga Mimamsa 2007;39:32-8. 7
8 Interestingly the gender based sub-analysis of our data 2. Deshmukh VD. Limbic autonomic arousal: Its physiological classification 8
9 reveals that our male participants evidenced significant and review of the literature. Clin Electroencephalogr 1991;22:46-60. 9
10 reductions in HR and SP with an insignificant decrease 3. Eccles R. Nasal airflow in health and disease. Acta Otolaryngol 2000;120: 10
580-95.
11 in DP while in female participants only the HR decreased 11
significantly with an insignificant decrease in SP. The 4. Shannahoff-Khalsa DS, Kennedy B. The effects of unilateral forced nostril
12 breathing on the heart. Int J Neurosci 1993;73:47-60.
12
13 statistically insignificant increase in DP in our female 13
5. Mohan SM. Svara (Nostril dominance) and bilateral volar GSR. Indian J
14 participants as opposed to its decrease in our male Physiol Pharmacol 1996;40:58-64. 14
15 participants seems to have influenced the overall result 6. Raghuraj P, Telles S. Immediate effect of specific nostril manipulating 15
16 with regard to DP. Similar differences between genders yoga breathing practices on autonomic and respiratory variables. Appl 16
17 following UFNB have been reported suggesting that Psychophysiol Biofeedback 2008;33:65-75.
17
there may be a nostril laterality affecting the autonomous 7. Telles S, Nagaratna R, Nagendra HR. Breathing through a particular nostril
18 can alter metabolism and autonomic activities. Indian J Physiol Pharmacol
18
nervous system differentially in males and females.[16] The
19 1994;38:133-7. 19
differential effect on BP between genders as evidenced
20 8. Seventh Report of the Joint National Committee on Prevention, Detection, 20
by our study is in agreement with another previous study
21 Evaluation, and Treatment of High Blood Pressure. US Department of Health 21
in normal healthy volunteers that reported significant and Human Services. NIH Publication No. 04-5230. Aug 2004.
22 reduction in HR, SP and DP after 15min of left nostril
22
9. Bhavanani AB, Madanmohan, Zeena S Immediate effect of sukha pranayama
23 breathing in males while the reduction in females was on cardiovascular variables in patients of hypertension. Int J Yoga Therapy
23
24 significant only with regard to HR.[17] The different 2011;21:4-7. 24
25 response of our female participants may also be due to the 10. Madanmohan, Udupa K, Bhavanani AB, Shatapathy CC, Sahai A. Modulation 25
26 fact that most of them were peri and postmenopausal and
of cardiovascular response to exercise by yoga training. Indian J Physiol 26
Pharmacol 2004;48:461-5.
27 this may have influenced their autonomic status. 27
11. Prakash ES, Madanmohan, Sethuraman KR, Narayan SK. Cardiovascular
28 autonomic regulation in subjects with normal blood pressure, high-normal
28
29 It is concluded that CNP is effective in reducing HR and blood pressure and recent-onset hypertension. Clin Exp Pharmacol Physiol 29
30 SP in hypertensive patients on regular standard medical 2005;32:488-94. 30
31 management. To the best of our knowledge, there is no 12. Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishnamurthy N. 31
Effect of pranayam training on cardiac function in normal young volunteers.
32 previous published report on immediate effects of left 32
Indian J Physiol Pharmacol 2003;47:27-33.
33 UFNB in patients of HT and ours is the first to report 13. Prakash ES, Ravindra PN, Madanmohan, Anilkumar R, Balachander J. Effect
33
34 on this beneficial clinical effect. This may be due to a of deep breathing at six breaths per minute on the frequency of premature 34
35 normalization of autonomic cardiovascular rhythms ventricular complexes. Int J Cardiol 2006;111:450-2. 35
36 with increased vagal modulation and/or decreased 14. Pramanik T, Sharma HO, Mishra S, Mishra A, Prajapati R, Singh S. Immediate 36
effect of slow pace bhastrika pranayama on blood pressure and heart rate. J
37 sympathetic activity along with improvement in baroreflex 37
Altern Complement Med 2009;15:293-5.
38 sensitivity. Further studies are required to enable a deeper
15. Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M, et al.
38
39 understanding of the mechanisms involved as well as Slow breathing improves arterial baroreflex sensitivity and decreases blood 39
40 determine how long such a BP lowering effect persists. We pressure in essential hypertension. Hypertension 2005;46:714-8. 40
41 recommend that this simple and cost effective technique 16. Dane S, Calişkan E, Karaşen M, Oztaşan N. Effects of unilateral nostril 41
42 be added to the regular management protocol of HT and breathing on blood pressure and heart rate in right-handed healthy subjects. 42
utilized when immediate reduction of BP is required in Int J Neurosci 2002;112:97-102.
43 17. Jain N, Srivastava RD, Singhal A. The effects of right and left nostril breathing
43
44 day-to-day as well as clinical situations. 44
on cardiorespiratory and autonomic parameters. Indian J Physiol Pharmacol
45 2005;49:469-74. 45
46 ACKNOWLEDGEMENTS 46
47 How to cite this article: ???. 47
The authors thank Selvi L Vithiyalakshmi, yoga instructor
48 ACYTER for her assistance during the study. We also thank the
48
49 Director, MDNIY and Director, JIPMER for their support as this Source of Support: Department of AYUSH, Ministry of Health and 49
50 study was possible because ACYTER has been established as a Family Welfare, Government of India, Conflict of Interest: None 50
declared
51 collaborative venture between the Morarji Desai National Institute 51
52 52
53 53
54 54
IJOY_41_11R7 1st EP done 17/12
Original Article
1 1
2 2
3
Effect of yoga therapy on reaction time, biochemical 3
4 parameters and wellness score of peri and post‑menopausal 4
5 5
6 diabetic patients 6
7 7
8 Madanmohan, Ananda Balayogi Bhavanani1, G Dayanidy2, Zeena Sanjay3, Ishwar V Basavaraddi4 8
9 Department of Physiology and Program Director, 1Program Co‑ordinator, 2Yoga Instructor, 3Senior Research Fellow, ACYTER, JIPMER, 9
10 Puducherry, 4Director, Morarji Desai National Institute of Yoga, New Delhi 10
11 11
12 Program Co‑ordinator, ACYTER, JIPMER, Puducherry ‑ 605 006, India. 12
13 E‑mail: ananda@icyer.com 13
14 14
15 15
16 ABSTRACT 16
17 Background: Yogic practices may aid in the prevention and management of diabetes mellitus (DM) and reduce cardiovascular 17
18 complications in the population. The present study has been undertaken to evaluate the effect of yoga therapy on reaction 18
19 time, biochemical parameters and wellness score of peri and post‑menopausal diabetic patients. 19
20 Materials and Methods: 15 peri and post‑menopausal patients receiving standard medical treatment for type 2 DM were
20
21 recruited and reaction time and biochemical investigations were done before and after a comprehensive yoga therapy program
21
22 comprising of three times a week sessions for six weeks. A post‑intervention, retrospective wellness questionnaire compiled
22
23 by ACYTER was used to evaluate the comparative feelings of the patients after the therapy program.
23
24 24
25 Results: Yoga training reduced auditory reaction time (ART) from right as well as left hand, the decrease being statistically 25
26 significant (P<0.05) for ART from the right hand. There was a significant (P<0.01) decrease in fasting and postprandial 26
27 blood glucose levels as well as low density lipoprotein. The decrease in total cholesterol, triglycerides, and very low density 27
28 lipoprotein and increase in high density lipoprotein was also statistically significant (P<0.05). All the lipid ratios showed desirable 28
29 improvement with a decrease (P<0.01) of TC/HDL and LDL/HDL ratios and increase (P<0.05) in the HDL/LDL ratio. 29
30 Discussion: Shortening of RT implies an improvement in the information processing and reflexes and is the first such report in 30
31 diabetic patients. This has clinical significance and is worth further exploration with wider, well controlled, randomized studies in 31
32 the diabetic population. Changes in blood glucose levels may be due to improved insulin sensitivity, decline in insulin resistance 32
33 and increased sensitivity of the pancreatic b cells to glucose signals. Yoga improved the ‘heart friendly’ status of lipid profile in 33
34 our subjects and as our participants were peri and post‑menopausal, the decrease in cardiovascular risk profile is of greater 34
35 significance. A comprehensive yoga therapy program has the potential to enhance the beneficial effects of standard medical 35
36 management of diabetes mellitus and can be used as an effective complementary or integrative therapy program. 36
37 Key words: Diabetes mellitus; lipid profile; peri‑menopausal; post‑menopausal; reaction time; yoga therapy. 37
38 38
39 39
40 40
41 INTRODUCTION consistent physiological changes and have sound scientific 41
42 basis.[2] Yogic lifestyle modification produces remarkable 42
43 The role of yoga in promoting health and preventing and improvements and can make an appreciable contribution 43
44 managing psychosomatic disorders has been established to primary prevention as well as management of lifestyle 44
45 by numerous scientific studies.[1] Yogic techniques produce diseases.[3] 45
46 46
47 Access this article online It is now recognized that diabetes mellitus (DM) is a 47
48 Quick Response Code lifestyle and psychosomatic disorder in which factors such 48
49 Website: as sedentary habits and physical, emotional and mental 49
www.ijoy.org.in
50 stress play a major role. Modern research has focused on 50
51 psycho‑physiological beneficial effects of yoga as it is more 51
52 DOI: than a mere physical exercise.[4‑8] It has been reported that 52
53 *** even a short lifestyle modification and stress management 53
54 education program based on yoga reduces risk factors for 54
10 International Journal of Yoga  Vol. 5  Jan-Jun-2012

Madanmohan, et al.: Yoga on peri and post‑menopausal diabetics
1 cardiovascular disease and DM within a period of 9 days[9] tested before and after the six‑week study period. 1
2 while a systematic review of 32 articles published between 2
3 1980 and 2007 found that yoga interventions are generally Reaction time 3
4 effective in reducing body weight, blood pressure, glucose 4
5 level and high cholesterol.[10] Reaction time (RT)apparatus (Anand Agencies, Pune) was 5
6 used for the study. The instrument has a built‑in 4 digit 6
7 Yogic practices may have a role in prevention and chronoscope with a display accuracy of 1 ms. It features 7
8 management of diabetes and in co‑morbid conditions four stimuli, two response keys and a ready signal. Switch 8
9 like hypertension and dyslipidemia.[7] Long‑term yoga for selecting right or left response key for any stimulus is 9
10 practice is associated with increased insulin sensitivity and provided. Recordings were taken in an air‑conditioned 10
11 attenuation of negative relationship between body weight laboratory 2 h after a light breakfast. To avoid the effect 11
12 or waist circumference and insulin sensitivity.[11] With no of lateralized stimulus, visual and auditory signals were 12
13 appreciable side effects and multiple collateral benefits, given from the front of the subject who was instructed to 13
14 yoga is safe, is simple to learn and can be practiced by even use his right hand first and then left hand while responding 14
15 ill, elderly or disabled individuals.[4] Being safe, simple and to the signal. In the present study, auditory reaction time 15
16 economical therapy, it should be considered as a beneficial (ART) was recorded for auditory beep tone stimulus and 16
17 adjuvant for DM patients.[12] visual reaction time (VRT) for red light stimulus. The 17
18 subjects were instructed to release the response key as 18
19 A comprehensive review by Innes and Vincent[4] found soon as they perceived the stimulus. The signals were 19
20 beneficial changes in several risk indices, including given from the front of the subjects to avoid the effect 20
21 glucose tolerance, insulin sensitivity, lipid profile, of lateralized stimulus and they used their dominant 21
22 anthropometric characteristics, blood pressure, oxidative hand while responding to the signal.[14,15] All subjects 22
23 stress, coagulation profiles, sympathetic activation and were given adequate exposure to the equipment on two 23
24 pulmonary function, as well as improvement in specific different occasions to familiarize them with the procedure 24
25 clinical outcomes. They suggested that yoga may improve of RT measurement. This was done because RT is more 25
26 risk profiles in adults with non insulin dependent (NIDDM) consistent when subjects have had adequate practice.[16] 26
27 and may have promise for the prevention and management RT was obtained with an accuracy of 1 ms. More than ten 27
28 of cardiovascular complications in this population. trials were recorded and mean of three similar observations 28
29 was taken as a single value for statistical analysis. 29
30 Reduced ovarian function after menopause results in 30
31 adverse changes in glucose and insulin metabolism with Biochemical investigations 31
32 derangement of lipoprotein profile that is associated with 32
increased risk of cardiovascular disease.[13] The present Biochemical investigations were done at the Central Lab of
33 the institute where blood was drawn from an antecubital vein
33
34 study has been undertaken to evaluate the effects of a 34
comprehensive six week yoga therapy program on reaction in post‑absorptive state. On the day of the blood collection,
35 subjects were asked to abstain from yoga practice. Fasting
35
36 time, biochemical parameters and wellness score in peri 36
and post‑menopausal female diabetic patients. blood glucose (FBG), 2‑h postprandial blood glucose (PPBG)
37 and lipid profile including total cholesterol (TC), triglyceride
37
38 (TG), high density lipoprotein (HDL), low density lipoprotein
38
39 MATERIALS AND METHODS 39
(LDL) and very low density lipoprotein (VLDL) were
40 The present study has been conducted as part of a larger requisitioned and evaluated before and after the study period. 40
41 study on the effects of yoga therapy on DM that had been
41
42 accorded permission by the Research and Ethics Councils
42
Wellness questionnaire
43 of the institute. 15 female patients aged 36 – 63 years 43
44 (50.40 ± 2.47 SEM) receiving medical treatment for type 2 A post‑intervention, retrospective wellness questionnaire 44
45 DM at JIPMER were recruited for this study by accidental compiled by ACYTER was used to evaluate the comparative 45
46 sampling method and informed consent obtained from feelings of the patients after the therapy program. Five 46
47 them. None of the patients had previously engaged in different responses ranging from ‘worse than before’ up to 47
48 yoga practice. 11 of them were menopausal for more “complete relief/total satisfaction’ were utilized to evaluate 48
49 than a year and 4 were peri‑menopausal. 4 of them had various physical and psychological aspects of the patient’s 49
50 coexisting hypertension, 3 musculoskeletal disorders condition. The questionnaire was finalized in consultation 50
51 and 7 neurological disorders. Patients with history, signs with a 12 member team consisting of 3 eminent medical 51
52 and symptoms and/or laboratory reports suggestive of practitioners, 2 psychologists, 2 yoga experts, 2 eminent 52
53 nephrologic and ophthalmologic complications were yoga therapy consultants, 2 educationalists and one legal 53
54 excluded from the study. The following parameters were anthropologist. 54
International Journal of Yoga  Vol. 5  Jan-Jun-2012 11
1 Yoga therapy program Table 1: Sequence and duration of yoga techniques 1

2 practiced by our subjects 2
3 The patients had an initial consultation session at the Yoga technique Duration (min) 3
4 ACYTER Yoga OPD and were given yogic counseling Surya namaskar 10.0 4
and lifestyle modification advice. They then attended Tadasan 0.5
5 Parivritta trikonasan 1.0
5
6 the special sessions conducted at ACYTER for diabetes 6
Padahastasan 0.5
7 patients. A comprehensive yoga therapy program was Ardh‑kati‑chakrasan 1.0 7
8 imparted to the patients by qualified yoga instructors at Vakrasan 1.0 8
9 ACYTER for the duration of 60 min thrice a week for six Pashchimottanasan 0.5
9
weeks. The schedule is given in Table 1. Patients were Pavanamuktasan 2.0
10 Ardha halasan 0.5 10
advised to practice without over straining depending on
11 Bhujangasan 0.5 11
their individual capacity. There was 99.63% attendance
12 Dhanurasan 0.5 12
during the 18 directly supervised sessions. Patients were Viparitakarani 1.0
13 Chandranadi pranayam 2.0
13
also motivated to practice at home on other days. Of the
14 Pranav pranayam 4.0 14
15 patients, 5 reported a home practice of 4 days/week,
15 Nadi shuddhi 2.0 15
4 a practice 3 days/week and 2 practiced 2 days/week
16 Savitri pranayam 3.0 16
at home. One patient each reported that they practiced Kayakriya 10.0
17 5, 6, and 7 days/week at home while one reported they Shavasan 10.0
17
18 didn’t practice at home at all. Analysis of patient feedback Rest period in‑between practices 10.0 18
19 showed that the duration of home practice was 30 min for Total 60 min 19
20 9 patients, 60 min for 3 patients and 40 min for 2 patients. 20
21 Table 2: Effect of six weeks yoga therapy on visual
21
22 reaction time (VRT) and auditory reaction time (ART) from 22
23 right and left hands of type 2 diabetes mellitus patients 23
24 Data was assessed for normality using GraphPad InStat before (B) and after (A) the study period 24
25 and passed normality testing by Kolmogorov–Smirnov test. B A % change P value 25
26 Statistical analysis was done using Students t (paired) test VRT (ms) 26
Right hand 250.82 ± 7.42 241.07 ± 5.92 −3.89 0.1096
27 and P values less than 0.05 were accepted as indicating 27
Left hand 259.80 ± 7.72 251.44 ± 4.20 −3.22 0.1931
28 significant differences between pre and post‑intervention ART (ms) 28
29 data. Right hand 196.87 ± 9.25 178.04 ± 6.36 −9.56 0.0357 29
30 Left hand 193.31 ± 6.19 179.44 ± 5.03 −7.18 0.0583 30
31 RESULTS
Values are mean±SEM for 15 subjects
31
32 32
33 The results are given in Tables 2 and 3. Table 3: Effect of six weeks yoga therapy on fasting 33
34 blood glucose (FBG), postprandial blood glucose (PPBG), 34
total cholesterol (TC), triglycerides (TG), low density
35 Reaction time
lipoprotein (LDL), very low density lipoprotein (VLDL)
35
36 and high density lipoprotein (HDL) in patients of type 2 36
37 Yoga training decreased ART and VRT from both right 37
diabetes mellitus before (B) and after (A) the study period
and left hands. However, the decrease was statistically
38 B A % change P value 38
significant (P=0.0357) only for ART from the right hand
39 FBG (mg/dl) 160.07 ± 15.65 127.07 ± 10.24 −20.62 0.0035 39
(from 196.87 ± 9.25 to 178.04 ± 6.36 ms). The decrease in
40 PPBG (mg/dl) 244.20 ± 17.12 208.73 ± 16.07 −14.52 0.0012 40
ART from left hand from 193.31 ± 6.19 to 179.44 ± 5.03 ms TC (mg/dl) 161.24 ± 9.10 152.95 ± 7.17 −5.14 0.0161
41 41
was appreciable (7.18%) but missed statistical significance TG (mg/dl) 110.53 ± 10.56 99.60 ± 8.37 −9.89 0.0203
42 LDL (mg/dl) 96.53 ± 9.46 86.27 ± 7.78 −10.64 0.0012 42
(P=0.0583). The decrease in VRT from right as well as left
43 VLDL (mg/dl) 22.11 ± 2.11 19.95 ± 1.67 −9.77 0.0222 43
hand was not statistically significant [Table 2].
44 HDL(mg/dl) 42.60 ± 5.16 47.07 ± 5.08 +10.49 0.0229 44
TC/HDL 4.36 ± 0.46 3.60 ± 0.31 −17.37 0.0035
45 45
Biochemical investigations LDL/HDL 2.77 ± 0.40 2.15 ± 0.27 −22.41 0.0059
46 HDL/LDL 0.65 ± 0.21 0.77 ± 0.24 +19.13 0.0165 46
47 FBG decreased significantly (P=0.0035) by 20.62% Values are mean±SEM for 15 subjects 47
48 from 160.07 ± 15.65 to 127.07 ± 10.24 mg/dl. PPBG 48
49 also decreased significantly (P=0.0012) by 14.52% from in LDL from 96.53 ± 9.46 to 86.27 ± 7.78 mg/dl (P=0.0012) 49
50 244.20 ± 17.12 to 208.73 ± 16.07 mg/dl. There was a and a significant (P=0.022) 9.77% decrease in VLDL from 50
51 statistically significant (P=0.016) decrease in TC from 22.11 ± 2.11 to 19.95 ± 1.67 mg/dl. On the other hand, 51
52 161.24 ± 9.10 to 152.95 ± 7.17 mg/dl (5.14%). The 9.89% HDL increased significantly (P=0.022) from 42.60 ± 5.16 52
53 decrease in TG from 110.53 ± 10.56 to 99.60 ± 8.37 mg/dl to 47.07 ± 5.08 mg/dl, an increase of 10.49%. There was a 53
54 was also significant (P=0.020) along with the 10.64% decrease significant (P=0.003) decrease of 17.37% in TC/HDL ratio 54

1 from 4.36 ± 0.46 to 3.60 ± 0.31, a significant (P=0.005) results of the total overall retrospective wellness scores 1
2 decrease of 22.41% in LDL/HDL ratio from 2.77 ± 0.40 to indicated that 7% attained complete relief and total 2
3 2.15 ± 0.27. There was a significant (P=0.016) increase of satisfaction after the therapy program while 27% were 3
4 19.13% in the HDL/LDL ratio from 0.65 ± 0.21 to 0.77 ± 0.24. much better than before. 42% were better than before while 4
5 23% reported no change in their condition. The condition 5
6 Wellness questionnaire of 1% was worse than before. 6
7 7
8 The post‑intervention overall wellness scores of the 8
DISCUSSION
9 participants are given in Figure 1 and the detailed breakup 9
of % responses to each question is given in Table 4. The In an earlier work, we have reported that diabetic patients
10 10
11 have a longer RT as compared to normal subjects.[14] In the 11
12 present work, we have demonstrated that a comprehensive 12
13 six‑week yoga therapy program produces a significant 13
14 shortening in ART in diabetic patients. To the best of 14
15 our knowledge, this is the first such report. Shortening 15
16 of RT can be explained by increase in sensory‑motor 16
17 conduction velocity and/or faster information processing 17
18 in the central nervous system.[17] This has physiological 18
19 as well as clinical significance as faster RT means better 19
20 performance of sports personnel, precision surgeons and 20
other professionals. Here, it is interesting to note that we
21 21
have previously reported an immediate shortening of RT
22 22
following the practice of nine rounds of mukha bhastrika,
23 23
a bellows type of yoga breathing.[18]
24 24
25 25
26 Fasting as well as post‑prandial blood glucose levels 26
Figure 1: Post‑intervention overall % responses of the participants to the
27 decreased significantly in our subjects following the 27
wellness questionnaire
yoga therapy program. This is consistent with earlier
28 28
Table 4: Post‑intervention % responses of the studies that have reported that yoga training results in a
29 29
participants to retrospective wellness questionnaire reduction in both FBG and PPBG levels and better glycemic
30 30
Worse Same Better Much Complete control.[8,19] The 20.62% reduction in FBG in our subjects
31 than as than better relief/
31
is comparable with the 6.1‑34.4% reduction reported in
32 before before before than totally 32
a review of 25 studies on yoga and diabetes by Innes and
33 before satisfied 33
Vincent.[4] Sahay[7] has reported an improvement in insulin
34 Ability to concentrate ‑ 28.57 50 21.43 ‑ 34
Control of anger/loss ‑ 35.71 28.37 28.57 7.14 sensitivity and decline in insulin resistance in subjects
35 of temper
35
practicing yoga while Manjunatha et al.,[20] reported that the
36 Appetite ‑ 33.33 25 25 16.67 performance of asanas leads to an increased sensitivity of
36
37 Confidence level ‑ 28.57 42.86 21.43 7.14
the b cells of pancreas to glucose signals. It is possible that
37
38 Ease of breathing ‑ 26.67 40 26.67 6.67
a similar mechanism is responsible for the improvements
38
Energy levels ‑ 33.33 33.33 33.33 ‑
39 Enjoyment of life ‑ 20 60 6.67 13.33 in blood sugar levels of our subjects. Increased sympathetic 39
40 Feeling calm and fresh ‑ 33.33 33.33 26.67 6.67 activity, enhanced cardiovascular reactivity and reduced 40
41 Feeling of hopelessness ‑ 40 40 20 ‑
parasympathetic tone have been strongly implicated 41
42 Feeling of loneliness ‑ 6.67 60 33.33 ‑
in the pathogenesis of insulin resistance syndrome, 42
General flexibility ‑ 13.33 53.33 26.67 6.67
43 General mood ‑ 8.33 50 33.33 8.33 atherosclerosis and cardiovascular diseases. Innes and 43
44 General sense of ‑ 14.28 50 28.57 7.14 Vincent[4] have suggested that yoga reduces this risk 44
45 relaxation profile by decreasing activation of the sympatho‑adrenal 45
46 General wellbeing ‑ 7.69 38.46 53 ‑
system and the hypothalamic‑pituitary‑adrenal axis and 46
Joint mobility ‑ 13.33 40 33.33 13.33
47 Nervousness ‑ 28.57 57.14 14.29 ‑ also by promoting a feeling of wellbeing along with direct 47
48 Normality of menstrual ‑ 25 25 ‑ 50 enhancement of parasympathetic activity via vagus nerve. 48
49 cycles They also suggested that yoga provides a positive source of 49
50 Pain levels ‑ 13.33 53.33 26.67 6.67
social support that is a factor associated with reduced risk 50
Performance of ‑ 21.43 42.86 35.71 ‑
51 day‑to‑day activities for cardiovascular diseases. All these factors are applicable 51
52 Sleep quality/duration 13.33 20 26.67 40 ‑ to our study and may explain the positive changes 52
53 Stress levels 9.09 27.27 36.36 27.27 ‑ produced following the adherence to the comprehensive 53
54 Total wellbeing score 1.07 22.80 42.19 26.76 7.13 yoga therapy program. 54
1 The significant decreases in TC, TG, LDL and VLDL It has been reported that a short lifestyle modification 1
2 values coupled with significant increase in HDL in our and stress management educational program leads to 2
3 participants imply an improved lipid profile having good remarkable improvement in the subjective wellbeing 3
4 prognostic value. This decrease of ‘bad’ cholesterol and a scores and can therefore make an appreciable contribution 4
5 concomitant increase in ‘good’ cholesterol has significance to primary prevention as well as management of lifestyle 5
6 when viewed in light of the cardiovascular risk profile of diseases.[3] Majority of our patients reported an improvement 6
7 diabetic patients.[4] It has been previously reported that in appetite, ability to concentrate, control anger, confidence 7
8 hatha yoga exercise and conventional PT exercise may have levels, ease of breathing, energy level, enjoyment of life with 8
9 preventative and protective effects on DM by decreasing calm and fresh feeling [Table 4 and Figure 1]. They also 9
10 oxidative stress and improving antioxidant status. [21] reported a reduced feeling of hopelessness, nervousness 10
11 A similar mechanism may be working in our patients as a and loneliness. They reported improvements in general 11
12 systematic review also found the effects of yoga training flexibility and joint mobility along with better general 12
13 to be more prominent with regard to fasting blood glucose mood, sense of relaxation and wellbeing. Menstrual 13
14 level and lipid profile.[22] Innes and Vincent[4] reported cycles normalized in all four patients who were pre and 14
15 that all 12 studies reviewed by them suggested that yoga peri‑menopausal. There was a decrease in stress levels 15
16 improves lipid profile. Reductions in TC, TG, and LDL, with improved quality and duration of sleep. This is 16
17 VLDL and increase in HDL in our subjects are comparable similar to a recent report that yoga improves psychological 17
18 with the findings of their review. Upon analysis of the outcomes in type 2 diabetes patients with improved well 18
19 different relative cholesterol ratios, it is apparent that being and reduced anxiety.[24] Yoga may be improving 19
the yoga therapy program improved the ‘heart friendly’ mental and emotional components of the personality and
20 20
status of lipid profile in our subjects. Normally the ‘safe’ subjective well being reported by our participants may be
21 21
TC/HDL ratio should be less than 4. This was initially a contributing psycho‑physiological factor in the desirable
22 22
4.36 ± 0.46 in our patients and after the six‑week therapy improvements shown by our patients. This aspect needs
23 23
program decreased by 17.37% to a safe level of 3.60 ± 0.31. further exploration. Interestingly, one participant who didn’t
24 24
A healthy LDL/HDL ratio should be less than 3. Though practice at home reported that there was an increase in her
25 25
the initial pre‑training level in our subjects was a higher medication while the one who practiced every day at home,
26 normal value it also reduced by 22.41% to a lower normal reported that her medication had reduced. Though both had
26
27 value. HDL/LDL ratio should normally be more than 0.3 reported improvements in the well being questionnaire,
27
28 but it is preferable to maintain it above 0.4. This also responses of the one who practiced every day were in the
28
29 increased by 19.13% to a higher normal value implying range of ‘much better’ to ‘total relief’ while responses of the 29
30 better prognosis of cardiovascular health. other one were mainly in the ‘same’ to ‘better’ range. 30
31 31
32 32
Malhotra et al., [8] reported a significant decrease in The potential benefits being contributed by the different
33 waist‑hip ratio and changes in insulin levels, suggesting a practices in our study may be hypothesized as follows.
33
34 positive effect of yoga asanas on glucose utilization and fat Surya namaskar improves metabolic function, helping in
34
35 redistribution in NIDDM. This is applicable in the present utilizing excess glucose while toning up the musculoskeletal 35
36 work as most of the practices used in both studies are the system. Tadasan evokes a sense of stability and balance both 36
37 same or of similar nature. In light of the above findings, physically and mentally while asanas such as parivritta 37
38 our study reiterates the conclusion made by Innes and trikonasan, padahastasan, ardha‑kati‑chakrasan, vakrasan, 38
39 Vincent that yoga may improve risk profiles in adults paschimottanasan, pavanamuktasan, bhujangasan and 39
40 with NIDDM and has promise in preventing and managing dhanurasan by their twisting and compression‑relaxation 40
41 cardiovascular complications in this population.[4] actions may be stimulating intra‑abdominal organs such 41
42 as liver and pancreas thus producing benefits in the 42
43 The findings of an improved lipid profile status is lipid profile. Ardha halasan and viparitakarani may be 43
44 especially important in our study as 11 of the participants harmonizing psycho‑neuro‑endocrine function as seen 44
45 were postmenopausal while the other 4 were pre and in reaction time while chandranadi pranayam may be 45
46 peri‑menopausal. Loss of ovarian function after menopause normalizing autonomic balance. Pranav pranayam, nadi 46
47 results in adverse changes in glucose and insulin metabolism shuddhi and savitri pranayam may contribute toward a 47
48 with derangement of lipid profile that is associated with sense of calmness that enhances inherent healing potentials 48
49 increased risk of cardiovascular disease.[13] It has also been while kayakriya and shavasan create a sense of mind‑body 49
50 reported that heart disease increases 5 times in females who harmony that corrects the psycho‑somatic component of DM. 50
51 have DM and that the ‘female advantage’ over men with regard 51
52 to coronary heart disease is lost after menopause.[23] Hence The main strength of present study is the excellent 52
53 the positive changes in lipid profile in our peri‑menopausal compliance and regularity of the yoga practice by the 53
54 diabetic subjects have great significance. patients both during the directly supervised sessions 54

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4 obtained can be attributed to the dedicated and regular 4
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19 19
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20
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Effect of yoga on cardiorespiratory functions.
*Giriwar Singh Gaur, *Madanmohan, **Ananda Balayogi Bhavanani and *Senthil Kumar
Subramanian.
*Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research,
Pondicherry - 605 006.
**Advanced Center for Yoga Training, Education and Research, Jawaharlal Institute of Postgraduate
Medical Education and Research, Pondicherry - 605 006
(Received: 18.01.2013 Revised: 07.04.2013 Accepted: 23.04.2013)
Corresponding Author
Dr. Giriwar Singh Gaur. Email : drgsgaur@yahoo.com Mobile : 09994470395
Abstract
Purpose: Yoga has a sound scientific basis and is an ideal and holistic tool for improving total health of our
masses. To further evaluate the effectiveness of yogic techniques, the present work was planned to study
the effect of yoga training on cardio-respiratory functions of normal young volunteers.
Methods: 15 healthy male (18-20 year) were given 10 week yoga training that included asanas (including
shavasan) and pranayams. Blood pressure, heart rate and respiratory parameters were recorded before
and after 10 week yoga training.
Results: Yoga training produced a significant decrease in resting blood pressure, heart rate and rate-
pressure product, indicating a reduction in load on the heart. This supports the view that yoga has a
cardio-protective role. Yoga training produced a significant increase in respiratory pressures and 40
mmHg endurance indicating that yoga training improves the strength of expiratory as well as inspiratory
muscles and cardio-respiratory endurance. Breath holding times also increased significantly after yoga
training.
Conclusion: The present study has shown that 10 week yoga training improves cardio-respiratory
functions in normal young volunteers.
Key words: Yoga, cardiorespiratory function, MIP, MEP, rate-pressure product.
Introduction To make yoga popular among the masses, it has to be
put on a firm scientific footing. There is evidence that
Y oga, a mind body technique is a scientific

philosophical discipline that involves
physical exercises performed in sync with
breathing, awareness and relaxation. Yoga improves
human performance and the physiological and
yoga produces consistent physiological changes and
has sound scientific basis (5 & 6). However, there is
need and great scope for further research on the
scientific basis and physiological aspects of yoga.
psychological benefits of yoga have been well Keeping this in mind, the authors planned to
documented (1-4). Practice of yoga leads to efficient undertake systematic research on the physiological
functioning of the body through improved basis of yoga. In the present project, the effect of yoga
functioning of psycho neuro immune endocrine axis training on cardiorespiratory functions of normal
and improved homeostasis. An equilibrium between young volunteers were studied.
sympathetic and parasympathetic wings of Materials and Methods
autonomic nervous system results in perfect health The present study was conducted on 15 healthy male
and dynamic homeostasis. The nervous system and volunteers. Their age was 18-20 years, height 155-
endocrine axis is re-oriented, leading to modulation 171 cm and weight 50-63 kg. History and clinical
of the functioning of other organ systems. examination did not reveal any abnormality. All the
boys were non athletes and gave no history of as long as possible. The time (in seconds) for which
substance abuse. After briefing them about the study the subject could maintain the mercury level at 40mm
protocol and purpose of the study, informed written was noted. BHTexp was determined by noting the
consent was obtained from them. Two days before maximum time (in seconds) for which the subject
the recordings were taken; the subjects were could hold his breath after breathing out fully.
familiarized with the laboratory environment. On the Similarly, BHTins was determined after taking in a full
day of the testing, the subject reported at Dept. breath. It was ensured that the subjects did not make
Physiology laboratory, JIPMER at 9 AM, about 2 any chest or abdominal movements during breath
hours after a light breakfast. holding.
The following parameters were recorded: After recording the baseline control measurements,
1. Blood pressure (BP) the subjects were given yoga training with practice
2. Heart rate (HR) sessions of 30 minutes, Monday through Friday for a
3. Maximum Expiratory Pressure (MEP) total duration of 10 weeks under the author's direct
4. Maximum Inspiratory Pressure (MIP) supervision. The practice schedule sequence and
5. 40 mmHg endurance test duration is given in Table 1. All the measurements
described above were repeated after the 10 weeks
6. Breath holding time after expiration (BHTexp)
yoga training program.
7. Breath holding time after inspiration (BHTins)
Statistical analysis: The pre and post training data
After 15 minutes rest in the laboratory, BP was were subjected to statistical analysis using student's
measured by auscultator method using a 't' test. p value of less than 0.05 was considered as
sphygmomanometer. Systolic pressure (SP) was indicating statistically significant difference between
taken at the point of appearance of regular Korotkoff the compared values.
sounds. Diastolic pressure (DP) was taken at the
point of disappearance of the sound. Pulse pressure Results and Discussion
was calculated as the difference between systolic The results are given in Table 2. The yoga training
pressure and diastolic pressure. Mean pressure (MP) given to the subjects was adequate to produce
was calculated using the formula: MP = DP + 1/3 PP. significant changes in the parameters studied. There
Rate-pressure product (RPP) was calculated from the was a significant fall in both systolic and diastolic
formula: RPP = HR x SP x 10-2. Double product blood pressure. A decrease in DP after yoga training
(DoP) was calculated using the formula: DoP = HR x has been reported by Ray et. Al., who have explained
MP. Three blood pressure and HR measurements this on the basis of a decrease in sympathetic activity
were taken at one minute intervals and the lowest of as a result of yoga training (7). This study subjects felt
similar three values were included for calculation. fresh and relaxed after yoga training is in agreement
HR was measured by palpation at the wrist. MEP was with the earlier observations that yoga training
determined by asking the subjects to take in a full produces deep psychosomatic relaxation (8). This
breath and blow against a mercury column and effect can be attributed to the decrease in the
maintain it at the maximum level for about 3 seconds. frequency and intensity of the nerve impulses
MIP was determined by asking the subjects to breathe reaching the brain areas from proprioceptors and
out fully and then perform maximum inspiratory enteroceptors. Tolley et. Al., found significantly
effort against the mercury column. MIP that could be higher plasma melatonin levels in experienced
maintained for about 3 seconds was noted. 40 mmHg mediators. This was found to be significantly
endurance test was conducted by asking the subjects correlated with the well-being score (9). These
to take in a full breath and blow against the mercury observations suggest that yogic practices can be used
column so as to maintain a pressure of 40 mmHg for as psychophysiologic stimuli to increase the
endogenous secretion of melatonin, which in turn have found that yoga training brings about an
might be responsible for improved sense of well- optimization of sympathetic response and restoration
being. Decrease in the secretion of stress hormones of autonomic regulatory reflex mechanisms (15).
like cortisol also contributes to health benefits of Thus it is clear that practicing yoga brings about a
yoga. balance and optimization of autonomic functions.
There was a significant fall in MP, but the pulse MEP, MIP and 40 mmHg endurance test all showed
pressure remained same. This is very important as significant increase after the yoga training. This goes
yoga practice can maintain the tissue perfusion even hand in hand with the previous study by the author
at low MP. This puts less effort on the heart. HR was himself (16). Joshi et. al., also have reported that a six
also decreased significantly. This decrease in MP and week pranayam training course improves pulmonary
HR can be explained on the basis of yoga training- functions (17). Evaluation of the strength of
induced decrease in sympathetic activity. RPP is an inspiratory as well as expiratory muscles has
index of myocardial oxygen consumption and load physiological as well as clinical significance.
on the heart (10). After yoga training, the RPP and Maximum respiratory pressures are specific indices
DoP decreased significantly (P < 0.001) which is of respiratory muscle strength. They are sensitive
consistent with the previous studies done by indices since their values can be altered even when
Madanmohan et. Al., (11). A decrease in RPP after there is little abnormality in other commonly
yoga training indicates that the normal load and work performed pulmonary function tests. An earlier study
done by the heart is less after yoga training (10). has reported that the highest MEP is obtained at lung
Although Bhattacharya and Krishnaswami have volumes of >70% of total lung capacity whereas the
concluded that yoga training does not produce any highest MIP is obtained at lung volumes nearer to the
marked effect on the physiological parameters of the functional residual capacity also have reported a
subjects, there are several reports of beneficial effect similar dependence of respiratory muscle strength on
of yoga training on physiological functions (12). lung volumes (18 & 19). The increase in MEP as well
Bera and Rajapurkar have reported that yoga training as MIP in the subjects indicates that yoga training
results in significant improvement in cardiovascular improves the strength of expiratory as well as
endurance and anaerobic threshold (13). This is inspiratory muscles. Functionally, respiratory
consistent with the findings of Muralidhara and muscles are like skeletal muscles. Asanas involve
Ranganathan, that yoga training improves physical isometric contraction which is known to increase the
efficiency as indicated by significant increase in skeletal muscle strength. Practice of pranayams and
cardiac recovery index measured by Harvard Step mukhbhastrika along with asanas can explain the
test (14). A reduction in blood pressure, HR and load improved strength of respiratory (inspiratory as well
on the heart by yoga training has physiological as expiratory) muscles which in turn results in
significance as well as clinical applications. These significant increase in respiratory pressures. A
studies support the view that yoga has a cardio significant increase in 40 mmHg endurance test of
protective role. After yoga training, a given level of the subjects is an indication of improved cardio-
exercise produces a much less cardiovascular respiratory endurance. This study findings support
response, suggesting an improved exercise tolerance. the observations of Ray et. al., who have reported that
Reduction in exercise-induced stress on yoga training increases muscular endurance delays
cardiovascular system has physiological significance the onset of fatigue and enables one to perform work
as well as clinical applications. The improved at lesser VO2max (7 & 20).
cardiovascular response induced by yoga training
Breath holding time after both inspiration and
indicates a state of parasympathetic dominance. In an
expiration has increased significantly. This study
interesting study from this laboratory, the authors
result do not agree with the finding of Gopal et. al.,
who have reported a lower breath holding time in Table 2. Effect of 10 weeks of yoga training on
yoga trained subjects (21). However, the results are in cardio-respiratory functions.
agreement with those of Nayar et. al., (1975) who Parameters Before After
have reported a significant increase in breath holding
Systolic pressure 117.20 ± 4.20 111.60 ± 3.94***
time after yoga training (22). In the subjects, breath
(mmHg)
holding time after inspiration was longer than breath
Diastolic pressure 71.33 ± 5.59 61.33 ± 5.78***
holding time after expiration. It is well known that
(mmHg)
breath holding time depends on the initial lung
Pulse pressure 45.87 ± 3.58 46.13 ± 5..32
volume. At greater lung volumes, the amplitude and
(mmHg)
frequency of voluntary contractions of respiratory
Mean pressure 86.62 ± 4.88 80.84 ± 4.60**
muscles is less. As a result, the discomfort of breath
(mmHg)
holding is less (23 & 24). During the practice of
Heart rate 71.40 ± 2.09 66.60 ± 3.79***
pranayam, the subject consciously tries to override
(beats/min)
the stimuli to respiratory centers, thus enhancing the
Rate pressure 83.69 ± 4.60 74.39 ± 5.89***
control over respiration. This, along with improved
product (units)
cardio-respiratory endurance can explain the
Double product 61.84 ± 4.12 53.88 ± 4.76***
prolongation of breath holding time in our yoga
(units)
trained subject.
Maximum 93.27 ± 16.07 119.46 ± 24.66**
Table 1. Sequence and duration of yoga expiratory pressure
techniques practiced by the subjects. (mmHg)
Yoga techniques Duration Maximum 72.93 ± 10.37 89.20 ± 28.11*
(min) inspiratory pressure
(mmHg)
1. Mukhbhastrika 0.5 40 mmHg 35.20 ± 10.63 54.20 ± 13.08***
2. Bandhtrayam 0.5 endurance
3. Pavanmuktasan 0.5 Breath holding 30.13 ± 9.65 45.07 ± 8.92***
4. Navasan 0.5 after expiration
5. Noukasan 0.5 (seconds)
6. Makarasan 0.5 Breath holding 58.00 ± 14.82 84.67 ± 7.05***
7. Bhujangasan 0.5 after inspiration
8. Shalabhasan 0.5 (seconds)
9. Dhanurasan 0.5 Values expressed in Mean ± SD.
10. Yog mudra 0.5 *p<0.05,**p<0.01,***p<0.001.
11. Ardh-matsyendrasan 1.0 Analysis done using students paired 't' test.
12. Pashchimottanasan 0.5
13. Ardh-kati-chakrasan 1.0 Conclusion
14. Trikonasan 1.0 Yoga training produced a significant decrease in
15. Hast-utthanasan&Padahastasan 1.0 resting BP, HR and RPP indicating a reduction in load
16. Viparitakarani 0.5 on the heart. This supports the view that yoga has a
17. Sarvangasan 0.5 cardio-protective role. Yoga training produced a
18. Matsyasan 0.5 significant increase in respiratory pressures and 40
19. Vrikshasan 1.0 mmHg endurance indicating improved strength of
20. Shavasan 8 expiratory as well as inspiratory muscles and cardio-
21. Pranayam 10 respiratory endurance. Breath holding times also
Total 30 increased after yoga training. The present study has
shown that 10 week yoga training significantly 11. Madanmohan, Udupa K., Bhavanani A. B., Shatapathy C.
improves cardiorespiratory function in normal young C., Sahai A., "Modulation of cardiovascular response to
exercise by yoga training", Indian J. Physiol. Pharmacol.,
healthy volunteers. 2004; 48(4): 461-465.
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exercise", Armed forces Med. J., 1960; 16: 222-228.
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that is consistent with Indian culture and traditions. It cardiovascular endurance and anaerobic power of yogic
is recommended that yoga can be introduced as a practitioner", Indian J. Physiol. Pharmacol., 1993; 37(3):
225-228.
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Babu K., "Modulation of stress induced by isometric
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16. Madanmohan, Mahadevan S. K., Balakrishnan S.,
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Original Article
A comparative study of the effects of asan, pranayama and

asan-pranayama training on neurological and neuromuscular
functions of Pondicherry police trainees
Madanmohan Trakroo, Ananda Balayogi Bhavanani1, Gopal Krushna Pal2, Kaviraja Udupa3, Krishnamurthy N4
Department of Physiology, Mahatma Gandhi Medical College and Research Institute, 1Advanced Centre for Yoga Therapy, Education,
and Research, 2Department of Physiology and Advanced Centre for Yoga Therapy, Education, and Research, Jawaharlal Institute of
Postgraduate Medical Education and Research, 4Department of Physiology, Pondicherry Institute of Medical Sciences, Pondicherry, India,
3
Department of Medicine, Division of Neurology, University of Toronto, Toronto Western Research Institute, Ontario, Canada

Advanced Centre for Yoga Therapy, Education and Research,
Jawaharlal Institute of Postgraduate Medical Education and Research,
Pondicherry - 605 006, India.
ABSTRACT
Background: Though neurological benefits of yoga training have been reported, lacunae still exists in understanding
neurophysiological effects of such training. Hence, the present study was conducted to find the effect of yogasanas and
pranayams on neurological and neuromuscular functions in healthy human volunteers and also determined differential effects
of training in asan, pranayama and their combination.
Materials and Methods: Eighty male trainees from Pondicherry Police Training School were randomly divided into asan,
pranayama, and asan-pranayama groups who received a training of 4 days a week for 6 months and a control group.
Electroencephalogram (EEG), nerve conduction (NC), electromyogram (EMG), visual evoked potentials (VEP), and auditory
reaction time (ART) were recorded before and after the study period. NC, EMG, and VEP data were obtained from 28 subjects;
EEG data from 48 subjects; and RT from 67 subjects. Intergroup differences were assessed by AVOVA/Kruskal–Wallis and
intragroup differences by Student’s t-test.
Results and Discussion: Police trainees showed beneficial effects of yoga training, although they were undergoing intensive
police training and the yoga training was relatively less intense. Alpha, theta, and total power of EEG increased as a result of
asan training. A shortening of visual reaction time and a decrease in red-green discriminatory reaction time signifies an improved
and faster processing of visual input. They also showed a decrease in resting EMG voltage, signifying better muscular relaxation
following pranayama training. Beta, theta and total power of EEG increased. ART and red-green discriminatory reaction times
decreased in the trainees, signifying a more alert state as well as improved central neural processing. A combination of asan
and pranayama training for 6 months produced an improvement in motor and sensory nerve conduction. Total power of EEG,
alpha and theta power as well as delta % increased, while reaction time decreased signifying an alert and yet relaxed state
of the neuromuscular system.
Summary and Conclusion: The present study has shown that 6 months training in asan, pranayama as well as their combination
is effective in improving physiological functions of police trainees. They showed beneficial effects of yoga training, although
they were undergoing intensive police training and the yoga training was relatively less intense. Hence, we recommend that
yoga training be introduced in police training curricula.
Key words: Asan-pranayama; neurophysiology; police trainees; yoga training.
Access this article online INTRODUCTION

Quick Response Code
Website: Yoga is the ancient heritage of India that has given man the
www.ijoy.org.in answers to his spiritual and holistic search for perfect health
and well-being. It is an effective and time-tested method
DOI:
for improving overall health and managing psychosomatic
10.4103/0973-6131.113398 and chronic degenerative disorders. Recently, there has
been an increased awareness and interest in health and

Trakroo, et al.: Yoga on neurological and neuromuscular functions
natural remedies amongst the general public as well as public, we planned to undertake a systematic study on the
health professionals. effect of different yogic techniques on neurophysiological
functions.
Numerous scientific studies from Jawaharlal Institute of
Postgraduate Medical Education and Research (JIPMER) and The aims and objectives of the present study were:
other laboratories all over the world have shown that yoga 1. To study the effect of yogasanas and pranayamas on
has beneficial effect on our physiological and psychological neurological and neuromuscular, functions in healthy
functions.[1-5] There is evidence that pranayama training human volunteers.
produces deep psychosomatic relaxation and improvement 2. To determine the differential effects of training in asan,
of cardiorespiratory efficiency.[6,7] This improvement could pranayama and their combination.
be either peripheral (heart and lung physiology) or central
(brain regulation of these functions by autonomic nervous MATERIALS AND METHODS
system). Raghuraj et al.[8] have found that practice of
nadishuddhi pranayama results in alteration of autonomic Subjects
balance towards the parasympathetic side whereas bellows
Eighty male trainees aged 24.82 ± 3.20 (SD) of Pondicherry
type pranayama like kapalabhati increases the sympathetic
Police in the Police Training School, Indra Nagar,
activity. Ramamurthi[9] has suggested that yoga training might
Pondicherry were recruited for the present study. Their
help to achieve voluntary control over medullary autonomic
height, weight, and BMI were 1.72 ± 1.16 m, 67.18 ± 6.17 kg,
centers to achieve supernormal functions. The neurological
and 23.06 ± 1.97 units, respectively. The institutional ethics
benefits of yoga have interested scientists all over the world
committee approved the study protocol. All the subjects
and studies have reported beneficial effects in both peripheral
gave informed consent. Exclusion Criteria: (i) Previous
nerve function as well as central neuronal processing.[10-14]
experience of yoga training. (ii) History of major medical
illness in the past, for example, tuberculosis, hypertension,
Modern life is full of stress and stress-related disorders are diabetes mellitus, bronchial asthma, etc. (iii) History of
rampant in today’s world. The very existence of mankind is major surgery in the recent past. (iv) Color blindness.
threatened by new epidemics of stress-related disorders that
disrupt human life. Yoga is the panacea for modern stress Training
epidemics and has been demonstrated to be an answer to
stress and stress-related disorders.[15] The yogic lifestyle, Subjects were randomly divided into the following groups:
yogic diet, yogic attitudes, and various yogic practices help Group I (asan group): The subjects were taught the
man to strengthen his body, mind, and develop positive following yogasanas for two weeks under the guidance of
health. Yoga enables us to withstand stress by normalizing a qualified yoga teacher: Talasana, utkatasana, trikonasana,
the perception of stress, optimizing the reaction to it, and ardha-matsyendrasana, bakasana, pavanamuktasana,
by effectively releasing the pent-up stress through various navasana, noukasana, matsyasana, pashchimottanasana,
yogic techniques. Yoga has various facets and the main halasana, bhujangasana, shalabhasana, sarvangasana and
techniques that are useful for modern man are hatha shavasana.[16,17]
yogasanas, pranayamas and meditation. These are most
effective when performed consciously and with awareness. Group II (pranayama group): The subjects were trained to
perform the following pranayamas: Vibhag pranayama,
Yogasanas help to develop strength, flexibility, willpower, mukh bhastrika, mahat-yoga pranayama, nadi shuddhi
good health, and stability; and when practiced as a whole and savitri pranayama. After 2 weeks of training, they
with the other limbs of yoga, they give the practitioner a practised the same under supervision for an hour daily
‘stable and unified strong personality’. Yoga pranayamas 4 days a week, for a total duration of 6 months.[16,17]
help us to control our breath and through this breath
control to attain the mental poise or samatvam (Bhagavad Group III (asan-pranayama group): The subjects were
Gita). Regulated slow, deep, and rhythmic breathing is taught a combination of all the practices that were taught
ideal for controlling stress and in overcoming emotional to group I and group II.
hang-ups. However, to the best of our knowledge, there is
no systematic study quantifying modulation of stress and Group IV (control group): The subjects of this group did
related neurophysiological functions with the practice of not receive any yoga training. They were asked to continue
yoga for 6 months. Also, there are still many lacunae in their regular activities throughout the period of the study.
our understanding of the neurophysiological basis of yogic
techniques and the mechanisms of their action. To shed Parameters
more light on these phenomena as well as to put yoga on a
firm scientific pedestal and popularize it among the general Two or three days before actual recordings, the subjects

were familiarized with the laboratory environment and wrapped around the wrist. Distal latency was recorded
their anthropometric measurements were taken. On the day by stimulating median nerve, 8 cm proximal to the active
of the test, subjects reported at the laboratory 2 h after a electrode located between the palmaris longus and flexor
light breakfast. The laboratory temperature was maintained carpi radialis tendon. Proximal latency was recorded by
at 27 ± 1°C. Subjects refrained from smoking, alcohol, and stimulating the median nerve at elbow, medial to the
caffeinated drinks on the morning of the test. None of them brachial artery. Distance between the two stimulating
were taking any medication at the time of the testing. cathodes was measured and the conduction velocity
1. Electroencephalogram (EEG) calculated by dividing this distance by the difference
2. Electrophysiological parameters: between proximal and distal latencies.
i. Nerve conduction (NC)
ii. Electromyography (EMG) Median nerve sensory conduction: The active and
iii. Visual evoked potentials (VEP) reference electrodes were placed 4 cm apart over the
3. Simple and choice reaction time (RT): middle finger of the dominant hand and the ground was
i. Auditory reaction time (ART) placed over the palmar aspect at wrist. The distal and
ii. Visual reaction time (VRT). proximal latencies were recorded by stimulating the
median nerve 14 cm proximal to the active electrode at
Due to the time consuming nature of the neurophysiological wrist and near brachial artery at elbow, respectively; and
testing, tight schedule of the labs that also cater to hospital the velocity was calculated by measuring the distance
patients, and the inability of the subjects to come more than between them.
twice, the actual number of subjects varied in the different
parameters. NC, EMG, and VEP data were obtained from
Electromyography: The surface EMG from frontalis muscle
28 subjects; EEG data from 48 subjects; and RT parameters
of the forehead and biceps of the dominant hand were
from 67 subjects. These parameters were recorded in all
studied. To evaluate the muscle relaxation and the muscle
the four groups at the beginning of the study and again at
strength, two surface electrodes were fixed on the muscle
the end of 6 month study period.
of the subject. EMG was recorded after 5 min supine rest
and during maximal voluntary contraction of the muscle.
Electroencephalogram The maximum amplitude of the raw EMG was determined.
Surface electrodes were fixed using an electrode cap on Mean values of the amplitude of the compound motor
the scalp of the subject according to 10-20 international action potential (CMAP) were compared before and after
electrode placement system. EEG recording was acquired yoga training.
continuously for 10 min (5 min eyes open followed by 5 min
eyes closed) using BIOPAC MP 100 hardware (BIOPAC Inc., Visual evoked potential (VEP): The visual evoked potential
USA). The spectral analysis of EEG of the right occipital study was performed according to the method adopted
area was performed using a Fast Fourier Transform (FFT) by Aminoff.[18] The recording electrode was placed at Oz
algorithm of the artifact-free epoch and the power spectra of as per the 10-20 international system of EEG electrode
alpha, beta, theta and delta waves were analyzed using the placement. The reference electrode was placed at Fpz and
BIOPAC AcqKnowledge 3.7.1 software (BIOPAC Inc., USA) the ground electrode at the back of right ear. The pattern
and a Microsoft Windows-based PC. Spectral power was reversal visual stimulus was given from a monitor kept
obtained by integrating the power spectrum from 8-15 Hz 1.2 m away from the subject. P100 latency was recorded
(alpha), 14-30 Hz (beta), 4-7 Hz (theta) and 1-3.5 Hz (delta) by giving the stimuli at a rate of 1 Hz, 128 averaging and
and the percentage of the respective wave in relation to the two trials were done for each eye.
total power was calculated.
Reaction time
Electrophysiologic studies
ART and VRT were measured on a digitalized reaction time
All electrophysiologic studies were done using EP–EMG apparatus (Anand Agencies, Pune, India) by instructing
Medelec Sapphire system (Sapphire II, Medelec, UK). The the subject to lift his finger from the key in response to a
methods followed were those recommended by Aminoff.[18] sound or light stimulus. The visual and auditory signals
were given from the front of the subject who was instructed
Median nerve motor conduction: The method adopted to use his dominant hand while responding to the signal.
was that of Johnson.[19] Active recording electrode was The subject’s response was obtained from the electronic
placed on thenar eminence of the dominant hand at the readings. Red and green discrimination time recordings
midpoint between metacarpophalangeal joint of thumb were performed by asking the subject to release the key
and midpoint of distal crease. Reference electrode was related to the respective color. At least ten trials were
placed distally on thumb and ground electrode was recorded for each measurement and mean of three similar

observations was taken as a single value for statistical intergroup comparison, post-training EMG amplitude of
analysis. All subjects were previously assessed for colour resting frontalis muscle in asan-pranayama group was
blindness and none failed the test. significantly (P < 0.05) lower than corresponding value of
asan group. There was no change in latency, but amplitude
Analysis of data showed a decrease in all the three yoga groups and this was
significant (P < 0.05) in asan-pranayama group [Table 4].
In all the groups, the above mentioned parameters were P100 increased significantly (P < 0.01) on the left side in
measured at the beginning and again at the end of the 6 the asan group. There was a post-training decrease in RT
months study period. The data was analyzed using paired in all the yoga groups [Table 5] and this was significant
t-test to compare the pre- and post-training values of each for VRT in asan group, ART in pranayama group, and VRT
group. Comparisons between groups were made by one- as well as ART in the asan-pranayama group (P < 0.05).
way analysis of variance (ANOVA) followed by Tukey’s
test. When data were non-homogeneously distributed,
DISCUSSION
Kruskal–Wallis test followed by Dunn’s test were used.
A two-tailed P < 0.05 was considered significant. Electroencephalogram
In the eyes open EEG, there was an increase in the
RESULTS
total integral (power) of all the groups [Table 1]. In the
The results are given in Tables 1-5. There was increase asan-pranayama group, the increase in the alpha and
in the total integral (power) of all the groups in both eyes theta integral was statistically significant (P < 0.05).
open and eyes closed EEG [Tables 1 and 2]. On intergroup On intergroup comparison, delta % was significantly
comparison, delta % was significantly (P < 0.05) higher (P < 0.05) higher in the asan-pranayama as compared
in the asan-pranayama as compared to the pranayama to the pranayama group. During the eyes closed EEG
group. Alpha and theta integrals increased in all the three recordings, the training-induced increase in total power
yoga groups, and this was significant (P < 0.05) for alpha was more pronounced and statistically significant
integral in asan and asan-pranayama groups, and theta [Table 2]. Pranayama training-induced increase in total
integral in pranayama and asan-pranayama groups. Post- power was highly significant (P < 0.001) when compared
training theta integral of asan and pranayama groups was to control group. There was an increase in alpha and
significantly (P < 0.05) higher than the control group. The theta integrals in all the three yoga groups, which was
standardized distal motor latency of median nerve reduced statistically significant (P < 0.05) for alpha integral in
significantly (P < 0.05) in asan and asan-pranayama asan and asan-pranayama groups and theta integral in
group, though the standardized distal latency of median pranayama and asan-pranayama groups. The post-training
nerve decreased in all the yoga groups [Table 3], it was theta integral of the asan and pranayama groups was
statistically insignificant. The resting EMG of frontalis significantly (P < 0.05) higher as compared to the control
muscle decreased in all the yoga groups [Table 3] and group. The alpha and delta waves signify synchronization
this was significant (P < 0.01) in pranayama group. On of brain potentials. Yoga practice is known to relax the
Table 1: Eyes open EEG recording of Pondicherry police trainees before and after training
Asan (N=14) Pranayama (N=15) Asan‑pranayama (N=11) Control (N=8)
B A B A B A B A
Total 0.0036±0.0020 0.0064±0.0052 0.0051±0.0030 0.0068±0.0041 0.0016±0.0008 0.0084±0.0069 0.0018±0.0012 0.0040±0.0059
integral
Beta 0.0005±0.0003 0.0009±0.0010 0.0008±0.0007 0.0014±0.0013* 0.0003±0.0002 0.0005±0.0002 0.0002±0.0001 0.0003±0.0002
integral
Beta % 14.70±4.68 11.62±6.63 15.39±7.59 22.03±15.59 19.40±14.12 9.93±6.27* 15.76±11.35 13.01±4.70
Alpha 0.0012±0.0009 0.0018±0.0017 0.0014±0.0010 0.0020±0.0017 0.0004±0.0003 0.0015±0.0014* 0.0003±0.0002 0.0007±0.0008
integral
Alpha 31.08±13.12 28.96±16.86* 27.43±15.97 31.18±18.17 25.98±14.88 22.83±13.33 16.57±4.10 24.42±17.15
%
Theta 0.0006±0.0005 0.0015±0.0020 0.0009±0.0004 0.0008±0.0005 0.0003±0.0002 0.0013±0.0012* 0.0003±0.0002 0.0006±0.0007
integral
Theta 16.48±5.69 22.10±10.77 18.18±6.72 13.85±7.10 17.76±5.23 15.48±6.71 16.94±8.21 16.91±5.18
%
Delta 0.0013±0.0006 0.0022±0.0018 0.0021±0.0013 0.0023±0.0031 0.0006±0.0004 0.0051±0.0056 0.0010±0.0008 0.0023±0.0043
integral
Delta 37.74±12.21 37.32±18.23 38.99±13.14 31.40±17.35 36.85±13.91 51.76±15.76*♦ 50.73±15.98 45.66±15.72
%
Values are expressed as mean±SD. EEG: Electroencephalogram; *P<0.05 by paired t‑test; ♦P=0.025 between groups for delta % by ANOVA with P<0.05 for
pranayama vs asan‑pranayama by Tukey’s test, P>0.05 for all other comparisons

Table 2: Eyes closed EEG recording of Pondicherry police trainees before and after training
B A B A B A B A
Total 0.0048±0.0038 0.0083±0.0046* 0.0050±0.0056 0.0132±0.0099**♦ 0.0023±0.0012 0.0078±0.0056* 0.0019±0.0014 0.0032±0.0020
integral
Beta 0.0006±0.0005 0.0010±0.0009 0.0005±0.0005 0.0016±0.0012*♦ 0.0004±0.0004 0.0005±0.0003 0.0002±0.0002 0.0003±0.0002
integral
Beta % 12.00±3.72 10.87±7.15 14.11±8.15 15.54±11.18 20.00±14.94 9.88±6.84** 10.82±8.60 10.49±5.09
Alpha 0.0021±0.0022 0.0030±0.0026* 0.0016±0.0023 0.0066±0.0081 0.0006±0.0004 0.0017±0.0015* 0.0006±0.0007 0.0013±0.0014
integral
Alpha 35.38±17.96 32.59±17.28 33.56±13.73 38.20±24.41 27.76±17.63 27.00±16.00 30.26±21.32 40.79±22.94
%
Theta 0.0008±0.0006 0.0017±0.0013♦ 0.0011±0.0014 0.0017±0.0013*♦ 0.0004±0.0003 0.0013±0.0011* 0.0003±0.0002 0.0005±0.0003
integral
Theta 17.28±5.23 21.43±10.35 20.43±6.49 15.77±10.45 19.03±5.21 16.02±4.36 17.23±10.92 15.59±6.66
%
Delta 0.0014±0.0010 0.0026±0.0019 0.0017±0.0024 0.0032±0.0033 0.0008±0.0007 0.0042±0.0038 0.0009±0.0010 0.0011±0.0010
integral
Delta 35.34±15.35 35.11±18.63 31.91±10.86 30.49±17.67 33.21±11.31 47.09±19.92 41.70±21.05 33.12±18.69
%
Values are expressed as mean±SD. EEG: Electroencephalogram; *P<0.05; **P<0.01 by paired t‑test; ♦P<0.01 by Kruskal–Wallis test between groups with P<0.01
for pranayama vs control and asan vs control by Dunn’s test
Table 3: Latency, amplitude and velocity of motor and sensory conduction in median nerve (of dominant hand) and
resting EMG of right frontalis muscle in Pondicherry police trainees (Group II) before and after training
B A B A B A B A
Motor conduction
Lat (ms) 4.26±0.73 4.06±0.61* 3.96±0.34 3.81±0.32 3.96±0.15 3.72±0.22*** 3.87±0.47 3.68±0.30
Amp (mV) 8.83±3.64 8.87±3.00 9.06±1.50 9.21±1.85 10.41±2.36 9.60±2.72 10.02±1.87 9.84±1.72
V (m/s) 53.41±10.58 53.34±11.18 57.76±1.92 56.76±2.56 58.18±3.74 56.81±2.30 57.56±2.60 55.76±3.95
Sensory conduction
Lat (ms) 3.79±0.45 3.59±0.64 3.50±0.31 3.23±0.13 3.42±0.18 3.11±0.43 3.28±0.36 3.20±0.17
Amp (V) 53.12±26.26 46.20±20.77 57.21±19.85 49.16±8.79 54.69±14.39 33.78±8.50** 46.56±10.55 51.52±8.74*♦
V (m/s) 54.50±3.22 59.08±4.27 57.60±2.20 55.68±3.68 57.41±2.53 56.44±3.36 58.80±2.09 58.24±1.87
EMG (V) 19.29±5.35 13.29±7.96 25.00±5.98 12.50±4.63** 21.25±4.43 15.94±6.81 16.00±4.18 16.00±5.82
Values are expressed as mean±SD. *P<0.05; **P<0.01; ***P<0.001 by paired t‑test. ♦P=0.03 by ANOVA between groups with P<0.05 for asan vs control by
Tukey’s test
Table 4: Latency, P100 and amplitude of visual evoked potential of Pondicherry police trainees (Group II) before and
after training
B A B A B A B A
Lat (ms)
Left 72.71±3.19 72.94±1.84 72.55±3.06 73.87±1.31 75.30±2.78 74.10±4.14 73.68±1.42 74.60±5.32
Right 73.06±3.18 74.54±4.06 73.70±1.92 77.60±8.96 73.47±3.98 75.45±4.80 73.56±1.44 73.35±3.15
P100
Left 98.37±2.28 99.57±1.76** 99.53±3.41 99.27±3.23 97.70±3.44 98.05±3.33 97.68±5.09 97.72±6.78
Right 100.51±4.09 97.49±2.88 99.03±2.97 99.47±2.59 98.37±2.95 98.20±3.62 97.48±2.15 97.36±3.99
Amp (V)
Left 7.24±2.72 6.51±1.98 8.36±3.37 7.01±2.57 6.42±1.83 4.93±1.90* 6.23±1.13 6.64±2.04
Right 8.15±2.02 6.42±1.75 6.54±3.09 6.22±2.34 7.07±2.80 5.27±2.49 6.62±1.34 4.98±2.32
Values are expressed as mean±SD. *P<0.05; **P<0.01 by paired t‑test
mind, decrease sympathetic activity, and synchronize these practices bring about such changes through strong
waves. Stancak et al.[20] has reported a relative increase of stimulation of somatic and splanchnic receptors.[21] The
slower EEG frequencies and subjective relaxation resulting pranayama training seems to be more effective in this
after pranayama. Previous studies have demonstrated EEG regard and this may be due to a prolonged and residual
changes around somatosensory and parietal areas of the neuromuscular effect influencing the RT. It has also
cerebral cortex, suggesting an affective arousal following been previously suggested that forceful expirations in
agnisara, nauli, and bhastrika; and it was suggested that pranayama may be altering afferent inputs from abdominal

Table 5: Visual and auditory simple and discrimination reaction times of Pondicherry police trainees before and after
training
B A B A B A B A
Simple RT
VRT 231.23±39.13 205.29±34.85* 203.72±29.02 200.09±27.10 219.28±19.28 207.46±25.86* 222.82±29.83 214.68±24.16
ART 179.14±31.89 168.70±32.49 178.82±28.15 162.26±21.24 * 173.44±19.67 164.45±16.13* 176.69±20.34 169.54±23.75
Discrimination RT
Red 379.75±83.95 312.58±68.49** 340.13±51.53 301.56±73.27 * 360.38±90.10 352.43±83.53 300.08±62.07 369.10±91.00*
Green 415.63±105.05 317.56±73.13** 376.44±85.29 306.00±66.26**♦ 382.78±81.77 345.05±80.06 323.08±56.81 384.75±72.24*
Values are expressed as mean±SD. *P<0.05, **P<0.01 by paired ‘t’ test, ♦P=0.02 by ANOVA with P<0.05 for pranayama vs. control by Tukey’s test
and thoracic regions which in turn modulates activity at muscle cells following exercise and this may be one of
ascending reticular activating system and thalamocortical the mechanisms behind improvements occurring in our
levels.[14] human subjects too. The lack of any major intergroup
differences may be attributed to the fact that our control
Motor conduction group was also participating in rigorous police training
that involves regular exercise.
The standardized distal motor latency of median nerve
reduced significantly (P < 0.05) in asan group at the end Electromyography
of 6 months training period [Table 3]. In asan-pranayama
group also, training produced a significant (P < 0.001) The resting EMG of frontalis muscle decreased in
reduction in standardized distal motor latency of median all three yoga groups [Table 3]. This decrease was
nerve. The amplitude of CMAP and conduction velocity statistically significant (P < 0.01) in pranayama group.
of median nerve did not change significantly after yoga On intergroup comparison by ANOVA, the post-training
training in any of the three yoga groups. The decreased EMG amplitude of the resting frontalis muscle in the
motor latency following yoga training can be attributed asan-pranayama group was found to be significantly
to either an increase in conduction velocity or facilitation (P < 0.05) lower than the corresponding value of the asan
of neuromuscular transmission. Since there was no group. The decrease in resting EMG amplitude can be
significant change in conduction velocity in our subjects, explained on the basis of the common observation that
it can be presumed that the decrease in latency is due to yoga practice produces psychosomatic relaxation. This
improved neuromuscular transmission. is consistent with the observation of Blumenstein et al.[25]
that relaxation techniques lead to a decrease in frontalis
Sensory conduction EMG amplitude. The maximum EMG during voluntary
muscular contraction did not change significantly in
Standardized distal latency of median nerve decreased any of the three yoga groups after training. This can be
in all the three yoga groups [Table 3]. However, this explained on the basis of the fact that maximum EMG
decrease was statistically insignificant. There was during voluntary muscular contraction is proportional to
no significant change in sensory conduction velocity the functional muscle mass and 6 months of yoga training
of the median nerve in any of the yoga groups. The of moderate intensity did not increase muscle mass in our
decreased standardized distal sensory latency can be subjects. In this context it is important to remember that
attributed to facilitated neuromuscular transmission our subjects were also undergoing police training which
following yoga training. This is an interesting finding was quite intense.
and needs further investigation. It has been reported that
short-term exercise stimulates endothelium-dependent Visual evoked potential
vasodilatation and this may be one of the mechanisms
by which nerve conduction is improving in our subjects. There was no change in latency, but amplitude showed
Gustaffson et al.[22] have proposed that higher vascular a decrease in all three yoga groups and this decrease was
endothelial growth factor expression during short-term significant (P < 0.05) in the asan-pranayama group [Table 4].
exercise may play a role in increasing the endoneurial P100 increased significantly (P < 0.01) on the left side in
blood flow. Terjung et al.[23] have reported improvements the asan group. There was no change in P100 in the other
in abnormal perfusion and plasma viscosity as well as groups. However, as VEP amplitude may be influenced by
the facilitation of oxygen delivery by exercise. During a number of variables,[18] it cannot be commented upon.
exercise, blood vessels are exposed to repeated episodes
of hyperemia and this stimulates increases in nitric Reaction time studies
oxide release that augments vasodilatation. Kjeldsen
et al.[24] have reported increases in Na/K-ATPase in rat The effect of yoga training on RT is given in Table 5. The

baseline values of VRT as well as ART were comparable in being into a better one while also modifying the above-
all the four groups. In all the groups, ART was shorter than mentioned neurophysiological functions beneficially.
VRT and this is consistent with our earlier findings.[11] Yoga
training produced a decrease in RT in all the three groups. The main limitation of our study is our inability to do all
This decrease was statistically significant for VRT in asan the electrophysiological tests in all the participants due
group, ART in pranayama group and VRT as well as ART in to the time consuming nature of the electrophysiological
the asan-pranayama group (P < 0.05). In the control group, testing, tight schedule of our labs that also cater to hospital
there was no significant change in VRT or ART. Red-green patients, and the inability of our subjects to come to the lab
discrimination RT decreased in all the three yoga groups after on more than two occasions (pre- and post-testing). The fact
the 6-month training period. This decrease was statistically that our subjects were simultaneously undergoing rigorous
significant for red-green discrimination RT in the asan group police training has compounded the neurophysiological
(P < 0.001), red discrimination RT for pranayama group changes as evidenced in the control group as well as the
(P < 0.05), and green discrimination RT in the pranayama three yoga groups. It is suggested that further detailed
group (P < 0.001). In contrast to the yoga group, there was
studies be done on a larger population to confirm these
a significant (P < 0.05) increase in red as well as green
findings and facilitate a deeper understanding of the
discrimination RT in the control group. A decrease in RT
mechanisms underlying such neurophysiological changes.
indicates an improved sensorimotor performance and an
enhanced processing ability of the central nervous system
(CNS). This indicates (i) greater alertness and faster rate SUMMARY AND CONCLUSION
of information processing and, (ii) improved ability to
Police trainees showed beneficial effects of yoga training,
concentrate and less distractibility.[11,14] Yoga is also known
although they were undergoing intensive police training
to decrease mental fatigability and increase performance
and the yoga training was relatively less intense. Alpha,
quotient.[26] Decrease in RT signifies an improvement
theta and total power of EEG increased as a result of
in central neuronal processing ability and this may be
asan training. A shortening of visual reaction time and a
attributed to greater arousal and faster rate of information
decrease in red-green discriminatory reaction time signifies
processing along with improved concentration. RT is related
an improved and faster processing of visual input. They
to the level of arousal and it has been reported that RT is
also showed a decrease in resting EMG voltage signifying
fastest with an intermediate level of arousal and deteriorates
better muscular relaxation following pranayama training.
when subjects are either too relaxed or too tensed.[27] Exercise
has been shown to improve RT and it has been reported that Beta, theta, and total power of EEG increased; while ART
moderate muscular tension shortened pre-contraction RT and red-green discriminatory reaction times decreased
and that isometric contraction allows the brain to work in the trainees, signifying a more alert state as well as
faster.[28-30] With the above in mind, we can attribute the improved central neural processing. A combination of
faster reactivity of our subjects following yoga training to an asan and pranayama training for 6 months produced an
intermediate level of arousal brought about by a conscious improvement in motor and sensory nerve conduction. Total
synchronization of dynamic muscular movements with power of EEG, alpha, and theta power as well as delta %
slow, regular, and deep breathing. The present study increased while reaction time decreased; signifying an
confirms that yoga training leads to a significant reduction in alert and yet relaxed state of the neuromuscular system.
visual, auditory as well as discriminatory RT. Measurement
of RT, which is an indirect index of the processing ability The present study has shown that 6 months training in
of CNS is simple to perform and requires inexpensive asan, pranayama as well as their combination is effective
apparatus. Hence, RT can be used as a simple, quantitative, in improving physiological functions of police trainees
objective, and non-invasive method for monitoring the who showed beneficial effects of yoga training, although
beneficial effects of yoga training. they were undergoing intensive police training and the
yoga training was relatively less intense. Hence, we
As Ramamurthi[9] suggested in his review, yogic control of recommend that yoga training be introduced in police
sub-cortical networks between voluntary (cerebral cortex) training curricula.
and involuntary (medullary centers) areas of brain may
induce special functions (siddhis) that cannot be quantified ACKNOWLEDGMENT
or explained within the parameters of present-day science.
However, through efforts such as ours, we may be able to The authors thank Central Council for Research in Yoga and
study and report on some apparent effects resulting from Naturopathy (CCRYN), Ministry of Health and Family Welfare,
training in asan and pranayamaa in normal subjects for Government of India, New Delhi for funding this research
a limited time using non-invasive laboratory techniques. project for which Dr. Madanmohan was chief investigator
Hence, we conclude by reiterating that even a limited span while Dr. Gopal Krushna Pal and Dr. N. Krishnamurthy were
of yogic training can transform the personality of a human co-investigators. Dr. Ananda Balayogi Bhavanani was Senior

Research Fellow (SRF) of the project while Dr. Kaviraja Udupa latency evoked potentials during yogic consciously regulated breathing and
was Junior Resident in the Department of Physiology. The alternative states of the mind. Int J Psychophysiol 1993;14:189-98.
14. Bhavanani AB, Ramanathan M, Harichandrakumar KT. Immediate effect of
authors thank Mr. G. Kumaran, Yoga Instructor for assisting
mukha bhastrika (a bellows type pranayama) on reaction time in mentally
in the yoga training and Mrs. Bharati Balakumar and Miss challenged adolescents. Indian J Physiol Pharmacol 2012;56:174-80.
R. Lalithambiga for their technical assistance. We also thank 15. Sharma R, Gupta N, Bijlani RL. Effect of yoga based lifestyle intervention
Dr. Zeena Sanjay, SRF, ACYTER for her help in preparing the on subjective well-being. Indian J Physiol Pharmacol 2008;52:123-31.
final manuscript. 16. Gitananda Swami. Yoga: Step-by-Step. Pondicherry: Satya Press; 1981.
17. Yoga: Asanas, Pranayama, Mudras, Kriyas. Chennai: Vivekananda Kendra
Prakashan Trust; 2002.
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Indian Journal of Traditional Knowledge
Vol. 12 (3), July 2013, pp. 535-541
Effects of eight week yoga therapy program on cardiovascular

health in hypertensives
Madanmohan1, Ananda Balayogi Bhavanani2*, Zeena Sanjay3, Vithiyalakshmi L4 & Dayanidy G5
1-5
Department of Physiology, ACYTER, JIPMER, Puducherry-605006
E-mails: drmadanmohan999@rediffmail.com; ananda@icyer.com; zeesanj@gmail.com;
lakshmivithiya@gmail.com; dayanidy@gmail.com
Received 28.11.11; revised 21.03.12
Yogic practices may aid in the prevention and management of Hypertension (HT) and reduce cardiovascular
complications in the population. The present study was undertaken to evaluate the effects of a comprehensive eight week
yoga therapy programme on anthropometric, cardiovascular, biochemical parameters and wellness scores in patients of
essential HT. 15 patients receiving standard medical treatment for essential HT were recruited and anthropometric,
cardiovascular and biochemical investigations were done before and after a comprehensive yoga therapy programme
comprising of three times a week sessions for 8 weeks. A post intervention, retrospective wellness questionnaire was used to
evaluate the comparative feelings of the patients after the therapy programme. There was a statistically significant decrease
in weight, BMI and all resting cardiovascular parameters such as heart rate and blood pressure indices. Total cholesterol
(TC), triglyceride (TG), low density (LDL) and very low density (VLDL) lipoproteins reduced significantly while high
density (HDL) lipoprotein increased significantly. All the cholesterol based ratios such as TC/HDL, LDL/HDL and showed
healthy improvements. Post intervention overall wellness scores of the participants indicated that 9% attained complete
relief and total satisfaction after the therapy programme while 29% were much better than before. 36% were better than
before while 25% had no change in their condition. The main strength of the present study is excellent compliance and
regularity of yoga practice by our participants both during directly supervised sessions and at home. Very few yoga studies
have reported such excellent compliance and hence our study stands out as a special case. Hence, the all round benefits
obtained in our study can be attributed to the dedicated and regular practice of the comprehensive yoga therapy programme
that reports a significant improvement in anthropometric and cardiovascular parameters coupled with healthy lipid profile
changes in patients of essential HT. It is concluded that a comprehensive yoga therapy programme has potential to enhance
the beneficial effects of standard medical management of essential HT and can be used as an effective complementary or
integrative therapy programme.
Keywords: Hypertension, Yoga therapy, Lipid profile, Cardiovascular risk
IPC Int. Cl.8: A01D 14/01, A01D 14/06, A61H 1/00, A61B 5/02, A61K
Hypertension (HT) is one of the most common health relieving stress and improving fitness as it decreases
disorders prevalent worldwide and is a major risk stress and anxiety and improves health status. Yoga as
factor for stroke, coronary artery disease and organ a therapy is simple and inexpensive and can be easily
failure. Increased sympathetic activity, enhanced adopted in most patients without any complications 5.
cardiovascular reactivity and reduced parasympathetic Yoga therapy encompasses the use of asans,
tone have been strongly implicated in the pranayams and relaxation techniques along with
pathogenesis of atherosclerosis, cardiovascular dietary advice and yogic counseling that address the
disease and insulin resistance which are leading root cause of the problem rather than merely
causes of death and disability worldwide1. providing symptomatic relief 6.
Multiple simultaneous modifications of lifestyle
Yoga can be an effective adjunct therapy in HT and are seen to provide the greatest lowering of blood
various studies have demonstrated the scientific basis pressure (BP) coupled with a reduced overall
of using it as a therapy and as an effective lifestyle cardiovascular risk status. Though it may be difficult,
modification measure 2,3,4. Yoga is a popular means of it is of great value as even a small persistent reduction
———————— in BP can have a major protective effect on
*Corresponding author cardiovascular disease7.
536 INDIAN J TRADITIONAL KNOWLEDGE, VOL 12, NO. 3 JULY 2013
It has been reported that autonomic deregulation Biochemical investigations: Biochemical

underlies initiation and maintenance of HT and investigations were done at the JIPMER Central
arterial baroreflex mechanisms operate in Laboratory where blood was drawn from an
hypertensives albeit at a higher BP range 8. A previous antecubital vein in post-absorptive state. On the day
study from our laboratory reported that yoga training of the blood collection, subjects were asked to abstain
optimizes sympathetic response to stressful stimuli from yoga training. Lipid profile including total
like isometric handgrip and restores autonomic cholesterol (TC), triglyceride (TG), high density
regulatory reflex mechanisms in hypertensive patients lipoprotein (HDL), low density lipoprotein (LDL) and
and that this occurs with just 4 weeks of training5. very low density lipoprotein (VLDL) were
In view of the above, the present study was requisitioned and evaluated.
undertaken to evaluate the effects of a comprehensive Wellness questionnaire: A post intervention,
eight week yoga therapy programme on retrospective wellness questionnaire compiled by
anthropometric, cardiovascular and biochemical ACYTER team was used to evaluate the comparative
parameters in patients of essential HT. feelings of the patients after the therapy programme.
Five different responses ranging from ‘worse than
Methodology before’ to “complete relief / totally satisfied’ were
This study was conducted as part of a larger study utilized to evaluate various physical and
on the effects of yoga therapy on essential HT that
psychological aspects of the patient’s condition.
had been accorded permission by the Research and
The questionnaire was finalized in consultation with a
Ethics Councils of the institute. Fifteen (9 male,
12 member team consisting of 3 eminent medical
6 female) patients aged 25 – 65yrs (M = 46.60,
SEM=2.95) receiving standard medical treatment at practitioners, 2 Psychologists, 2 Yoga experts,
JIPMER were recruited for this study by accidental 2 eminent yoga therapy consultants, 2 Educationists
sampling method and prior informed consent obtained and one legal anthropologist.
from them. None of the patients had previously Yoga therapy programme: The patients had an
engaged in yoga practice. Seven of them had initial consultation session at the ACYTER Yoga
coexisting diabetes mellitus, three were suffering OPD and were given yogic counseling and lifestyle
from respiratory disorders, two from musculoskeletal modification advice including increased physical
disorders and one from peptic ulcer. Patients with activity, reduction of dietary sodium, increased
history, signs, symptoms and/or laboratory reports dietary consumption of potassium through fresh fruits
suggestive of nephrologic and ophthalmologic and vegetables along with a diet rich in fiber7.
complications were excluded from the study. They then attended the special yoga practise sessions
The following parameters were tested before and after conducted at ACYTER for HT patients. A
the 8 week study period. comprehensive yoga therapy programme was
Anthropometry: Anthropometric measurements imparted to the patients by qualified yoga instructors
were made prior to BP recording. Subjects were for the duration of 60 min thrice a week for 8 weeks.
weighed in normal clothing to the nearest 0.1 kg There was 99.17% attendance during the 24 directly
(Krups, New Delhi). Their height was measured to supervised sessions. Patients were also motivated to
the nearest 0.1 cm on a calibrated stature meter practice the yoga therapy schedule at home on other
(Nisco, Delhi). Body mass index (BMI) was days. Of the 15 patients, 5 reported a home practice
calculated as weight (Kg) / height (m2). of 3 days/week, 3 practiced 2 days/week and
Cardiovascular parameters: Recordings were 2 practiced 4 days/week and 1 day/week at home. One
taken in an air-conditioned laboratory 2 hours after a patient each reported that they practiced 6 and
light breakfast. Basal recordings were taken in sitting 7 days/week at home while one reported they didn’t
posture after 5 minutes of rest in a chair. Systolic practice at home at all. Analysis of patient feedback
pressure (SP) and diastolic pressure (DP) and heart showed that the duration of home practice was 30 min
rate (HR) were measured with non-invasive semi- for 7 patients, 20 min for 4 patients and 60 min for
automatic BP monitor (Omron Inc., Japan). Rate- 2 patients and 40 min for one. Patients were advised
pressure product (RPP = SP × HR × 10-2) and double to do the practices without over straining depending
product (Do P = HR × MP × 10-2) were calculated for on their individual capacity. The schedule is given
each recording. in Table 1.
MADANMOHAN et al.: YOGA ON HYPERTENSIVES 537
Table 1—Sequence and duration of yoga techniques practiced Table 2—Effect of 8 weeks yoga therapy programme on heart rate
by our subjects (HR), systolic pressure (SP), diastolic pressure (DP), pulse pressure
(PP), mean pressure (MP), rate-pressure product (RPP) and double
Yoga technique Duration (min)
product (DoP) in patients of essential hypertension.
1 Talasan 0.5 B: before and A: after the 8 week study period.
2 Ardhkati chakrasan 1.0
B A % Change p Value
3 Ushtrasan 0.5
4 Balasan 0.5 HR (beats/min) 84.13 80.53
- 4.28 0.0089
5 Sashasan 0.5 ± 2.79 ± 2.89
6 Matsyasan 0.5 SP (mmHg) 149.60 132.60
- 11.36 < 0.001
7 Pashchimottanasan 0.5 ± 3.13 ± 2.51
8 Pavanamuktasan 3.0 DP (mmHg) 95.60 86.27
- 9.76 < 0.001
9 Dwipad uttanasan 0.5 ± 3.10 ± 1.78
10 Bhujangasan 0.5 PP (mmHg) 54.00 46.33
- 14.20 0.0174
11 Chandranadi pranayam 3.0 ± 3.75 ± 2.89
12 Vibhag pranayam 3.0 MP (mmHg) 113.60 101.71
- 10.47 < 0.001
13 Pranav pranayam 5.0 ± 2.56 ± 1.53
14 Nadi shuddhi 3.0 RPP (units) 125.95 106.79
- 15.21 < 0.001
15 Vyagrah pranayam 1.0 ± 5.04 ± 4.34
16 Bhramari pranayam 3.0 DoP (units) 95.90 82.07
- 14.42 < 0.001
17 Savitri pranayam 3.0 ± 4.40 ± 3.47
18 Kayakriya 6.0 Values are M ± SEM for 15 subjects.
19 Shavasan 15.0 Table 3—Effect of 8 weeks yoga therapy programme on total
Rest period in-between practices 10.0 cholesterol (TC), triglycerides (TG), low density
Total 60 min lipoprotein (LDL),very low density lipoprotein (VLDL), high
densitylipoprotein (HDL), TC/HDL ratio, LDL/HDL ratio,
Statistical analysis: Statistical analysis of pre HDL/LDL ratio, weight, height and body mass index (BMI)
in patients of essential hypertension. B: before and
and post intervention data was done using
A: after the 8 week study period
GraphPad InStat version 3.06 for Windows 95,
GraphPad Software, San Diego California USA, B A % Change p Value
www.graphpad.com. Data that passed normality TC (mg/dl) 173.67 161.07 - 7.26 0.0084
testing by Kolmogorov-Smirnov Test was analyzed ± 10.23 ± 9.11
using Students paired t test. Data that failed normality TG (mg/dl) 142.33 125.00 - 12.18 < 0.001
testing was analyzed using Wilcoxon Matched-Pairs ± 15.57 ± 13.19
Signed-Ranks test. P values less than 0.05 were LDL (mg/dl) 108.87 101.73 - 6.56 0.0381
accepted as indicating significant differences between ± 8.75 ± 8.35
pre and post intervention data. VLDL (mg/dl) 30.80 26.80 - 12.99 < 0.001
± 3.08 ± 2.62
HDL (mg/dl) 39.00 41.87 + 7.36 0.0459
Results
± 2.24 ± 2.06
The results are given in Tables 2, 3, 4 and Fig.1.
TC/HDL 4.67 3.95 - 15.50 0.0214
All data are expressed as M ± SEM.
± 0.39 ± 0.25
Anthropometry: Wilcoxon Matched-Pairs Signed- LDL/HDL 2.97 2.50 - 15.88 0.0181
Ranks test showed a statistically significant ± 0.35 ± 0.22
(p=0.0039) decrease in both weight and BMI. HDL/LDL 0.40 0.45 + 13.75 0.0062
± 0.046 ± 0.048
Resting cardiovascular parameters: Students Weight (kg) 66.60 65.60 - 1.50 0.0039
paired t test showed significant reductions in HR, ± 1.98 ± 1.92
t (14) =3.03, p=0.0089, SP, t (14) =7.78, p <0.001, Height (m) 1.62 1.62 0.00 -
DP, t (14) =4.25, p<0.001, PP (pulse pressure) ± 0.02 ± 0.02
t (14) =2.70, p = 0.0174, MP (Mean Pressure) BMI 25.54 25.16 - 1.49 0.0039
t (14) =6.86, p <0.001, RPP, t (14) =7.28, p<0.001, ± 1.02 ± 1.00
DoP, t (14) =6.77, p <0.001. Values are M ± SEM for 15 subjects.
Table 4—Post intervention % responses of participants to retrospective wellness questionnaire

Worse than before Same as before Better than Much better than Complete relief /
before before Totally satisfied
Ability to concentrate - 33.34 40 26.67 -
Control of anger / loss of temper - 20 46.67 26.67 6.64
Appetite - 23.07 46.15 23.07 7.69
Confidence level - 20 26.67 20 6.64
Ease of breathing - 20 40 26.67 13.34
Energy levels - 38.46 23.07 30.76 7.69
Enjoyment of life - 33.34 26.67 26.67 13.34
Feeling calm & fresh - 26.67 33.34 26.67 13.34
Feeling of hopelessness - 20 40 33.34 6.64
Feeling of loneliness - 33.34 26.67 33.34 6.64
General flexibility - 20 53.34 13.34 13.34
General mood - 14.28 35.71 35.71 14.28
General sense of relaxation - 13.34 40 33.34 13.34
General wellbeing - 14.28 42.85 42.85 -
Joint mobility - 28.57 35.71 28.57 7.14
Nervousness 9.09 14.28 50 9.09
Pain levels - 46.15 30.76 15.38 7.69
Performance of day-to-day Activities - 35.71 35.71 28.57 -
Sleep quality / duration 6.64 26.67 13.34 33.34 20
Stress levels - 26.67 26.67 40 6.64
Total wellbeing score 0.79 25.41 35.67 28.68 8.67
Biochemical parameters: Wilcoxon Matched-

Pairs Signed-Ranks test showed a statistically
significant decrease in TC, p=0.0084 and TG,
p < 0.001. Students paired t test showed significant
reductions in LDL, t (14) = 2.29, p = 0.038, VLDL,
t (14) =4.27, p <0.001 and significant increase
in HDL, t (14) =2.19, p= 0.046. Wilcoxon Matched-
Pairs Signed-Ranks test showed a statistically
significant decrease in LDL/HDL, p=0.018 while
Students paired t test showed significant decrease in
TC/HDL, t (14) = 2.59, p = 0.021 and increase in
HDL/LDL, t (14) = 3.21, p = 0.006.
Wellness questionnaire: The post intervention
overall wellness scores of the participants are given in
Fig. 1 and the detailed breakup of % responses to each
question is given in Table 4. Overall responses to the
retrospective wellness scores indicated that our patients
felt a sense complete relief and total satisfaction (9%), Fig.1—Post intervention overall % responses of the participants to
the wellness questionnaire
they were much better than before (29%), they were
better than before (36%) or felt no change in their (p=0.0039) reduction of weight and BMI. The lesser
condition (25%). The condition of 1% was reported to magnitude of change may be attributed to a lower
be worse than before the therapy programme. initial BMI of our participants (25.54 ± 1.02 kg/m2)
and gentle and relaxed practice schedule appropriate
Discussion for patients of HT. This provides an insight into a
Anthropometric parameters: The yoga therapy positive trend towards normalcy even though the
programme resulted in a small yet significant magnitude of change may not be great. The reduction
of 0.38 kg/m2 in the present study (Table 3) is (Table 2) implies a reduced load on the heart due to
comparable to other studies that have reported reduced oxygen consumption15 and this correlates
significant reductions in BMI following yoga training. with a previous study in our laboratory that reported a
Recent studies have reported reductions of 0.5 kg/m2 consistent and significant reduction in oxygen
after 3 months 9 and 0.57 kg/m2 after a 6-day consumption and psychosomatic relaxation with
residential yoga programme in patients whose initial shavasan and savitri pranayam16 that is one of the
BMI was > 30 kg/m2 10. A reduction of a greater practices used in our therapy programme.
magnitude (0.62 kg/m2) was reported in patients Sympathetic activation is known to increase HR
whose initial BMI was > 30 kg/m2 11. A normalization and RPP and decrease overall heart rate variability
of BMI is significant since it has been reported that (HRV) and this is evident in our pre-training values.
women over 18 with an initial BMI of 24 developed The RPP provides a simple measure of overall HRV
diabetes 5 times more often and HT twice more often in hypertensive patients and is a surrogate marker in
than women with BMI </=21 7. situations where HRV analysis is not available8. It has
Cardiovascular parameters: Increased been previously reported that standard deviation of
sympathetic activity, enhanced cardiovascular normal-to-normal RR intervals (SDNN), an index of
reactivity and reduced parasympathetic tone have overall HRV is reduced in hypertensive patients8.
been strongly implicated in the pathogenesis of It has also been shown that SDNN and total power of
atherosclerosis and cardiovascular diseases12. Innes HRV are inversely correlated with mean HR and RPP
17
and Vincent suggested that yoga reduces this risk . Hence, the significant post-training decrease in
profile by decreasing activation of the sympatho- HR and RPP in our study indicates a better autonomic
adrenal system and the hypothalamic-pituitary- regulation of the heart with decreased oxygen
adrenal axis and also by promoting a feeling of consumption and load. This can be attributed to the
wellbeing along with direct enhancement of pranayam practices used in our study.
parasympathetic activity via the vagus nerve12. Biochemical investigations: The significant
Balasan, matsyasan and sashasan may be altering the decreases in TC, TG, LDL and VLDL values coupled
hemodynamics in the thoracic cavity and thus with significant increase in HDL in our participants
influencing the vagus nerve. In an earlier study from implies a better lipid profile having good prognostic
our laboratory, it has been reported that 3 months of value. A study on yogic practises on lipid profile and
pranayam training results in modulation of ventricular body fat composition in patients of coronary artery
performance by increasing parasympathetic activity disease reported insignificant reductions of TC,
and decreasing sympathetic activity13. As TG and LDL after 6 months 18. However, Innes and
nadishuddhi, pranav and savitri pranayams were part Vincent reported that all 12 studies reviewed by them
of that study as well as the present study, they may suggested that yoga improves lipid profile 12.
have produced a similar effect in our subjects. In their Reductions in TC, TG, LDL and VLDL and an
review, Innes and Vincent have suggested that yoga increase in HDL in our subjects are comparable with
provides a positive source of social support that may the findings of their review. Upon analysis of the
also be one of the factors reducing risk for different relative cholesterol ratios, it is apparent that
cardiovascular diseases 12. All of the above factors are the yoga therapy programme improved the ‘heart
applicable in our study and may explain the positive friendly’ status of lipid profile in our subjects.
changes produced following strict adherence to the Normally the ‘safe’ TC/HDL ratio should be less than
comprehensive yoga therapy programme. 4. This was initially 4.67 ± 0.39 in our patients and
It has been reported earlier that yogic training decreased (16%) to a safe level of 3.95 ± 0.25 after
including inverted posture produces an improvement the 8-week yoga therapy programme. A healthy
of baroreflex sensitivity and attenuation of the LDL/HDL ratio should be less than 3. Though the
sympathetic and renin angiotensin activity14. The initial pre-training level in our subjects was a higher
reduction in HR and BP seen in our study (Table 2), normal value it also reduced (16%) to a lower normal
may be attributed to a similar mechanism as we have value. HDL/LDL ratio should normally be more than
included “head below the heart” postures like 0.3 but it is preferable to maintain it above 0.4.
balasan, sashasan and dwipad uttanasan in our yoga This also increased (14%) to a higher normal value
therapy schedule. Reduction in RPP and Do P implying better prognosis of cardiovascular health.
These positive changes in lipid profile may be decreased BP, TC and TG with overall improvement
attributed to the twisting and compression-relaxation in subjective wellbeing and quality of life 21.
effects of postures such as paschimottanasan, The main strength of the present study is the
pawanamuktasan and bhujangasan. The decrease of excellent compliance and regularity of the yoga
‘bad’ cholesterol and increase in ‘good’ cholesterol practice by our participants both during the directly
has significance when viewed in light of the supervised sessions (99%) and at home, where all
cardiovascular risk profile of diabetic patients as expect one patient practiced regularly for an average of
7 participants had concomitant DM. It has been 3 days/week for a minimum duration of 30 min. Hence,
previously reported that hatha yoga decreases the all round benefits obtained in our study can be
oxidative stress and improves antioxidant status 19 and attributed to the dedicated and regular practice of the
this could also be the mechanism behind the positive comprehensive yoga therapy programme. Very few
changes in lipid profile of our subjects. It has been yoga studies have reported such excellent compliance
reported that a short lifestyle modification and stress and hence our study stands out as a special case.
management education program leads to favorable As all of our participants were simultaneously also
metabolic effects and that yoga reduces risk factors receiving medication, it is difficult to determine
for cardiovascular disease and DM20. The improved ‘actual’ benefits of the therapy intervention and
healthier ‘heart friendly’ lipid profile evidenced in our differentiate them from the benefits of better medical
study may be the biochemical mechanism by which management in the same period. The main drawback
such risk profiles are reduced. of our study is the accidental sampling method used
and the lack of a control group. However, as there
Wellness questionnaire: It has been reported that
was no change in the medical management protocol
a short lifestyle modification and stress management
that had already stabilized their clinical status, we can
educational program leads to remarkable
reasonably conclude that any additional benefits were
improvement in subjective wellbeing scores and can
due to the yoga therapy programme. It is suggested
therefore make an appreciable contribution to primary
that further randomized control studies can be done to
prevention as well as management of lifestyle
confirm these findings and facilitate a deeper
diseases2. A majority of the patients in our study
understanding of the mechanisms underlying these
reported an improvement in ability to concentrate,
beneficial results.
control of anger, appetite, confidence levels, ease of
breathing, energy level, enjoyment of life with calm Conclusion
and fresh feeling (Table 4 and Fig.1). They also It is evident that a comprehensive 8-week yoga
reported a reduced feeling of hopelessness, therapy programme produces significant improvement
nervousness and loneliness. They reported in anthropometric and cardiovascular parameters and
improvements in general flexibility and joint mobility lipid profile in patients of essential HT. It is also
along with improved general mood, sense of concluded that a comprehensive yoga therapy
relaxation and well being. There was decrease in pain programme has potential to enhance the beneficial
with improvement in their ability to perform their effects of standard medical management of essential
day-to-day activities. They also felt a reduction in HT and can be used as an effective complementary or
their stress levels with improved quality and duration integrative therapy programme. This study provides a
of sleep. Yoga may be improving mental and scientific basis for further applied research on the
emotional components of the personality and the effects of yoga therapy in hypertensives.
subjective well being reported by our participants may
be a contributing psycho-physiological factor in the Acknowledgement
healthy improvements shown by our patients and this The authors thank the Director, MDNIY and
aspect needs further exploration. Director, JIPMER for their support. This study was
Our findings can be correlated with those of an possible because ACYTER has been established as a
earlier study on patients with mild to moderate collaborative venture between Morarji Desai National
essential HT that reported decreased VMA Institute of Yoga (MDNIY), New Delhi and JIPMER,
catecholamine and MDA levels suggestive of Puducherry with funding from Department of
decreased sympathetic activity and oxidant stress after AYUSH, Ministry of Health and Family Welfare,
3 months of yoga training. They also reported Government of India.
References 12 Innes KE& Vincent HK The Influence of yoga-based

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Original Article
Effect of fast and slow pranayama on perceived stress and

cardiovascular parameters in young health‑care students
Vivek Kumar Sharma, Madanmohan Trakroo, Velkumary Subramaniam, Rajajeyakumar M, Anand B Bhavanani1,
Ajit Sahai2
Departments of Physiology, 1Advanced Centre for Yoga Therapy Education and Research, 2Department of Biostatistics, JIPMER,
Pondicherry, India
Address for correspondence: Dr. Vivek Kumar Sharma,

Department of Physiology, JIPMER, Pondicherry ‑ 605 006, India.
E‑mail: drviveksharma@yahoo.com
ABSTRACT
Context: Perceived stress is higher for students in various healthcare courses. Previous studies have shown that pranayama
practice is beneficial for combating stress and improve cardiovascular functions but both fast and slow pranayama practice
produce different physiological responses.
Aim: Present study was conducted to compare the effects of commonly practiced slow and fast pranayama on perceived
stress and cardiovascular functions in young health‑care students.
Materials and Methods: Present study was carried out in Departments of Physiology and Advanced Centre for Yoga
Therapy Education and Research, JIPMER, Pondicherry. Ninety subjects (age 18‑25 years) were randomized to fast
pranayama (Group 1), slow pranayama (Group 2) and control group (Group 3). Group 1 subjects practiced Kapalabhati, Bhastrika
and Kukkuriya Pranayama while Group 2 subjects practiced Nadishodhana, Savitri and Pranav Paranayama. Supervised
pranayama training was given for 30 min, 3 times a week for the duration of 12 weeks to Groups 1 and 2 subjects by certified
yoga trainer. Following parameters were recorded at the baseline and after 12 weeks of training; perceived stress scale (PSS),
heart rate (HR), respiratory rate, systolic blood pressure and diastolic blood pressure (DBP), mean arterial pressure (MAP),
rate pressure product (RPP), and double product (Do P).
Results: There was a significant decrease in PSS scores in both Group 1 and Group 2 subjects but percentage decrease was
comparable in these groups. Significant decrease in HR, DBP, RPP, and Do P was seen in only Group 2 subjects.
Conclusion: This study demonstrates that both types of pranayama practice are beneficial in reducing PSS in the healthy
subjects but beneficial effect on cardiovascular parameters occurred only after practicing slow pranayama.
Key words: Blood pressure; perceived stress scale; pranayama.
INTRODUCTION yoga, hypnosis, imagery, muscle relaxation etc., have

shown improvement in their positive coping skills.[5]
Stress can be considered as a state of mental or emotional Yoga is an ancient science, which originated in India
strain or tension resulting from adverse or demanding and many studies have found that yoga and pranayama
circumstances. Perceived stress has been reported higher can be practiced to combat stress. Pranayama involves
for students in health‑care courses including dental, manipulation of the breath that is a dynamic bridge
medical, nursing, and graduate health‑workers.[1‑4] Stress between the body and mind.[6] Pranayama consists of three
management programs for students including meditation, phases: “Puraka” (inhalation); “kumbhaka” (retention)
and “rechaka” (exhalation) that can be either fast or
Access this article online slow.[7] Pranayama has been assigned very important
Quick Response Code
role in Ashtanga Yoga of Maharishi Patanjali and is said
Website:
www.ijoy.org.in to be much more important than yogasanas for keeping
sound health.[8] Previous studies have shown that both
fast and slow pranayamas are beneficial,[9‑11] but they
DOI: produce different physiological cardiovascular responses
10.4103/0973-6131.113400 in healthy subjects.[12] Slow pranayama like Nadishuddhi,
Savitri and Pranav have been shown to decrease Heart

Sharma, et al.: Effect of pranayama on perceived stress
rate (HR), systolic blood pressure (SBP), diastolic blood Anthropometric parameters

pressure (DBP), and increase pulse pressure (PP).[13,14] Very
few references are available on the effect of practicing fast • Height (in cm) was recorded on Stadiometer (Easy Care,
pranayamas. Few studies indicate that fast pranayamas Hongkong)
like Kapalabhati and Bhastrika when practiced alone • Weight (in kg) (weighing machine supplied by Crown,
increases sympathetic activity[12,15] thereby, increasing New Delhi).
HR, SBP, and DBP whereas, other studies showed that
they decrease sympathetic activity and therefore, decrease Resting cardiovascular parameters
HR, SBP and DBP.[8] Other studies have found no effect
After giving 10 min of supine rest to the subjects,
of fast pranayama after 12 weeks of practice.[16] Previous
brachial systolic (SBP) and DBP and HR were recorded on
studies have shown that perceived stress negatively affects
semi‑automatic non‑invasive BP monitor (CITIZENCH432B,
cardiovascular function by raising blood pressure (BP)
Japan). PP = SBP − DBP, mean arterial pressure (MAP =
and diminishing cardiovascular reactivity in the
DBP + PP/3), rate pressure product (RPP = [HR × SBP]/100)
subjects.[17,18] To the best of our knowledge, there is no
and double product (Do P = HR × MAP) were calculated
study comparing the cumulative effect of fast and slow
for each recording. Three BP and HR recordings at 1‑min
types of pranayama on perceived stress and cardiovascular
intervals were taken and the lowest of these values was
parameters in health‑care students. Therefore, we have
included for the present study.
planned to compare three commonly practiced fast
i.e., Kapalabhati, Bhastrika and Kukkuriya Pranayama and
slow pranayama i.e., Nadishodhana, Savitri and Pranav Perceived stress scale
on these parameters. All the subjects were then administered PSS.[19] PSS is the
most widely used psychological instrument for measuring
MATERIALS AND METHODS the perception of stress. The questions in the PSS are of
general nature, relatively free of content specific to any
Present study was conducted in the Departments of sub‑population group and enquire about feelings and
Physiology and Advanced Centre for Yoga Therapy thoughts to measure the “degree to which situations in
Education and Research (ACYTER), JIPMER, Pondicherry. one’s life is appraised as stressful” especially, over last
1 month. The items are easy to understand and response
Study design alternatives are simple to grasp. Items are designed to
tap how unpredictable, uncontrollable, and overloaded
This study is a randomized control trial and prior
respondents find their lives. It comprises of 10 items,
permission for the study was taken from the institutional
four of which are reverse‑scored, measured on a 5‑point
scientific advisory committee and human ethics committee.
scale from 0 to 4. PSS scores are obtained by reversing
After taking written informed consent, 90 healthy subjects
responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1 and 4 = 0) to the
pursuing various health‑care courses including medical, four positively stated items (items 4, 5, 7, and 8) and then
nursing, and allied medical sciences were recruited for summing across all scale items. Total score ranges from
the present study after meeting inclusion and exclusion 0 to 40.
criteria.
Thereafter, all the subjects were randomized into three
Inclusion criteria groups as follows:
• Subjects aged between 18 years and 25 years of either
gender. Group 1 (n = 30): Subjects practiced following group of
fast breathing pranayama
Exclusion criteria • Kapalabhati
• Bhastrika
• Subjects who practiced yogic techniques in past 1 year • Kukkriya
• Subjects with history of previous or current organic
diseases. Group 2 (n = 30): Subjects practiced following group of
• Subjects were unable to practice pranayama due to slow breathing pranayama:
physical abnormalities • Nadishodhana
• Pranava
Subjects were asked to report to the Department of • Savitri
Physiology, JIPMER between 9 AM and 10 AM at least 2 h
after taking light breakfast. Then following measurements Group 3 (n = 30): Control group. Subjects did not participate
were recorded: in any form of pranayama training.
Pranayama training nine or more rounds according to their capacity.

• Nadishodhana Pranayama: This is slow, rhythmic,
Subjects practiced pranayama in a quiet room maintained alternate nostril breathing. One round consisted of
at comfortable temperature at 25 ± 2°C. Supervised inhaling through one nostril, exhaling through other
pranayama training to Group 1 and Group 2 subjects was
nostril and repeating the same procedure through
given for 30 min a day, 3 times per week for the duration of
other nostril.
12 weeks in ACYTER by trained and certified yoga trainer.
• Savitri Pranayama is a slow, deep and rhythmic
Before starting pranayama training, the yoga instructor gave
breathing, each cycle having a ratio of 2:1:2:1 between
1 week of practice sessions to both Group 1 and 2 subjects
inspiration (purak), held‑in breath (kumbhak),
to familiarize them with the techniques of pranayama.
expiration (rechak), and held out breath (shunyak)
phases of the respiratory cycle. Each lobular
The technique used for fast and slow types of pranayamas
segment of the lungs was filled and a six count was
was as described in the literature.[20] Typical session for
used for inspiration and expiration, with a three
Group 1 and Group 2 subjects consisted as follows:
count for the retained breaths (6 × 3 × 6 × 3).
• Pranava Pranayama is slow, deep and rhythmic
1. Fast Pranayama: Each cycle (6 min) consisted of
breathing where emphasis is placed on making the
practicing 1 min of Kapalabhati, Bhastrika and Kukkriya
sound AAA, UUU and MMM while breathing out for
pranayama interspersed with 1 min of rest between
duration of 2 to 3 times the duration of the inhaled
each pranayama. Subjects were asked to complete 3
breath. It is a four part technique consisting of Adham
or more cycles in each session.
• Kapalabhati Pranayama: The subjects were Pranayama (lower chest breathing with the sound of
instructed to sit in Vajrasana and to forcefully expel AAA), Madhyam Pranayama (mid‑chest breathing
all of the air from the lungs while pushing the with the sound of UUU), Adhyam Pranayama (upper
abdominal diaphragm upwards. The expulsion is chest breathing with the sound of MMM) and then
active but the inhalation is passive. Subjects rapidly the union of the earlier three parts in a complete
breathed out actively and inhaled passively through yogic breath known as Mahat Yoga Pranayama with
both nostrils. One hundred and twenty rounds at the sound of AAA, UUU and MMM.
a sitting was the maximum. It is considered an
excellent rejuvenator of the respiratory system as At the end of session, all Group 1 and 2 subjects were
all muscles of expiration are exercised. instructed to lie down in shavasana and relax for 10 min.
• Bhastrika Pranayama: In this, emphasis is given to
thoracic (not abdominal) breathing activity. Subjects Control Group: They did not practice any pranayama
were instructed to take deep inspiration followed during the study period.
by rapid expulsion of breath following one another
in rapid succession. This is called as “bellow” type
All the parameters were again recorded after 12 weeks of
of breathing. Each round consisted of 10 such
“bellows.” After 10 expulsions, the final expulsion intervention and data was statistically analyzed.
is followed by the deepest possible inhalation.
Breath is suspended as long as it can be done with Statistical analysis
comfort. Deepest possible exhalation is done very
For each group, mean and standard deviation of the
slowly. This completes one round of Bhastrika.
• Kukkriya Pranayam: To perform this dog pant like scores were calculated. Analysis of the data was done
breathing technique, the subject sat in Vajrasana with using SPSS version 13 and normality testing of data
both palms on the ground in front with wrists touching was done by Kolmogorov–Smirrnov test. Power and
knees and fingers pointing forward. The mouth was Sample size software version 3.0 was used to calculate
opened wide and the tongue pushed out as far as adequate sample size (at assumed power of 0.9) required
possible. They then breathed in and out at a rapid rate for the study and to analyze post‑test power of the study.
with their tongue hanging out of their mouth. After Intergroup mean differences in age, anthropometric,
10 or 15 rounds they relaxed back into Vajrasana. The physiological parameters and PSS were measured by
whole practice was repeated for 3 rounds. using one way ANOVA and post‑hoc analysis was done
by Tukeys–Krammer test. For intra‑group comparisons
2. Slow pranayama: Each round (7 min) of session of parameters, paired t‑test was used for parametric and
consisted of practicing 2 min of Nadishodhana, Pranava Wilcoxon signed rank test for non‑parametric parameter.
and Savitri pranayama interspersed with 1 min of Chi‑square test was used to compare intergroup gender
rest between each pranayama done in comfortable distribution. P value less than 0.05 was considered as
posture (sukhasana). Subjects were asked to perform statistically significant.

RESULTS baseline (pre‑test) values in Group 3 subjects.
Table 1 demonstrates that there was no significant

Figure 1 depicts the flow chart of protocol carried out
difference in one way ANOVA test for intergroup
during the study.
comparison of age, height and weight distribution
amongst three groups. Similarly, there was no significant
On post‑test analysis, the power of study with the mean
difference in gender distribution amongst three groups
PSS difference of 4.67 and SD of 4.5 is 0.99 which shows
when analyzed by Chi‑square test.
sample size was adequate and strength of the study is good.
Table 2 shows that there was no significant difference
in one way ANOVA test for the comparison of baseline DISCUSSION
values of all the tested cardiovascular parameters and PSS
We observed no significant difference in the baseline
scores amongst the three groups and post‑hoc analysis
parameters of three groups and therefore, they can be
between these groups done by Tukey–Krammer test was
considered comparable for the study.
also insignificant.
After 12 weeks of study period, we observed a significant

Table 3 shows that there was significant reduction in PSS
decrease in DBP, HR, MAP, RPP, and Do P in only slow
score in Group 1 and Group 2 subjects (P = 0.000) after
pranayama group (Group 2) with no change in control
12 weeks of intervention (post‑test) when compared to
group (Group 3). However, trend towards insignificant
pre‑test score (baseline value). However, no longitudinal
decrease in SBP (2%), DBP (1.63%), MAP (1.74%) and
change occurred in PSS score in Group 3 subjects.
RPP (1.93%) was seen in fast pranayama group (Group 1).
Similar results were observed in previous studies which
Table 4 shows that there was no significant longitudinal found significant decrease in BP and HR with the practice
change in post‑test values in all the tested cardiovascular of Savitri Pranayama.[12] Resting HR is mainly determined
parameters in Group 1 subjects. by parasympathetic nervous system (PNS) and DBP
is a function of peripheral vascular resistance (PVR)
Table 5 shows there was significant decrease in HR which is mainly determined by sympathetic nervous
(P = 0.000), DBP (P = 0.01), MAP (P = 0.01) RPP (P = 0.01) and system (SNS).[21] MAP is determined by both SNS and PNS
Do P (P = 0.000) in Group 2 subjects after 12 weeks (post‑test and refers to the mean pressure throughout the cardiac
values) of intervention when compared to baseline values. cycle. Decrease in HR, DBP, and MAP represents increase
in parasympathetic and decrease in sympathetic activity
Table 6 shows there was no significant change in all the in slow pranayama group.[22] Non‑significant increase
tested parameters at post‑test level when compared to in PP (15.23%) was observed in slow pranayama group
Table 1: Comparison of baseline subject’s characteristics amongst three groups (mean±SD)

Parameters Group 1 Group 2 Group 3 F/df P value
Age (years) (mean±SD) 18.43±1.13 19.20±1.78 18.93±1.52 1.996 (2, 87) 0.142
Height (cm) (mean±SD) 159.10±7.61 157.45±9.09 157.16±8.58 0.457 (2, 87) 0.634
Weight (kg) (mean±SD) 49.63±6.12 50.13±8.94 53.10±12.32 1.174 (2, 87) 0.314
Gender
Male 7 4 5 ‑ 0.587
Female 23 26 25
One way ANOVA test for intergroup comparison of age, height and weight and Chi‑square test for the comparison of intergroup gender distribution
Table 2: Comparison of baseline cardiovascular parameters amongst three groups (mean±SD)

Parameters Group 1 (n=30) Group 2 (n=30) Group 3 (n=30) F/df P value
HR (bpm) 76.83±5.41 76.60±5.15 77.70±5.73 0.341 (2, 87) 0.712
RR (bpm) 17.40±2.13 17.06±1.77 17.06±1.14 0.370 (2, 87) 0.691
SBP 114.36±10.86 116.26±9.15 115.06±8.75 0.298 (2, 87) 0.743
DBP (mm Hg) 75.80±7.16 74.30±7.40 73.33±5.35 1.031 (2, 87) 0.361
PP (mm Hg) 39.43±11.26 41.96±9.55 41.73±10.43 0.540 (2, 87) 0.585
MAP (mm Hg) 88.94±7.96 89.03±8.09 87.24±4.52 0.612 (2, 87) 0.544
RPP (bpm‑mm Hg) 88.01±11.55 89.26±11.16 89.23±7.52 0.145 (2, 87) 0.865
Do P (bpm‑mm Hg) 6587.40±977.43 6839.71±945.51 6774.3±556.90 0.080 (2, 87) 0.923
PSS 19.10±4.53 19.50±4.59 20.60±3.06 1.062 (2, 87) 0.350
One way ANOVA test for the intergroup comparison of baseline cardiovascular parameters; Post‑hoc analysis by Tukey-Krammer test for baseline parameters:
Group 1 versus Group 2: Nil; Group 2 versus Group 3: Nil; Group 1 versus Group 3: Nil; HR = Heart rate; RR = Respiratory rate; SBP = Systolic blood
pressure; DBP = Diastolic blood pressure; PP = Pulse pressure; MAP = Mean arterial pressure; RPP = Rate pressure product; Do P = Double product;
PSS = Perceived stress scale

Table 3: Comparison of perceived stress scale score Table 5: Comparison of parameters between baseline
between baseline and post 12 weeks in 3 groups and post 12 weeks in group 2 (Slow pranayama group)
(mean±SD) (mean±SD)
Groups PSS score W value P value Parameters Pre Post t value P value
Pre Post HR (bpm) 76.60±5.15 73.66±3.90 4.915 ***0.000
Group 1 19.10±4.53 14.43±4.24 403 ***0.000 RR (bpm) 17.06±1.77 16.33±1.29 1.943 0.062
Group 2 19.50±4.59 14.00±2.90 388 ***0.000 SBP 116.26±9.15 114.36±7.14 0.979 0.336
Group 3 20.60±3.06 19.86±3.31 103 0.171 DBP (mm Hg) 74.30±7.40 70.16±4.48 2.746 *0.010
Analysis was done by Wilcoxon signed rank test; W value represents sum of PP (mm Hg) 41.96±9.55 44.20±7.89 ‑1.092 0.284
all signed ranks; PSS = Perceived stress scale MAP (mm Hg) 89.03±8.09 84.90±4.22 2.746 *0.010
RPP 89.26±11.16 84.22±6.78 2.707 *0.011
(bpm‑mm Hg)
Table 4: Comparison of parameters between baseline
Do P 6839.71±945.51 6251.90±426.51 4.121 ***0.000
and post 12 weeks in group 1 (Fast pranayama group)
(bpm‑mm Hg)
(mean±SD)
*P<0.05; **P<0.01; ***P<0.001, Pre versus post values were analyzed by
Parameters Pre Post t value P value paired t‑test; HR = Heart rate; RR = Respiratory rate; SBP = Systolic blood
HR (bpm) 76.83±5.41 75.73±4.89 0.863 0.395 pressure; DBP = Diastolic blood pressure; PP = Pulse pressure; MAP = Mean
RR (bpm) 17.40±2.13 16.73±1.04 1.747 0.091 arterial pressure; RPP = Rate pressure product; Do P = Double product
SBP 114.36±10.86 112.30±8.82 1.114 0.274
DBP (mm Hg) 75.80±7.16 74.16±6.80 1.109 0.277 Table 6: Comparison of parameters between baseline
PP (mm Hg) 39.43±11.26 38.13±10.3 0.691 0.495 and post 12 weeks in group 3 (Control group)
MAP (mm Hg) 88.94±7.96 86.87±5.76 1.376 0.179 (mean±SD)
RPP 88.01±11.55 85.01±8.37 1.224 0.231
(bpm‑mm Hg) Parameters Pre Post t value P value
Do P 6587.40±977.43 6570.70±502.65 1.481 0.149 HR (bpm) 77.70±5.73 76.83±4.59 1.089 0.285
(bpm‑mm Hg) RR (bpm) 17.06±1.14 17.10±1.37 -0.235 0.816
Pre versus post values were analyzed by paired t‑test; HR = Heart rate; SBP 115.06±8.75 113.50±8.26 1.517 0.140
RR = Respiratory rate; SBP = Systolic blood pressure; DBP = Diastolic blood DBP (mm Hg) 73.33±5.35 74.1000±4.18 -1.104 0.279
pressure; PP = Pulse pressure; MAP = Mean arterial pressure; RPP = Rate PP (mm Hg) 41.73±10.43 39.40±0.90 1.962 0.060
pressure product; Do P=Double product MAP (mm Hg) 87.24±4.52 87.233±4.10 0.018 0.985
RPP 89.23±7.52 87.09±6.91 1.581 0.125
(bpm‑mm Hg)
and no change was observed in other groups. Rise in PP
Do P 6774.3±556.90 6698.40±452.01 0.813 0.423
represents better tissue perfusion. RPP and Do P represent (bpm‑mm Hg)
sympathetic activity and are indirect measures of O2 Pre versus post values were analyzed by paired t‑test; HR = Heart rate;
consumption of heart or work load on heart.[23‑26] Rise in RR = Respiratory rate; SBP = Systolic blood pressure; DBP = Diastolic blood
pressure; PP = Pulse pressure; MAP = Mean arterial pressure; RPP = Rate
PP with decreased RPP indicates that the tissue perfusion pressure product; Do P = Double product
is increased with decreased work load on heart in slow
pranayama group. Therefore, our study demonstrates
tidal inspiration (as seen in Hering Breuer’s reflex),
that decrease in sympathetic activity and increase in
stretch of lung tissue produces inhibitory signals by
parasympathetic activity and thereby, improvement
action of slowly adapting stretch receptors and stretch
of autonomic tone towards parasympatho‑dominance of connective tissue (fibroblasts) localized around the
was seen in both fast and slow pranayama groups but lungs generates hyperpolarization currents, which are
statistically significant change in measured physiological propagated through neural and non‑neural tissues and
parameters was seen in only slow pranayama group. both of them cause synchronization of neural elements
in heart, lungs, limbic system and cortex. Inhibitory
We observed significant reduction in PSS scores in both current synchronizes rhythmic cellular activity between
fast and slow pranayama groups. Therefore, both types cardiopulmonary center and central nervous system and
of pranayama practice were equally effective in reducing also regulates excitability of nervous tissues indicative of
perceived stress in both Group 1 and Group 2 subjects. state of relaxation. Hyperpolarization of tissues manifests
Reduction in stress may have occurred due to better itself in parasympathetic like change. Synchronization
autonomic tone (higher parasympathetic and lesser within the hypothalamus and the brain stem is mainly
sympathetic tone) observed in Group 1 and 2 subjects and responsible for the parasympathetic response. Modulation
reduced stress may have resulted in improved cardiovascular of the nervous system and decreased metabolic activity is
functions in the slow and fast pranayama groups. indicative of the parasympathetic state.[27]
Both fast and slow pranayamas can be considered as deep Another study has explained changes in cardiovascular
breathing exercises performed at different frequencies of autonomic activity by breathing exercises on the basis
respiration. One study has hypothesized how pranayamic of known anatomical asymmetries in the respiratory,
breathing interacts with the nervous system affecting cardiovascular, and nervous system and that the coupling
metabolism and autonomic functions.[27] During above mechanisms between each of these systems: Lung‑heart,

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Figure 1: Flow chart of protocol carried out during the study
heart‑brain and lungs‑brain, are also asymmetrical.[28,29] Explanation of finding more effect with slow pranayamic
These asymmetrical vector forces resulting from the breathing can be due to the reason that slow breathing
mechanical activity of the lungs, heart and blood moving has been found to increase baroreflex sensitivity, reduce
throughout the circulatory system, will also produce sympathetic activity and chemo reflex activation in
a lateralization effect in the autonomic balance. There healthy subjects as well as hypertensives.[30,31] Furthermore,
are negative feedback loops between brain autonomic strongest cardioventilatory coupling is seen when there
controls and mechanical functions in the body as a is decreased breathing frequency like slow pranayamic
fundamental part of the body’s homeostatic mechanisms. breathing. [31] Increase in parasympathetic activity
A long‑term improvement in autonomic balance as well decreases resting HR and decrease in sympathetic tone
as in respiratory, cardiovascular and brain function can in skeletal muscle blood vessels decreases PVR resulting
be achieved if mechanical forces are applied to the body in decrease in DBP, MAP, reduced work load on heart and
with the aim of reducing existing imbalances of mechanical improved tissue perfusion.[22]
force vectors. This technique implies continually
controlling the body functions for precise timings like in To summarize, our study demonstrates that both types
pranayamic breathing techniques.[29] of pranayama practice are equally effective in reducing

perceived stress but significant benefit on physiological of slow and fast pranayams on reaction time and cardiorespiratory variables.
Indian J Physiol Pharmacol 2005;49:313‑8.
parameters is seen in only subjects practicing slow
13. Singh S, Gaurav V, Parkash V. Effects of a 6‑week nadi‑shodhana pranayama
pranayama. Since the results on perceived stress are
training on cardio‑pulmonary parameters. Journal of Physical Education and
comparable, slow pranayamas can be given to subjects in all Sports Management 2011;2:44‑7.
age groups (both young and old) whereas fast pranayamas 14. Subbalakshmi NK, Saxena SK, Urmimala, D’Souza UJ. Immediate effect of
are more suitable for subjects with stable cardiovascular “Nadi‑shodhana Pranayama” on some selected parameters of cardiovascular,
function. On post‑test analysis, sample size (power = 0.99) pulmonary, and higher functions of brain. Thai J Physiological Sci 2005;18:10‑6.
was found adequate for the present study. 15. Raghuraj P, Ramakrishnan AG, Nagendra HR, Telles S. Effect of two selected
yogic breathing techniques of heart rate variability. Indian J Physiol Pharmacol
1998;42:467‑72.
In the present study, it was not possible to attempt double 16. Pal GK, Velkumary S, Madanmohan. Effect of short‑term practice of breathing
blind conditions. Only single composite questionnaire was exercises on autonomic functions in normal human volunteers. Indian J Med Res
used to measure perceived stress. Future studies should 2004;120:115‑21.
include biochemical parameters such as vanillylmandelic 17. Allen MT, Bocek CM, Burch AE. Gender differences and the relationships of
acid, metanephrines along with other personality scales, perceived background stress and psychological distress with cardiovascular
responses to laboratory stressors. Int J Psychophysiol 2011;81:209‑17.
which could be related to stress levels. Therefore, the
18. Suter PM, Maire R, Holtz D, Vetter W. Relationship between self‑perceived stress
results can be considered to be preliminary and be viewed and blood pressure. J Hum Hypertens 1997;11:171‑6.
with caution of potential rater bias. No significant clinical 19. Cohen S. Perceived stress in a probability sample of United States. In: Spacapan
side‑effects (confusion, cardiovascular accidents, dyspnea Shirlynn, Oskamp Stuart, editors. The social psychology of health. The Claremont
etc.) occurred with pranayama practice during the study Symposium on Applied Social Psychology. Thousand Oaks, CA, US: Sage
period. Publications; 1988. p. 31‑67.
20. Gitananda Giri Swami. Pranayama: The Fourth Limb of Ashtanga Yoga.
Pondicherry, India: Satya press; 2008.
ACKNOWLEDGEMENTS 21. Hainsworth R. Circulatory responses from lung inflation in anesthetized dogs.
Am J Physiol 1974; 226:247‑55.
The authors thank Sri G Dayanidy, yoga instructor ACYTER for
22. Willam F Ganong. Cardiovascular regulatory mechanisms. Review of Medical
giving pranayama training to the subjects. Authors feel deep Physiology. 22nd ed. Singapore: The McGraw‑Hill Companies; 2005. p. 597‑610.
gratitude for all the subjects who volunteered for the present
23. Kitamura K, Jorgensen CR, Gobel FL, Taylor HL, Wang Y. Hemodynamic
study. We also thank Director JIPMER and Director Morarji Desai correlates of myocardial oxygen consumption during upright exercise. J Appl
National Institute of Yoga, New Delhi for their support. Physiol 1972;32:516‑22.
24. Hermida RC, Fernández JR, Ayala DE, Mojón A, Alonso I, Smolensky M.
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Indian J Physiol Pharmacol 2013; 57(2) : 199–204 Suryanamaskar on Reaction Time and Heart Rate 199
SHORT COMMUNICATION
IMMEDIATE EFFECTS OF SURYANAMASKAR ON REACTION TIME

AND 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 dynamic

muscular movements synchronised with deep rhythmic breathing. As it
may have influence on CNS, this study planned to investigate immediate
effects of SN on reaction time (RT) and heart rate (HR). 21 female volunteers
attending yoga classes were recruited for study group and 19 female
volunteers not participating in yoga were recruited as external-controls.
HR, auditory reaction time (ART) and visual reaction time (VRT) were
recorded before and after three rounds of SN in study group as well as 5
minutes of quiet sitting in both groups. Performance of SN produced
immediate decrease in both VRT and ART (P<0.001). This was significant
when compared to self-control period (P<0.001) and compared to external-
control group, it decreased significantly in ART (p=0.02). This was
pronounced when Δ% was compared between groups (P<0.001). HR
increased significantly following SN compared with both self-control
(p=0.025) and external-control group (p=0.032). Faster reactivity may be
due to intermediate level of arousal by conscious synchronisation of dynamic
movements with breathing. Rise in HR is attributed to sympathetic arousal
and muscular exertion. We suggest that SN may be used as an effective
training means to improve neuro-muscular abilities.
Key words : yoga suryanamaskar reaction time heart rate
INTRODUCTION means of determining sensory-motor

association, performance and cortical arousal
Beneficial effects of Yoga have been (3).
reported in peripheral and central neuronal
processing (1, 2, 3, 4). Reaction time (RT) is It has been reported that changes in
simple and effective method of studying breathing period produced by voluntary
central neuronal processing and is a simple control of inspiration are significantly
*Corresponding author : Dr. Ananda Balayogi Bhavanani, Honorary Advisor, Centre for Yoga Therapy,
Education and Research (CYTER), MGMCRI, Pondicherry – 607 402
correlated to changes in RT (5). Some studies part of the Gitananda Tradition and involves
on yoga have shown that regular practice of dynamic performance of a sequential
yoga over a period of few weeks to a few combination of yogic postures in synchrony
months can significantly decrease both visual with breathing (13). The speciality of this
reaction time (VRT) and auditory reaction variation is the usage of nasarga mukha
time (ART) (2, 3, 6). Previous studies by bhastrika, a bellows type of yogic breathing
Bhavanani et al have reported a significant done with internalized awareness of
and immediate decrease in RT following the diaphragmatic actions.
practice of nine rounds of mukha bhastrika,
a bellows type of pranayama in normal The keywords for SN are “stretch” and
school children as well as mentally “breathe” and the breathing must be deep
challenged adolescents (7, 8). and regular with the movements flowing with
the breath. From a standing position
Suryanamaskar (SN) is a sequential (samasthiti asana) both arms are stretched
combination of yogic postures performed up breathing in, and the palms brought
dynamically in synchrony with the breath. together in anjali mudra. While exhaling,
Energy cost and physiological changes during stretch down with palms flat to the ground
the practice as well as after training have and forehead to knees in pada hastha asana.
been reported (9, 10, 11, 12). Lift the head while breathing in and then
blast out with a “whoosh” jumping back with
Keeping the above in mind, this study the whole body parallel to the ground in
was planned to investigate the acute effects chatur danda asana. On the next in-breath,
of SN on RT and heart rate (HR) in trained lift the head and bend back as much as
female volunteers. possible (kokila asana). Come into meru
asana by lifting the buttocks up, keeping the
METHODS knees tight and straight while pushing down
on the heels. In this position, inhale through
Twenty-one female volunteers (mean age the nose and “whoosh” out forcefully through
28.29±1.71 years) were recruited from those the mouth (nasarga mukha bhastrika).
attending regular yoga classes at CYTER in Breathe in and jump forward bringing both
Mahatma Gandhi Medical College and feet between the hands placed firmly on the
Research Institute, Puducherry. Another ground. Stretch the head up and feel a
group of 19 female volunteers (mean age stretch through the entire back. Breathe out
32.11±1.41 years) not attending yoga classes and lower the head down to knees. Breathe
were recruited as external-controls. Informed in and lift back up to anjali mudra and finally
consent was obtained from all participants return and relax in samasthiti asana.
and ethical clearance was obtained from
Institutional Human Ethics Committee. RT apparatus manufactured by Anand
Agencies, Pune was used with built in 4 digit
Numerous variations of the SN are chronoscope and display accuracy of 1ms.
taught and the one used in the present study Simple ART was recorded for auditory beep
is known as Aruna SN. This is an integral sound and simple VRT for red light. Subjects
Indian J Physiol Pharmacol 2013; 57(2) Suryanamaskar on Reaction Time and Heart Rate 201
were instructed to release response key with Statistical analysis

dominant hand as soon as they perceived
the stimulus given from the front to avoid Data are expressed as mean±SEM.
effect of lateralised stimulus (14). All subjects Statistical analysis was done using GraphPad
were given adequate exposure to the InStat version 3.06 and all data passed
equipment on 2 different occasions to normality testing by Kolmogorov-Smirnov
familiarize them with the procedure. To Test and hence analyzed using Students t
ensure objectivity, HR was recorded using test for paired data for intra-group
non-invasive semi-automatic BP monitor (CH comparisons and Students t test for unpaired
– 432, Citizen Systems, Tokyo, Japan) having data between groups. P values less than 0.05
range from 40 to 180 beats/min and accuracy were accepted as indicating significant
± 5%. differences.
For SN group, RT measurements and HR RESULTS

recordings were done twice; before and after
a control period of 5 minutes of quiet sitting Mean age of subjects in the SN group
and then before and after practice of SN. was 28.29±1.71 and in external-control group
Control period was 5 minutes, equivalent to was 32.11±1.41 years and difference between
duration taken to perform SN. To avoid groups was not significant.
influence of recording on different days and
order of recording, half subjects performed Comparison of self-control HR, ART and
self-control recordings on day-1 and VRT recordings in SN group showed no
others did SN recordings. This was reversed significant differences (P>0.05) when
on day-2. For external-control group, RT compared with external-control group
measurements and HR recordings were done recordings both at baseline and after 5
before and after 5 minutes of quiet sitting minutes of quiet sitting.
with half recording on day-1 and others on
day-2. Ten trials were recorded and average The mean±SEM values of HR, ART and
of lowest three similar observations were VRT recordings and their statistical
taken as single value (14). comparison between SN, self-control and
TABLE I : Immediate effect of suryanamaskar on heart rate (HR), auditory reaction time (ART) and
visual 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.
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 immediately
after (A) three rounds of suryanamaskar and in an external- control group of 19
female 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 0.004

ART 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 < 0.001
VRT 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.
external-control groups are given in Tables compared to both self-control period (p=0.025)
I and II. and external-control group (p=0.032). The Δ%
difference in HR between SN and external-
The changes were significant with regards control group was statistically significant
to a rise in HR and fall in ART and VRT (p=0.004) and just missed significance with
following SN as compared with both self- self-control period (p=0.072). This rise in HR
control and external-control group data. This can be attributed to sympathetic arousal as
was more pronounced (P<0.001) in ART and well as muscular exertion and this is in
VRT data when the baseline adjusted agreement with another report that average
percentage changes (Δ%) were compared intensity during SN was 80% HRmax,
between groups. sufficient to elicit a cardio-respiratory
training effect (12). It has been previously
DISCUSSION reported that SN produces an increase in
VO2 max indicating improved aerobic
To the best of our knowledge, this is the capacity and that it exerts only moderate
first report on the immediate effects of SN stress on cardio-respiratory system as it
on RT. Previous studies on immediate/acute keeps the practitioner within their lactate
effects of SN have focussed on energy cost and anaerobic threshold (9, 10).
and cardio-respiratory changes during the
practice or cardiorespiratory and metabolic Performance of SN produced immediate
responses to four rounds of the practice and statistically significant decreases in VRT
(9, 12). Both these studies lacked control and ART. The faster reactivity is in agreement
groups whereas our present study analyses with previous studies on immediate effects
immediate effects of RT with reference to of mukha bhastrika and three weeks of
both self-control data as well as data from a slow and fast pranayama training (7, 8, 14).
separate external-control group. Decrease in RT signifies improvement in
central neuronal processing ability and this
HR increased significantly following may be attributed to greater arousal and
performance of three rounds of SN (P<0.01). faster rate of information processing along
This was statistically significant when with improved concentration. RT is fastest
Indian J Physiol Pharmacol 2013; 57(2) Suryanamaskar on Reaction Time and Heart Rate 203
with an intermediate level of arousal and expirations may alter afferent inputs from
deteriorates when subjects are either too abdominal and thoracic regions, in turn
relaxed or too tensed. Exercise improves RT modulating activity at ascending reticular
and moderate muscular tension shortens pre- activating system and thalamo-cortical levels
contraction RT while isometric contraction (7, 8).
allows the brain to work faster (15).
Alternate forward and backward bending On the basis of the present study, it is
movements as well as the jumping back and concluded that three rounds of SN produce
forth movements in SN may have influenced significant shortening of RT in female
RT in a manner similar to isometric subjects as part of a generalised sympathetic
muscular exercise. Though RT shortening arousal as evidenced by significant rise in
effect of exercise is normally lost in post HR. We suggest that SN may be used as an
exercise period as arousal diminishes (16), effective training means to improve neuro-
in our subjects shortening of RT was carried muscular abilities. As our study is limited
over into post SN period too. With the above by a small sample size, further studies with
in mind, we attribute faster reactivity of our larger sample sizes may help to understand
subjects following SN to an intermediate better underlying mechanisms involved in
level of arousal brought about by conscious bringing about such an immediate benefit.
synchronisation of dynamic muscular
movements with slow, regular and deep ACKNOWLEDGMENTS
breathing.
The authors thank management and
Previous studies have demonstrated EEG authorities of Sri Balaji Vidyapeeth
changes around somato-sensory and parietal University for setting up the Centre for Yoga
areas of cerebral cortex suggesting affective Therapy, Education and Research (CYTER)
arousal following agnisara, nauli and in Mahatma Gandhi Medical College and
bhastrika and suggested such changes occur Research Institute (MGMCRI).
through strong stimulation of somatic and
splanchnic receptors (17). The nasarga The authors are grateful to Yogacharini
mukha bhastrika in meru asana, involving Meenakshi Devi Bhavanani, Director ICYER
multiple forceful expirations done rapidly and for her constant motivation, encouragement
consecutively may have prolonged and and supportive guidance. We thank Miss
residual neuro-muscular effect influencing Subashana, ANM for assistance during
RT. It has been suggested that such forceful recording sessions and data entry.
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1. Malhotra V, Singh S, Tandon OP, Madhu SV, N, et al. Effect of yoga training on reaction
Prasad A, Sharma SB. Effect of yoga asanas on time, respiratory endurance and muscle strength.
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3. Malathi A, Parulkar VG. Effect of yogasanas on
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Alterations of auditory middle latency evoked Ravindra P. A comparative study of slow and
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12. Mody BS. Acute effects of surya namaskar on
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14. M a d a n m o h a n , U d u p a K , B h a v a n a n i A B ,
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Int. Res J Pharm. App Sci., 2013; 3(4):116-118 ISSN: 2277-4149
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
Research Article
EFFECT OF 8 WEEKS OF PRANAV PRANAYAMA TRAINING ON PULMONARY FUNCTION
TEST PARAMETERS IN YOUNG HEALTHY, VOLUNTEERS OF JIPMER POPULATION
Dinesh T1, Sharma V K2, Raja Jeyakumar M3, Syam Sunder A4, Gopinath M 5 Ananda Balayogi Bhavanani6
1
Assistant Professor, Department of Physiology, Vinayaka Missions medical college, Karaikal- 609605,
2
Sharam V K Assistant Professor, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research,
Puducherry- 605006
3
Assistant Professor, Department of Physiology, Chennai Medical college hospital and research centre, Irungalur, Trichirappalli-
621105
4
PhD Scholar, Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry-
605006
5
Assistant Professor, Department of Physiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research,
Melmaruvathur- 603319
6
Deputy Director, CYTER, Mahatma Gandhi Medical College and Research Institute, Puducherry - 607 402
Corresponding Author: Dinesh T, Email: arvindr84@gmail.com
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 throughout the lungs, in contrast with shallow breathing that

Yoga, an ancient Indian science has been practiced refreshes air only at the base of the lungs(3). Spirometry is
as a healthy way of life. Yoga emphasizes on controlled the most commonly used technique to screen the respiratory
breathing (pranayama), body posture (asana), relaxation of diseases. It includes the assessment of lung volumes and
mind (meditation) keeps a person energetic & healthy for flow-volume curves (1, 2). Among the previous Studies
maintaining health and fitness and for treating diseases. conducted at pranayama in several institutions in India have
Pranayama is a method of yogic type of breathing and chest reported impressive success in improving the lung functions
expansion exercise, has been reported in previous studies as and has a positive effect and permanent relief from asthma.
it is known to improve respiratory function in healthy It has also been proved that asthma attacks can usually be
individuals as well as in respiratory diseases. Pranayama, prevented by Yoga methods without resorting to drugs.
the fourth step of ash tang yoga is an important component Physicians have found that the addition of improved
of yoga training. „Prana‟ the vital life force that acts as a concentration ability and yogic meditation together with the
catalyst in all our activities and „Ayama‟ is the expansion of practice of simple postures and pranayama makes treatment
Pranayama can be defined as the science of controlled, more effective in patients who practice. Yoga has a better
conscious expansion of Prana in our energy body sheath. As chance of gaining the ability to control their breathing
a deep breathing technique, Pranayama reduces ventilation problems. With the help of yogic breathing exercises, it is
and decreases work of breathing. It also refreshes air possible to control an attack of severe shortness of breath
Dinesh T et al., 2013 116
without having to seek medical help. Various studies have Therapy Education and Research (ACYTER), JIPMER,
confirmed the beneficial effects of pranayama for patients Pondicherry. Practice sessions were conducted three days
with respiratory problems (2, 3) .The ultimate goal of per week (Monday, Wednesday and Friday) during the
traditional yogis was “self realization” or “enlightenment”, a evening time for 20-30 minutes for a total duration of eight
concept, which perhaps is quite esoteric to you and me. The weeks. On rest of the days subjects were motivated to
first step on this path is to reduce peripheral mental activity practice at their home. Pranav pranayama is slow, deep and
through bringing awareness into the body, and then later rhythmic breathing in co ordination with A, U; M sounds
through relaxation and meditation to simply observe the which were pronounced during expiration. They were asked
breath. This helps to quiet the mind and take us to a place of to assume „Sukhasana‟ (the comfortable posture). Deep
peace. The reduction, and ultimately cessation of mental inhalation for 6 counts in co ordination with turning the
activity is the goal or aim of meditation. On experiencing head to right side. This is followed by chanting „ah‟ in
this state we become aware of our unity with all things and coordination with the movement of head towards centre.
our essential nature of peace (3). Deep inhalation for 6 counts in co ordination with turning
the head to left side. This is followed by chanting „vu‟ in
Materials and methods coordination with the movement of head towards centre.
The present study was conducted on 12 young Deep inhalation for 6 counts in co ordination with turning
healthy, volunteers of both the genders. Mean age was the head and chin up. This is followed by chanting „ma‟ in
18.58+0.66 years. After obtaining clearance from the coordination with the movement of head towards
Institute Ethics Committee, subjects were motivated and centre.Pranav pranayama was given for 3 cycles. At the end
recruited for the study. Subjects with the history of active subjects were made to lie down in Shavasana for 10
sports training, previous experience of yoga, history of minutes.
chronic respiratory illness, history of major surgery in the
recent past, smoking, alcohol consumption were excluded Statistical analysis:
from the study. The subjects were familiarized with the aims Graph pad software was used to analyze the data.
and objectives of the study as well as laboratory The values obtained from pre and post training period were
environment. After giving detailed information about the analyzed using Student‟s paired t - t e s t. Data were
study, written consent was obtained from the volunteer expressed as Mean ± SD.„P‟ value of less than 0.05 was
subjects. considered as significant.
Analysis of Parameters: Results:

Baseline parameters (pre values) were recorded at Our results showed a significant difference in
the beginning of the study. Height and weight were pulmonary function parameters. Before paranayma training
measured using height scale and weighing scale FVC was around 2.29+ 0.58, after it was 2.35+0.63, FEV1
respectively. Using spirometer (Micro lab Version 1.32) was around 2.22+0.59 after it was 2.285+0.63, FEV1/FVC
pulmonary function parameters were recorded. Pulmonary was around 97.11+3.83 after it was 97.45+3.36, FEF was
Function Tests parameters analyzed are studied were around 3.35+1.01,after it was around 5.85+8.15, PEFR was
Forced Vital Capacity (FVC), Forced Expiratory Volume in around 266.83+72,after it was around 290.91+82.56, MVV
first second (FEV1), Ratio between FEV1 and FVC (FEV1/ was around 84.2+23.16 after it was around 85.90+ 23.59,
FVC), Peak Expiratory Flow Rate (PEFR), and Forced from the above results we concluded that PEFR was not
Expiratory Flow at 25-75 (FEF25-75) and Maximum statically significant P< 0.05. Other parameters showed a
Voluntary Ventilation (MVV). The values of all tests were significantly high value in pre and post data which is
taken as % predicted as per age, sex and height of each statistically significant P> 0.05. The above values are coded
subject according to standard equation .The subjects were in table 1 as the pre and post data of our study which was
instructed to do the procedure in the sitting posture, with the conducted on 12 healthy volunteers of both the genders of
erect spine, without forward bending. The subject is asked to age group around18.58+0.66 years. A positive result was
keep the mouth piece inside the mouth with the lips closed analyzed among the pulmonary function parameters from
so as to make a seal, to avoid air leak while blowing; nose our study.
was closed with the nose clips. They performed slow
expiratory vital capacity and forced vital capacity Table 1: Effect of savitri pranayama training on
maneuvers. These procedures were repeated for two more pulmonary function parameters before and after 8 weeks
times with of 3-5 minutes of interval in-between. The of study period. Values are expressed as Mean±SD
subjects are instructed to give their maximal effort. The PFT Parameters BeforePranayama After pranayama
above said PFT parameters such as FVC, FEV1, FEV1 / training (n=12) training (n=12)
FVC, FEF25-75, PEFR and MVV were noted. Three readings FVC (L) 2.29+ 0.58 2.35+0.63
were taken and the best value out of them was recorded. The FEV1 (L) 2.22+0.59 2.285+0.63
same procure was followed while recording the post values FEV1/FVC (%) 97.12+3.83 97.45+3.36
at the end of 8 weeks of pranayama training. PEFR (L/m) 266.83+72 290.91+82.56 *
FEF25-75 (L/s) 3.35+1.01 5.85±1.15**
Pranayama training: MVV (L) 84.2+23.16 85.90+23.59
The subjects were given pranav pranayama training LEGEND -1 the values obtained before and after the
and practiced the same under the guidance of a trained, training period were compared using Student‟s paired t - t e
certified yoga instructor at Advanced Centre for Yoga
s t *P< 0.05, **P < 0.01. Forced Vital Capacity (FVC), Acknowledgement
Forced Expiratory Volume in first second (FEV1), Ratio We acknowledge Mr. Dayanidy yoga instructor, ACYTER,
between FEV1 and FVC (FEV1/ FVC), Peak Expiratory JIPMER. Dr.Velkumary, Assistant Professor, Mr. Shyam
Flow Rate (PEFR), Forced Expiratory Flow at 25-75 (FEF25- Sundar Kiran PhD scholar, Department of Physiology,
75) and Maximum Voluntary Ventilation (MVV). JIPMER who helped us for the conduct of this project.
And a warm thanks to the volunteers who participated in our
Discussion study.
Yoga consists of different type of practices, most
common of which is pranayama. Different pranayama REFERENCES:
produce different physiological effects. Madan Mohan et al 1. Madanmohan, Udupa K, Bhavanani AB,
conducted a study on effect of slow and fast pranayama on Vijayalakshmi P, Surendiran A. Effect of slow and
cardiorespiratory changes they concluded that pranayama fast pranayamas on reaction time and
has a positive effect by improving the cardio respiratory cardiorespiratory variables. Indian J Physiol
performance by minimizing the sympathetic effect on Pharmacol 2005; 49: 313–318.
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in which they found that yogic Asanas and pranayama term „pranayamaa‟ practice on breathing rate and
reduce the resting respiratory rate and increase vital ventilatory functions of lung. Indian J Physiol
capacity, timed vital capacity, maximum voluntary Pharmacol 1992; 36: 105-108.
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expiratory pressures (2) . They concluded pranayama Pranayamas and Kriyas. Bijilani RL, editor,
sessions in young male volunteers. The results of the study Understanding medical physiology, Third edition.
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may have occurred due to strength and endurance of 7. Madanmohan, Rai UC, Balavittal V, Thombre
respiratory muscles and improvement in cardio, respiratory DP,Swami Gitananda. Cardiorespiratory changes
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previous studies of Udupa et al… A in1975. In our study Review 1983; 3: 25–34.
the changes did not reach statistical significance probably 8. Ganong WF. Review of Medical Physiology.
due to differences in the protocols, study design and lesser Boston: McGraw-Hill, 2003.
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substantiates the claim that yoga practice is beneficial on the on the effect of some yogic breathing exercises
pulmonary function in normal subjects. In future we are 1975
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CONCLUSION and Neelima Kantak, Study of lipid profile and
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improve the lung function.

International Standard Serial Number 2321-7049
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.
2
Department of Physiology, Jawaharlal Institute of Postgraduate Medical
Education & Research, Puducherry – 605006.
3
Education & Research, Puducherry – 605006.
4
Education & Research, Puducherry – 605006
5
Deputy 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.
www.ijmpsrr.com Page 53
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-
(2)
respiratory system . 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.
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
(6)
glottis . 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
(9)
controlling breathing pattern, it is possible to influence ANS functions . 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
(10,11)
of Kapalabhati pranayama . 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-
(13)
heart, heart-brain and lungs-brain are also asymmetrical . 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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Bhavanani et al., Altern Integ Med 2013, 2:9
Alternative & Integrative Medicine http://dx.doi.org/10.4172/2327-5162.1000144
Research Article Open Access
Immediate Cardiovascular Effects of a Single Yoga Session in Different

Conditions
Ananda Balayogi Bhavanani1*, Meena Ramanathan1 and Madanmohan2
1
Centre for Yoga Therapy, Education and Research, Mahatma Gandhi Medical College & Research Institute, Pillayarkuppam, Pondicherry, India
2
Department of Physiology, Mahatma Gandhi Medical College & Research Institute, Pondicherry, India
Abstract
Aim 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.
Keywords: Yoga therapy; Cardiovascular effects; Psycho-somatic advantage of its birthright of health and happiness, it is imperative
harmony that modern, science-based medicine integrate the holistic approach of
traditional healing techniques like yoga. Only in this way can medical
Introduction practitioners provide true health care, as opposed to merely caring for
Humanity is today faced with numerous debilitating chronic the sick. The result will be an improvement in the quality of health, and
illnesses related to aging, environment and an increasingly hedonistic life, around the world.
lifestyle. These illnesses include cancer, diabetes, osteoporosis, and Numerous studies have been done in the past few decades on
cardiovascular disease, as well as incurable diseases such as AIDS. psycho-physiological and biochemical changes occurring following
While modern medicine has much to offer in its treatment of acute practice of yoga [2-9]. A few clinical trials have also shown promise
illness, accidents and communicable diseases, it cannot provide all the despite yoga not being ideally suited for the scientific gold standard
solutions for the many ills that plague 21st century (woman). Yoga, as of ‘double-blind’ clinical trials [10,11] and though we are truly yet to
a complement to modern medicine, can be especially useful in helping research and understand subtler effects of yoga [12]. Evidence is also
to fill in the gaps in the fields of disease prevention, management and growing that yoga practice is a relatively low-risk, high-yield approach
rehabilitation. When combined, modern medicine and yoga turn out to to improving overall health and wellbeing [13]. It has been rightly
be more than the sum of their parts. What is the source of this synergy pointed out that yoga is qualitatively different from any other mode of
between modern and ancient science? While modern science looks physical activity in that it consists of a unique combination of isometric
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 *Corresponding author: Ananda Balayogi Bhavanani, CYTER, Mahatma Gandhi
Medical College & Research Institute, Pillayarkuppam, Pondicherry 607402, India,
proves to be more effective than either alone. Tel: 91-413-2622902; E-mail: yognat@gmail.com
Dr. Dean Ornish, the renowned American physician and author Received September 28, 2013; Accepted November 11, 2013; Published
who has shown that a yogic lifestyle can reverse heart disease, says, November 13, 2013
“Yoga is a system of perfect tools for achieving union as well as healing” Citation: Bhavanani AB, Ramanathan M, Madanmohan (2013) Immediate
[1]. Dr. B. Ramamurthy, the eminent neurosurgeon, has observed that Cardiovascular Effects of a Single Yoga Session in Different Conditions. Altern
Integ Med 2: 144. doi:10.4172/2327-5162.1000144
yoga practice reorients the functional hierarchy of the entire nervous
system [1]. He has also noted that yoga benefits the cardiovascular, Copyright: © 2013 Bhavanani AB, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
respiratory, digestive, and endocrine systems, in addition to bringing unrestricted use, distribution, and reproduction in any medium, provided the
about other positive biochemical changes. For humanity to take full original author and source are credited.
Altern Integ Med

ISSN: 2327-5162 AIM, an open access journal Volume 2 • Issue 9 • 1000144
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
Page 2 of 4
muscular contractions, stretching exercises, relaxation techniques, and India. CYTER is conducting regular yoga therapy sessions daily for
breathing exercises [14]. patients of different conditions as well as normal subjects. Data of
1896 patients (1229 female, 633 male and 34 transgender) with mean
There are only a few studies that have focused on the immediate
age of 36.28 ± 12.64 y who attended yoga therapy sessions at CYTER
effects of a single yoga session and these include one that investigated
the effectiveness of a single 90-minute hatha yoga class and concluded between November 2010 and September 2012 was used for analysis.
that it can significantly reduce perceived stress [15]. Another recent These sessions were carried out in CYTER Yoga hall between 10 AM
study showed that cognitive performance after a yoga session was and 12 noon on weekdays in a quiet environment, with a comfortable
significantly superior as compared with an aerobic session [16]. A temperature and subdued lighting. The participants had been advised
recent report on the acute effects of one session of hatha yoga practice to finish their breakfast at least 2 hours earlier and come after emptying
on blood pressure and other cardiovascular responses in healthy bowel and bladder.
volunteers has showed that systolic (SP), mean (MP), and diastolic
(DP) blood pressures increased significantly during the yoga practice Heart rate (HR), SP and DP had been recorded before and after the
[14]. However they have not compared the pre-post effects of the 60 minute yoga sessions at CYTER. To ensure objectivity, all recordings
entire session and only focused on the individual techniques during were performed using non-invasive semi-automatic BP monitor (CH-
the session. 432, Citizen Systems, Tokyo, Japan) with an instrumental accuracy of
± 5% for HR and ± 3 mm Hg for BP. Pre intervention HR and BP
With the above in mind, this retrospective review of data was done
was recorded after 5 min of supine rest while the post-intervention
to determine cardiovascular effects of a single 60-minute yoga session
recordings were taken at the end of the session in supine position.
in normal subjects as well as patients of different medical conditions.
Cardiovascular indices like pulse pressure (PP), MP, rate-pressure
Materials and Methods product (RPP) and double product (DoP) were derived from the
recorded parameters.
This retrospective review of clinical data was conducted at the Center
for Yoga Therapy Education and Research (CYTER) functioning in The participants were undergoing appropriate yoga therapy
Mahatma Gandhi Medical College and Research Institute, Puducherry, protocols as per their individual condition (Table 1) while normal
Yogic technique Normal Endocrine and Respiratory Hypertension & Musculo-skeletal Psychiatric
subjects skin disorders disorders CV disorders disorders disorders
Jathis & kriyas (loosening techniques) √ √ √ √ √ √
Aruna surya namaskar (slow, breath coordinated) √ √ √
Standing asanas
Trikona asana √ √ √ √
Veera asana 1 & 2 √ √ √
Tada asana √ √ √ √
Ardhakati & kati chakra asana √ √ √
Mehru asana & nasarga mukha bhastrika √ √
Ardha utkat asana √ √
Sitting asanas
Vakra asana √ √ √ √ √
Paschimottana/purvottana asana √ √ √ √ √
Matsya asana √ √ √ √
Chatuspada kriya/vyagraha pranayama √ √ √
Danda kriya √ √
Ashwini mudra/moola bandha √
Face prone asanas
Bhujanga asana/ bhujangini mudra √ √ √ √ √
Ardha shalaba asana √ √ √
Makara asana √ √ √ √ √
Supine asanas
Pawanamukta series √ √ √ √ √
Pada uttana series √ √ √ √ √
Sethu kriya √
Relaxation
Savitri pranayama in shava asana √ √ √ √ √ √
Marmanasthanam/kaya kriya √ √ √ √ √ √
Pranayamas
Mukha 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.
Altern Integ Med

Page 3 of 4
subjects had a general schedule of practice. Typical yoga sessions in those having endocrine/skin (n=230) and musculoskeletal (n=120)
included simple warm ups (jathis and surya namaskar), breath body conditions. It was moderately significant in the normal subjects
movement coordination practices (kriyas), static stretching postures (n=582) as well as patients having psychiatric (n=302) and respiratory
(asana), breathing techniques (pranayama), relaxation and chanting. (n=157) conditions.
At our centre, we are using the yoga therapy methods and schedules
as elucidated in Yoga Chikitsa: The Application of Yoga as a Therapy Discussion
authored by Yogacharya Dr. Ananda Balayogi Bhavanani, published by There is a healthy reduction in HR, BP and derived cardiovascular
Dhivyananda Creations, Pondicherry, India 2013. indices following a single yoga therapy session. The magnitude of this
Data were assessed for normality using GraphPad InStat version reduction appears to depend on the pre-existing medical condition as
3.06 for Windows 95, (GraphPad Software, San Diego California well as the yoga therapy protocol adopted.
USA, www.graphpad.com). As all data passed normality testing by Reductions in various cardiovascular parameters following a
Kolmogorov-Smirnov Test, statistical analysis was carried out using single session of yoga implies better autonomic regulation of the heart
Student’s paired t test and ‘p’ values less than 0.05 were accepted as in our subjects. This can be attributed to either an overall increase of
indicating significant differences for pre-post comparisons (Tables 1 parasympathetic tone and/or a reduction in sympathetic tone. RPP and
and 2). 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].
Results
Sympathetic activation is known to increase HR and RPP and decrease
The results are given in Tables 2 and 3. There were statistically overall heart rate variability (HRV). RPP provides a simple measure of
significant (p<0.001) reductions in all the studied cardiovascular HRV in hypertensive patients and is a surrogate marker in situations
parameters following the yoga session in the overall analysis. The where HRV analysis is not available [19]. It has also been shown that
magnitude of reductions differed in the groups, it being more SDNN and total power of HRV are inversely correlated with mean HR
significant in those having hypertension (n=505) and less significant and RPP [17].
Groups HR SP DP
B A B A B A
Normal subjects 79.93 ± 8.33 77.14 ± 7.40*** 115.35 ± 10.42 114.45 ± 9.36* 74.37 ± 9.46 73.48 ± 7.11*
(n=582)
Endocrine/skin 80.05 ± 9.46 78.06 ± 8.54*** 111.65 ± 10.64 112.51 ± 10.04 70.77 ± 9.00 71.88 ± 7.40 *
(n=230)
Respiratory 78.55 ± 7.76 76.36 ± 6.35 ** 112.32 ± 6.75 111.18 ± 5.57* 72.94 ± 6.52 72.79 ± 5.97
(n=157)
Hypertension 78.50 ± 7.38 75.84 ± 6.71*** 129.04 ± 14.65 124.98 ± 11.35*** 80.59 ± 9.96 79.10 ± 8.39***
(n=505)
Musculo-skeletal 77.78 ± 7.25 75.80 ± 6.49 * 112.98 ± 12.14 112.03 ± 9.13 72.59 ± 9.12 73.30 ± 7.31
(n=120)
Psychiatry 81.53 ± 9.81 78.66 ± 9.06 *** 115.06 ± 11.54 112.86 ± 10.56 *** 74.01 ± 9.18 73.50 ± 8.02
(n=302)
Total 79.55 ± 8.44 77.00 ± 7.61*** 118.13 ± 13.58 116.39 ± 11.29 *** 75.3 ± 9.85 74.76 ± 8.04 ***
(n=1896)
*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 DoP

B A B A B A B A
Normal subjects 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***
(n=582)
Endocrine/skin 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
(n=230)
Respiratory 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**
(n=157)
Hypertension 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***
(n=505)
Musculo-skeletal 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*
(n=120)
Psychiatry 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***
(n=302)
Total 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***
(n=1896)
*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.
Altern Integ Med

Page 4 of 4
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Acknowledgments 221-227.
The authors thank the management and authorities of Sri Balaji Vidyapeeth 21. Madanmohan S, Rai UC, Balavittal V, Thombre DP, Gitananda S (1983)
University for setting up the Centre for Yoga Therapy, Education and Research Cardiorespiratory changes during savitri pranayama and shavasan. The Yoga
(CYTER) in Mahatma Gandhi Medical College and Research Institute (MGMCRI). Review 3: 25-34.
We are grateful to Yogacharini Meenakshi Devi Bhavanani, Director ICYER for her
constant motivation and supportive guidance. Thanks are due to Yoga instructors Citation: Bhavanani AB, Ramanathan M, Madanmohan (2013) Immediate Cardiovascular
Mrs D Pushpa and Dr. R Balaji for conducting the therapy sessions and for their Effects of a Single Yoga Session in Different Conditions. Altern Integ Med 2: 144.
valuable assistance during recording sessions and data entry. doi:10.4172/2327-5162.1000144
Altern Integ Med

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
Research Article
HEMATOLOGICAL, BIOCHEMICAL AND PSYCHOLOGICAL EFFECTS OF A YOGA

TRAINING PROGRAMME IN NURSING STUDENTS
Ananda Balayogi Bhavanani1*, Meena Ramanathan2, Madanmohan3, 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: yognat@gmail.com
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 patients suffering from lifestyle disorders. (12,13) It has been

Holistic health, integrative treatment and mind– suggested that yoga enhances mood, balances emotions and
body medicine are some of the current buzz words in health modulates activity of hypothalomo-pituitary-adrenal (HPA)
care. Integrative medicine is gaining in popularity and, here, axis. (3,4,14) )It reduces allostatic load in stress response
yoga has the potential to make a significant contribution. systems, restoring optimal homeostasis by normalizing
The art and science of yoga has been practised for thousands parasympathetic nervous system and GABA under-
of years. Recently, numerous scientists have studied its activity.(15) Another recent study detailed the
effects and reported consistent, beneficial physiological and psychophysiological benefits of Yoga training in a
psychological changes. (1-10) Yoga may be considered the paramedical student population, reporting improvements in
original mind-body medicine; its philosophy and practice anthropometric, cardiovascular and neurological parameters,
are highly effective in producing psycho-somatic and coupled with positive changes in heart rate variability
somato-psychic re-integration. Yoga improves mood and (HRV) and Quality of Life (QoL) indices, signifying a
reduces stress by emphasizing every-moment body healthier state of body and mind. (16)
awareness involving attentional focus on one‟s breathing,
emotions, thoughts or specific parts of the body. (11) These Authorities of Kasturba Gandhi Nursing College
responses may be mediated by frontal lobe structures, whose requested the authors to impart yoga training to students
physiological markers, such as reaction time, have shown enrolled in their Bachelor of Nursing course. This
improvement in short-term and long-term yoga training opportunity was used to study hematological, biochemical
programmes. (1,5,10) and QoL indices, in order to help students understand the
effects of their yoga training and to scientifically validate
Practitioners of yoga claim that it provides one of those effects.
the best means for self-improvement and enables the
manifestation of one‟s highest physical, mental, emotional MATERIALS AND METHODS
and spiritual potential. Such improvements in mental and Sixty apparently healthy nursing students (12 M, 48 F),
emotional well-being enhance one‟s ability to manage aged 18.60 ± 0.67 (SD) years, who were novices to yoga
stress. This has been documented in normal volunteers and took part in the present study after granting informed
Bhavanani AB et al., 2013 17
consent. Because yoga training was part of their co- 1. The health and functioning subscale was evaluated
curricular activity, we devised a 6-month comprehensive by 13 questions dealing with health, pain, worries
training programme. The programme was delivered in etc
twice-weekly, 60 min sessions and included the following 2. The social and economic subscale was evaluated by
components: 8 questions dealing with friends, neighborhood,
1. Brief theory of yoga and its practices and their education etc.
benefits. 3. The psychological and spiritual subscale was
2. Jathis (loosening practices) and kriyas (breath- evaluated by 7 questions dealing with peace of
body coordination practices). mind, faith in god, happiness etc.
3. Surya namaskar (sun salutation) with breath 4. The family subscale was evaluated by 5 questions
awareness. dealing with family health, family happiness and
4. Yogasanas (postures): trikona (triangle), nataraja emotional support from family etc.
(cosmic dancer), veera–I, II & III (warrior), vriksha
(tree), pashchimottana (posterior stretch), Statistical analysis of pre and post intervention data was
purvottana (anterior stretch), chatushpada (four done using GraphPad InStat version 3.06 for Windows 95
footed), ushtra (camel), matsya (fish), janushirasa (GraphPad Software, San Diego California USA,
(head to knee), vakra (twist), ardhamatsyendra www.graphpad.com). All data passed normality testing by
(half twist), makara (crocodile), bhujanga (cobra), Kolmogorov-Smirnov Test and, hence, was analyzed using
shalabha (locust), dhanura (bow), pada-uttana (leg Students t test for paired data. Repeated measures ANOVA
lift), pavana mukta (wind releasing), viparitakarani with Tukey-Kramer Multiple Comparisons testing was
(topsy-turvy), hala (plough), sarvanga (pan limb) applied for QoL indices comparing pre, mid and post
and shava (corpse) asanas. changes. Percent changes (∆%) were tested for correlation
5. Pranayamas (breathing techniques): mukha with attendance in training sessions using Pearson‟s
bhastrika (oral bellows), vyagraha (tiger), surya correlation coefficient. P values less than 0.05 were
nadi (sun channel), chandra nadi (moon channel), accepted as indicating significant differences between pre
pranava (AUM chanting breath), nadishuddhi and post intervention data.
(alternate nostril-I), aloma viloma (alternate nostril-
II) and sadanta pranayamas (cooling breath).
6. Relaxation: shavasana with savitri pranayama (2:1 RESULTS
ratio breathing in corpse posture), kayakriya The results are given in Tables 1-5. Post-
(dynamic body relaxation), marmanasthanam kriya intervention statistical analysis revealed a highly significant
(sequential relaxation) and yoga nidra (yogic and beneficial change in all parameters that correlated
sleep). positively with attendance of the subjects.
The following hematological and biochemical There was a highly significant (p< 0.001) increase
parameters were tested by qualified technicians in the in total WBC, RBC and platelet count, urine pH, TC, HDL,
Central Laboratory of the hospital before and after the 6 HDL/LDL and chloride levels and a decrease in eosinophils,
month training period: monocytes, creatinine, LDL, TC/HDL and LDL/HDL. The
1. Total and differential leucocyte (WBC) counts, Neutrophils and AG ratio increased significantly (p<0.01)
ESR at ½ and 1hr, erythrocyte (RBC) count, with a concurrent significant increase (p<0.05) in basophils,
platelet count, hemoglobin (Hb) and hematological urea, sodium, albumin and bilurubin.
indices.
2. Urine pH. There was a significant improvement in QoL for
3. Random blood sugar, urea, creatinine, total both mid-training (3 months) and post-training (6 months)
cholesterol (TC), triacylglycerols (TG), high comparisons, and this correlated positively (p< 0.001 to p<
density lipoprotein (HDL), low density lipoprotein 0.05) with the attendance of the subjects. The improvements
(LDL), very low density lipoprotein (VLDL ) and of QoL were highly significant (p <0.001) for pre-mid and
ratios calculated for TC / HDL, TC / LDL, HDL / pre-post comparisons. It was highly significant (p< 0.001)
LDL, LDL / HDL. for pre-mid comparisons of health function and psycho-
4. Blood electrolytes: sodium, potassium and spiritual as well as for pre-post of socio-economic subscales.
chloride. The improvement was significant (p< 0.01) for pre-post of
5. Liver function test (LFT): total protein, albumin, health function, psycho-spiritual and family subscales and
globulin, AG ratio, bilurubin (direct), SGOT, for pre-mid comparison of family subscale. It was p< 0.05
SGPT and alkaline phosphatase. for pre-mid comparisons in socio-economic subscale.
The Ferrans and Powers QoL Index: Generic III version There were insignificant changes in the other
was used to evaluate total QoL Score. (16) The QoL was parameters like random blood sugar, potassium, total
tested before training, at mid-term (3 months) and after protein, globulin, SGOT, SGPT, alkaline phosphatase,
completion of training (6 months). Part I (33 questions) basophils, monocytes, urea, keratinize, ESR and RBC
evaluated the subject‟s satisfaction with different aspects of indices like PCV, MCV, MCH and MCHC.
life and Part II (33 questions) evaluated the importance of
those aspects in the subject‟s life. DISCUSSION
The improvement in the hematological, following tissue injury. The biochemical changes in urea
biochemical and psychological profiles of our subjects may and bilurubin levels indicate increased cellular metabolism
be attributed primarily to yoga training, since these changes with a resultant increase in cellular waste products for
were significantly correlated to the frequency of their excretion (Tables 2 and 3). The alkalization of urine (Table
attendance. Since yoga training was part of the curriculum 2) is a positive sign, as medical management of urinary tract
of our host institute, it was not possible to establish a infections and calculi usually aims to promote alkalization
separate control group. To overcome this limitation, we of urine. The post yoga decreases in the number of pus cells
correlated changes in all parameters with attendance, and a and epithelial cells in the urine also indicates a healthier
majority of them were significantly positive. This urinary tract and excretory system.
strengthens the direct correlation between the observed
changes and yoga training, and, rules out the possibility that The lipid profile showed a healthy response, with
these were due to other normal, extraneous or growth- an increase in HDL and decreases in LDL and VLDL (Table
related factors such as nutrition or other forms of physical 2). All cholesterol ratios also showed positive changes
activity training. including total cholesterol whose increase (within normal
levels) may be attributed to the significant increase in HDL.
Hematological and biochemical parameters: Hb Normally, the „safe‟ TC/HDL ratio is less than 4. It was
and blood components (WBC, RBC and platelets) showed initially 4.57 ± 0.83 in our subjects, but decreased to a safe
significant increases that were positively correlated to the level of 3.88 ± 0.87 following the training programme.
student‟s frequency of attendance in classes (Table 1). We Similarly, a healthy LDL/HDL ratio is less than 3. Although
hypothesize that this may be attributed to either asanas the initial pre-training level in our subjects was a higher
exercising limbs or pranayamas stimulating erythropoiesis, normal value (2.95 ± 0.86), it also fell to a lower normal
or both. Our hypothesis is based on the fact that a natural value (2.25 ± 0.80). The HDL/LDL ratio should normally be
response to hypoxia (which can occur during aerobic more than 0.3, but it is preferable to maintain it above 0.4.
exercise or changes in altitude) is endogenous erythropoietin This ratio also increased from a lower normal value of 0.37
(eEpo) synthesis, which stimulates erythropoiesis. (17) An ± 0.15 to a higher normal value of 0.49 ± 0.19, implying a
earlier report by Malshe has suggested that benefits of better prognosis for cardiovascular health. HDL, or good
pranayama may be due to daily self-administered brief, cholesterol, is involved in transporting cholesterol from
intermittent hypoxia causing release of eEpo and Vascular tissues to the liver. Its increased presence, along with
Endothelial Growth Factor (VEGF), thus offering a positive changes in all cholesterol ratios, is a sign of the
multitude of benefits in health and a variety of disease anti-atherogenic effects of yoga. A similar conclusion is also
conditions. (18 ) Our hypothesis is also supported by another found in the review by Innes (7,8) and in recent reports on
recent study that reported rapid gene expression changes in healthy volunteers and patients of hypertension and diabetes
peripheral blood lymphocytes upon practice of a mellitus. (21, 22, 23).
comprehensive yoga program. (19 ) They speculated that the
increased expression of Nuclear Factor Erythroid 2 (NFE2) The TG/HDL ratio decreased significantly from
induced by the yoga program may have favorable effects on 2.60 ±0.53 to 2.05±0.60, a healthy fall of more than 20%.
megakaryocyte maturation and platelet production. This finding has positive prognosis as the TG/HDL ratio is
an indicator of insulin resistance and a ratio > or =3.5 has
The increase in leukocyte count signifies an been reported to provide a simple means of identifying
improvement in immune function, since these cells play a insulin-resistant, dyslipidemic patients, likely to be at
crucial role in inflammatory processes and in defending increased risk of cardiovascular disease. (24) Five of our
against pathogens. In this context, the insignificant rise of subjects had initial values more than 3.5 and 6 had values
ESR in our subjects does not indicate an inflammatory more than 3. All of them except for one had reductions in
event, but suggests that ESR is playing the role of the ratio on post training analysis. This implies a possible
modulator, as proposed by Carranquea. (20) Carranquea also breakdown of insulin resistance that is of great health
proposed that this rise is due to the metabolic activity of enhancing value in the prevention and management of
blood cells and is a consequence of a reduction in oxidation metabolic conditions such as diabetes and the syndrome X.
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 The increase in bilurubin in our subjects correlates
be explored further before definite conclusions can be made. positively with their attendance. Bilurubin is a major
intravascular product of heme catabolism and is a potent
The decrease in eosinophils is evidence of a antioxidant. A preliminary meta-analytic study
reduction in allergic tendencies. This provides a scientific demonstrated an unambiguous, inverse relationship between
basis for using yoga in allergic conditions where serum bilurubin levels and atherosclerosis, thus indicating
eosinophilia is implicated. Erythrocytes contain hemoglobin, its preventive potential in oxidative, stress-mediated
which is involved in the transport of oxygen from the lungs diseases. (25) In fact it was recently stated in the editorial of a
to the tissues and in the buffering of hydrogen ions. Hence, research topic forum that bilurubin is now recognized as an
the increase in RBC and Hb is evidence of the health- endogenous cytoprotective compound at low
promoting aspects of yoga even at the cellular level. Such (“physiological”) concentrations. (26) Hence, its increase
changes are further seen in the significant rise of platelets or within normal limits in the present study may be interpreted
thrombocytes, which provide the first hemostatic plug
as a physiological change that indicates the health- environmental and internal stressors, which thus enabled
promoting effects of yoga. participants to better and more calmly perform their routine
duties.
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 Harinath et al reported improvements in both
been reported to help yoga practitioners attain ideal body cardiorespiratory performance and psychological profile
weight and improve their cardiovascular endurance and after three months of yoga. These changes were
anaerobic power. (27) Innes and Vincent have suggested that accompanied by increases in plasma melatonin. (30) A recent
Yoga reduces the cardiovascular risk profile by decreasing review by Sengupta et al suggested that yoga triggers
activation of the sympatho-adrenal system and neurohormonal mechanisms that reduce stress and anxiety
hypothalamic-pituitary-adrenal axis and by promoting a and acts as a psychophysiological stimulus to increase
feeling of well-being, along with direct enhancement of endogenous secretion of melatonin. This, in turn, improves
parasympathetic activity via the vagus nerve. (8) the sense of well-being. (4) Another large-scale study in the
USA reported that mind-body interventions showed
Quality of life index scores: There was a significant significantly greater improvements on perceived stress,
improvement in QoL both at mid training (3 months) and sleep quality, and the heart rhythm coherence ratio of HRV.
(31)
post training (6 months), and this correlated positively with Here, the authors concluded that both mindfulness-based
attendance in the yoga sessions (Tables 4 and 5). and therapeutic yoga programs may provide effective
Improvements appeared in all subscales, including the interventions to target high stress levels, sleep disturbances,
health function, psycho-spiritual, family and socio-economic and autonomic imbalances in employees. These results are
categories. Our findings are in line with those of Sharma and applicable to our study population, a group of nursing
Michelson, who reported that a short lifestyle modification students exposed to numerous stressors.
and stress management educational programme leads to
remarkable improvement in subjective well-being scores. The potential benefits of the various practices in
Such interventions can therefore make an appreciable our study may be hypothesized as follows: suryanamaskar
contribution to both primary prevention and management of improves metabolic function and tones up the
lifestyle diseases. (13, 28) This is supported by Innes and musculoskeletal system; trikona, nataraja and veera asanas
Vincent, who suggest that yoga-based training programmes evoke a sense of stability and balance both physically and
provide a source of social support that may be a factor in mentally; vakra, ardhamatsyendra, paschimottana,
reducing risk for cardiovascular diseases. (8) According to pavanamukta, bhujanga and dhanura asanas, by virtue of
Madanmohan, 60 hour, comprehensive yoga training their twisting and compression-relaxation actions, may be
programme for medical students at JIPMER showed stimulating intra-abdominal organs such as the liver and
improvements in psychological well-being, as well as in the pancreas, resulting in improvements in hematological,
subscales of anxiety, depressive mood, positive well-being, biochemical and lipid profiles; sarvangasana, halasana and
self control, general health and vitality. (29) Another recent viparitakarani may be harmonizing psycho-neuro-endocrine
study on yoga for paramedical students used the Ferrans and function, as reflected in the biochemical parameters; aloma
Powers QoL index and reported improvements in total QoL viloma, suryanadi and chandranadi pranayamas may be
and positive changes in all subscales. (16) Although there normalizing emotional and autonomic balance; pranava and
were 8-12% changes in ∆% scores, these changes did not savitri pranayama in shavasana may contribute toward a
reach statistical significance due to the smaller sample size sense of inner calmness, thus enhancing inherent
and shorter duration of training (3 months). Nevertheless, homeostatic mechanisms; and kaya kriya, marmanasthanam
our present study confirms those findings. kriya and yoga nidra create a sense of mind-body harmony
that facilitates psycho-somatic re-integration.
Our findings are similar to those of Malathi and
CONCLUSION
Damodaran, who reported decreased anxiety levels in The present study substantiates the psychological
MBBS students following yoga training. (12) The authors also and physical benefits of yoga training. All the tested
reported improvements in their subjects´ sense of well- parameters showed desirable changes and most were
being, their feeling of relaxation, and the quality of their statistically significant. The major findings are enhanced
interpersonal relationships, as well as improved bone marrow function, reduced allergic tendency,
alkalization of urine, metabolic reconditioning with special
concentration, efficiency, self-confidence and, attentiveness,
emphasis on liver function and improved QoL indices. This
along with lowered irritability levels and a more optimistic may be attributed to an improved functioning of the body-
outlook on life. They concluded that yoga had reduced basal mind complex, which is facilitated by breath-body
anxiety levels and attenuated the increase in anxiety scores coordination in the yoga practices. On the basis of the
in stressful states. They postulated that the decrease in present study, we recommend that yoga be made an integral
anxiety led to better adjustment adaptability towards part of medical and paramedical collegiate education.

Table 1. Hematological parameters before and after 6 months of yoga training.
n Before After ∆% r p
Total Count 58 6570.69 7591.38 18.24
0.2853 0.03
(/ mm3) ±1478.38 ±1395.01 *** ±22.10
Neutrophils 58 54.88 57.71 6.21
0.1362 0.3081
(%) ±7.24 ±6.08 ** ±12.80
Lymphocytes 58 39.71 39.66 3.47
0.1011 0.4502
(%) ± 7.51 ± 5.54 ± 24.91
Eosinophils 57 4.61 2.26 -47.53
0.401 0.0018
(%) ± 2.63 ± 1.84 *** ± 36.65
ESR -1/2hr 57 6.79 7.56 33.05
0.01026 0.9391
(mm) ± 4.33 ± 2.92 ± 60.16
ESR-1hr 57 15.26 15.30 14.70
0.1089 0.4201
(mm) ± 8.75 ± 6.73 ± 50.14
Erythrocytes( RBC) 56 4.33 4.58 5.83
0.2743 0.0372
(million/ mm3) ± 0.43 ± 0.52*** ± 7.64
Hemoglobin (Hb) 11.82 12.19 3.58
0.3048 0.0200
(gm %) ±1.90 ±1.73*** ±5.75
Platelet 57 2.38 2.72 16.41
0.3514 0.0068
(lakhs/ mm3) ± 0.43 ± 0.47*** ± 21.62
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.
Urine pH 57 6.18 6.42 3.95
0.429 0.0008
± 0.24 ± 0.35*** ± 6.34
Total cholesterol (TC) 53 147.96 154.87 4.69
0.2846 0.0303
(mg/dL) ± 28.08 ± 31.27*** ± 7.98
Triacylglycerols (TG) 53 83.87 80.94 -2.54
0.2376 0.0725
(mg/dL) ± 21.02 ± 22.52 ± 15.56
High density lipoprotein (HDL) 53 32.25 40.04 24.91
0.5096 0.0001
(mg/dL) ± 4.01 ± 5.45*** ± 16.50
Low density lipoprotein (LDL) 53 93.68 88.11 -5.60
0.2652 0.0443
(mg/dL) ± 25.05 ± 25.56*** ± 11.83
Very low density lipoprotein (VLDL) 53 17.68 16.55 -3.44
0.3396 0.0091
(mg/dL) ± 4.52 ± 4.54 ± 24.40
2.60 2.05 -20.84
TG / HDL 53 0.4362 0.0011
± 0.53 ± 0.60*** ± 15.83
TC / HDL 53 4.57 3.88 -15.04
0.3801 0.0033
± 0.83 ± 0.87*** ±10.99
TC / LDL 53 1.64 1.84 12.23
0.4385 0.0006
±0.56 ±0.68*** ±14.48
HDL / LDL 53 0.37 0.49 34.85
0.4876 0.0001
± 0.15 ± 0.19*** ± 27.88

Table 3. Liver function parameters before and after 6 months of yoga training.
Total Protein 23 7.36 7.37 0.38
0.1906 0.1518
(g/dL) ± 0.44 ± 0.33 ± 5.38
Albumin 25 4.29 4.52 6.51
0.4312 0.0007
(g/dL) ± 0.51 ± 0.34* ± 14.76
Globulin 22 3.08 2.90 -5.06
0.1058 0.4293
(g/dL) ± 0.43 ± 0.38 ± 13.92
AG ratio 22 1.40 1.60 16.73
0.3868 0.0027
± 0.29 ± 0.38** ± 30.40
Bilurubin total 24 0.82 0.91 22.78
0.3371 0.0097
(mg/dL) ± 0.42 ± 0.43* ± 40.40
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.
Parameter Comparison Attendance ∆% r value p value

pre-post 19.48 ± 8.27 12.11±19.87 0.4868 < 0.0001
Overall QoL 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
pre-post 19.48 ± 8.27 14.74±30.02 0.3936 0.0019
Health and function 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
pre-post 19.48 ± 8.27 15.40±25.46 0.3778 0.0029
Socio-economic 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
pre-post 19.48 ± 8.27 17.99±32.92 0.2582 0.0464
Psycho-spiritual 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
pre-post 19.48 ± 8.27 27.96±71.22 0.3149 0.0143
Family subscale 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
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: Therapy, Education and Research (CYTER) in Mahatma

The authors thank the management of Sri Balaji Gandhi Medical College and Research Institute (MGMCRI).
Vidyapeeth University for setting up the Centre for Yoga We are grateful to Yogacharini Meenakshi Devi Bhavanani,
Director ICYER for her constant motivation and psychological effects of a yoga training programme in
supportive guidance. Thanks are due to Yoga instructors paramedical students. Yoga Mimamsa 2013; 44: 246-64.
Miss D Pushpa and Dr. R Balaji for conducting the 17. Elliott S. Erythropoiesis-stimulating agents and other
training programme and for their valuable assistance methods to enhance oxygen transport. British Journal of
Pharmacology 2008; 154: 529–41
during recording sessions and data entry. For help in
18. Malshe PC. Nisshesha rechaka pranayama offers benefits
improving the language of this paper, our thanks go to through brief intermittent hypoxia. Ayu 2011; 32: 451–57.
Billy Uber of Baden-Baden, Germany. 19. Qu S, Olafsrud SM, Meza-Zepeda LA, Saatcioglu F. Rapid
Gene Expression Changes in Peripheral Blood Lymphocytes
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Vithiyalakshmi L, Madanmohan. Physiological and
Short Communication
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

Deputy Director, Centre for Yoga Therapy, Education, and Research,
Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry India.
E‑mail: yognat@gmail.com
ABSTRACT
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.
INTRODUCTION human life and one such example is swarodaya vigyan, the
ultradian nasal cycle as codified in the Shiva swarodaya,
Pranayama, the fourth limb of classical ashtanga yoga is wherein differential effects of different phases of the nasal
an essential part of yogabhyasa and is increasingly being cycle are given in great detail.[2]
used as a tool of yoga chikitsa or the application of yoga as
a therapy. There are a multitude of pranayama techniques
A group of pranayama, namely chandra and surya
and it is traditionally taught that each of them has different
nadi (CN and SN, respectively) and chandra bhedana and
psycho‑physiological benefits.[1] The ancient rishis, the
surya bhedana (CB and SB, respectively) have uninostril
seers of India have intuitively analyzed all aspects of
breathing (UNB) and alternate nostril breathing (ANB)
Access this article online patterns using left and/or right nostrils, respectively. This
Quick Response Code type of yogic nostril manipulation is also furthered in nadi
Website: shuddhi (NS), a specific technique involving alternate use
www.ijoy.org.in of both nostrils in a specific pattern.
DOI:
These yogic UNB and ANB techniques have captured
10.4103/0973-6131.123489 the imagination of researchers worldwide and recent
studies have reported their differential physiological and
60 International Journal of Yoga • Vol. 7 • Jan-Jun-2014

Bhavanani, et al.: Immediate differential effects of pranayamas
psychological effects including effects on O2 consumption, were undergoing regular treatment for one or more medical
metabolism and body weight,[3] blood glucose,[4] involuntary conditions such as hypertension,[6] hypothyroidism,[3] type 2
blink rates[4] and intraocular pressure,[5] heart rate (HR), diabetes mellitus,[2] polycystic ovary syndrome,[2] bipolar
stroke volume and end diastolic volume[6] as well as skin affective disorder,[1] sinusitis,[1] psoriasis,[1] and uterine
resistance, digit pulse volume, and blood pressure (BP).[7] prolapse.[1] None were receiving autonomic modifying
ANB (as done in NS pattern) has been reported to rapidly agents like α‑ or β‑blocking drugs.
alter cardiopulmonary responses and improve simple
problem solving.[8] Raghuraj and Telles have suggested Each subject came to the CYTER lab on six different days.
that yogic breathing through the right, left, or through They were instructed to have a light breakfast before 8 a.m.
both nostrils alternately produces distinct autonomic and report for the study between 10 a.m. and 12 noon. On
changes.[9] They reported that right UNB increased systolic each of the 6 days, they performed nine rounds of any one
pressure (SP) and diastolic pressure (DP), whereas left of the six techniques selected by random selection of both
UNB resulted in significant reduction in SP and mean subject and technique so as to avoid any bias or influence
pressure (MP). of different days on the group.
However, none have studied the immediate effect of these The subjects were instructed to sit in any comfortable
UNB and ANB techniques on reaction time (RT), a sensitive posture and relax for 5 min before the pre‑intervention
and simple indicator of central neuronal processing. RT recordings of resting HR, BP, and RT were taken. They then
is the interval between the onset of a signal (stimulus) performed nine rounds of the following techniques after
and the initiation of a movement response and is an which the post‑recordings of HR, BP, and RT were repeated.
indirect index of central neuronal processing as well as a • Right UNB (SN) using nasika mudra wherein the ring
simple means of determining sensory‑motor association, finger was used to occlude left nostril by pressing on
performance, and cortical arousal. Though RT shortening the outside of the nostril
effects of pranayama as well as comprehensive yoga • Left UNB (CN) using nasika mudra wherein the thumb
training of different durations have been reported,[10‑12] was used to occlude right nostril by pressing on the
earlier none have studied the immediate effects. Previous outside of the nostril
studies by Bhavanani et al. have reported significant and • Breathing in through right nostril and out through the
immediate decrease in auditory reaction time and visual left (SB) using nasika mudra to regulate flow through
reaction time (ART and VRT, respectively) following nine respective nostrils
rounds of mukha bhastrika, a bellows type of pranayama • Breathing in through left nostril and out through the
in normal school children as well as mentally challenged right (CB) using nasika mudra to regulate flow through
adolescents.[13,14] respective nostrils
• Breathing in through left nostril and out through right
With the above in mind, we have studied the immediate followed by breathing in through right and out through
effects of UNB and ANB on cardiovascular (CV) parameters left (NS) using nasika mudra to regulate flow through
and RT. The aim of the study is to determine the differential respective nostrils
effects of these techniques if any and understand the • Performance of normal breathing (NB) through both
mechanisms behind their physiological effects. It is nostrils with nasika mudra (just performed as a placebo
hypothesized that right/left UNB, ANB performed by right but not closing either nostril).
in and left out/left in and right out methods as well as NS
will have different effects. Keeping all of this in mind, Participants were instructed to focus their mind on their
this study was planned to investigate the acute effects breath and ensure it was slow, deep, and regular while
of different UNB and ANB pranayamas on resting CV attempting to utilize all sections of their lungs. Respiratory
parameters and RT. 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
Twenty subjects (13 females and 7 males) regularly attending regular yoga sessions, none reported any difficulty in doing
yoga sessions at the Centre for Yoga Therapy, Education, and the techniques in this manner.
Research (CYTER) thrice weekly for more than 3 months
were recruited for the study by convenience sampling. Their To ensure objectivity in measuring HR and BP, the
mean age and Body mass index (BMI) were 34.10 ± 13.62 recordings were done using non‑invasive semi‑automatic
standard deviation (SD) and 25.28 ± 7.65 (SD), respectively. BP monitor (CH – 432, Citizen Systems, Tokyo, Japan) with
All of them were right handed. Eight of them reported an instrumental accuracy of ± 5% for HR and ± 3 mm Hg
normal health status, whereas the other 12 reported that they for BP. Pulse pressure (PP) was calculated as SP‑DP, MP as
International Journal of Yoga • Vol. 7 • Jan-Jun-2014 61

DP + 1/3 PP, rate‑pressure product (RPP) as HR × SP/100, Test. Statistical analysis was done using analysis
and double product as HR × MP/100. of variance (ANOVA) with Tukey-Kramer Multiple
Comparisons Test for data with identical SDs and Kruskal-
RT apparatus manufactured by Anand Agencies, Pune Wallis (non‑parametric ANOVA) with Dunn’s Multiple
was used for the study. The instrument has a built in Comparisons Test for data with non‑identical SDs.
4‑digit chronoscope with a display accuracy of 1 ms. It Students t (paired) test was done and P values less than
features four stimuli, two response keys, and a ready 0.05 were accepted as significant differences in pre‑post,
signal. Switches for selecting right or left response key for intra‑group comparisons.
any stimulus are provided. In this study, simple ART was
recorded for auditory beep sound stimulus and simple RESULTS
VRT for red light stimulus. The subjects were instructed
The overall comparison of ∆ % changes showed
to release the response key as soon as they perceived the
statistically significant differences between groups for
stimulus. The signals were given from the front of the
all parameters [Tables 1 and 2]. As seen in Table 1, HR
subjects to avoid the effect of lateralized stimulus and
reduced significantly following both CB and CN, whereas
they used their dominant hand while responding to the
SP fell significantly following CB and NS and a significant
signal. All subjects were given adequate exposure to the
rise was seen in DP following SB. PP fell significantly
equipment on two different occasions to familiarize them following NS, MP reduced significantly following CB,
with the procedure of RT measurement as this is found while it increased following SB and there was significant
to be more consistent when subjects have had adequate reduction in RPP and Double product (DoP) following CB
practice. For statistical analysis of RT, more than 8‑10 trials and CN, while only RPP decreased significantly following
were recorded and the average of the lowest three similar NS. Inter‑group differences were statistically significant for
observations was taken as a single value.[11‑14] HR, DP, MP, RPP, and DoP comparisons between CB and SB,
as well as SB and CN. The comparisons were significant for
Data were assessed for normality using GraphPad InStat RPP and DoP between CN and SN as well as CB and SN.
and passed normality testing by Kolmogorov-Smirnov 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 value
HR 0.19±4.79 −4.61±5.99 2.22±6.42* −4.78±7.17 1.13±8.05 0.30±8.41 0.0017
SP −0.90±5.05ϒ −2.29±5.58 1.23±5.33ρρρ −1.28±5.13 1.49±5.17υυυ −5.04±4.97 <0.0001
DP 0.36±5. 91 −2.42±6.94 4.17±6.46** −2.05±7.59 −0.50±6.36 0.59±6.98 0.0089
PP −0.57±18.84ϒ −1.26±13.14 −2.70±13.95 −1.16±13.42 6.12±11.70υυυ −12.83±15.04 0.0008
MP 0.34±3.85 −2.40±5.62 2.80±4.98** −1.76±5.70 0.33±5.36 −2.02±4.86ρ 0.0027
RPP −1.03±7.83 −6.84±7.25 3.64±10.25** −5.90±9.74 2.74±10.65ψψΩ −4.82±8.70ρυ <0.0001
DoP 0.47±7.11 −6.93***±7.52 5.20±9.77 −6.33±10.15 1.56±10.70ψΩ −1.82±8.46 <0.0001
Values 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 value
ART −2.62 4.73 −4.84 3.95 6.596 1.09 <0.0001
(−7.35,7.23) (−6.88, 7.43) (−12.75,8.40)*** (−9.42,10.67) (−15.05,4.82)ψψψΩΩΩρ (−8.38,8.97)υυ
VRT 1.40 2.02 −6.05 2.83 −6.67 1.28 <0.0001
(−4.09, 5.18) (−6.86,9.89) (−13.04,6.64)**υ (−9.31,10.17) (−0.89,−10.94)ψψψΩΩΩρρρ (−7.58,10.66ϒϒϒ♠♠
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; consumption and load. This can be attributed to either an
between NS and CN, SN and NB for PP; between NS and overall increase of parasympathetic tone and/or a reduction
SB for MP; and between NS and SB and SN for RPP. In in sympathetic tone as it has also been previously reported
contrast to all of this, there were no significant changes that sympathetic activity is lower during left UNB.[18]
following NB.
Raghuraj and Telles[9] reported significant decreases in
ART and VRT shortened significantly following SB and SP and MP following 30 min of left UNB, while the small
SN [Table 2]. There was a significant prolongation of ART reduction in DP in that study also missed significance as in
and VRT following CB while only ART was prolonged this study. Though they reported a significant increase in
following CN. The overall comparison of ∆ % changes for HR, we have found a significant decrease in HR following
RT showed statistically significant differences between both CB and CN in this study where the fall in SP was
groups for ART and VRT that were significantly lowered significant only following CB and NS and not after CN.
following both SB and SN with no apparent differences These changes may be attributed to changes in cardiac
between SB and SN or CB and CN and no significant output (CO), peripheral vascular resistance, and humoral
changes following NB and NS. factors.[9] As the HR reduced significantly following CB
and CN in this study, it is plausible that the coexisting
DISCUSSION fall in SP is related to CO. It has been recently suggested
that there is an immediate increase in cardiac autonomic
Resting CV parameters modulation following ANB and paced breathing at five
BPM without a shift in autonomic balance in individuals
There was an overall reduction in majority of CV
inexperienced with yogic breathing.[19]
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 Breathing at the rate of six BPM is known to increase
initiated (CB, CN, and NS) UNB and ANB techniques vagal modulation of sinoatrial (SA) and atrioventricular
were clearly evidenced by statistically significant nodes and enhances baroreceptor sensitivity.[15] This may
differences between them. The changes following NB were be responsible for reduction in HR and the BP indices
insignificant in all respects. 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
The significant reductions in HR, RPP, and DoP following
sympathomimetic effects of SB and SN; it has been
CB and CN as well as the significant fall in SP following
earlier suggested that sympathetic activation produced
CB and the same coupled with decrease of RPP following NS
may be attributed to reduction in sympathetic activity by right UNB may be masked by vagally mediated lung
and/improvement of vagal tone as supported by previous baroreceptor activity due to voluntary breathing efforts.[20]
studies.[3,6,9,15] The significant decrease in PP following NS
may be attributed to the combination of the significant fall Srivastava et al. have earlier reported a tilt toward
in SP coupled with a small and insignificant rise in DP. parasympathetic dominance after just 15 min of ANB.[21]
Interestingly, there was a significant rise in DP and MP It is to be noted that this type of ANB (NS) involves a two
and a small insignificant rise in SP following SB. There breath cycles for each round of the practice as opposed to
was also a small but insignificant rise in HR, RPP, and DoP the one breath cycle as done in SB and CB. It is possible
following SB and all of these changes may be attributed to that the significant changes seen in SP, PP, and RPP
an enhanced sympathetic activity as reported by previous following NS are a result of the longer duration and double
studies.[3,7,9,16] the number of breaths compared to the other techniques.
RPP and DoP are indirect indicators of myocardial O2 Our study provides evidence of sympathomimetic effects
consumption and load on the heart, thereby signifying a as manifested by increases in all resting CV parameters
lowering of strain on the heart.[15,17] Sympathetic activation following the right nostril pranayamas. This is in
is known to increase HR and RPP and decrease overall heart agreement with previous studies suggesting that right
rate variability (HRV). RPP provides a simple measure of UNB has sympathomimetic effects including increase
HRV in hypertensive patients and is a surrogate marker in in metabolism, baseline O2 consumption, and enhanced
situations where HRV analysis is not available. It has also cardio‑sympathetic activity.[6,3,7,9,16] These effects have
been shown that standard deviation of normal to normal been demonstrated after a month‑long training[3] as well
beats and total power of HRV are inversely correlated as immediately after 45 min of the practice.[7] A recent
with mean HR and RPP.[17] Hence, the reduction in HR and study also has reported significant increase in SP, DP,
RPP following CB, CN, and NS implies better autonomic and MP after 30 min of the practice.[9] Earlier studies in
regulation of the heart in our subjects with decreased O2 normal subjects[3,6,7,16] have reported significant increases

in HR and/or BP following right UNB though Jain et al. It has been previously suggested that the faster reactivity
conversely reported no significant change in HR and a seen post‑pranayama may be due to a modulation of
significant reduction in BP in healthy male subjects with activity at ascending reticular activating system and
no significant changes in female subjects after 15 min generalized alteration in information processing at
of SN.[20] A month of right UNB practice compared to the primary thalamo‑cortical level occurring during
ANB resulted in a significant increase in the HR and O2 pranayama.[13,14] Changes in breathing period produced by
consumption and a decrease in the body weight.[3] Another voluntary control of inspiration have been reported to be
study, which compared the immediate effects of right UNB significantly correlated to changes in RT.[22] According to
with NB, both practiced for 45 min, showed a reduction the traditional wisdom of yoga, pranayama is the key to
in skin resistance, digit pulse volume with an increase in bringing about psychosomatic integration and harmony.
SP following right UNB.[7] It may be easily understood that a calm mind will be able
to process information much better and react appropriately
Studies on the dog by Levi et al. have reported considerable than an agitated one. A previous study from JIPMER
right left asymmetry in the distribution of sympathetic reported a reduction in RT following 3 weeks of training
fibers to the heart with right‑sided stellate ganglion in both slow and fast pranayamas.[12]
stimulation having greater chronotropic effects while
the left produced greater inotropic effects.[4] It is to be Decrease in RT signifies an improvement in central
noted that there are differences between the right and neuronal processing ability of the special children.
left vagus nerves too with the right vagus having greater This may be due to (1) greater arousal and faster rate
cardiac deceleratory effect compared to the left and the of information processing; (2) improved concentration;
right vagus exerting greater restraint on the SA node and/or (3) ability to ignore or inhibit extraneous stimuli.
than the left.[4] Shannahoff‑Khalsa and Kennedy have RT tends to improve as arousal increased and it has been
suggested that ultradian rhythms of HR may be also reported that RT is fastest with an intermediate level of
governed by alternating rhythmic influences of the right arousal and deteriorates when the subject is either too
and left branches of the autonomic nervous system with relaxed or too tensed. An enhancement of contralateral
increased HR resulting from right sympathetic with left
hemisphere function has been reported with selective
parasympathetic dominance.[6]
nostril breathing,[23] while Werntz et al. reported relatively
greater integrated electro encephalogram (EEG) value in one
Despite the above findings, it is to be noted that there are no hemisphere that correlated with predominant airflow in
significant differences between right nostril initiated UNB the contralateral nostril, defining a new inter‑relationship
and ANB techniques (SB and SN). Similarly, there are no between cerebral dominance and peripheral autonomic
significant differences between left nostril initiated UNB nervous function.[24] It has also been suggested that forced
and ANB techniques (CB and CN). Most of the significant ANB has a balancing effect on functional activity of left
changes seemed to be following SB rather than SN where and right hemispheres.[4]
the changes were on the similar lines but statistically
insignificant. The picture was not so demarcated with
It has been previously suggested that right nostril dominance
regard to CN and CB as both seemed to be producing
in the nasal cycle as well as right UNB may be correlated
equivalent changes in all parameters. The changes in
with the “activity phase” of the basic rest‑activity cycle, the
NS were more on the lines similar to left nostril initiated
techniques. On the basis of these findings, we suggest that time during which sympathetic activity in general exceeds
the main effect of the various UNB and ANB techniques is parasympathetic activity throughout the body.[4] Another
determined more by the nostril used for inspiration rather study suggested that the lowering of intraocular pressure
than that used for expiration. by right UNB indicated sympathetic stimulation.[6] Various
mechanisms have been postulated to explain differential
physiological and psychological changes due to right and
Reaction time
left nostril breathing. Shannahoff‑Khalsa suggested that
Both ART and VRT shortened significantly following SB mechanical receptors in the nasal mucosa register flow of
and SN [Table 2]. There was a significant prolongation of air across membranes (unilaterally) and transmit this signal
ART following both CB and CN, while VRT was prolonged ipsilaterally to the hypothalamus, the highest center for
following CB. These changes were significantly lower autonomic regulation.[4] Even alternating left–right levels
following both SB and SN as compared to NB, NS, CN, of catecholamines have been found to occur in peripheral
and CB but there were no apparent differences between SB circulation of resting humans with rhythms coupled to the
and SN or CB and CN and no significant changes following nasal cycle.[25] It is possible that the right nostril initiated
NB and NS. All the ART values were significantly shorter techniques are producing such a state of autonomic
than respective VRT values, and this is in agreement with arousal, whereas left nostril initiated techniques are
previous reports.[10‑14] inducing autonomic relaxation/balance in our subjects.
A major limitation of this study as well as the past studies unilateral and forced unilateral nostril breathing in young healthy human
subjects. Int Ophthalmol 2001;24:305‑11.
in UNB and ANB is that most researchers have not taken
6. Shannahoff‑Khalsa DS, Kennedy B. The effects of unilateral forced nostril
into account the pre‑intervention nasal dominance pattern
breathing on the heart. Int J Neurosci 1993;73:47‑60.
of the subjects before initiating their study protocol. As
7. Telles S, Nagarathna R, Nagendra HR. Physiological measures of right nostril
the flow of air in the subjects’ dominant/non‑dominant breathing. J Altern Complement Med 1996;2:479‑84.
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in future studies. pulmonary, and higher functions of brain. Thai J Physiol Sci 2005;18:10‑6.
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CONCLUSION Psychophysiol Biofeedback 2008;33:65‑75.
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We conclude that right and left yogic UNB and ANB reaction time. Indian J Physiol Pharmacol 1989;33:110‑2.
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On the other hand, left nostril initiated UNB and ANB
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inducing a sense of inert lethargy and may induce a state 2003;47:297‑300.
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This finding is in tune with the traditional swara yoga mukha bhastrika (a bellows type pranayama) on reaction time in mentally
concept that air flow through right nostril (SN and pingala challenged adolescents. Indian J Physiol Pharmacol 2012;56:174‑80.
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on cardiovascular variables in patients of hypertension. Int J Yoga Therap
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ACKNOWLEDGMENTS Physiol Pharmacol 1996;40:58‑64.
19. Ghiya S, Lee CM. Influence of alternate nostril breathing on heart rate
The authors thank the management and authorities of Sri Balaji variability in non‑practitioners of yogic breathing. Int J Yoga 2012;5:66‑9.
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DOI: 10.7860/JCDR/2014/7256.3668
Original Article
Effect of Fast and Slow Pranayama

Physiology Section
Practice on Cognitive Functions

in Healthy Volunteers
Vivek Kumar Sharma1, Rajajeyakumar M.2, Velkumary S.3, Senthil Kumar Subramanian4,
Ananda B. Bhavanani5, Madanmohan6, Ajit Sahai7, Dinesh Thangavel8
ABSTRACT cognitive parameters-letter cancellation test, trail making tests

Objectives: To compare the cumulative effect of commonly A and B, forward and reverse digit spans and auditory and visual
practised slow and fast pranayama on cognitive functions in reaction times for red light and green light.
healthy volunteers. Statistical Analysis: Inter–group comparison was done by one way
Settings and Design: 84 participants who were in self-reported ANOVA and intra group comparison was done by paired t-test.
good health, who were in the age group of 18-25 years, who Results and Conclusion: Executive functions, PSS and
were randomized to fast pranayama, slow pranayama and reaction time improved significantly in both fast and slow
control group with 28 participants in each group. pranayama groups, except reverse digit span, which showed
Material and Methods: Fast pranayama included kapalabhati, an improvement only in fast pranayama group. In addition,
bhastrika and kukkuriya. Slow pranayama included nadishodhana, percentage reduction in reaction time was significantly more
Pranav and Savitri. Respective pranayama training was given for in the fast pranayama group as compared to that in slow
35 minutes, three times per week, for a duration of 12 weeks pranayama group. Both types of pranayamas are beneficial for
under the supervision of a certified yoga trainer. Parameters cognitive functions, but fast pranayama has additional effects on
were recorded before and after 12 weeks of intervention: executive function of manipulation in auditory working memory,
Perceived stress scale (PSS), BMI, waist to hip ratio and central neural processing and sensory-motor performance.
Keywords: Pranayama, Cognitive functions, Reaction time
Introduction study was commenced after obtaining approval from the institute’s
Anxiety, stress and mental tensions have become almost inevitable scientific advisory committee and human ethics committee.
companions of human life at all cross sections of populations [1].
Studies have reported higher perceived stress among students Participants
in healthcare courses, including dental, medical and nursing We considered volunteers who were in the age group of [18-
courses [2-5], as compared to students from other fields. Yoga 25] years, who were in self-reported good health, who were
and pranayama are ancient sciences which originated in India, undergoing various healthcare courses (medical, nursing and allied
which can be practised to combat stress [6]. Pranayama involves medical sciences). We excluded volunteers who had practised
manipulation of the breath and it consists of three phases: yoga in the past one-year and those with current or previous
“puraka” (inhalation); “kumbhaka’ (retention) and “rechaka” mental or neurological diseases. We explained the study design to
(exhalation) [7,8]. Pranayama can be practised as either fast or the volunteers and made them aware that their participation would
slow pranayamas. Both fast and slow pranayamas are beneficial remain anonymous and that they had the freedom to withdraw
[9-11], but their physiological responses are different in healthy from the study at any time.We included only those who gave their
participants [12]. Executive functions refer to cognitive processes written informed consents to participate in the study (n=84).
that regulate, control, and manage other cognitive processes [13]. Parameters Measured
Executive functions include working memory, concentration span, 1. Height
scanning and retrieval of stored information and mental flexibility,
2. Weight
i.e. the ability to shift from one criterion to another in sorting or
matching tasks [14,15]. Perceived stress has a negative impact 3. Cognitive Functions Test Battery [19]
on executive functions [16,17]. There is a paucity of data on Letter Cancellation Test (LCT)
evaluation of the cumulative effect of commonly practised slow and
Trail Making Test A (TTA)
fast pranayamas on cognitive parameters such as attention span,
executive functions, perceived stress and reaction time. Therefore, Trail Making Test B (TTB)
the current study aimed to compare the effects of twelve weeks Forward digit span (FDS)
of fast and slow pranayama training on these parameters in young
Reverse digit span (RDS)
healthcare students.
4. Reaction time (RT)
Material and methods Reaction time for the detection of auditory (ART) and visual
This study was conducted in the Department of Physiology, signals (red and green lights) (VRT- R and VRT – G respectively)
JIPMER, Pondicherry India, during May 2011 to December 2011. was recorded on apparatus supplied by Ananda agencies (Pune,
Yoga training was given at the Advanced Centre for Yoga Therapy India). RT is an indirect index of the processing capacity of the
Education and Research (ACYTER), JIPMER, Pondicherry. The central nervous system, and it is a simple and inexpensive method
10 Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 10-13

www.jcdr.net Vivek Kumar Sharma et al., Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers
of determining sensorimotor performance [20]. size was adequate and that the strength of the study was good.
There were no significant differences in age, height or weight
Study design between the three groups [Table/Fig-1]. There was no significant
The persons involved in the recording of the parameters and the
difference in gender distribution between the groups. The 3 groups
analysis of data were blind to the experimental conditions (i.e. the
were comparable in executive functions and attention span before
group that the participants belonged to).
the intervention [Table/Fig-2]. There was a significant decrease in
We familiarized the participants with the test batteries and gave LCT (time) (p<0.001), number of omissions in LCT (p<0.001), total
them adequate practice on the reaction time apparatus on two time taken for TTA (p<0.001), total time taken for TTB (p<0.001),
separate occasions, to produce results that were more consistent. ART (p<0.001) and VRT (both green and red light) (p<0.005) in
On the day of assessment, participants reported to the Department both the study groups but not in the control group after the study
of Physiology, JIPMER, between 9 and 10 AM, at least two period (12 weeks). We have also observed that practice of fast
hours after eating a light breakfast. Then, the above-mentioned and slow pranayama lead to siginificant decrease in Perceived
parameters were recorded. We administered these tests in the stress scale scores [18]. In addition, a significant improvement
same order as are given here, to all the participants. was seen among participants of both fast pranayama group and
Then, the participants (n=84) were randomly assigned into three slow pranayama group in FDS (p<0.001), whereas a change in
groups: RDS was seen only in fast pranayama group participants.
1. Fast pranayama group (n = 28): Kapalabhati, Bhastrika and There were no significant differences in the percentage of change
Kukkriya. from pre- to post-test between fast and slow pranayama groups
2. Slow pranayama group (n = 28): Nadishodhana, Pranava in stress scores and in all of the executive function parameters.
and Savitri. However, the fast pranayama group showed a significantly
3. Control group (n = 28): No pranayama intervention. All improved performance as compared to the slow pranayama group
the parameters were recorded again after 12 weeks of Parameters Fast pranayama Slow pranayama Control group
intervention. group (n=28) group (n=28) (n=28)
Age (years) (Mean ± SD) 18.39 ± 1.133 19.28 ± 1.82 19.0 ± 1.56
Intervention Height (cm) (Mean ± SD) 158.46 ± 7.30 157.33 ± 9.42 157.25 ± 8.86
We trained the participants in their respective pranayama technique Weight (Kg) (Mean ± SD) 49.63 ± 6.12 51.82 ± 11.65 50.21 ± 9.26
for one week, before the start of the intervention period. Pranayama
Gender
intervention was carried out for about thirty-five minutes a day,
Male 5 4 5
three times per week, for a duration of 12 weeks. A certified yoga
trainer at ACYTER gave the Pranayama training and intervention. Female 23 24 23
Participants practised the pranayama in a quiet room which was [Table/Fig-1]: Comparison of subject’s characteristics amongst three
maintained at a comfortable temperature (25 ± 2ºC). We followed groups. *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
pranayama techniques followed in ACYTER, JIPMER 21. Typical
distribution
sessions of fast and slow pranayamas were as follows:
Parameters Fast pranayama Slow pranayama Control group
Fast Pranayama: Each cycle (6 minutes) consisted of practising group (n=28) group (n=28) (n=28)
one minute of Kapalabhati, one minute of Bhastrika and one minute LCT Pre 114.03 ± 17.13 104.89 ± 19.20 111.36 ± 18.74
of Kukkriya pranayamas, interspersed with one minute of rest (time in sec)
Post 104.17 ± 114.15*** 89.32 ± 19.37*** 109.36 ± 24.05
between each pranayama. Participants were asked to complete 4
LCT Pre 2.64 ± 2.52 1.36 ± 1.54 0.86 ± 0.97
cycles in each session (24 minutes). (omissions)
Post 0.71 ± 1.08*** 0.42 ± 0.69** 0.70 ± 1.08
Slow Pranayama: Each cycle (9 minutes) consisted of practising
LCT Pre 0.035 ± 0.18 0.03 ± 0.18 0.06 ± 0.25
two minutes of Nadishodhana, two minutes of Pranava and two (commission)
minutes of Savitri pranayamas which were interspersed with one Post 0.071 ± 0.62 0.07 ± 0.26 003 ± 0.18
minute of rest between each pranayama. While they were sitting TTA Pre 73.60 ± 23.4 65.12 ± 14.96 74.10 ± 11.64
(in sec)
in a comfortable posture (sukhasana), participants were asked to Post 58.67 ± 21.62*** 51.89 ± 13.14*** 72.10 ± 12.95
perform three rounds per session (27 minutes). TTB Pre 104.57 ± 26.50 97.05 ± 24.36 106.73 ± 34.45
(in sec)
Post 83.96 ± 18.94*** 85.39 ± 25.47*** 98.46 ± 33.47
Statistical analysis FDS Pre 6.03 ± 0.83 6.00 ± 0.94 5.93 ± 1.36
Power and sample size software, version 3.0 was used to calculate
Post 6.75 ± 1.07*** 6.42 ± 0.71* 5.73 ± 1.25
the adequate sample size (at assumed power of 90%) which
RDS Pre 4.14 ± 0.80 4.21 ± 0.95 3.83 ± 1.14
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, Post 4.50 ± 1.07* 4.57 ± 1.13 3.80 ± 1.32
version 19. The normality of the data was tested by Kolmogorov– ART Pre 188.99 ± 30.36 186.61 ± 30.43 189.54 ± 28.08
(msec) †
Smirnov test. Intergroup comparison was done using one way Post 154.89 ± 29.10*** 167.58 ± 23.99*** 189.76 ± 26.61
ANOVA, followed by Tukey Krammer post–hoc test for pair wise VRT–R Pre 219.79 ± 35.21 208.11 ± 37.02 221.88 ± 34.45
comparisons. Intragroup comparisons were done by using paired (msec) †
Post 177.85 ± 22.22*** 189.32 ± 40.19* 222.0 ± 27.79
t-test for parametric measures and Wilcoxon signed rank test was
VRT-G Pre 240.70 ± 39.44 226.53 ± 41.67 222.68 ± 31.69
used for non-parametric measures. Chi-square test was used (msec) †
Post 186.31 ± 28.02*** 206.32 ± 39.02* 223.21 ± 30.04
to compare intergroup gender distributions. The Mann Whitney
U-test was used to compare the percentage change between PSS Pre 19.21 ± 4.33 19.21 ± 4.38 20.57 ± 3.17
groups. A p value less than 0.05 was considered to be statistically Post 14.42 ± 4.14*** 13.89 ± 2.94*** 19.82 ± 3.41
significant. [Table/Fig-2]: Comparison of pre test and post test values of cognitive
test parameters and reaction time in three groups (Mean ± S.D). LCT- letter
Results 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
A post-test analysis, revealed that the lowest power of the study for green, PSS- Perceived stress score. *P<0.05; **P<0.01; ***P<0.001; Pre-Post analysis was done by
with a mean RDS difference of 0.36 (SD=1.13) between fast and wilcoxon signed rank test. †Pre-Post analysis was done by Students paired ‘t’ test; #P<0.05; ##P<0.01;
slow pranayama groups was 85%, which showed that the sample ###
P<0.001; #Intergroup analysis of pre values between groups was done by One way ANOVA
Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 10-13 11

Vivek Kumar Sharma et al., Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers www.jcdr.net
Parameters Fast pranayama group Slow pranayama group neural representation within the CNS and improves bidirectional
(n=28) (n=28) communication between the cerebral cortex and the limbic,
LCT (time in sec) 7.82 ± 10.91 13.24 ± 15.10 autonomic, neuro endocrine, emotional, and behavioural activation
LCT (omissions) 52.45 ± 43.32 35.57 ± 52.36 [22]. Also, generalized alteration in information processing at
thalamo-cortical level induces modification in neural mechanisms
LCT (commission) 3.57 ± 18.98 -0.035 ± 0.188
which regulate the respiratory system [28].
TTA (in sec) 18.47 ± 19.92 15.87 ± 23.06
The shortening of auditory and visual RT in our pranayama
TTB (in sec) 17.65 ± 17.25 7.23 ± 28.66
groups represents greater arousal, better concentration and faster
FDS -13.1 ± 20.32 -9.29 ± 14.83 responsiveness [12]. The improvement was significantly greater in
RDS -9.52 ± 19.74 -10.62 ± 32.94 the fast pranayama group as compared to that in slow pranayama
ART (msec) 16.72 ± 16.38* 8.31 ± 15.27 group. One previous study found insignificant decreases in ART
VRT–R (msec) 17.33 ± 14.91* 8.42 ± 16.32 and VRT, with a shorter (three weeks) training period of Savitri
(slow breathing) and Bhastrika (fast breathing) pranayamas [12].
VRT-G (msec) 20.72 ± 16.80** 7.89 ± 12.75
Our study, on the other hand, demonstrated that a prolonged
PSS 23.47 ± 20.38 23.04 ± 18.31
practice (12 weeks) of pranayama could be beneficial in reducing
[Table/Fig-3]: Comparison of percentage difference between groups.
LCT- letter cancellation test, TTA – Trial test A, TTB – Trial test A , FDS- Forward
RT.
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. Analysis was done using Mann Whitney U test. *P<0.05; **P<0.01; ***<0.001
Limitations of the study
There was a difference in training times between the fast and slow
pranayama groups (24 vs. 27 minutes), since the participants in
in ART, VRT-R (P<0.05) and VRT-G (P<0.01) [Table/Fig-3]. the fast pranayama group found it difficult to do more than four
rounds in a session. Also, there was a difference in the number
Discussion of male and female participants in the study. Nevertheless, the
According to the traditional wisdom of yoga, pranayama is the key male and female participants were equally distributed between the
to bringing about psychosomatic integration and harmony. groups, i.e. the gender ratio was almost similar. Since this study
was conducted only on healthy participants, future studies should
Specifically, we observed a significant reduction in perceived broaden the current research and include clinical populations such
stress and improvement in the following cognitive domains: as patients with psychiatric disorders, whose cognitive functions
attention, visuo-motor speed and memory retention capacity in are adversely compromised.
both fast and slow pranayama groups. Prefrontal cortex regulates
physiological functions by integrating information from ongoing
cognitive processes, emotional processes and current stress
Conclusion
Slow and rapid types of pranayama are beneficial for stress
level [14,22]. Chronic (perceived) stress alters normal patterns
reduction and for improving cognitive functions, but fast pranayama
of prefrontal cortex activation during cognitive tasks, resulting in
has additional effects on sensori-motor performance (i.e. faster
enhanced autonomic arousal [14,22]. The reduced stress in both
auditory and visual RT).
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
Declaration from the authors:
The findings discussed in this research article are a part of the
domains with the practice of different yoga breathing techniques
bigger study to evaluate the effect of fast and slow pranayama on
[10,23-25].
various physiological parameters in adolescents. Part of the study
In the present study, it was not possible to determine the mechanism has earlier been published in Int J Yoga 2013;6:104‑10. [29]
of action of pranayama techniques, but we hypothesized that the
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Neuropsychological assessment. 4 ed. New York: Oxford University Press; deep breathing shifts the autonomic nervous system. Med Hypotheses. 2006;
2004; 337-74. 67(3):566-71.
[20] Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. Effect [28] Telles S. Alterations of auditory middle latency evoked potentials during yogic
of slow and fast pranayams on reaction time and cardiorespiratory variables. consciously regulated breathing and attentive state of mind. 1993 May.
Indian J Physiol Pharmacol. 2005 Jul;49(3):313-8. [29] Sharma Vivek, Trakroo Madanmohan, Subramaniam Velkumary, Rajajeyakumar
[21] Gitananda Swami. Pranayama: The fourth limb of Ashtanga yoga. Satya press; M, Bhavanani Anand, Sahai Ajit. Academic journal article. Int J Yoga.
2008. 2013;6:104‑10.

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,
Date of Submission: Aug 04, 2013
Senior Resident, Department of Physiology, Jawaharlal Institute of Post-Graduate
Medical Education and Research, Pondicherry-605 006, India. Date of Peer Review: Sep 10, 2013
Phone: 91+ 9962267560, E-mail: drsenthilkumar83@gmail.com Date of Acceptance: Oct 28, 2013
Date of Publishing: Jan 12, 2014
Financial OR OTHER COMPETING INTERESTS: None.
Journal of Clinical and Diagnostic Research. 2014 Jan, Vol-8(1): 10-13 13

Online International Interdisciplinary Research Journal, {Bi-Monthly}, ISSN 2249-9598, Vol-IV, Jan 2014 Special Issue
Immediate Effect of Alternate Nostril Breathing On Cardiovascular

Parameters and Reaction Time
Ananda Balayogi Bhavanania, Meena Ramanathanb, Madanmohanc

a
Deputy Director, CYTER, MGMCRI, Pillayarkuppam, Pondicherry 607402, India
b
Co-ordinator and Yoga therapist, CYTER, MGMCRI, Pondicherry, India
c
Professor and Head, Department of Physiology and Director CYTER, MGMCRI,
Pondicherry, India
Corresponding author:
Ananda Balayogi Bhavanani
Deputy Director, CYTER, MGMCRI, Pillayarkuppam, Pondicherry 607402, India
Abstract
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”.
www.oiirj.org ISSN 2249-9598 Page 297

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:

• 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

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:
1. Bhavanani AB, Swarodaya Vigjnan- A Scientific Study of the Nasal Cycle.
Yoga Mimamsa 2007; 39 : 32-8.
2. 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.
3. Mohan SM. Svara (Nostril dominance) and bilateral volar GSR. Indian J
Physiol Pharmacol 1996; 40: 58–64.

4. 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.
5. Srivastava RD, Jain N, Singhal A. Influence of alternate nostril breathing on
cardiorespiratory and autonomic functions in healthy young adults. Indian J
Physiol Pharmacol 2005;49:475-83.
6. Telles S, Nagaratna R, Nagendra HR. Breathing through a particular nostril
can alter metabolism and autonomic activities. Indian J Physiol Pharmacol
1994; 38: 133–7.
7. 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.
8. Lofthus GK. Sensory motor performance and limb preference. Percepts Motor
Skills 1981; 52: 688-93.
9. Das S, Gandhi A, Mondal S. Effect of Premenstrual stress on Audiovisual
reaction time and audiogram. Ind J Physio Pharmacol 1997; 41: 67-70.
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.
13. 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.
14. Kennedy B, Ziegler MG, Shannahoff-Khalsa DS. Alternating lateralization of
plasma catecholamines and nasal patency in humans. Life Sci 1986; 38: 1203-
14.

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 Aloma viloma Comparison

Pranayama Pranayama (p value)
B A ∆% B A ∆% B A ∆%
HR 86.67 78.67 -8.89 82.69 85.77 3.72

0.13 0.032 <0.001
(beats/min) ± 9.41 ± 7.31 *** ±4.89 ±10.36 ± 12.16 ±7.36
SP 119.42 113.58 -4.76 117.17 120.16 2.82

0.07 <0.001 <0.001
(mmHg) ±11.24 ±10.44*** ±3.76 ±11.27 ±8.91* ±4.45
DP 74.92 73.00 -1.98 75.67 79.76 5.55

0.66 <0.001 <0.001
(mmHg) ± 8.15 ± 5.05* ±4.74 ±7.05 ±7.26*** ±5.28
ART 193.75 204.08 5.51 190.35 178.65 -6.17

0.50 <0.001 <0.001
(msec) ±16.44 ±14.86*** ±3.12 ±18.79 ±19.26*** ±3.15
VRT 213.68 221.75 3.94 211.31 203.69 -3.51

0.64 0.002 <0.001
(msec) ±16.44 ± 15.46 ** ±3.87 ±17.83 ± 18.08** ±4.82
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.

DOI Number: 10.5958/j.2320-608X.1.2.001
International Journal of Physiology, January-June 2014, Vol. 2, No. 1 59
Immediate effect of Chandra and Suryanadi Pranayamas

on Cardiovascular Parameters and Reaction Time in a
Geriatric Population
Meena Ramanathan1, Ananda Balayogi Bhavanani2

1
Co-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 right
and left nostril breathing. Though potential health benefits have been postulated, further clinical
research is required to prove immediate and sustained efficacy of these techniques. This study
evaluated 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 yoga
sessions at a senior citizen hospice, were recruited for this self-controlled study. They were instructed
to sit in any comfortable posture and relax for 5 min before taking the pre-intervention recordings of
Heart rate (HR), blood pressure (BP), auditory and visual RT (ART and VRT respectively). They then
performed the selected technique and parameters were recorded immediately after performance of 9
rounds 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 that
passed normality testing and Wilcoxon matched-pairs signed-ranks test applied for the others. Overall
intra-group comparison of pre-post data and inter-group Δ % comparisons showed statistically
significant (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 a
significantly greater reduction after CNP for all parameters. Inter-group comparisons revealed highly
significant decreases (p < 0.001) in VRT and ART after SNP. In conclusion, our study sheds new light
on the physiological changes occurring after SNP and CNP in a geriatric population. While both
techniques reduce HR and BP, CNP does it more significantly. There is shortening of RT following
SNP and this may be attributed to enhance sensory motor function that is of great significance in the
elderly. We suggest that Yoga should be part of the heath care facilities for the elderly as it can enhance
their quality of life and improve their overall health status.
Keywords: Cardiovascular, Geriatrics, Pranayama, Reaction Time, Yoga
INTRODUCTION characterised by progressive and generalised

impairment of homeostasis resulting in declining
Ageing is a progressive, generalised impairment
ability to respond to external or internal stresses and
of function, resulting in a loss of adaptive response to
increased risk of diseases. (2)
stress and in a growing risk of age-related disease. (1) It
is a natural process characterised by declining physical Yoga is a conventional long-established and time-
performance, slower speed of reaction, inadequate tested art and therapeutic science that has positive
working of various systems with poor motor and contribution to make in maintenance of general
sensory conduction. The process of aging is wellbeing and happiness. According to the
Hathapradipika, one of the traditional Yoga texts, it is
Corresponding author: a safe and reliable practice that can be done at any age
Ananda Balayogi Bhavanani (Yuva vrddho’thivrddho va vyadhito durbalo’pi va abhyasat
Deputy Director
siddimapnoti sarvayogeshvatandritah. Whether young,
CYTER, MGMCRI, Pillayarkuppam, Pondicherry
13. Yognat --59--.pmd 59 3/20/2014, 7:26 AM

60 International Journal of Physiology, January-June 2014, Vol. 2, No. 1
old or very old, sick or debilitated, one who is vigilant normal health status, whereas others reported that they
attains success in all yoga, by means of practice, were on regular treatment for one or more medical
provided they abide to the rules and regulations conditions like hypertension (14), hypothyroidism (3),
properly- Hathapradipika I:64). (3) Yoga has preventive, type 2 diabetes mellitus (15), knee pain (4), low back
curative as well as rehabilitative potential and this may
pain (3), arthritis (1), asthma (2), dyslipidemia (4) and
be explained on the basis of its ability to modulate
insomnia (2). None were receiving autonomic
autonomic functions, relieve stress, improve
physiological functions including cardio-respiratory modifying agents like α- or β-blocking drugs.
fitness and improve quality of life. (4,5,6)
The study was conducted on four different days
Swarodaya vigyan, the science of understanding between 4pm and 5.30 pm. To avoid any confounding
the ultradian nasal cycle has been traditionally codified effects of recording on different days, subjects were
in Shiva Swarodaya wherein differential effects of randomly assigned to do one of the techniques on two
different phases of the nasal cycle are given in great days of their recording. One half of the subjects
detail (7) It is traditionally taught that breathing performed CNP, while the others performed SNP and
exclusively through the left nostril or chandra nadi this was reversed on the next day. The subjects were
pranayama (CNP) potentiates ida nadi, the “lunar
instructed to sit in any comfortable posture and relax
channel” while breathing exclusively through the right
in surya nadi pranayama (SNP), activates the pingala for 5 min before taking the pre-intervention recordings
nadi, the “solar channel”. of HR, systolic pressure (SP), diastolic pressure (DP),
auditory and visual RT (ART and VRT respectively).
There is some evidence that the practice of They then performed the selected technique and the
Pranayama (the fourth limb of Ashtanga Yoga) can parameters were recorded immediately after the
significantly lower dangerous free radicals while performance of 9 rounds of either the SNP or CNP.
increasing the body’s intrinsic potential to produce
The entire sequence of recordings was randomised to
protective antioxidants. (8) This may be one of the
avoid any bias.
intrinsic mechanisms by which it helps improve
psycho-physiological wellbeing in patients suffering SNP was performed using nasika mudra wherein
from chronic degenerative diseases that are more
the ring finger of the right hand was used to occlude
common in the elderly.
the left nostril by pressing on the outside of the nostril.
Previous studies have reported differential CNP was performed using nasika mudra wherein the
physiological and psychological effects of exclusive thumb was used to occlude right nostril by pressing
right and left nostril breathing. (9,10,11) Though potential on the outside of the nostril. The left hand was held in
health benefits have been postulated, further clinical Jnana Mudra on both the occasions. Participants were
research is required to prove immediate and sustained instructed to focus their mind on their breath and
efficacy of these techniques especially in a geriatric
ensure it was slow, deep, and regular while attempting
population.
to utilize all sections of their lungs. Respiratory rate
With the above in mind, this study planned to for all techniques was maintained at 5-6 breaths per
evaluate immediate effects of SNP and CNP on min (BPM) and this was regulated by providing an
cardiovascular (CV) parameters and reaction time (RT) audible count of six for both inspiration and expiration.
in a geriatric population. We selected heart rate (HR) As they were all attending regular Yoga sessions, none
and blood pressure (BP) as these indicate changes in reported any difficulty in doing the techniques.
cardiac autonomic regulation while RT is an index of
processing ability of central nervous system and a HR, SP and DP were recorded using non-invasive
simple, non invasive means of determining semi-automatic BP apparatus (CH – 432, Citizen
sensorimotor co-ordination and performance. (12, 13) Systems, Tokyo, Japan) having range from 40 to 180
beats/min and accuracy ± 5%. Mean pressure (MP),
MATERIALS AND METHOD pulse pressure (PP), rate-pressure product (RPP) and
Twenty six subjects (21 females, 5 males) attending double product (Do P) were calculated by respective
regular yoga sessions at a senior citizen hospice, twice formulae.
weekly for more than 3 months were recruited for this
self-controlled study by convenience sampling. Their RT apparatus (Anand Agencies, Pune) with a built
mean age and body mass index (BMI) were 61.38 ± in 4 digit chronoscope and display accuracy of 1 ms
3.61 (SD) years and 25.26 ± 6.33 units respectively. All was used for the study. Simple ART was recorded for
of them were right handed. Three of them reported auditory beep sound stimulus and simple VRT for red
13. Yognat --59--.pmd 60 3/20/2014, 7:26 AM

light stimulus. The subjects were instructed to release matched-pairs signed-ranks test was applied for other
response key as soon as they perceived stimulus. data. P values less than 0.05 were accepted as indicating
Signals were given from the front to avoid effect of significant differences for pre-post and intergroup
lateralized stimulus and they used dominant hand comparisons.
while responding to signals.(10,11) All subjects were
given adequate exposure to the equipment on two RESULTS
different occasions to familiarize them with the
procedure as RT is more consistent when subjects have The results are given in Table 1. Overall intra-group
had adequate practice. (14) More than ten trials were comparison of pre-post data and inter-group Δ %
recorded and the mean of three similar observations comparisons showed statistically significant (p < 0.05)
was taken as a single value for purpose of statistical differences for all parameters. There was an overall
analysis. (15, 16) reduction in HR and BP-based parameters following
Data were assessed for normality using GraphPad both SNP and CNP. However, inter-group Δ %
InStat version 3.06 for Windows 95, (GraphPad comparisons revealed a significantly greater reduction
Software, San Diego California USA). Intra and inter after CNP for all parameters except DP and HR (that
group statistical analysis was carried out using just missed statistical significance). Inter-group
Student’s paired t test for data that passed normality comparisons revealed highly significant decreases (p
testing by Kolmogorov-Smirnov Test. Wilcoxon < 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 geriatric
population before (B) and immediately after (A) nine rounds of the technique.
Parameters CNP SNP Comparison

(n = 26) (n = 26) (p value)
B A Δ% B A Δ% B A Δ%
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 given
for paired t test (HR, DP, MP, PP, RPP and DoP) and Wilcoxon matched-pairs signed-ranks test (SP, ART and VRT.) are given for the
intergroup comparisons. Δ % comparisons were done by paired t test for PP and RPP and by Wilcoxon matched-pairs signed-ranks test
for the rest.
13. Yognat --59--.pmd 61 3/20/2014, 7:26 AM

DISCUSSION processing. (15) This is usually attributed to an alert state

produced by sympathetic activation, but in the present
In the present study we have found a reduction in study, as CV parameters haven’t shown such a change,
all CV parameters following 9 rounds of both CNP it must be due to other mechanisms. Earlier studies
and SNP, but these changes were more significant by the authors have reported shortened RT following
following CNP. This may be due to the fact that slow mukha bhastrika in both normal and mentally
and deep breathing at the rate of 5-6 BPM has been challenged children and also after surya namaskar. (16,
reported to enhance cardiac autonomic regulation. (17) 23)
It has been previously suggested that right nostril
A normalization of autonomic CV rhythms as a result dominance in the nasal cycle as well as right uninostril
of increased vagal modulation and/ or decreased forced breathing, may be correlated with the “activity
sympathetic activity and improved baroreflex phase” of the basic rest-activity cycle, the time during
sensitivity have been suggested in an earlier report on which sympathetic activity in general exceeds
CNP in hypertensive patients (18) It has been however parasympathetic activity throughout the body. (24)
reported that yogic breathing through right, left, or Werntz et al have also reported relatively greater
through both nostrils in normal subjects produces integrated electro encephalogram (EEG) value in one
distinct autonomic changes and that SNP increased SP hemisphere correlating with predominant airflow in
and DP, whereas CNP resulted in significant reduction contralateral nostril, defining the inter-relationship
in SP and MP. (11) Jain et al suggested that sympathetic between cerebral dominance and peripheral
activation produced by right nostril breathing may be autonomic nervous function.(25) In this study, the wider
masked by vagally mediated lung baroreceptor variation in RT values may be attributed to reduced
activity enhanced by voluntary breathing efforts. (19) sensory awareness and attention span in the elderly.
Hence changes following CNP may be attributed to a This may also be why there were significant differences
parasympatho-mimetic effect as the nasal cycle is in pre-test values too.
dependent upon tonic activity of limbic autonomic
nervous system with hypothalamus as control centre, In conclusion, our study sheds new light on
as well as levels of circulating catecholamines and physiological changes occurring after SNP and CNP
other neuro-hormones. (20, 21) in a geriatric population. While both techniques reduce
HR and BP, CNP does it more significantly. There is
Interestingly in our geriatric population, even right shortening of RT following SNP and this may be
nostril breathing decreased CV parameters. This seems attributed to enhanced sensory motor function of great
to be a contradiction to concepts of swara yoga but a significance in the elderly. We suggest that Yoga should
recent report has found that SNP is safe in be part of heath care facilities for elderly as it can
hypertensives and attributed this to in-built safety enhance quality of life and improve overall health
mechanisms of yoga that enhances homeostatic status.
normalcy. (22) The goal of Yoga is to restore homeostasis,
hence, if sympathetic reactivity of a subject is already Conflict of Interest: None
higher than normal, it is suggested that yogic
Source of Funding: Mahatma Gandhi Medical College
techniques will not further increase such a hyper
and Research Institute (MGMCRI), Sri Balaji
reactivity but rather bring it back to normal. Hence,
Vidyapeeth Deemed University, Pondicherry.
we suggest that SNP may be practiced safely by the
geriatric population though CNP has greater benefits. Ethical clearance: IHEC of MGMCRI approved the
Changes in the RPP and DoP signify a reduced work research study at the meeting held on 13th December
load on the heart with reduced O2 consumption, and 2011. (FAC/2011/05)
this is indeed a positive finding in the geriatric
population. ACKNOWLEDGMENTS
The RT changes following CNP and SNP were The authors thank Mrs D Pushpa, Miss G Sarulatha,
however very divergent with significant reduction Miss Imma Sivaraj and Miss Visalakshi for their
being seen in SNP and no such changes in CNP. The valuable assistance during recording sessions and data
activation following SNP may be attributed to an entry. We thank the inmates and authorities of the
improved central neuronal processing ability due to Hospice of Saint Cluny for their wholehearted
greater arousal and faster rate of information cooperation during the training and recording sessions.
13. Yognat --59--.pmd 62 3/20/2014, 7:26 AM

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13. Yognat --59--.pmd 63 3/20/2014, 7:26 AM

DOI Number: 10.5958/j.2320-608X.1.2.001
Immediate effect of Different Pranayam on Short Term

Heart Rate Variability in Health Care Students - A
Preliminary Study
Rajajeyakumar M1, Amudharaj D2, Bandi harikrishna3, Madanmohan T4, Jeyasettiseloune5, Bhavanani AB6
1
Assistant Professor, Department of Physiology, Chennai Medical College Hospital & Research Centre, Trichy,,
2
Assistant Professor, Department of Physiology, Aarupadai Veedu Medical College & Hospital Pondicherry,
3
PhD 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. Heart
rate variability (HRV) has come to be widely used as a non-invasive tool to assess autonomic
function in physiological as well as disease states. In view of this, the present study was aimed
to study the effect of suryanadi(SNP) and chandranadi pranayams(CNP) on HRV in healthy young
volunteers.
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 under
direct supervision between 4-6.30 pm in ACYTER lab, JIPMER. HRV was recorded by using
BIOHARNESS AcqKnowledge 4.1 version and analyzed by Kubios HRV 2.00 software. Basal resting
parameters and HRV were recorded for 5 minutes after that SNP was performed in six cycles per
minute for 5 minutes followed by 5 min rest. Three such sessions (before, during and after) HRV
were 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 decreased
HF power and LF/HF ratio increased after the intervention. In CNP, the time domain analysis, showed
decreased heart rate and an increased pNN50. The frequency domain analysis revealed an increased
HF power with decreased LF/HF ratio.
Discussion: SNP increase the sympathetic activity and CNP increases the parasympathetic activity
and these can be appropriately advocated in many chronic cardiovascular diseases where the
autonomic imbalance is one of the primary derangements.
Keywords: Suryanadi Pranayam, Chandranadi Pranayam , Heart Rate Variability
INTRODUCTION respiration rhythmic and to calm the mind1, 8. This

practice is called Pranayama. Nadisuddhi pranayama
The ancient Indian science of Yoga makes use of
means “purification of subtle energy paths”, inhalation
voluntary regulation of the breathing to make
and exhalation are through alternative nostrils for
successive respiratory cycles.
Corresponding author:
M Rajajeyakumar Surya Anuloma Viloma Pranayama means “heat
Assistant Professor
generating breathing particle” when the respiratory
Department of Physiology, Chennai Medical College
Hospital & Research Centre, Irungalur, Trichy cycle of inhalation and exhalation is completed
Email id: rajakumar60@ gmail.com. through the right nostril exclusively. When completed
Contact No: 09751382650 through the left nostril alone the practice is called “
9. Rajajeykumar--39--.pmd 39 3/20/2014, 7:26 AM

Chandra Anuloma Viloma Pranayam” which means (SNP) and chandranadi pranayam (CNP) by trained
a heat dissipating or cooling liberating practice2,3 yoga teacher and made to practice under direct
supervision until they were familiar. The procedures
Heart rate variability (HRV) has come to be widely
and recordings were carried out in lying down posture
used as a non-invasive tool to assess autonomic
for all volunteers between 4-6.30 pm in ACYTER lab,
function in a variety of physiologic as well as
disease states4. However, there is paucity of literature JIPMER.Basal resting parameters and HRV were
on immediate effect of suryanadi and Chandranadi recorded for five minutes followed by
pranayam on HRV.In view of this, the present study
Day 1: SNP (only right nostril breathing) was
was aimed to study the immediate effect of suryanadi
performed in six cycles per minute (each cycle consists
and chandranadi pranayams on HRV in healthy young
of five seconds for each inspiration and expiration) for
volunteers.
five minutes followed by five min rest. Three such
sessions (before, during and after) HRV were recorded.
MATERIALS AND METHOD
Day 2: The same procedure and parameters were
Materials
recorded for CNP (left nostril breathing only).
HRV was recorded by using BIOHARNESS
AcqKnowledge 4.1 version and analyzed by Kubios Statistical analysis:
HRV 2.00 software. Blood pressure and heart rate were
Statistical analysis was done using SPSS version
recorded with the subject seated comfortably, using
16 (Repeated measures of ANOVA followed by post
the noninvasive automated BP monitor (NIBP).
hoc analysis with Benferroni adjustment) and the level
Methods & procedure of statistical significance is considered at a p value <
0.05.
Study involves human subjects only
Inclusion criteria RESULTS
• Subjects aged between 20-30years males The results of our study were much in accordance
with the previous studies. The time domain analysis
• Willing for learning pranayam technique
of SNP revealed an increased heart rate with a
Exclusion criteria decreased RMSSD, the index of short term HRV.
However the SDNN which is considered the index of
• Subjects with history of previous or current organic long term HRV increased. Also, in the frequency
diseases. domain analysis there is an increased LF power and
• Subjects currently receiving yoga therapy decreased HF power.
including meditation & biofeedback.
The index of sympathovagal balance as reflected
The present study was conducted on 11male by LF/HF ratio increased i.e. from 1.8 to 2.2 after the
volunteers’ 20-30yrs. after obtaining ethical clearance intervention. All the observation showed that SNP is
from the institutional Human Ethics Committee. All sympathomimetic. In CNP, the time domain analysis
consenting subjects meeting inclusion and exclusion of HRV revealed a decreased heart rate and an
criteria of the study will be selected and informed increased pNN50. The frequency domain analysis
written consent will be obtained after thoroughly revealed an increased HF power with decreased LF/
explaining the procedure. HF ratio i.e. from 2.1 to 1.5. The observations of CNP
clearly indicated that CNP is an activator of the
Their height, weights were recorded and BMI was
calculated. Each volunteer was taught both suryanadi parasympathetic 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 reported
are 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.

Time domain
Mean 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 domain
VLF (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.)

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 reported
are for the pre-test vs. during and pre-test vs. after comparisons respectively.
DISCUSSION A long-term improvement in autonomic balance

as well as in respiratory, cardiovascular and brain
The present study evaluated the effect of SNP and function can be achieved if mechanical forces are
CNP on HRV in three different sessions (before, during applied to the body with the aim of reducing existing
& after). Heart rate variability has come to be widely imbalances of mechanical force vectors. This technique
used as a non-invasive tool to assess autonomic implies continually Controlling the body functions for
function in a variety of physiologic as well as precise timings like in Pranayamic breathing
disease states 4. HF component predominately a techniques. 7
consequence of vagal activity. LF component probably
due to combination of sympathetic and The hypothalamus is considered the highest center
parasympathetic activity. for autonomic regulation. SNP increase the
sympathetic activity and CNP increases the
LF/HF ratio has been used as a non-invasive index parasympathetic activity and these can be
of sympathovagal balance. Our studies show that SNP appropriately advocated in many chronic
revealed an increased heart rate with a decreased cardiovascular diseases where the autonomic
RMSSD, the index of short term HRV. Frequency imbalance is one of the primary derangements. The
domain analysis there is an increased LF power and beneficial effect of SNP and CNP can be applied to all
decreased HF power. The index of sympathovagal school children to improve the physical health and
balance as reflected by LF/HF ratio increased. All the sports activities of the students.
observation showed that SNP is sympathomimetic.
Limitation
CNP, the time domain analysis of HRV revealed a
decreased heart rate and an increased pNN50. The All participants were right hand dominant used to
frequency domain analysis revealed an increased HF manipulate the nostrils. There was no separate control
power with decreased. The observations of CNP for this study.
clearly indicated that CNP is an activator of the
parasympathetic activity. It seems possible that Recommendation
mechanical receptors in the nasal mucosa are activated • Sample size has to be increased
with air flow in to the nostril and this signal is
unilaterally transmitted to the hypothalamus5.This • Female can be include to find out the gender
indicates that the practice of slow breathing exercise difference.
improves vagal activity. Practice of pranayam has been
known to modulate cardiac autonomic status with an • To compare the immediate effect with long term
training.
improvement in cardio-respiratory functions 6.

ACKNOWLEDGMENT 4. Task Force of the European Society of Cardiology

and the North American Society of Pacing and
The authors thank Dr. E.S.Prakash, Associate Electrophysiology. Heart rate variability.
Professor of Physiology, Division of Basic Medical Standards of measurement, physiological
Sciences, Mercer University School of Medicine, USA, interpretation, and clinical use. Eur Heart J (1996);
for helping me to write the manuscript. 17: 354–381.
5. Shannahoff-khalsa, D.S. Lateralized rhythms of
Conflict of Interest: No Conflict of interest applicable
the central and autonomic nervous
for this study.
systems. International Journal of Neuroscience:
Source of Funding: Not applicable (1991) ; 11: 222-251.
6. Pal GK, Velkumary S,& Madanmohan. Effect
Ethical Clearance: Enclosed (Human ethical of short term practice of breathing exercises on
committee certificate -JIPMER). autonomic functions in normal human
volunteers. Indian J Med Res( 2004); 120:
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Bhavanani et al. Yoga Mimamsa 2013; 45 (1&2): 1-13
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: yognat@gmail.com
2
Senior Research Fellow, ACYTER, JIPMER, Puducherry- 6. Email: jss8yoga@gmail.com
3
Senior Research Fellow, ACYTER, JIPMER, Puducherry-6. Email: zeesanj@gmail.com
4
Director, CYTER, MGMCRI, Puducherry. Email: drmadanmohan999@rediffmail.com
*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.
1
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
2
INTRODUCTION:
Heart rate variability (HRV), the beat-to-beat alterations in heart rate, is a simple noninvasive
(1)
measurement for investigating autonomic influence on the cardiovascular system. 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
(3)
allostatic load in stress response systems such that optimal homeostasis is restored. 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
(2, 4, 5)
management of diabetes as well as co-morbid conditions like HT and dyslipidemia . 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
(7, 8, 9 )
done on normal subjects. Further clinical research is however needed to establish the
3
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
(10)
regular standard medical management. 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 8M/6F 8M/4F 9M/4F
BMI 27.21 ± 3.21 25.00 ± 2.05 26.62 ± 3.66
Respiratory rate during 18.43 ± 2.68 19.31 ± 5.88 18.00 ± 3.34

basal recording
Respiratory rate during CNP 8.29 ± 4.10 7.62 ± 4.17 6.62 ± 1.26
Respiratory rate during post 18.14 ± 3.46 * 17.77 ± 5.10 16.15 ± 4.04 **
CNP recording
Medications Amlodipine, Glimipride, Amlodipine,
Enalopril Glibenclamide Enalopril
Atorvastatin and Metformin, Atorvastatin,
Aspirin Rosaglitazone Glimipride
Proglitazone, Glibenclamide,
Insulin 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.
4
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)
5
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
6
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
880.67 786.83
Mean 852.21 774.24 769.77 774.22 P= 0.0187
± ±
RR ± ± ± ± P = 0.1219 with * for
109.86 127.29
(ms) 105.57 83.77 97.48 134.76 D vs HT
** *
P = 0.0224
SDNN 30.44 34.14 33.16 29.12 20.30 23.31
with * for P = 0.0782
(ms) ± 16.33 ± 15.62 ± 15.21 ± 14.70 ± 10.32 ± 12.91
DM vs DMHT
Mean 77.93 P = 0.0184
71.56 69.40 78.53 79.24 79.40
HR ± 10.31 P = 0.0724 with * for
± 8.68 ± 8.84** ± 7.89 ± 9.07 ± 11.23
(1/min) * DM vs HT
p = 0.0087
RMSS 35.51 36.45 39.16 29.17 23.15 24.35
with ** for P = 0.1145
D (ms) ± 23.92 ± 18.38 ± 19.84 ± 14.50 ± 12.08 ± 9.75
DM vs DMHT
LF 407.00 615.143 507.33 475.00 163.15 331.85
P=
Power ± ± ± ± ± ± P= 0.0675
0.3237
(ms 2) 493.854 638.313 750.13 613.00 170.29 396.50
HF 576.93 379.79 536.83 372.58 212.77 301.85 P=0.0125
P=
Power ± ± ± ± ± ± with * for
0.4891
(ms 2) 1092.44 580.14 483.83 429.20 339.50 478.96 DM vs DMHT
47.19 58.03 45.36 59.13 46.38 52.39
LF
± ± ± ± ± ± P = 0.9731 P = 0.6499
(n.u)
23.61 20.60 19.46 21.00* 15.65 16.95
52.81 41.97 54.64 40.88 53.62 47.61
HF
± ± ± ± ± ± P = 0.9731 P = 0.6499
(n.u)
23.61 20.60 19.46 21.00* 15.65 16.95
P=0.0115
Total 984.29 994.86 1044.0 848.00 376.00 633.69 with * for
Power ± ± ± ± ± ± DM vs DMHT P = 0.2979
(ms 2) 1501.74 1105.56 1143.18 867.43 494.36 774.61 and * for HT vs
DMHT
1.44 2.02 1.03 2.06 1.09 1.39
LF/HF P = 0.9994 P = 0.3614
± 1.44 ± 1.52 ± 0.64 ± 1.42* ± 0.92 ± 0.93
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.
7
(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 DM DMHT
ANOVA
(n=14) (n=12) (n=13)
B A B A B A B A
70.86 67.86 74.67 71.08 74.69 71.92
HR (beats/min) ± ± ± ± ± ± P= 0.6415 P=0.4894
11.18 9.80 * 6.62 7.49 ** 11.31 10.07 **
137.00 130.50 126.00 123.25 130.85 128.00
SP (mm Hg) ± ± ± ± ± ± P= 0.0804 P=0.2332
14.54 13.53 * 12.48 12.75 * 8.19 12.27
83.71 80.86 80.08 78.67 82.00 79.08
DP (mm Hg) ± ± ± ± ± ± P=0.5412 P=0.7686
8.42 8.37 * 8.58 9.36 7.78 6.93 *
53.29 49.64 45.92 44.58 48.85 48.92
PP (mm Hg) ± ± ± ± ± ± P=0.2555 P=0.2440
14.54 9.20 6.60 6.99 10.60 12.12
101.48 97.40 95.39 93.53 98.28 95.38
MP (mm Hg) ± ± ± ± ± ± P=0.1762 P=0.5478
8.41 9.43 ** 9.55 10.09 ** 6.14 7.04
97.47 89.27 94.03 87.32 97.48 91.46
RPP (units) ± ± ± ± ± ± P=0.8306 P=0.7747
20.57 19.14 ** 11.70 10.14 ** 14.46 11.68 **
72.35 66.66 71.13 66.25 73.50 68.41
DoP (units) ± ± ± ± ± ± P=0.8938 P=0.8693
15.22 14.02** 8.42 7.86*** 12.38 9.45**
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
8
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
(13)
reduction implies an improved cardiac autonomic regulation in our subjects. 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,
(14)
phasic changes in cardiovagal and sympathetic noradrenergic outflows. 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
9
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
(17)
prominent than sympathetic over activity. 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
10
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
(19)
HRV variable to measure as none provides significant, consistent and accurate outcome.
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:
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shavasan training on spectral measures of short term heart rate variability in young healthy
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12
DOI: 10.7860/JCDR/2014/7452.4390
Original Article
Effect of Slow and Fast Pranayama

Physiology Section
Training on Handgrip Strength and

Endurance in Healthy Volunteers
Dinesh Thangavel1, Girwar Singh Gaur2, Vivek Kumar Sharma3,

Ananda Balayogi Bhavanani4, Rajajeyakumar M.5, Syam Sunder A.6
ABSTRACT recorded using handgrip dynamometer (Rolex, India) at baseline

Background: Pranayama has been assigned very important and after 12 weeks of pranayama training.
role in yogic system of exercises and is said to be much more Statistical Analysis Used: Longitudinal changes in each group
important than yogasanas for keeping sound health. Also different were compared by using Student’s paired t-test. Delta changes
pranayamas produce divergent physiological effects. in each group were analysed by ANOVA with Tukey post-hoc
Aim: To study the effect of 12 weeks training of slow and fast analysis.
pranayama on handgrip strength and endurance in young, Results: In SPG significant improvement occurred only in HGE
healthy volunteers of JIPMER population. parameter from 83.95±45.06 to 101.62±53.87 (seconds) (p<0.001)
Settings and Design: Present study was conducted in the whereas in FPG, significant improvement was observed in HGS
Department of Physiology, JIPMER in 2011-12 (1.06.11 to from 33.31±9.83 to 37.9±9.41 (Kilograms) (p=0.01) as well as in
1.04.12). 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
Materials and Methods: Total of 91 volunteer subjects were
HGS is found to be 1.17±5.485 in SPG and in FPG is 4.59±7.26
randomised into slow pranayama (SPG) (n=29), fast pranayama
(p=0.39); HGE difference in SPG is 1.77±21.17 and in FPG is
(FPG) (n=32) and control groups (CG) (n=30). Supervised
2.38±43.27 (p>0.05).
pranayama training (SPG - Nadisodhana, Pranav pranayama and
Savitri pranayama; FPG - Kapalabhati, Bhastrika and Kukkuriya Conclusion: Pranayama training decreases sympathetic
pranayama) was given for 30 minutes thrice a week for 12 weeks activity, resulting in mental relaxation and decreased autonomic
to both slow and fast pranayama groups by certified yoga trainer. arousal thereby, decreasing force fluctuations during isometric
Hand grip strength (HGS) and endurance (HGE) parameters were contraction. This is reflected as improvement in HGS and HGE.
Keywords: Pranayama, Physiological parameters
Introduction Subjects and Methods

The spiritual-scientific discipline of yoga incorporates a wide Present study was conducted in the Department of Physiology,
variety of practices and many scientific researches conclusively JIPMER, Puducherry. The subjects were recruited from the students
document its preventive, therapeutic and excelling powers in the of various courses conducted in JIPMER, Puducherry as well as
individuals [1,2]. staff, friends and relatives of them. The study involved less than
The versions of pranayama vary from single nostril breathing to minimal risk.
bellow breathing and it consists of three phases: purak (inhalation),
kumbhak (retention) and rechak (exhalation) and these phases can Inclusion criteria
be practised in either slow or fast manner [3]. Hand grip strength • Healthy volunteers of both gender in the age group of 18-30
(HGS) is an indicator of muscle function and nutritional status. years.
It has been used as an objective clinical measure in a variety of
situations including assessing the general strength in order to Exclusion criteria
determine work capacity [4]. HGS is influenced by effort, skeletal • History of chronic respiratory illness.
muscle bulk and contractility. Regular practice of pranayama has • Subjects receiving medication for any chronic ailment.
shown improvement in HGS of both hands [5]. One previous • Smokers and alcoholics.
study has compared the effect of six months practice of fast • Athletes.
(FSN) and slow (SSN) practice of Suryanamaskar (SN) (type of
• Any history of previous yoga or bio feedback techniques
yogasana) on adolescents and found out that both types of SN
training in last one year.
had positive physiological benefits but the effects of FSN were
similar to physical aerobic exercises, whereas the effects of SSN The purpose of the study, procedures and benefits were briefed to
were similar to those of yoga training [6]. As different types of them. The willing participants were randomised into SPG (n=29),
pranayamas have also been demonstrated to produce different FPG (n=32) and CG (n=30) after getting informed written consent,
physiological benefits in the subjects [7–9], the present study by simple randomisation method using random numbers generated
was planned to study the effect of 12 weeks of slow and fast through computer. Average age of the volunteers was average age
pranayama training on handgrip strength and handgrip endurance of 18.58 ±2.27 (mean ± SD) were considered for analysis. Among
in young adult subjects of JIPMER population. these 91 volunteers, 72 were females and the remaining 19 were
Journal of Clinical and Diagnostic Research. 2014 May, Vol-8(5): BC01-BC03 1

Vivek Kumar Sharma et al., Effect of Slow and Fast Pranayama Training on Handgrip Strength and Endurance in Healthy Volunteers www.jcdr.net
SPG(n=29) FPG (n=32) CG (n=30)
Parameters 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.
males. The study did not involve invasive procedures at any stage. Parameters SPG (n=29) FPG (n=32) CG (n=30)
Hand grip strength (HGS) and endurance (HGE) parameters were HGS (Kg) 1.17 ± 5.28 4.59 ± 7.26 1.97 ± 7.42
recorded at baseline and after 12 weeks of pranayama training
HGE (s) 1.77 ± 21.17 2.38 ± 43.27 -6.03 ± 35.53*, ##
using handgrip dynamometer (Rolex, India). The subjects were
[Table/Fig-2]: Comparison of the delta changes (difference between post test &
asked to sit comfortably and proper instructions were given to them. baseline) amongst the studygroups on handgrip strength (HGS) and endurance
They were asked to perform maximum voluntary contraction (MVC) (HGE) parameters (Mean ± SD).
using the handgrip dynamometer. The test was repeated three SPG - slow pranayama group, FPG - fast pranayama group, CG - control group.
*with respect to slow pranayama group, # with respect to fast pranayama group.
times with a gap of two minutes and the highest value was recorded Analysis done by one way ANOVA with Tukey post-hoc analysis .*p<0.05, **p<0.01,
as HGS. Following HGS, the subjects were instructed to maintain ***p<0.001. #p<0.05, ##p<0.01, ###p<0.001.
one-third of HGS for as long as possible. Duration in seconds was
noted as HGE using the stop watch. Supervised pranayama training Control Group: consisted of group of volunteers who were not
(SPG - Nadisodhana, Pranav pranayama and Savitri pranayama; included in 12 week training of pranayama.
FPG - Kapalabhati, Bhastrika and Kukkuriya pranayama) was given
for 30 minutes/ day, thrice/week for the duration of 12 weeks by Results
certified yoga trainer as per the guidelines of Morarji Desai National The comparison of parameters between baseline and post test
Institute of Yoga, New Delhi. The details of pranayama training are amongst the groups on hand grip dynamometry parameters are
as follows: given in [Table/Fig-1]. The details on the comparison of handgrip
1. Fast Pranayama: Each cycle consisted of practicing one minute dynamometry parameters considered for the study at baseline were
of Kapalabhati, Bhastrika and Kukkriya pranayama interspersed comparable (p>0.05).
with one minute of rest between each pranayama. Subjects The analysis on the effect of 12 weeks of slow pranayama on HGS
were asked to complete three or more cycles in each session. and HGE parameters shows a statistically significant improvement
• Kapalabhati pranayama: The subjects forcefully expelled during (p<0.001) for HGE and statistically insignificant change (p>0.05)
the expiration but the inhalation was passive. One hundred for HGS parameter. The analysis on the effect of 12 weeks of
and twenty rounds per sitting was the maximum allowed. fast pranayama on HGS and HGE shows statistically significant
• Bhastrika pranayama (Bellows): Subjects were instructed to improvement in both HGS and HGE (p=0.01 and p=0.004,
take deep inspiration followed by rapid expulsion of breath respectively).
following one another in rapid succession. This is called as In CG there was no significant change observed in both HGS and
‘bellow’ type of breathing. Each round consisted of 10 such HGE parameters (p>0.05) after 12 weeks of study period. In HGS
‘bellows’. parameter, longitudinal changes amongst the groups were not
• Kukkriyapranayama (Dog Pant): The subjects sat in vajrasana statistically significant (p>0.05). In HGE parameter, changes
with both palms on the ground in front with wrists touching amongst the groups were statistically significant (p=0.003).An
knees and fingers pointing forward. With wide open mouth and average increase of 2.38 ± 43.27in FPG and 1.77 ± 21.17in SPG
the tongue pushed out as far as possible subjects breathed in was observed (P=0.003 and P=0.03 respectively) compared to
and out at a rapid rate with their tongue hanging out of their the CG.
mouth. The whole practice was repeated for three rounds.
Also, [Table/Fig-2] demonstrates that on comparing HGS and HGE
2. Slow Pranayama: Each round (seven minutes) of session parameters, there was no significant difference between SPG and
consisted of practicing two minutes of nadishodhana, pranava FPG groups. Therefore, our study demonstrates that the effect of
and savitri pranayama interspersed with one minute of rest slow and fast pranayama groups can be considered comparable on
between each pranayama done in comfortable posture handgrip dynamometer parameters (HGS & HGE).
(sukhasana). Subjects were asked to perform nine or more
rounds according to their capacity.
Discussion
• Nadishodhana pranayama: is rhythmic and slow alternate Since pranayama can be practiced in either slow or fast manner
nostril breathing. One round consisted of inhaling through one [3], the beneficial effects obtained by the practice of different prana
nostril, exhaling through other nostril and repeating the same yamas may be derived from the differences in duration of the phases
procedure through other nostril. of the breathing cycle, tidal volume and other factors including the
• Savitri pranayama is a slow, deep and rhythmic breathing, use of mouth, nostrils, constriction of the laryngeal muscles and
each cycle having a ratio of 2:1:2:1 between inspiration position of the glottis [10].
(purak), held-in breath (kumbhak), expiration (rechak), and held
Results of our study demonstrate that there was no significant differ
out breath (shunyak) phases of the respiratory cycle.
ence in the baseline values of handgrip dynamometry parameters.
• Pranava pranayama is slow, deep and rhythmic breathing
Therefore, all the three groups can be considered comparable for
where emphasis is placed on making the sound AAA, UUU
the present study. There was significant improvement in HGS and
and MMM while breathing out for duration of two to three
HGE in fast pranayama group whereas in slow pranayama group,
times the duration of the inhaled breath.
there was significant improvement in only HGE parameter (p<0.001)
At the end of session, all SPG and FPG subjects were instructed to along with statistically non significant but definite trend towards
lie down in shavasana and relax for 10 minutes. increase in HGS. However, on comparing longitudinal changes
2 Journal of Clinical and Diagnostic Research. 2014 May, Vol-8(5): BC01-BC03

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 Acknowledgement
significant difference between these groups. Therefore, our study Special thanks are due to the Advanced Centre for Yoga Therapy
demonstrates that both slow and fast pranayamas are beneficial Education and Research (ACYTER) team of Mr. Dayanidy G and
on the handgrip dynamometer parameters (HGS & HGE) and the Ms. Vithiyalakshmi L, Yoga Instructors, for an excellent conduct of
beneficial effect of the two groups can be considered comparable. pranayama training sessions. We are also grateful to the subjects
To the best of our knowledge, there is no previous study which for cooperating during the study in all possible aspects.
compared the effect of slow and fast pranayamas on HGE and
HGS. However, many previous studies had shown beneficial effect References
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to the short duration training which evokes sympathetic activity.

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.
Dr. Vivek Kumar Sharma, Date of Submission: Aug 25, 2013
Assistant Professor, Department of Physiology, JIPMER, Puducherry-605006, India. Date of Peer Review: Jan 17, 2014
Phone: 9442529673, E-mail: drviveksharma@yahoo.com Date of Acceptance: Mar 12, 2014
Financial OR OTHER COMPETING INTERESTS: None. Month of Publishing: May, 2014
Journal of Clinical and Diagnostic Research. 2014 May, Vol-8(5): BC01-BC03 3

Original Article
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.

Centre for Yoga Therapy, Education and Research,
Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
ABSTRACT
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.
INTRODUCTION of studies documenting various facets of this art and

science.[1‑4] However, though many studies have elucidated
Yoga has truly captured the imagination of scientists applied aspects of Yoga in different health conditions,
in recent times with a dramatic increase in the number
very few have focused on the basic research needed to
Access this article online understand the intricate mind‑body mechanisms involved
Quick Response Code in the different yogic techniques.[5]
Website:
www.ijoy.org.in
The different Yogic psychophysiological techniques are
bound to have different effects on each and every cell
DOI: of the human body and this in turn will depend on the
10.4103/0973-6131.133870 various body systems, organs, and tissues involved in the
performance of such practices.[6] As the role of the spinal
International Journal of Yoga • Vol. 7 • Jul-Dec-2014 89
Bhavanani, et al.: Differential effects of Asanas
column is emphasized in Yoga, it follows logically that the Gandhi Medical College and Research Institute, Puducherry,
effects of forward bending postures would be different than India. Ethical clearance was obtained from the Institutional
those of back bending ones and that these in turn may be Human Ethics Committee and 22 students (16 female,
different from the physiological effects of twisting postures. 6 male), aged 19.05 ± 0.79 standard deviation (SD) years,
As both intra thoracic and intra‑abdominal pressure‑volume with body mass index of 20.54 ± 3.15 (SD) undergoing
changes affect the cardiovascular system, it is plausible that the B Sc., Nursing course at Kasthurba Gandhi Nursing
these Asanas will produce changes in the heart rate (HR) College, Sri Balaji Vidyapeeth, Puducherry were recruited
and blood pressure (BP). The conscious self‑effort made in for the study by convenience sampling. CYTER staff was
Asana practice may be understood as the Spanda (tension) conducting regular Yoga training sessions twice weekly
component whereas the relaxation of effort (Prayatna for 6 months for nursing students and these participants
shaithilya) may be understood as the Nishpanda (relaxation) were selected as they could perform the required set of
component. Even Maharishi Patanjali tells us that the pair Asanas with an adequate level of proficiency. Asanas
of opposites (Dwandwa) is transcended (Dwandanabigata) selected for the study were: DA, Vakrasana (VA) (both
when one perfects the state of Asana. Hence, it is essential sides), Janusirasasana (JSA) (both sides), Matsyasana, and
to physiologically evaluate not only the actual performance Shavasana [Figure 1].
of an Asana, but also the period of recovery following it.
We selected these Asanas as they manipulated the spinal
However, there is a lacuna of studies on such effects column indifferent positions. The human spine is given
and there is only one study[7] comparing cardiovascular great importance in the Yoga tradition (Brahma Danda
effects of some Asanas and that too was carried out in or Meru Danda). The forward bending (JSA), backward
untrained subjects with only a single recording without bending (DA from the prone position and Matsyasana
pre‑post comparisons. That study had evaluated only the from supine position) and twisting VA nature of the
BP during the performance of Sukhasana, Vajrasana, and Asanas was taken into consideration and also the fact
Dhanurasana (DA) by 25 medical students and compared that the effects of two of them (VA and JSA) could be
these findings with the supine, sitting, and standing evaluated on both right and left sides. These Asanas were
positions. As a pre‑post comparison was lacking in that also part of the syllabus of Yoga training the subjects
study, no concrete conclusion could be inferred about the had received earlier and hence an adequate level of
actual effects of performing Asanas or about the recovery proficiency in performance of the postures was also
following their performance. ensured.
The Swara Yoga tradition[8] also emphasizes the subtle Each subject came to CYTER on seven different days and
differences existing between energy flows on the right and the entire study took 3 weeks for its completion as all
left sides (Pingala and Ida nadi respectively) manifesting subjects couldn’t be studied on the same day due to the
through the ultradian rhythmicity of right or left nostril lack of space and manpower. On each of the days, they
dominance (Surya and Chandra Swara respectively). performed one of the Asanas that was selected by random
Autonomic function is affected by right‑left brain selection of both subject and technique so as to avoid any
activity[9,10] and as there is a sensory‑motor crossover bias or influence of different days on the group. All tests
relationship between right and left sides of the body and were carried out in CYTER between 10 and 12 noon. The
the contralateral hemispheres, this leads to speculation environment was quiet, with a comfortable temperature
to differences in autonomic function depending on and subdued lighting. The subjects were briefed about the
techniques performed utilizing either right/left sides. study protocol and written informed consent was obtained
from them. They were advised to finish their breakfast
With the above rational in mind, this study was planned to at least 2 h earlier and come after emptying bowel and
compare the immediate cardiovascular effects of different bladder.
Yoga Asanas in healthy young volunteers. In addition
to studying the immediate effect of the Asanas, we also To ensure objectivity in measuring HR and BP, the
studied the post posture supine recovery period for ten recordings were performed using non‑invasive
min. Hence, Shavasana also served as a control to the semi‑automatic BP monitor (CH – 432, Citizen Systems,
supine rest being carried out after the performance of the Tokyo, Japan) with an instrumental accuracy of ± 5% for
other Asanas. HR and ± 3 mm Hg for BP. Pre intervention HR and BP
was recorded after 5 min of supine rest. The subjects then
MATERIALS AND METHODS performed one of the Asanas for 30 s, following which
the post‑intervention recordings were taken. HR and BP
This study was conducted at the Center for Yoga Therapy were further recorded during the supine recovery period
Education and Research (CYTER) functioning in Mahatma at 2,4,6,8 and 10 min.
90 International Journal of Yoga • Vol. 7 • Jul-Dec-2014

Figure 1: Asanas performed by participants in the study: Janusirasasana (right), Janusirasasana (left), Vakrasana (right), Vakrasana (left), Dhanurasana, Matsyasana,
and Shavasana
Data were assessed for normality using GraphPad InStat DA [Table 1, Figure 2]. In the recovery phase, there were
version 3.06 for Windows 95, (GraphPad Software, San significant intergroup differences from 2 min onward in
Diego California USA, www.graphpad.com). As all data both systolic pressure (SP) and diastolic pressure (DP) as
passed normality testing by Kolmogorov‑Smirnov Test, given in Tables 2 and 3 and Figures 3 and 4. The decrease
statistical analysis was carried out using repeated measures of SP after VA (right side) (VA‑R) was significantly greater
of ANOVA with Tukey‑Kramer multiple comparisons test to than Shavasana (4th, 6th, and 8th min) and JSA‑L at 6th and
compare differences between groups at each point of time. 8th min [Table 2 and Figure 3]. DP decreased significantly
Student’s paired t test and P values less than 0.05 were after performing JSA‑L compared to VA‑R at the 6th and
accepted as indicating significant differences for pre‑post 8th min [Table 3 and Figure 4]. The plot of ∆% changes
and recovery period intra‑group comparisons. during the recovery period showed greater fall in SP and
DP after all the other Asanas as compared to that following
RESULTS Shavasana [Figures 3 and 4].
There were significant changes in HR and BP both DISCUSSION

immediately after performing asanas as well as during
the recovery period [Tables 1‑3 and Figures 2‑4]. The cardiovascular changes immediately after performing
Overall comparisons of changes immediately after the the Asanas and during the recovery phase as evidenced in
performance of the Asanas revealed significant differences this study reveal inherent differences between the selected
with regard to HR that increased significantly after postures [Tables 1‑3, Figures 2‑4]. Differences between

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 min
Time DA JSA‑R JSA‑L VA‑R VA‑L MA SA P
frame
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 0.1367
Zero 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* <0.0001
2 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** 0.7718
4 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*** 0.7713
6 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*** 0.8621
8 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*** 0.6125
10 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*** 0.7844
HR = 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
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 0.5865
Zero 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** 0.7473
2 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** 0.0574
4 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 0.0140
6 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*** 0.0064
8 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*** 0.0079
10 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*** 0.0146
SP = 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
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 0.2195
Zero 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** 0.2150
2 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* 0.0438
4 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* 0.0254
6 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** 0.0427
8 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*** 0.0234
10 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** 0.3520
DP = 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
the selected Asanas were especially significant for HR after 2 min. This also implies that a rest of 2 min should
immediately after performing DA [Table 1 and Figure 2]. be given in between the Asanas if one is to attain the best
There was a higher stress response to DA as opposed relaxatory effect of Yoga practices.
to the other Asanas and this may be attributed to an
increased sympathetic response due in part to the relative A previous study on individual Asanas evaluated the
difficulty of the posture as well as the intense abdominal BP while 25 medical students performed Sukhasana,
compression occurring while performing it. Vajrasana and DA and also compared these findings
with the supine, sitting, and standing positions.[7] DA
Each of the Asanas had its own pattern and through there had the highest BP as compared to all other postures in
were overall similarities, some differences can be made out that study too. The main difference between our present
in a detailed examination. VA‑R had the greatest fall in HR study and that study is that they had measured the BP
during the recovery period while JSA‑R had the greatest while the subjects were in the posture, whereas we
fall of both SP and DP by the end of the 10 min recovery have measured before and after the posture along with
period [Tables 1‑3, Figures 2‑4]. There were significant a 10 min recovery period. They had only recorded a
differences between the selected Asanas mainly during single value and thus there was no pre‑post comparison
the recovery period after 2 min and this finding helps us in their study. It is also to be noted that their subjects
to understand that the effects of the Asanas is quite similar were not regular practitioners of Yoga while our subjects

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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

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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 that Virasana induces temporarily a hyper metabolic
practicing the techniques for more than 3 weeks at the state characterized by enhance sympathetic activity
time of the study. that gets inhibited upon the adoption of Shavasana.[11]
Siddhasana was reported to be a mild type of exercise
Previous studies have reported the energy expenditure as it had higher energy expenditure and ventilatory
and ventilatory responses of Yogic standing (Virasana) responses as compared to supine and chair sitting
and sitting (Siddhasana) postures.[11,12] They reported postures.[12]

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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
The effect of supine relaxation is more pronounced Asanas. However, when oral glucose tolerance test ( GTT)
after the performance of the Asanas as compared to just was administered, there was a greater insulin response
relaxing in Shavasana [Figures 2‑4]. This may be attributed that may be interpreted as an enhanced sensitivity of
to a normalization and resultant homeostatic effect pancreatic β cells to the glucose challenge too. At the
occurring towing to a greater, healthier de‑activation of the metaphysical level, this may be taken to imply a dynamic
autonomic nervous system occurring due to the presence state of balance where one is balanced, yet ready to face
of prior activation. any challenge that may occur.
A study by Telles et al. studied O2 consumption and One of the extra findings of this study is the revelation of
respiration following four Yoga postures interspersed with subtle differences between the right sided and left sided
relaxation and supine relaxation alone, and concluded that performance of VA and JSA that may be occurring as a
the combination of stimulating and relaxing techniques result of the different internal structures being either
reduced physiological arousal better than the mere practice compressed or relaxed on either side. This requires further
of relaxation techniques alone.[13] They also pointed out exploration and studies with a greater number of subjects
that though the practical performance of Yoga techniques and doing the Asanas in different positions may help
seem to be stimulatory in nature, their physiological unravel the scientific basis of such differences.
effects are in fact more relaxatory. This is corroborated by
a previous study from JIPMER reporting that Shavasana The aim of Yoga is harmony or homeostatic balance at all
relaxation is enhanced with the addition of Savitri levels of existence (Samatvam yogah uchyate) as elucidated
Pranayama thus decreasing O2 consumption by 26%.[14] in the Bhagavad Gita[16] and the psychophysiological
nature of Yoga Asanas may be producing such a
Manjunatha et al. studied the effects of selected Yogic balance even if they initially have a hyper metabolic
postures on fasting and postprandial glycaemia and or cardio‑respiratory stimulatory action. This is well
insulinemia in healthy young subjects and concluded evidenced by the cardiovascular responses to all the
that the performance of Asanas led to increased Asanas in our study, as the post postural HR and BP both
sensitivity of the β cells of the pancreas to the glucose fell below the initial values during the recovery period
signal.[15] It was found in that study that the performance and this was consequently seen to be even lower than the
of four different sets of Asanas had similar effects of responses to supine relaxation in Shavasana. This has been
reducing fasting and postprandial glycaemia and that corroborated by recent reports that both the sympathetic
blood insulin levels also fell after the performance of the and parasympathetic limbs of the autonomic nervous

system activity were enhanced in hypertensives following studying yoga. Int J Yoga Therap 2011;21:21.
Yoga training.[17,18] 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.
In conclusion, our study provides initial evidence of 8. Bhavanani AB. Swarodaya vijnana‑A scientific study of the nasal cycle. Yoga
differential cardiovascular effects of Asanas and subtle Mimamsa 2007;39:32‑8.
differences between right and left sided performance. 9. Werntz DA, Bickford RG, Bloom FE, Shannahoff‑Khalsa DS. Alternating
Further, cardiovascular recovery is greater after the cerebral hemispheric activity and the lateralization of autonomic nervous
performance of the Asanas as compared to Shavasana; function. Hum Neurobiol 1983;2:39‑43.
thus, implying a better response when effort precedes 10. Shannahoff‑Khalsa DS. Unilateral forced nostril breathing: Basic science,
clinical trials, and selected advanced techniques. Subtle Energies and Energy
relaxation. Medicine Journal 2002;12:79‑106.
11. Rai L, Ram K. Energy expenditure and ventilatory responses during
ACKNOWLEDGMENTS 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
The authors thank the management and authorities of Sri ventilatory responses during Siddhasana – A yogic seated posture. Indian J
Balaji Vidyapeeth University for setting up the Centre for Physiol Pharmacol 1994;38:29‑33.
Yoga Therapy, Education and Research (CYTER) in Mahatma 13. Telles S, Reddy SK, Nagendra HR. Oxygen consumption and respiration
following two yoga relaxation techniques. Appl Psychophysiol Biofeedback
Gandhi Medical College and Research Institute (MGMCRI).
2000;25:221‑7.
The authors are grateful to Yogacharini Meenakshi Devi 14. Madanmohan S, Rai UC, Balavittal V, Thombre DP, Gitananda S.
Bhavanani, Director ICYER and Dr. Madanmohan, Professor Cardiorespiratory changes during savitri pranayama and shavasan. Yoga Rev
and Head Department of Physiology, MGMCRI for their constant 1983;3:25‑34.
motivation, encouragement and supportive guidance. We thank 15. Manjunatha S, Vempati RP, Ghosh D, Bijlani RL. An investigation into
Miss Subashana, ANM for her valuable assistance during the the acute and long‑term effects of selected yogic postures on fasting and
postprandial glycemia and insulinemia in healthy young subjects. Indian J
recording sessions and data entry.
16. Swami C. The Bhagavad Gita. Trichy: Ramakrishna Tapovanam; 1984.
REFERENCES 17. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Babu K. Modulation
of stress induced by isometric handgrip test in hypertensive patients following
1. Khalsa SB. Yoga as a therapeutic intervention: A bibliometric analysis of yogic relaxation training. Indian J Physiol Pharmacol 2004;48:59‑64.
published research studies. Indian J Physiol Pharmacol 2004;48:269‑85. 18. Bhavanani AB, Madanmohan S, Zeena S. Suryanadi pranayama (right unilateral
2. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin nostril breathing) may be safe for hypertensives. J Yoga Phys Ther 2012;2:118.
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
How to cite this article: Bhavanani AB, Ramanathan M, Balaji R,
in adults with type 2 diabetes mellitus: A systematic review. Evid Based Pushpa D. Comparative immediate effect of different yoga asanas on
Complement Alternat Med 2007;4:469‑86. heart rate and blood pressure in healthy young volunteers. Int J Yoga
4. Bhavanani AB. Yoga as a therapy: A perspective. Yoga Mimamsa 2014;7:89-95.
2011;42:235‑41.
5. Bhavanani AB. Don’t put yoga in a small box: The challenges of scientifically
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Original Article
A novel rejuvenation program for cancer patients at

Kaivalyadhama, India
Lee Majewski1, Ananda Balayogi Bhavanani2
1
Kaivalyadhama Yoga Institute, Lonavala, Maharashtra, India, 2Centre for Yoga Therapy, Education and Research (CYTER), Mahatma
Gandhi Medical College and Research Institute (MGMCRI), Pillayarkuppam, Pondicherry, India
Abstract Background: The modern intensive treatment for cancer leaves the patients physically and mentally exhausted
by the end of it. There is great potential for Yoga, the original mind–body medicine, in such a situation as it
conjointly emphasizes body, mind, and spirit, which may be particularly useful for enhancing patients’ social
and spiritual well-being. Some studies have reported the effectiveness of Yoga, meditation, and mindfulness as
a rehabilitative and palliative therapy in various types of cancer.
Objectives: With the above background in mind, we created a 3-week residential program for cancer patients
to empower them in their journey, “back to health.” The curriculum was geared specifically for those who had
undergone chemotherapy and/or radiation.
Methods: The program utilized the sister life sciences of Yoga and Ayurveda with a healthy dose of self-education to
assist patients in their recovery from the devastation of cancer and its modern treatment. The modes of reintegration
used in this program were designed to specifically address the physical, mental, and psychic (spiritual) needs
of the participants. The curriculum included various asanas, kriyas, pranayama, mudras, and bandha, as well as
chanting. Ayurvedic treatment based on panchkarma science was designed and applied according to each patient’s
disposition. An educational component was included to inform patients of potential carcinogenic factors in their life
and to change their mindset and attitudes from victimhood to self-empowerment. In order to scientifically validate
the program, physiological, biochemical, psychological, and Ayurvedic assessment of tridoshas was carried out.
Conclusion: Our special Cancer Rehabilitation Yoga program is expected to have several beneficial effects for
those recovering from the aftermath of anti-cancer therapies even at 3-month follow-up. Subjective observations
so far reveal that the program led to overall empowerment of the participants.
Key Words: Cancer, rehabilitation, Yoga
INTRODUCTION cancer patients undergo extensive chemotherapy with or

without surgery, followed often by radiation (Life After Cancer,
The media worldwide is reporting an increase in the incidence of n.d.). After such intensive treatment schedules provided by
cancer, and the 5-year global cancer prevalence was estimated to modern medicine, patients are physically exhausted (Life After
be 28.8 million in 2008 with half the burden in areas of very high Cancer, n.d.; Shaw, n.d.). Their bodies are usually subjected to a
human development, comprising only one-sixth of the world’s wide array of chemical poisons, which indiscriminately attack
population (Bray, Ren, Masuyer, & Ferlay, 2008). Typically, all generative cells resulting in physical exhaustion. However,
the toll on the physical body is only one side of the coin as many
Access this article online enter various degrees of depression after completion of intensive
Quick Response Code: treatments (Feuerstein, 2007). Long-term chemotherapy results
Website:
in chemotherapy-induced cognitive dysfunction or “chemo
www.ym-kdham.in brain” that may be due to restriction in blood supply to the
brain, manifesting as depression, mental confusion, inability to
DOI: focus, and loss of short-term memory (Life After Cancer, n.d.;
10.4103/0044-0507.137843 Asher, 2011; Phillips et al., 2012). Such states often lead to a state
of confusion and crisis in values in the lives of cancer survivors.
Address for correspondence:

Dr. Ananda Balayogi Bhavanani, Deputy Director, CYTER, MGMCRI, Pillayarkuppam, Pondicherry - 607 402, India.
20 Yoga Mīmāṃsā | Vol. 46 | Issue 1 & 2 | Jan-Jun 2014

Majewski & Bhavanani: Rejuvenation program for cancer patients
The mental strain on cancer survivors is often underestimated. natural, inherent body, mind, and emotional healing processes
After their allopathic therapy is completed, patients are told to (Khalsa, 2004; Levine & Balk, 2012; Carlson et al., 2003, 2004;
go back to their “normal life” and are regarded by the society Coker, 1999; Wolsko, Eisenberg, Davis, & Phillips, 2004).
as “normal as before.” This adds to the patients’ confusion as
it increases their stress of not being “understood.” They begin Throughout the program, we adopted primarily the group
to feel that their family and friends do not understand their classes pattern as it has been previously noted that such
depression, mental confusion, and display of lack of memory. group Yoga classes provide patients with a community
and a forum in which to share their experience (Levine &
Yoga, the original mind-body medicine, is regarded as being Balk, 2012).
beneficial in various disorders (Funderburk, 1997; Innes,
Bourguignon, & Taylor, 2005; Khalsa, 2004; Yang, 2007; Sharma, Daily schedule Monday to Saturday
Gupta, & Bijlani, 2008), and can be of immense help to such 07:00-08:15 Yoga-Asana/pranayama
cancer patients as well. The practice of Yoga is therapeutically 08:30 Breakfast
unique in that it conjointly emphasizes body, mind, and spirit, 10:00-11:30 Cleansing and rejuvenating
Ayurvedic treatments (Panchkarma)
which may be particularly useful for enhancing patients’
12:00-12:30 Yoga-Silent meditation
social and spiritual well-being (Levine & Balk, 2012). Some
12:30 Lunch
studies have reported the effectiveness of Yoga, meditation,
03:00-04:30 Group activity (education, therapy)
and mindfulness as a rehabilitative and palliative therapy in
various types of cancer (Bower, Wooler, Sternlieb, & Garet, 05:00-06:15 Yoga Nidra
2005; Carlson, Speca, Patel, & Goodey, 2003, 2004; Cohen, 06:30 Dinner
Warneke, Fouladi, Rodriguez, & Chaoul-Reich, 2004; Coker, 08:15-09:00 Yoga-Chanting and silent meditation
1999; Culos-Reed, Carlson, Daroux, & Hately-Aldous, 2006;
Harder, Parlour, & Jenkins, 2012; Wolsko, Eisenberg, Davis, & 1. Asana–pranayama–mudra–bandha
Phillips, 2004; Zhang, Yang, Tian, & Wang, 2012). We used the following strategy for this module:
A recent review by Levine and Balk concluded that yoga a. Simple joint movement and warming up stretching
benefits women’s emotional functioning during and after b. Asanas
breast cancer treatment, and causes decrease in anxiety and
1st week 2nd week 3rd week
depression and enhanced cognitive functioning (Levine &
Lying supine
Balk, 2012). They mentioned thus: “patients cite physical
Supta Tadasana
activity, breathing, meditation, and group support as
Simple crocodiles‑ 1, Crocodile (with Crocodile‑ 5th
particularly helpful components of Yoga.” Practitioners of 2, 3, 4 maintenance)
Yoga vouch for its efficacy and relative safety in a multitude
Suptabhadrasana
of conditions. Yoga may be understood as a re-integrator (butterfly)
of this complex, inducing a state of dynamic well-being, Ekapada uttanasana Ardhahalasana‑ Ardhahalasana‑
a state of health (Bhavanani, 2011a, 2011b). one leg both legs
Setubandhasana
METHODS Ardha‑pavanamuktasana Pavanamuktasana Pavanamuktasana
(single leg)
We created a 3-week residential program for cancer Lying prone
patients to empower them in their journey, “back to Niralambasana (without raising) (with raising)
health.” The curriculum was geared specifically for those Simple bhujangasana
who had undergone chemotherapy and/or radiation, and (forearm support)
the program utilized the sister life sciences of Yoga and Ardhashalabhasana
Ayurveda with a healthy dose of self-education to assist (with support)
patients in their recovery from the devastation of cancer Sitting
and its modern treatment. The first of these programs was Marjarasana (simple
cat/cow)
held recently at Kaivalyadhama Yoga Institute in Lonavla,
India (www.kdham.com/cancer). Vajrasana
Modes of re-integration Shashankasana Uttanamandukasana

The modes of re-integration used in the program were Gomukhasana
designed to specifically address the physical, mental, and Bharadwajasana Vakrasana
psychic (spiritual) needs of the participants. Many studies Simple janusirasana
have reported the effectiveness of yogic techniques, while Bhadrasana
the technique of silent meditation and chanting may enhance Contd...
Yoga Mīmāṃsā | Vol. 46 | Issue 1 & 2 | Jan-Jun 2014 21

1st week 2nd week 3rd week be useful in stress management and in creating an inner
Standing sense of relaxation manifested as reduced heart rate (HR)
Tadasana and blood pressure (BP) (Bhavanani, Madanmohan, Sanjay,
Katichakrasana‑ 1, 2 (waist rotation) & Vithiyalakshmi, 2012).
Parvatasana
Side bending chakrasana Konasana Simple Trikonasana 3. Ayurveda: Every morning patients had Ayurvedic
Natarajasana‑ 1st step Natarajasana treatment based on panchkarma science. The treatment
Padhastasana‑90° Padhastasana was designed and applied according to each patient’s
disposition and was very personalized. It included
cleansing practices, full body massage, steam bath, herb oil
c. Following pranayama application, and three daily meals based on sattvic vegan
diet. Licensed Ayurvedic therapists administered it under
Practices 1st week 2nd week 3rd week the watchful eyes of two Ayurvedic doctors. Ayurveda is
Kapalabhati 40-40-40 60-60-60 80-80-80
viewed as a sister science of Yoga and, hence, we felt the
Lung expansion skills Upper lobe‑ 8 10-12 15-20 integration of both ancient sciences can produce a better
Lower lobe‑ 8 sense of healing and well-being in the participants.
Puraka-rechaka Bhramari‑ 8-10 10-12 15-20
Easy kumbhaka Ujayi‑ 8-10 8-10 rounds 4. Education: The goal of educational component of the
Shitali‑ 8-10 Bhastrika‑ Bhastrika program was to inform patients of potential carcinogenic
3-5 rounds 10-12 rounds
factors in their life and to change their mindset and
Gradual development 5-6 rounds
of Kumbhaka
attitudes from victimhood to self-empowerment. As
the International Association of Yoga Therapists (IAYT)
definition of Yoga therapy includes the empowerment of
Bandha-Mudras: Three basic bandhas, ashwini mudra, and the individual (Taylor, 2007), we considered this a vital
brahmamudra component of our program and every afternoon, patients
spent 90 min learning about Ayurveda treatments, yogic
We used simplified asanas and increased the complexity values, environmental toxicity, diet, healthy lifestyle, and
over 3 weeks, always being mindful of the following: yogic tools to maintain health and well-being. Change must
• to meet individual client level of tolerance, come from within, and this was the goal, to educe such a
• of skin incisions and peripheral neuropathy, and positive change in our participants.
• of poor balance issues.
5. Therapy: Throughout the program, patients had access
The pranayama also had to be modified according to Ayurvedic and allopathic doctors for any consultations
to specific cancer. So, those with colon cancer would if needed. Yogic therapy was also available upon request
replace Kapalbhati with alternating nostril breathing and generally the participants were eager to discuss their
(Nadhi Shoddhana). These psycho-physical practices of issues with chosen specialists. In addition, toward the end
Yoga enable participants to get to “know their bodies” of the program, they worked on creating personal mandalas
better and create a positive sense of oneness between breath to help them find a new sense and direction in life.
and body movements.
Psycho-physio-biochemical parameters
2. Chanting: Chanting is widely used in the Yoga tradition In order to scientifically validate the program, we tested
as it creates a sense of inner peace that is conducive to the following parameters with plans of repeating them at
healing. When we chant, we are in the “now” and this 3 months follow-up:
induces empowerment as we begin to take charge of our 1. Psychological tests: Given that a majority of patients
thoughts, feelings, and actions (Bhavanani, 2011b). For end up depressed after completing modern anti-cancer
our participants, we used healing mantras culled from therapy, we used standard tools such as WHO Quality
different traditions. In the first week, the Ra Ma Da Sa of Life, Hospital Anxiety and Depression Score
from Kundalini Yoga tradition was used as it also provides (HADS), and Profile of Mood States (POMS). These
a beautiful musical experience. It was noticed that even are standardized tools that enable us to document the
those who do not usually like chanting enjoyed the beautiful state of mind, levels of anxiety and depression, and
music and mantra intonations. In the second week, we understand the subjective feelings of our participants
switched to chanting 108 rounds of the Maha Mrityunjaya both before and after the program (Levine & Balk, 2012;
(Om trayambakam) mantra as this is traditionally believed Carlson et al., 2003; Cohen et al., 2004; Culos-Reed
to reduce the fear of death and create a sense of life and living et al., 2006; Harder et al., 2012). Such tools are used
in the individual. In the third week, we used 108 rounds regularly in both in-patient and out-patient scenarios
of Omkara as the Pranava AUM has been documented to to understand the psychological effects of different

treatment modalities and, hence, their application gives up. However, our subjective observations indicate that
us a hardcore scientific understanding of the subjective yoga has benefitted those recovering from the aftermath
changes in our participants. of anti-cancer therapies in terms of empowerment of the
2. Physiological tests: We recorded the HR and BP both participants. This is likely because they are given the tools,
before and after the program. Changes in cardiovascular which make them feel in control of their health and well-
parameters such as HR and BP imply a better capacity to being. They arrived with long-drawn faces, often with a
manage stress with a more balanced autonomic nervous lot of pain and suffering. In the 3 weeks of the program,
system (Funderburk, 1997; Innes et al., 2005; Khalsa, their faces slowly lighted up, their moods changed, their
2004; Yang, 2007; Bhavanani et al., 2012). This can be friendships become strong, and their outlook on life
correlated with the psychological changes, thus enabling became optimistic. We hope to corroborate our subjective
us to understand the mind–body connections and observations with the results of our scientific assessments
positive psycho-physical changes occurring due to the in the future.
program. We also noted improvement in the physical
performance of asanas by both subjective and objective ACKNOWLEDGMENTS
assessment done by the participants and instructors,
respectively. The authors thank the management of Kaivalyadhama Yoga
3. Biochemical tests: Standardized complete hematological Institute and, especially, Swami Maheshananda for sparking the
analysis was done with liver and renal profiles. These idea and supporting the Rejuvenation and Detoxification Program
tests were used to determine changes in red and for Cancer Patients. They are grateful to Shri O. P. Tiwari for his
white blood counts, hemoglobin, liver function, and constant motivation and supportive guidance. They also thank all
the subjects for their wholehearted cooperation during the program.
kidney function due to the program. The psycho-
physiological changes measured by previous tests may
be corroborated with these to understand better innate REFERENCES
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also started a full research project with a multinational (DHEAS) and melatonin in breast and prostate cancer outpatients.
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patients/resources/life_after_cancer/.
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Streeter, C. C., Jensen, J. E., Perlmutter, R. M., Cabral, H. J., Tian, H., Director of CYTER, MGMCRI, Pillayarkuppam, Pondicherry, India.

Original Article
Comparative effect of 12 weeks of slow and fast pranayama

training on pulmonary function in young, healthy volunteers:
A randomized controlled trial
Dinesh T, Gaur GS1, Sharma VK1, Madanmohan T3, Harichandra Kumar KT2, Bhavanani AB4
Department of Physiology, Vinayaka Mission’s Medical College and Hospital, Karaikal, Departments of 1Physiology and 2Medical Biometrics
and Informatics, Jawaharlal Institute of Postgraduate Medical Education and Research, 3Department of Physiology, 4Centre for Yoga Therapy
Education and Research, Mahatma Gandhi Medical College and Research Institute, Puducherry, India.
Address for correspondence: Dr. Girwar Singh Gaur,

Jawaharlal Institute of Postgraduate Medical Education and Research,
Puducherry - 605 006, India.
E-mail: drgsgaur@yahoo.com
ABSTRACT
Context: Pranayamas are breathing techniques that exert profound physiological effects on pulmonary, cardiovascular, and
mental functions. Previous studies demonstrate that different types of pranayamas produce divergent effects.
Aim: The aim was to compare the effect of 12 weeks of slow and fast pranayama training on pulmonary function in young,
healthy volunteers.
Settings and Design: This study was carried out in Departments of Physiology and ACYTER, Jawaharlal Institute of
Postgraduate Medical Education and Research, Puducherry in 2011.
Subjects and Methods: Ninety one healthy volunteers were randomized into slow pranayama group (SPG), n =29, fast
pranayama group (FPG), n = 32 and control groups (CG) (n = 30). Supervised pranayama training (SPG: Nadisodhana,
Pranav pranayama and Savitri pranayama; FPG: Kapalabhati, Bhastrika and Kukkriya pranayama) was given for 30 min/day,
thrice/week for 12 weeks by certified yoga instructors. Pulmonary function parameters (PFT) such as forced vital capacity
(FVC), forced expiratory volume in first second (FEV1), ratio between FEV1 and FVC (FEV1/FVC), peak expiratory flow rate
(PEFR), maximum voluntary ventilation (MVV), and forced expiratory flow25-75 (FEF25-75), were recorded at baseline and after
12 weeks of pranayama training using the computerized spirometer (Micro laboratory V1.32, England).
Results: In SPG, PEFR, and FEF25-75 improved significantly (P < 0.05) while other parameters (FVC, FEV1, FEV1/FVC,
and MVV) showed only marginal improvements. In FPG, FEV1/FVC, PEFR, and FEF25-75 parameters improved significantly
(P < 0.05), while FVC, FEV1, and MVV did not show significant (P > 0.05) change. No significant change was observed in CG.
Conclusion: Twelve weeks of pranayama training in young subjects showed improvement in the commonly measured PFT.
This indicates that pranayama training improved pulmonary function and that this was more pronounced in the FPG.
Key words: Fast pranayama; healthy lungs; pulmonary function test; slow pranayama.
INTRODUCTION They are gaining more importance and becoming

acceptable to the public as well as scientific community.[1]
In the recent decades, awareness and interest have
increased in yogic techniques that include pranayamas.
As a deep breathing technique, pranayama reduces dead
Access this article online
space ventilation and decreases work of breathing. It
Quick Response Code also refreshes the air throughout the lungs, in contrast
Website: with shallow breathing that refreshes the air only at
www.ijoy.org.in
the base of the lungs.[2] Regular practice of pranayama
improves cardiovascular and respiratory functions,
DOI: improves autonomic tone toward the parasympathetic
10.4103/0973-6131.146051 system, decreases the effect of stress and strain on the
body and improves physical and mental health. [3-5]

Dinesh, et al.: Slow and fast pranayama training effect on pulmonary function in healthy volunteers
Pulmonary function parameters (PFT) provide important voluntary ventilation (MVV), and forced expiratory flow25-75
clinical information to identify and quantify the defects (FEF25-75) were recorded at baseline and after 12 weeks of
and abnormalities in the functioning of the respiratory pranayama training by using the computerized spirometer
system.[6] Spirometry is the basic and useful method (Micro laboratory, V1.32, England).Supervised pranayama
available for evaluating these PFT.[7] To the best of our training (SPG: Nadisodhana, Pranav pranayama and Savitri
knowledge, there has been no study, which compared the pranayama; FPG: Kapalabhati, Bhastrika and Kukkriya
effect of slow and fast pranayama training on PFT. In view pranayama) was given for 30 min/day, thrice/week for
of the above background, this study was planned to study the duration of 12 weeks to SPG and FPG by the certified
the effect of 12 weeks of slow and fast pranayama training yoga trainer as per the guidelines of Morarji Desai National
on PFT in young healthy volunteers. Institute of Yoga, New Delhi (Appendix). Rest of the days,
subjects were motivated to practice at their home. CG did
SUBJECTS AND METHODS not practice any pranayama during the study period. The
techniques of fast and slow type of pranayamas were as
This study was conducted at Puducherry in 2011. The described in the previous literatures.[8,9]
subjects were recruited from the students of various
courses conducted in Jawaharlal Institute of Postgraduate RESULTS
Medical Education and Research (JIPMER), Puducherry as
well as staff, friends, and relatives of them after obtaining The comparison of PFT between baseline and post test is
approval from JIPMER Scientific Advisory Committee and given in Table 1 and Figures 1 and 2. The normality of the
Ethics Committee (Human Studies). Subjects after meeting continuous data was tested by using Kolmogorov–Smirnov
the inclusion and exclusion criteria mentioned below were test. After 12 weeks of slow pranayama training PEFR and
explained the benefits of yoga training and motivated to FEF25-75 were significantly improved (P = 0.02 and P < 0.01,
enroll for the study. respectively) when compared with the values at baseline.
However, other parameters (FVC, FEV1, FEV1/FVC, and
Inclusion criteria MVV) had shown only a marginal improvement (P > 0.05).
• Healthy volunteers of both genders in the age group of After 12 weeks of fast pranayama training FEV1/FVC,
18-30 years. PEFR, and FEF25-75 were significantly improved (P = 0.02,
P < 0.001, and P < 0.001, respectively) compared
Exclusion criteria
• History of chronic respiratory illness Table 1: Comparison of pulmonary function parameters
between baseline and post test among the study groups
• Subjects on medication
(mean±SD)
• Smokers and alcoholics
Parameters SPG (n=29) FPG (n=32) CG (n=30)
• Athletes
FVC (L)
• Any history of previous yoga or bio feedback techniques Pre 2.45±0.66 2.36±0.66 2.12±0.48
training in last 1-year. Post 2.51±0.69 2.28±0.55 2.13±0.48
FEV1 (L)
The purpose of this study, procedures and benefits were Pre 2.39±0.63 2.32±0.61 2.07±0.44
Post 2.44±0.70 2.272±0.55 2.11±0.45
briefed to them. The willing participants were randomized FEV1/FVC (%)
into slow pranayama group (SPG) (n = 29), fast pranayama Pre 97.8±3.42 98.4±3.38 98.32±4.64
group (FPG) (n = 32), and control group (CG) (n = 30), after Post 97.51±3.05 99.84±0.47* 98.82±2.15
getting informed written consent, by simple randomization PEFR (L/m)
method using random numbers generated through Pre 296.76±96.32 288.88±108.3 264.57±84.23
computer. Average age of the volunteers was 18.58 ± 2.27 Post 322.31±104.36* 336.31±89.21*** 274.9±76.03
MVV (L/m)
(mean ± standard deviation). Among these 91 volunteers, Pre 89.61±23.79 87.04±22.86 79.29±16.37
72 were females and the remaining 19 were males. Post 91.46±26.34 84.39±21.30 75.62±13.77
FEF25-75 (L/s)
The subjects were advised to come at least 2 h after light Pre 3.52±0.96 3.68±1.04 3.45±0.94
breakfast and with light clothing. They were instructed Post 3.68±0.98** 4.28±0.89*** 3.56±0.84
Analysis done by Student’s paired t‑test. *P<0.05; **P<0.01; ***P<0.001.
to avoid drinking beverages and performing a vigorous SPG = Slow pranayama group; FPG = Fast pranayama group;
exercise 30 min before the recording of parameters. PFT CG = Control group; FEV1 = Forced expiratory volume in first second;
such as forced vital capacity (FVC), forced expiratory FVC = Forced vital capacity; FEV1/FVC = Ratio between forced expiratory
volume in first second and forced vital capacity; PEFR = Peak expiratory flow
volume in first second (FEV1), ratio between FEV1 and FVC rate; MVV = Maximum voluntary ventilation; FEF25‑75 = Forced expiratory flow
(FEV1/FVC), peak expiratory flow rate (PEFR), maximum at 25-75%; SD = Standard deviation

with the values at baseline. However, other parameters FEV1, MVV, and PEFR in healthy subjects.[15] Sivakumar
(FVC, FEV1, and MVV) did not show significant (P > 0.05) et al. studied the acute effect of deep breathing (2-10 min)
change. In CG, no significant change was observed in any and observed an improvement in the PFT parameters in
of the PFT after 12 weeks of the study period. healthy volunteers.[16]
Comparison of longitudinal changes in PFT is given in Yadav and Das attributed that improvement in the PFT
Table 2 and Figure 3. The changes in PFT such as MVV parameters by yogic practices due to increased respiratory
and FEF25-75 were found to be statistically significant
overall among the three groups (P < 0.05 and P = 0.001,
respectively). The value of MVV was increased by
1.85 ± 5.20 on an average in SPG (P = 0.04). However,
in FPG and CG, it was decreased by 2.65 ± 7.60 and
3.67 ± 11.92, respectively (P > 0.05).
Table 2 and Figure 2 demonstrate that on comparing SPG

and FPG, significantly higher change was observed only
in FEF25-75 parameter in FPG (P = 0.001). Therefore, our
results demonstrate that FPG is more effective than SPG
on the above-mentioned PFT.
Figure 1: Comparison of peak expiratory flow rate of the study participants after
DISCUSSION 12 weeks of study period. SPG: Slow pranayama group, FPG: Fast pranayama
group, CG: Control group. Analysis done by Student’s paired t-test. *P < 0.05,
Pranayama involves manipulation of breath movement, **P < 0.01, ***P < 0.001
and the breath is a dynamic bridge between the body
and mind. It consists of three phases: Purak (inhalation),
Kumbhak (retention), and Rechak (exhalation) that can
be practiced in either slow or fast manner.[10] Results
of our study demonstrate that there was no significant
difference in the baseline values of PFT. Therefore,
all the three groups can be considered comparable for
this study. Our results indicate that both pranayama
practices had beneficial effect on PFT except respiratory
pressure parameters, and the effect of fast pranayama
was significantly more on FEF25-75, which is in the effort
dependent area of a flow-volume curve. Our results are in
agreement with previous studies who have reported that
yogic practices, including pranayama training produce Figure 2: Comparison of forced expiratory flow at 25-75% (FEF25-75) of expiratory
statistically significant improvement in the commonly flow volume (FEF25-75) of the study participants after 12 weeks of study period.
SPG: Slow pranayama group, FPG: Fast pranayama group, CG: Control group.
measured PFT.[11-14] A study by Joshi et al. has demonstrated Analysis done by Student’s paired t-test. *P < 0.05, **P < 0.01, ***P < 0.001
that 6 weeks of exclusive pranayama training improves the
ventilatory functions in the form of the increase in FVC,
Table 2: Comparison of the delta changes in pulmonary

function parameters among the study groups (mean±SD)
Parameters SPG (n=29) FPG (n=32) CG (n=30)
FVC (L) 0.06±0.17 −0.08±0.23 −0.02±0.36
FEV1 (L) 0.05±0.149 −0.05±0.20 −0.03±0.32
FEV1/FVC (%) −0.29±3.397 −1.44±3.38 −0.51±4.71
PEFR (L/m) 25.55±56.11 47.44±63.92 10.33±75.71
MVV (L/m) 1.85±5.20 −2.65±7.60 −3.67±11.92*
FEF25–75 (L/s) 0.17±0.27## 0.60±0.72 0.10±0.47##
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. SPG = Slow
pranayama group; FPG = Fast pranayama group; CG = Control Figure 3: Comparison of ∆forced expiratory flow25-75 (difference between posttest and
group; FEV1 = Forced expiratory volume in first second; FVC = Forced baseline parameters) in the three study groups after 12 weeks of the study period.
vital capacity; FEV1/FVC = Ratio between FEV1 and FVC; PEFR = Peak SPG: Slow pranayama group, FPG: Fast pranayama group, CG: Control group. *With
expiratory flow rate; MVV = Maximum voluntary ventilation; respect to SPG, #with respect to FPG. Analysis done by one-way ANOVA with Tukey
FEF25‑75 = Forced expiratory flow at 25–75%; SD = Standard deviation post-hoc analysis. *P < 0.05, **P < 0.01, ***P < 0.001. #P < 0.05, ##P < 0.01, ###P < 0.001

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How to cite this article: Dinesh T, Gaur GS, Sharma VK, Madanmohan
1. Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishnamurthy N. T, Harichandra Kumar KT, Bhavanani AB. Comparative effect of 12
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Conflict of Interest: None declared
Brothers Medical Publishers; 2004. p. 883-89.

APPENDIX
Methods of pranayama training given to study groups
1. Fast pranayama: Each cycle (6 min) consisted of practicing 1 min of Kapalabhati, Bhastrika and Kukkriya
pranayama interspersed with 1 min of rest between each pranayama. Subjects were asked to complete three or
more cycles in each session.
• Kapalabhati pranayama: The subjects were instructed to sit in Vajrasana and to forcefully expel all of the air
from the lungs, while pushing the abdominal diaphragm upwards. The expulsion is active, but the inhalation
is passive. Subjects rapidly breathed out actively and inhaled passively through both nostrils. One hundred
and twenty rounds at a sitting was the maximum. It is considered an excellent rejuvenator of the respiratory
system as all muscles of expiration are exercised
• Bhastrika pranayama: In this, emphasis is given to thoracic (not abdominal) breathing activity. Subjects were
instructed to take 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.” After 10
expulsions, the final expulsion is followed by the deepest possible inhalation. Breath is suspended as long as
it can be done with comfort. Deepest possible exhalation is done very slowly. This completes one round of
Bhastrika
• Kukkriya pranayam: To perform this dog pant like breathing technique, the subject sat in Vajrasana with both
palms on the ground in front with wrists touching knees and fingers pointing forward. The mouth was opened
wide, and the tongue pushed out as far as possible. They then breathed in and out at a rapid rate with their
tongue hanging out of their mouth. After 10 or 15 rounds, they relaxed back into Vajrasana. The whole practice
was repeated for three rounds
2. Slow pranayama: Each round (7 min) of the session consisted of practicing 2 min of Nadishodhana, Pranava
and Savitri pranayama interspersed with 1 min 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: This is slow, rhythmic, alternate nostril 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. Each lobular segment of the lungs was filled and a six-count was used for inspiration and expiration,
with a three-count for the retained breaths (6 × 3 × 6 × 3)
• Pranava pranayama is slow, deep and rhythmic breathing where an emphasis is placed on making the sound
AAA, UUU and MMM, while breathing out for duration of 2-3 times the duration of the inhaled breath. It is a
four-part technique consisting of Adham pranayama (lower chest breathing with the sound of AAA), Madhyam
pranayama (mid-chest breathing with the sound of UUU), Adhyam pranayama (upper chest breathing with the
sound of MMM) and then the union of the earlier three parts in a complete yogic breath known as Mahat Yoga
pranayama with the sound of AAA, UUU, and MMM.
At the end of session, all Groups 1 and 2 subjects were instructed to lie down in shavasana and relax for 10 min.
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Journal of Intercultural Ethnopharmacology
Original Research
www.jicep.com
DOI: 10.5455/jice.20141228065658
Single session of integrated “silver

yoga” program improves cardiovascular
parameters in senior citizens
Ananda Balayogi Bhavanani1, Meena Ramanathan2, Madanmohan3
1
Department of Yoga
Therapy, Centre for Yoga ABSTRACT
Therapy, Education and
Aim and Objective: This pilot study was carried out to determine cardiovascular effects of a single session
Research, Mahatma
Gandhi Medical College
of an integrated “silver yoga” program in senior citizens of Serene Pelican Township, Pondicherry. Materials
and Research Institute, and Methods: Heart rate (HR) and blood pressure (BP) measurements were recorded in 124 senior citizens
Pillayarkuppam, (75 female, 49 male) with mean age of 67.19 ± 10.61 year who attended an integrated “Silver Yoga” program
Puducherry, India, at Centre for Yoga Therapy, Education and Research from August to October 2014. Participants practiced
2
Department of Yoga the protocol that was specially designed for senior citizens, keeping in mind their health status and physical
Therapy, Centre for Yoga limitations. This included simple warm-ups (jathis), breath body movement coordination practices (kriyas),
Therapy, Education and static stretching postures (asanas), breathing techniques (pranayamas), relaxation and simple chanting.
Research, Mahatma Non-invasive BP apparatus was used to record the HR, systolic (SP) and diastolic pressure (DP) before
Gandhi Medical College
and after the 60 min sessions. Pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and
and Research Institute,
Pillayarkuppam,
double product (DoP) indices were derived from the recorded parameters. Student’s paired t-test was used
Puducherry, India, to compare data that passed normality testing by Kolmogorov–Smirnov Test and Wilcoxon matched-pairs
3
Department of Physiology, signed-ranks test for those that did not. P < 0.05 were accepted as indicating significant differences for
Centre for Yoga Therapy, pre-post comparisons. Results: All parameters witnessed a reduction following the single session. This was
Education and Research, statistically more significant (P < 0. 0001) in HR, RPP and DoP while it was also significant (P < 0.01 and
Mahatma Gandhi Medical P < 0.05) in SP and PP, respectively. The decrease in MP just missed significance (P = 0.054) while it was
College and Research not significant in DP. Conclusion: There is a healthy reduction in HR, BP and derived cardiovascular indices
Institute, Pillayarkuppam, following a single yoga session in geriatric subjects. These changes may be attributed to enhanced harmony
Puducherry, India
of cardiac autonomic function as a result of coordinated breath-body work and mind-body relaxation due to
an integrated “Silver Yoga” program.
Ananda Balayogi Bhavanani,
Centre for Yoga Therapy,
Education and Research,
Mahatma Gandhi Medical
College and Research
Institute, Pillayarkuppam,
Puducherry - 607 402, India.
Received: December 09, 2014

Accepted: December 28, 2014
Published: January 08, 2015 KEY WORDS: Cardiovascular, psycho-somatic harmony, senior citizen, yoga
INTRODUCTION a yogic lifestyle can reverse heart disease, says, “Yoga is a system
of perfect tools for achieving union as well as healing” [3].
Ageing is a natural process characterized by declining physical Dr. Ramamurthy, the eminent neurosurgeon, has observed that
performance, slower speed of reaction, inadequate working of yoga practice reorients the functional hierarchy of the entire
various systems with poor motor and sensory conduction. There nervous system while benefiting cardiovascular, respiratory,
is a progressive and generalized impairment of homeostasis digestive, and endocrine systems, in addition to bringing about
resulting in declining ability to respond to external or many positive biochemical changes.
internal stresses and increased risk of diseases [1]. The loss of
adaptive response to stress increases risk of many age-related, The practice of yoga has been shown to have preventive, curative
degenerative disorders [2]. Dr. Dean Ornish, the renowned as well as rehabilitative potential that can be explained on the
American physician and bestselling author who has shown that basis of modulation of autonomic functions, stress reduction,
134 J Intercult Ethnopharmacol ● Apr-Jun 2015 ● Vol 4 ● Issue 2

Bhavanani, et al.: Single yoga session in seniors
improvement in physiological functions and enhanced quality of Table 1: Components of an integrated ‘Silver Yoga’ program
life [4-6]. It has become quite apparent that yoga is a relatively Jathis and kriyas (loosening techniques)
low-risk, high-yield approach to improving overall health and Standing asanas
wellbeing [7]. Veera asana 1
Tada asana
Ardhakati and kati chakra asana
Yoga is qualitatively different from other modes of physical Ardha utkat asana
activity as it has a unique combination of isometric muscular Sitting asanas
contractions, stretching exercises, relaxation techniques, and Vakra asana
breathing exercises. A recent report on the acute effects of Paschimottana/purvottana asana
one session of hatha yoga practice on blood pressure (BP) Chatuspada kriya/vyagraha pranayama
Nava kriya
and other cardiovascular responses in healthy volunteers has
Face prone asanas
showed that systolic (SP), mean (MP), and diastolic (DP) BP Bhujanga asana/bhujangini mudra
increased significantly during the yoga practice [8]. However, Makara asana
they did not compare pre-post effects of the entire session but Supine asanas
focused only on the individual techniques used during the Pawanamukta series
session. Very few studies have focused on immediate effects of Pada uttana series
Sethu kriya
a single yoga session, and these include one that investigated Pranayamas
the effectiveness of a single 90-min hatha yoga class concluding Chandra nadi
that it significantly reduced perceived stress [9]. Pranava
Bhramari
The only major report on effects of a single session of yoga, was a Mudras
Brahma mudra
retrospective review of clinical data of 1896 patients done by us
Relaxation
at Centre for Yoga Therapy, Education and Research (CYTER) Savitri pranayama in shava asana
in 2013 [10]. We found significant reductions in all the studied Marmanasthanam/kaya kriya
cardiovascular parameters following the yoga session. However, Chakra awareness sequence
the magnitude of reductions differed in different groups of
patients depending on pre-existing medical conditions as well
as the specific yoga therapy protocol. were performed using non-invasive automatic BP monitor
(Omron HEM 7203, Kyoto, Japan) that uses oscillometric
With the above in mind, this pilot study was done to determine method with an instrumental accuracy of ± 5% for HR and ±
cardiovascular effects of a single, 60-min, integrated “Silver 3 mm Hg for BP. The pre-session recordings were taken after
Yoga” session in senior citizens of Serene Pelican Township 5 min of quiet comfortable sitting while post-session recordings
attending regular sessions at CYTER. were taken at the end of the session. Pulse pressure (PP), mean
pressure (MP), rate-pressure product (RPP) and double product
MATERIALS AND METHODS (DoP) indices were derived from the recorded parameters.
This pilot study was conducted at the CYTER functioning in Data were assessed for normality using GraphPad InStat
Mahatma Gandhi Medical College and Research Institute of version 3.06 for Windows 95, (GraphPad Software, San Diego
the Sri Balaji Vidyapeeth University, Puducherry, India. These California USA, www.graphpad.com). Student’s paired t
sessions were carried out in the CYTER Yoga hall between test was used to compare data that passed normality testing
11 am and 12 noon on Thursdays in a quiet environment, by Kolmogorov-Smirnov Test and Wilcoxon matched-pairs
with a comfortable temperature and subdued lighting. The signed-ranks test for those that didn’t. P < 0.05 were accepted
participants had been advised to finish their breakfast at least as indicating significant differences for pre-post comparisons.
2 h earlier and come after emptying bowel and bladder.
RESULTS
Heart rate (HR) and BP measurements were recorded in 124
senior citizens (75 female, 49 male) with mean age of 67.19 ± The results are given in Table 2. All cardiovascular parameters
10.61 y who were attending an integrated “Silver Yoga” program and derived indices witnessed a reduction following a single
at CYTER from August to October 2014. Participants practiced session of “Silver Yoga.” This was statistically very significant
the protocol that was specially designed for senior citizens, (P < 0. 0001) in HR, RPP and DoP while it was also significant
keeping in mind their health status and physical limitations. (P < 0.01 and P < 0.05) in SP and PP, respectively. The
This included simple warm-ups (jathis), breath body movement decrease in MP just missed significance (P = 0.054) while it
coordination practices (kriyas), static stretching postures was insignificant in DP.
(asanas), breathing techniques (pranayamas), relaxation and
simple chanting. The complete protocol is given in Table 1. DISCUSSION
Non-invasive BP apparatus was used to record HR, systolic There is a healthy reduction in HR, BP and derived cardiovascular
pressure (SP) and diastolic pressure (DP) readings before and indices following a single yoga therapy session. This implies a
after the 60 min session. To ensure objectivity, all recordings healthier autonomic regulation of the heart that may be
J Intercult Ethnopharmacol ● Apr-Jun 2015 ● Vol 4 ● Issue 2 135

Table 2: HR, SP, DP, PP, MP, RPP and DoP before (B) and This is again corroborated by another report that shavasana
after (A) a single session of Silver Yoga relaxation is enhanced with the addition of savitri pranayama
B A P value thus decreasing O2 consumption by 26% [15].
HR (bpm) 77.74±11.99 73.92±12.12 <0.0001
SP (mmHg) 131.93±13.63 128.97±14.34 0.0047 In another study, we compared cardiovascular changes
DP (mmHg) 71.63±11.83 70.94±11.52 0.4059 immediately after performance of different asanas and during
PP (mmHg) 60.30±12.48 58.03±13.00 0.0372 the recovery phase [16]. In that study, there was a temporary
MP (mmHg) 91.73±10.98 90.28±10.93 0.0541 rise of HR following dhanurasana due to relative difficulty of
RPP (units) 103.20±22.51 95.60±20.57 <0.0001
DoP (units) 71.95±16.99 67.17±15.71 <0.0001
the posture. However cardiovascular recovery was found to be
greater after performance of asanas when compared to merely
HR: Heart rate, SP: Systolic pressure, DP: Diastolic pressure, relaxing in shavasana (a supine relaxation posture). This implies
PP: Pulse pressure, MP: Mean pressure, RPP: Rate-pressure product,
DoP: Double product, Student’s paired t-test was used to compare data
a healthier cardiac autonomic de-activation response when
that passed normality testing by Kolmogorov-Smirnov test (SP, DP, PP, effort precedes relaxation.
MP, RPP) and Wilcoxon matched-pairs signed-ranks test for those that
didn’t (HR and DoP). P<0.05 were accepted as indicating significant We have also previously also studied the immediate effects of
differences for pre-post comparisons uninostril breathing techniques in a geriatric population and
reported that exclusive left nostril breathing (chandranadi
attributed to either an overall increase of parasympathetic pranayama) resulted in a decrease of cardiovascular parameters
tone and/or a reduction in sympathetic tone. As the RPP and with a slowing down of the reaction time [17]. This is one of
DoP are indirect indicators of myocardial O2 consumption and the techniques used in the present study and hence may have
load on the heart, their reductions signify a lowering of strain also contributed toward these positive cardiovascular relaxatory
on the heart that is beneficial for the senior citizens [11,12]. changes.
RPP also provides a simple measure of HR variability (HRV)
in hypertensive patients and is a surrogate marker in situations As the integrated “Silver Yoga” program was devised with the
where HRV analysis is not available [13]. Hence, reduction in needs of the seniors in mind, it consisted of more breath-body
RPP in our subjects is an indirect evidence of better cardiac work, breathing awareness and yogic relaxation. This may be
autonomic modulation in them. The reduction of adrenergic the main factor behind the cardiac autonomic balance in our
tone coupled with normalization of parasympathetic tone is subjects irrespective of their initial condition. Yoga is defined
potentially very useful in this population as increased adrenergic as the state of balance (samatvam yoga uchyate - Bhagavad
tone has been implicated in precipitation of heart attacks. Gita) and the restoration of physical, mental, emotional and
The elderly often have cardiac disorders with higher risk of spiritual balance may be the prime factor behind the changes
heart attacks and strokes. Hence, such a program has potential seen in our study.
benefits in prevention, management, and rehabilitation of such
conditions. Our findings are in agreement with a previous suggestion
that yoga appears to modulate stress response systems by
One of the few earlier studies on acute effects of a single reducing perceived stress and anxiety, which in turn, decreases
session of hatha yoga showed that SP, MP and DP increased physiological arousal with decreases in HR and BP and
significantly during the yoga practice [8]. Elevation in BP due respiration [18]. They also reiterate the results of our earlier
to yoga practice was associated with increases in cardiac output retrospective study on 1896 patients where we found significant
(CO) and HR. This is similar to those changes observed in reductions in all the studied cardiovascular parameters following
isometric exercise. However that study continuously measured a single yoga session [10].
HR, SP, DP, MP, stroke volume and CO. On the other hand we
are evaluating the pre-post effects and hence are commenting CONCLUSION
on overall effects of the whole integrated practice session rather
than the individual techniques. As suggested in our earlier There is a healthy reduction in HR, BP and derived cardiovascular
report the conscious self-effort made in asana practice may be indices following a single yoga session in geriatric subjects. These
understood as the spanda (tension) component, whereas the changes may be attributed to enhanced harmony of cardiac
relaxation of effort (Prayatna shaithilya) may be understood autonomic function as a result of coordinated breath-body work
as the nishpanda (relaxation) component [10]. Hence, it is and mind-body relaxation due to an integrated “Silver Yoga”
essential to physiologically evaluate the cardiovascular changes program. We recommend that such an integrated Yoga program
occurring not only during the actual performance of an asana, should be part of the heath care facilities for the elderly as it can
but maybe more importantly during and after period of recovery enhance their quality of life and improve their overall health
following it. We are supported in this assertion by a previous status. Our study is limited by the fact that it only addressed
report by Telles et al. that concluded that a combination of immediate effects of a single session. Therefore, further studies
stimulating and relaxing techniques reduced physiological on the effects of short and long-term training may deepen our
arousal better than the mere practice of relaxation techniques understanding of the intrinsic mechanisms by which such
alone [14]. They also pointed out that though the practical positive changes are occurring. This would help strengthen
performance of yoga techniques seem to be stimulatory in our conclusion about the cardiovascular benefits of Yoga in a
nature, their physiological effects are, in fact, more relaxatory. geriatric population.
136 J Intercult Ethnopharmacol ● Apr-Jun 2015 ● Vol 4 ● Issue 2

ACKNOWLEDGMENTS 9. Huang FJ, Chien DK, Chung UL. Effects of Hatha yoga on stress in
middle-aged women. J Nurs Res 2013;21:59-66.
10. Bhavanani AB, Ramanathan M, Trakroo M. Immediate cardiovascular
The authors thank the management and authorities of Sri effects of a single yoga session in different conditions. Altern Integr
Balaji Vidyapeeth University for setting up the Center for Med 2013;2:144.
Yoga Therapy, Education and Research (CYTER) in Mahatma 11. Madanmohan, Prakash ES, Bhavanani AB. Correlation between
short-term heart rate variability indices and heart rate, blood pressure
Gandhi Medical College and Research Institute (MGMCRI). indices, pressor reactivity to isometric handgrip in healthy young
We are grateful to Yogacharini Meenakshi Devi Bhavanani, male subjects. Indian J Physiol Pharmacol 2005;49:132-8.
Director ICYER for her constant motivation and supportive 12. Bhavanani AB, Sanjay Z, Madanmohan. Immediate effect of sukha
pranayama on cardiovascular variables in patients of hypertension.
guidance. Thanks are due to Yoga instructors Mrs M Latha
Int J Yoga Therap 2011;73-6.
andMr. Dhanushapnadeesh for conducting the therapy sessions 13. Prakash ES, Madanmohan, Sethuraman KR, Narayan SK.
and for their valuable assistance during recording sessions and Cardiovascular autonomic regulation in subjects with normal blood
data entry. We thank the senior citizens from Serene Pelican pressure, high-normal blood pressure and recent-onset hypertension.
Clin Exp Pharmacol Physiol 2005;32:488-94.
Township for their wholehearted participation in these sessions 14. Telles S, Reddy SK, Nagendra HR. Oxygen consumption and
and their authorities for facilitating logistics. respiration following two yoga relaxation techniques. Appl
Psychophysiol Biofeedback 2000;25:221-7.
15. Madanmohan S, Rai UC, Balavittal V, Thombre DP, Gitananda S.
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New Delhi: CBS Publication; 2001. p. 34-9. immediate effect of different yoga asanas on heart rate and blood
2. Kirkwood TB. The evolution of aging. Rev Clin Gerontol 1995;5:3-9. pressure in healthy young volunteers. Int J Yoga 2014;7:89-95.
3. Bhavanani AB. Understanding the science of yoga. Yoga Mimamsa 17. Ramanathan M, Bhavanani AB. Immediate effect of chandra and
2012;44:228-45. suryanadi pranayamas on cardiovascular parameters and reaction
4. Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. time in a geriatric population. Int J Physiol 2014;2:59-63.
Effect of slow and fast pranayams on reaction time and cardiorespiratory 18. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of
variables. Indian J Physiol Pharmacol 2005;49:313-8. yoga on the autonomic nervous system, gamma-aminobutyric-acid,
5. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the and allostasis in epilepsy, depression, and post-traumatic stress
insulin resistance syndrome, cardiovascular disease, and possible disorder. Med Hypotheses 2012;78:571-9.
protection with yoga: A systematic review. J Am Board Fam Pract
2005;18:491-519.
6. Sengupta P. health impacts of yoga and pranayama: A state-of-the-art
review. Int J Prev Med 2012;3:444-58. © SAGEYA. This is an open access article licensed under the terms
7. Available from: http://www.health.harvard.edu/newsletters/Harvard_ of the Creative Commons Attribution Non-Commercial License (http://
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noncommercial use, distribution and reproduction in any medium, provided
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the work is properly cited.
8. Miles SC, Chun-Chung C, Hsin-Fu L, Hunter SD, Dhindsa M,
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J Intercult Ethnopharmacol ● Apr-Jun 2015 ● Vol 4 ● Issue 2 137

Research Article
Randomized controlled trial of 12-week yoga therapy

as lifestyle intervention in patients of essential
hypertension and cardiac autonomic function tests
Pushpanathan Punita1, Madanmohan Trakroo2, Swaminathan Rathinam Palamalai3,
Senthil Kumar Subramanian4, Ananda Balayogi Bhavanani5, Chandrasekhar Madhavan1
1
Department of Physiology, Meenakshi Medical College and Research Institute, Kancheepuram, Tamil Nadu, India.
2
Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.
3
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
4
Department of Physiology, ESIC Medical College and Hospital, Coimbatore, Tamil Nadu, India.
5
Deputy Director of the Center for Yoga Therapy Education and Research (CYTER), Mahatma Gandhi Medical College and Research
Institute, Pondicherry, India.
Correspondence to: Pushpanathan Punita, E-mail: drpuni08@gmail.com
Received August 24, 2016. Accepted September 22, 2015
||ABSTRACT
Background: In the Indian subcontinent, 118 million people are with hypertension, and this figure is anticipated to double by
2025. Yoga has been widely claimed to play a role in the prevention and management of psychosomatic, stress-induced, and lifestyle
disorders such as hypertension. Aims and Objective: To study the effect of 12 weeks of yoga therapy as a lifestyle intervention on
cardiac autonomic functions in patients of essential hypertension. Materials and Methods: Subjects with hypertension from the
Medicine Outpatient Department of the Jawaharlal Institute of Postgraduate Medical Education and Research were randomized into
control and yoga groups. The control group was treated only with the allopathic medicines. The yoga group was given 12 weeks of
yoga therapy module designed by JIPMER Institute Advanced Center for Yoga Therapy Education and Research along with the
routine medical treatment. The participants’ blood pressure and cardiac autonomic function were recorded before and after the
12 weeks of the study period. Result: No significant change was observed in the body weight (BW), body mass index (BMI),
abdominal circumference, and waist–hip ratio (WHR) in both the control and yoga groups at the end of the 12 week-study period.
There was a significant decrease in the resting systolic pressure (SP), diastolic pressure (DP), rate pressure product (RPP), and
mean arterial pressure (MAP) in the yoga group. In contrast, there was no significant change in the SP, DP, RPP, and MAP of the
control group. High frequency (HF) power, total spectral power, and HF normalized units (nu) showed a significant increase in the
yoga group. Low frequency (LF) power, HF power, and LF (nu) showed a significant (p o 0.05) decrease in the yoga group at the
end of the 12-week yoga therapy. Conclusion: Twelve weeks of yoga therapy reduced both the SP and DP in the yoga group.
Furthermore, yoga therapy increased the heart rate variability and vagal tone and decreased the sympathetic tone in the subjects
with hypertension. At the same time, it increased both the parasympathetic and sympathetic reactivity.
KEY WORDS: Autonomic Function Tests; Hypertension; Yoga; HRV
||INTRODUCTION
Quick Response Code: In the Indian subcontinent, hypertension (HT) has a prevalence of
Website: http://www.njppp.com
20%–40% among the urban population and 12%–17% among the
DOI: 10.5455/njppp.2015.5.2408201572 rural population. Studies have shown that about 118 million
people in India are with HT, and this figure is anticipated to double
by 2025.[1–3] In general, medical treatment of hypertension
requires a long-term and, sometimes, lifelong use of drugs. It has
been seen that HT being a disease involving both the genetic and
National Journal of Physiology, Pharmacy and Pharmacology Online 2016. © 2016 Pushpanathan Punita. This is an Open Access article distributed under the terms of the Creative Commons
Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform,
and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
National Journal of Physiology, Pharmacy and Pharmacology 2016 | Vol 6 | Issue 1 19

Punita et al. Effect of yoga therapy on patients with hypertension
environmental factors can be modifiable to some extent. It can also Selection of Subjects
be prevented and can be treated effectively by appropriate lifestyle The subjects with HT in the age group of 35–55 years were
modifications.[4,5] Therefore, the magnitude of the burden of HT not recruited from the Medicine Outpatient Department (OPD) of
only needs an increase in awareness and treatment but also efforts JIPMER. Subjects with secondary HT, diabetes, ischemic heart
should be targeted on lifestyle modification in general population.[3] disease, nephropathy, retinopathy, and any other chronic illness
In India, from ancient times, yoga has been widely claimed to were also excluded by medical history. Subjects with any
possess a role in the prevention, management, and rehabilitation in physical conditions hindering the performance of yoga practices
psychosomatic and stress-induced and lifestyle disorders such as were excluded. The sitting BP was recorded to see whether BP is
HT.[6–8] Now, in the modern era, different scientific communities under control with their current treatment regimen. Block
are taking interests to evaluate its validity and role in all these randomization was used to generate allocation sequence, and
modifiable diseases. Earlier studies have shown that autonomic serially numbered opaque sealed envelope technique (SNOSE)
imbalance occurs in patients with HT,[9] and yoga training helps in was applied to allot the subjects either to the control group or to
restoring the sympathovagal balance. Yoga training has been the yoga group after obtaining their written informed consent.
reported to result in a significant decrease in basal heart rate (HR)
and blood pressure (BP) in patients with HT.[7,10] Experimental Design
Therefore, this study was planned to evaluate the role of All the parameters were recorded in autonomic function testing
yoga as a lifestyle modality and its effectiveness on cardiac lab, Department of Physiology, JIPMER between 9 a.m. and 11 a.
autonomic functions in patients’ of essential HT. m. The laboratory environment was quiet; the temperature was
maintained between 25°C and 27°C and the lighting subdued.
The subjects were advised to come at least 1 h after a light
||MATERIALS AND METHODS breakfast with an empty bowel and bladder. All the subjects
were advised to refrain from smoking and alcohol on the day
Before the commencement of the study, approval of the of test and during the entire study period. The subjects were
Jawaharlal Institute of Postgraduate Medical Education and asked to take the morning dosage of antihypertensive agent after
Research (JIPMER) Scientific Advisory Committee and Ethics the procedure, as it may interfere with the cardiac autonomic
Committee was obtained. functions.
Figure 1: Project flow diagram.
20 2016 | Vol 6 | Issue 1 National Journal of Physiology, Pharmacy and Pharmacology

Effect of yoga therapy on patients with hypertension Punita et al.
Parameters Recorded in the nonexercising arm every minute for the next 3 min after
Anthropometric parameters. Height was measured by a starting a sustained handgrip. Increase in DP above the resting
wall-mounted stadiometer and weight with a spring balance. stage with 30% MVC at the end of 3 min of contraction was
Waist circumference was measured at the narrowest point seen taken as a measure of sympathetic reactivity (DDP).
anteriorly between the subcostal margin and iliac crest. The hip
circumference was measured at the level of gluteal region with Intervention (12 weeks)
maximum girth, and the waist–hip ratio (WHR) was calculated. The subjects of both the groups received antihypertensive drugs
Short-term heart rate variability. The subjects were asked to lie provided in JIPMER OPD. The yoga group received a validated yoga
comfortably in the couch and relax. After 5 min of supine rest, lead therapy in addition to the drug therapy. The yoga therapy delivered
II ECG and respirations were recorded at 500 samples per s using to the subjects was validated by the Advanced Center for Yoga
BIOPAC MP100 data acquisition system with AcqKnowledge 3.8.2. Therapy Education and Research (ACYTER) and JIPMER in accor-
software for the next 300 s in resting condition. The RR interval dance with Morarji Desai National Institute of Yoga (MDNIY) Guide-
variation trend was analyzed using HRV software (version 1.1.; lines and given by a trained ACYTER yoga teacher. Each session of
Biomedical Signal Analysis Group, University of Kuopio, Kuopio, yoga therapy was for about 45 min. Yoga therapy was given 3 days
Northern Savonia, Finland) for frequency and time domain a week under our direct supervision for 12 weeks. Patients were
parameters. Frequency domain parameters include: very low motivated to practice the same daily at home. Only highly motivated
frequency [(VLF); 0.003 Hz–0.04 Hz], low frequency [(LF); 0.04 patients were included in the study. Attendance register was
Hz to 0.15 Hz], high frequency [(HF); 0.15 Hz–0.4 Hz], total spectral maintained for yoga therapy sessions, and the data were obtained
power [(TP) = VLF + LF + HF), and LF/HF ratio; the ratio of LF only from those patients whose attendance was at least 70%.
power to HF power, low frequency power in normalized units
(LF nu) = LF/(TP–VLF) 100, and similarly HF nu was calculated.
The time domain components include: mean and standard deviation Components of Therapy
of RR intervals (SDNN), square root of the mean of the sum of the Yoga classes started with a brief prayer. Preparatory practices
squares of differences between adjacent RR intervals (RMSSD), such as breath–body coordination and joint loosening exercises
adjacent RR interval differing more than 50 ms (NN50), and NN50 were undertaken for 10 min. This was followed by 10 min asan,
counts divided by all the RR intervals (pNN50). HF, HF nu, SDNN, 10 min pranayam, and 15 min Shavasan practice [Table 1]. At
RMSSD, NN50, and pNN50 reflect cardiovagal tone; LF reflects both the end of the class, attendance was taken, and the subjects
the sympathetic and parasympathetic tones; VLF component’s were motivated to practice at home on other days. Some of the
interpretation is not clear, and it cannot be interpreted using classes were preceded by talk on diet and lifestyle modification
short-term HRV recordings; LF nu and HF nu represent a relative in controlling chronic lifestyle disorders.
tone of sympathetic and parasympathetic nervous system (PSNS),
and LF/HF ratio indicates sympathovagal balance. The BPs Data Analysis
(SP, DP) and HR were measured at the end of ECG recording The pre- to postintervention change of all the parameters and their
(OMRON MX3, USA). percentage change were calculated. SPSS software (version 19.0)
Orthostatic stress test. After recording ECG in supine position was used for data analysis. Pre-post intervention comparisons were
for 15 s, the subject was asked to stand as quickly as possible, made using Student’s paired t-test within the group. In between the
preferably within 3 s with minimal effort so that artefacts can be
minimized. HR response to standing was calculated as the ratio Table 1: Yoga therapy module
between the longest RR interval around the 30th beat and the
1. Yogic counseling
shortest around the 15th beat. The 30/15 ratio indicates both the
2. Preparatory practices: Breath–body coordination practices
sympathetic and parasympathetic functions.
and joint loosening practices
Heart rate response to deep breathing. The subjects were
3. Asans or static postures: Talasan
trained to breath at the rate of six cycles per minute guided with
Ardhakati chakrasan
a metronome. Deep breathing was done for a complete1 min and
Ardha chakrasan
during this period (the period of deep breathing), ECG was
Uttanpadasan
recorded. The ratio between the maximum RR interval during
Ardha halasan
expiration and the minimum RR interval during inspiration were
Pavanmuktasan
calculated for each breath cycle. The average of six such
Makarasan
measurements was taken as the expiratory to inspiratory (EI)
Bhujangasan
ratio of the subject. This quantitates respiratory sinus arrhythmia,
Vajrasan
which is predominantly a manifestation of vagal tone.
4. Pranayam or breathing Chandra nadi
Isometric handgrip test. After familiarizing the subjects with
techniques: Pranav
the procedure, they were asked to perform a maximum
Nadi shuddhi
voluntary contraction (MVC) in the handgrip dynamometer
5. Relaxation techniques: Kayakriya in shavasan
(Inco, Ambala). Following it, they were instructed to maintain
Shavasan with savitri pranayam
30% of MVC for up to 3 min, while BP and HR were monitored

study and control groups, comparison was made using Student’s Short-term HRV
unpaired t-test for continuous data and w2-test for categorical data. Frequency domain measures. The short-term spectral com-
ponents namely VLF power, LF power, HF power, total power
(TP), LF: HF, LF (nu), and HF (nu) showed no significant change
||RESULT in the control group. In the yoga group, there was no significant
change in VLF power and LF power. But, HF power, TP, and HF
There was no significant difference in age, gender, smoking history, (nu) showed a significant increase in the yoga group. LF: HF and
alcohol intake, diet pattern, drug intake, and anthropometric para- LF (nu) showed a significant (p o 0.05) decrease in the yoga
meters between the control and the study groups before the start of group at the end of the 12 week-yoga therapy [Table 5].
the study; hence, the groups were comparable [Table 2]. Time domain statistical measures. In the control group, no
significant change was observed in the mean RR interval, SD of RR
Anthropometric Parameters (SDNN), mean HR, RMSSD, NN50, and pNN50 at the end of the
We observed no significant change in BW, BMI, abdominal 12 week-period. In the yoga group, the mean RR interval, mean HR,
circumference, and WHR in both the control and yoga groups at RMSSD, NN50, and pNN50 showed no significant difference at the
the end of 12 week-study period [Table 3]. end of the study period. SDNN showed a significant (p o 0.01)
increase in the yoga group after 12 weeks of yoga therapy [Table 6].
Resting Cardiovascular Parameters Reactivity tests. In our study, the HR response to standing
In our control group, there was no change in the resting HR. In did not show a significant change in both the control and yoga
the yoga group, there was an insignificant decrease in HR. groups. EI ratio did not show a significant change in the control
Moreover, there was a significant decrease in the resting SP, DP, group at the end of the study period. In the yoga group, the EI
rate pressure product (RPP), and mean arterial pressure (MAP) ratio showed an insignificant increase at the end of the 12-week
in the yoga group. In contrast, there was no significant change study period. In isometric handgrip test, the yoga group showed
in the SP, DP, RPP, and MAP of the control group [Table 4]. a significant increase in DDP. The control group did not show a
significant difference in DDP [Table 7].
Table 2: Baseline characteristics in the control and yoga groups

Parameters, n (%) Control group Yoga group ||DISCUSSION
(n = 30) (n = 25)
Anthropometric Parameters
Age (years; mean ± SD) 43.63 ± 6.79 43.08 ± 8.53
We observed no significant change in BW, BMI, abdominal
Male 25 (83) 19 (76) circumference, and WHR in both the control and yoga groups at
Female 5 (17) 6 (24) the end of the 12 week-study period. Our finding is supported by
Smoker 3 (10) 2 (8) Cohen et al.,[11] who reported no change in BW and BMI after 12
Alcoholic 10 (33) 7 (28) weeks of Iyengar yoga therapy in pre-HT and stage 1-HT
Nonvegetarian 23 (77) 19 (76) patients. In contrast, Bera and Rajapurkar[12] have reported a
CCB 12 (40) 13 (52) significant decrease in the abdominal circumference of young
ACEI 16 (53) 11 (40) practitioners of yoga after a period of 1 year in their study.
CCB + ACEI 2 (7) 1 (4) Studies by Murugesan et al.[5] and Yogendra et al.[13] showed a
significant decrease in BW in patients with hypertension and
CCB, subjects on calcium channel blockers; ACEI, subjects on
ischemic heart disease, respectively. The findings of these studies
angiotensin-converting enzyme inhibitors.
Analysis done with Student’s unpaired t-test for continuous data and can be attributed to the duration of yoga therapy, as it was for a
w2-test for categorical data. longer period and to other measures followed by them, which
p 4 0.05 for all the above-mentioned parameters. include strict low fat, high fiber diet, and aerobic exercise. Our
Table 3: Anthropometric parameters in control and yoga groups before and after the 12 week-study period
Parameters Control group (n = 30) Yoga group (n = 25)
Height (m) 1.64 ± 0.08 1.65 ± 0.09

Body weight (kg) 73.53 ± 12.2 74.28 ± 13 73.4 ± 13.37 73.1 ± 13.23
BMI (kg/m2) 27.32 ± 4.17 27.59 ± 4.47 26.79 ± 4.07 26.68 ± 4
WHR 0.88 ± 0.05 0.879 ± 0.048 0.851 ± 0.051 0.85 ± 0.052
BMI, body mass index; WHR, waist–hip ratio.

Values are expressed as mean ± SD.

Table 4: Resting cardiovascular parameters in control and yoga groups before (B) and after (A) the 12 week-study period
B A Change % change B A Change % change
HR (bpm) 72.37 ± 11.88 71.83 ± 10.15 -0.53 ± 9.18 0.18 ± 11.59 72.88 ± 9.8 69.72 ± 8.73 -3.16 ± 9.3 -3.47 ± 12.9
SP (mm Hg) 126.47 ± 11.21 125.97 ± 10.95 -0.5 ± 11.64 0.02 ± 8.96 124.8 ± 8.1 118.56 ± 11.06***w -6.24 ± 8.2 -4.98 ± 6.43
DP (mm Hg) 83.2 ± 7.11 81.87 ± 7.28 -1.33 ± 6.98 -1.27 ± 8.12 80.44 ± 7.02 76.84 ± 8.78**w -3.6 ± 5.8 -4.47 ± 7.3
PP (mm Hg) 43.27 ± 7.8 44.1 ± 7.2 0.83 ± 7.86 3.5 ± 17.62 44.36 ± 5.9 41.72 ± 10.25 -2.64 ± 7.5 -6.39 ± 17.4
MAP (mm Hg) 97.62 ± 7.87 96.57 ± 7.99 -1.06 ± 7.99 -0.76 ± 7.94 95.23 ± 6.83 90.75 ± 8.29***w -4.48 ± 5.7 -4.68 ± 5.9
National Journal of Physiology, Pharmacy and Pharmacology

Effect of yoga therapy on patients with hypertension
RPP 91.83 ± 19.04 90.38 ± 15.15 -1.45 ± 16.2 0.4 ± 16.36 91.04 ± 13.97 82.71 ± 13.1**w -8.3 ± 13.7 -8.16 ± 14.7
HR, heart rate; SP, systolic pressure; DP, diastolic pressure; PP, pulse pressure; RPP, rate pressure product; MAP, mean arterial pressure.
*p o 0.05; **p o 0.01; ***p o 0.001 comparison within group; wp o 0.05 comparison between the yoga and control groups.
Table 5: Frequency domain (nonparametric) measures in control and yoga groups before (B) and after (A) the 12 week-study period
B A Change % change B A Change % change

2)
VLF power (ms 81.77 ± 75.03 77.7 ± 70.59 -4.07 ± 66.75 19.12 ± 79.38 69.32 ± 61.73 96.16 ± 81.73 26.84 ± 80.19 137.05 ± 260.3
LF power (ms2) 99.67 ± 71.72 95.43 ± 74.64 -4.23 ± 71.82 29.33 ± 96.69 121.48 ± 90.26 139.24 ± 81.7w 17.76 ± 65.92 69.57 ± 141.05
HF power (ms2) 76.73 ± 58.9 78.3 ± 56.71 1.57 ± 51.04 101.58 ± 340.87 111.96 ± 100.41 175.48 ± 142.8****www 63.52 ± 88.4 220.42 ± 378.3
Total power (ms2) 258.17 ± 156.24 251.43 ± 167.29 -6.73 ± 138.92 24.06 ± 91.27 302.76 ± 204.54 410.88 ± 241.7**ww 108.12 ± 177.8 110.51 ± 214.1
LF:HF 1.95 ± 1.64 1.56 ± 1.18 -0.39 ± 1.72 3.64 ± 67.68 2.18 ± 2.8 1.12 ± 0.7* -1.06 ± 2.3 -15.65 ± 74.37
LF (nu) 58.51 ± 15.8 54.36 ± 16.5 -4.15 ± 16.24 -4.11 ± 28.78 56.41 ± 19.28 47.78 ± 15.83* -8.63 ± 15.34 -10.24 ± 34.4
HF (nu) 41.49 ± 15.8 45.64 ± 16.5 4.15 ± 16.24 26.44 ± 77.71 43.59 ± 19.28 52.22 ± 15.83* 8.63 ± 15.34 42.74 ± 71.78
2016
VLF, very low frequency; LF, low frequency; HF, high frequency; nu, normalized units.
*p o 0.05, **p o 0.01 comparison within group; wp o 0.05, wwp o 0.01, wwwp o 0.001 comparison between the yoga and control groups.
| Vol 6 | Issue 1
23
Punita et al.
HR, heart rate; SD of RR, Standard deviation of all NN intervals; RMSSD, Root mean of the sum of the squares of differences between adjacent NN intervals; NN50, number of NN
31.07 ± 60.14
35.62 ± 82.72
study constituted breathing and relaxation techniques and only a
% change few asans. Moreover, the duration of each asan was less, and the
yoga sessions were conducted only thrice a week.
–
–
Resting Cardiovascular Parameters
Values are expressed as mean ± SD. *p o 0.05, **p o 0.01 comparison within group; wp o 0.05, wwp o 0.01 comparison between the yoga and control groups.
Many workers have reported a decrease in HR after the yoga
12.25
36.25
11.59
therapy.[5,7,14–16] In contrast, other studies have reported that
9.7
Change
yoga training increases HR.[17] This can be explained on the

±
±
±
±
type of yoga training practiced by the subjects. We conclude

Yoga group (n = 25)
5.24
3.32
6.68
2.32
that the intensity and duration of yoga training in our subjects

was not sufficient to produce a decrease in the resting HR.
Yoga training produced a significant decrease in the resting
Table 6: Time domain statistical measures of HRV in control and yoga groups before (B) and after (A) the 12 week-study period
**ww
SP, DP, and MAP. In contrast, there was no change in the SP, DP,
intervals differing by more than 50 ms to their adjacent NN intervals; pNN50, NN50 count divided by the total number of NN intervals.
41.89w
13.27w
13.35
and MAP of the control group. DP is mainly owing to the

14w
peripheral vascular resistance, which in turn is maintained

A
±
±
±
±
by sympathetic tone. The significant decrease in DP can be

33.88
28.39
34.36
10.58
explained on the basis of a decrease in sympathetic tone.

Although Udupa et al.[18] and Khanam et al.[15] have concluded
that yoga training does not result in a decrease in resting BP,
many studies have reported a decrease in BP with yoga
11.14
11.87
29.56
9.46
training.[5,14,19,20] This difference can be explained on the basis

of the type of yoga training and duration. Furthermore, we
±
±
±
±
B
observed no change in pulse pressure in the yoga group after

28.64
25.07
27.68
8.26
intervention. Pulse pressure says about the tissue perfusion. So,

even though the BP is reduced in the yoga group, maintenance of
pulse pressure denotes that the tissue perfusion is maintained.
4.37 ± 44.06
17.82 ± 83.03
RPP is an index of myocardial oxygen consumption and load

% change
on the heart.[21] Decrease in RPP in the yoga group suggests that

–
–
yoga training is instrumental in reducing the resting myocardial

oxygen consumption and load on the heart. Our result is
consistent with those of Madanmohan et al.[7] and Vijayalakshmi
et al.[16] With the results of our resting cardiovascular para-
9.19
9.06
20.4
meters, it is concluded that 12 weeks of yoga therapy reduces BP

5.9
Change
in people with hypertension, while reducing the workload on the

Control group (n = 30)
±
±
±
±
heart and retaining the tissue perfusion.

-1.5
-1.2
-0.27
-0.33
Short-term HRV
Frequency domain measures. Total power is the variance of
17.31
9.55
8.58
5.01
NN intervals over the temporal segment. Increase in total

power is an indicator of improved heart rate variability. Total
±
±
±
±
A
power increased in the yoga group after the 12 weeks of

25.37
22.31
4.66
15.9
intervention leaving us to hypothesize reduced cardiovascular

complication in future.
High frequency (HF) power in the control group showed no
10.21
19.47
9.77
5.66
significant change, while in the yoga group, there was a significant

increase at the end of 12 weeks. In addition, a significant difference
±
±
±
±
B
in HF power was noticed between the groups at the end of

26.87
22.58
17.1
4.99
the study period. It is well documented in literature that HF

component is predominantly modulated by parasympathetic
system.[22] So, an increase in HF power shows parasympathetic
SD of RR (ms)
predominance with yoga therapy. Telles et al.[23] showed a

NN50 (count)
RMSSD (ms)
Parameters
pNN50 (%)
decrease in HF power with high frequency breathing and Raghuraj

et al.[24] showed a decrease or no change in HF power.
At the end of the study period, there was a significant
difference in LF power in the yoga group on comparison with the

Effect of yoga therapy on patients with hypertension Punita et al.
Table 7: Reactivity test in control and yoga groups before and after the 12 week-study period
HRmax/HRmin ratio 1.39 ± 0.17 1.44 ± 0.19 1.37 ± 0.18 1.36 ± 0.16
I–E 18.57 ± 5.97 18.65 ± 7.71 18.27 ± 8.36 21.23 ± 9.86*
EI ratio 1.29 ± 0.11 1.3 ± 0.15 1.33 ± 0.18 1.37 ± 0.17
ΔDP (mmHg) 26.37 ± 8.42 27.83 ± 9 22.60 ± 7.99 27.36 ± 12.36*
HRmax, immediate maximum rise in heart rate after standing; HRmin; minimum heart rate observed after standing; I–E, inspiration to expiration
difference. ?DP, rise in diastolic pressure from supine rest.
*p o 0.05 comparison within group.
control group. Even though both the sympathetic and parasympa- time domain and frequency domain measures, it is clear that yoga
thetic limbs of autonomic nervous system govern LF power, it is decreases sympathetic tone and increases parasympathetic tone.
predominantly by the sympathetic system. Hence, increase in LF Reactivity tests. The results of reactivity tests indicate an
power can lead to a false conclusion that resting sympathetic tone increase in vagal activity, as the change in HR during breathing is
is increased. The result has to be interpreted along with the mainly owing to the change in vagal activity. In the yoga group,
normalized values of LF and HF, which clearly gives the relative there was a significant increase in ?DP as far as isometric handgrip
power each system. There is a decrease in LF nu and an increase in test is concerned. Increase in ?DP in our study shows that with yoga
HF nu after the yoga intervention. With this result, we can safely therapy, there is an improvement in sympathetic response during
conclude that relative sympathetic tone is reduced after yoga pressor stimuli in subjects with hypertension. Grassi et al.[30] have
intervention even though LF power is increased. In addition, study reported that, although baseline muscle sympathetic nerve activity
by Rahman et al.[25] suggests that LF power is an indicator of is higher in hypertensives, changes in sympathetic nerve activity
baroreflex function independent of cardiac sympathetic innerva- during pressor stimuli are attenuated in people with hypertension.
tions. Therefore, increase in LF power is an indicator of increase in The significant increase in ?DP shows that there is improvement in
BRS for which further studies are needed. reactivity to pressor stimuli. This is consistent with the findings of
Our study suggests an increase in parasympathetic tone, which Mourya et al.[19] Our finding is consistent with the study done by
is evident from a significant decrease in LF:HF and LF nu and an Vijayalakshmi et al.,[16] who have concluded that yoga optimizes
increase in HF nu. Therefore, the yoga practices followed in our sympathetic response to isometric hand grip and restores
study is suitable for the patients to restore the sympathovagal autonomic regulatory reflex mechanism. In contrast, Khanam
balance in whom sympathetic drive is increased.[26,27] In contrast, et al.,[15] in their study, have shown a decrease in DP with isometric
studies by Raghuraj et al.[24] and Telles et al.[23] showed a hand grip at the end of 1-week yoga therapy and concluded that
significant increase in LF:HF immediately after pranayam practice yoga training reduces sympathetic reactivity in asthmatic subjects.
(high frequency breathing), suggesting an increase in sympathetic
tone.
Time domain statistical measures. There is evidence from ||CONCLUSION
literature that SDNN (the estimate of overall HRV) is significantly
decreased in HT[9,28] and is an indicator of cardiovascular morbi- Twelve weeks of yoga therapy reduced both SP and DP in subjects
dity and mortality. So, increase in SDNN with 12 weeks of yoga with hypertension. Furthermore, yoga therapy increases parasym-
therapy suggests that practice of yoga regularly can decrease pathetic tone and decreases sympathetic tone in subjects with
cardiovascular risk factors owing to HT. Our results are consistent hypertension. At the same time, it increased both the parasympa-
with the studies by Khattab et al.[28] and Pinheiro et al.[20] who thetic and sympathetic reactivity.
showed a significant increase. RMSSD, NN50, and pNN50
measurements of short-term variation that estimates HF variations
in HR, showed a significant increase in the yoga group when Limitations
compared with control group at the end of the study period. This In this study, yoga therapy was given to the subjects only three
indicates that in yoga group, there is an increased parasympathetic times a week. In the rest of the days, the subjects’ were asked to
tone after yoga therapy. Study by Khattab et al.[29] showed a practice at home. This may have resulted to noncompliance by
significant increase in RMSSD and NN50, which is consistent with the subjects. Supervised yoga therapy for all the days of the
our study. Telles et al.,[23] in their study, showed a significant week would be ideal. Beat-to-beat noninvasive BP recording
decrease in NN50 and pNN50 with high frequency breathing, was not done. Hence, BP variability and baroreflex sensitivity
which is associated with increased sympathetic tone. On analyzing could not be determined in our subjects.

Acknowledgments 16. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Babu K.

Modulation of stress induced by isometric handgrip test in
We would like to thank the yoga teachers of ACYTER for their hypertensive patients following yogic relaxation training. Indian J
help in the conduction of yoga sessions. Physiol Pharmacol. 2004;48(1):59–64.
17. Raghuraj P, Telles S. Immediate effect of specific nostril manipulat-
ing yoga breathing practices on autonomic and respiratory variables.
Appl Psychophysiol Biofeedback. 2008;33(2):65–75.
18. Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishna-
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Effects of a Single Session of Yogic Relaxation on
Cardiovascular Parameters in a Transgender Population
Ananda Balayogi Bhavanani1, Meena Ramanathan2, Madanmohan Trakroo3, Senthil Thirusangu4

1
Deputy Director, 2Coordinator-cum-Yoga Therapist, 3 Professor and Head, Department of Physiology and Director,
Centre for Yoga Therapy, Education & Research (CYTER), Mahatma Gandhi Medical College & Research Institute
(MGMCRI), Pillayarkuppam, Pondicherry, 4 IInd Year Student, MSc (Nursing), Kasturba Gandhi Nursing College,
MGMCRI Campus, Pillayarkuppam, Pondicherry
ABSTRACT
Aim and objective: This pilot study was done to determine effects of a single session of yogic relaxation
on cardiovascular parameters in a transgender population.
Methods: Heart rate (HR) and blood pressure (BP) measurements were recorded in 106 transgender
participants (mean age of 23.86 ± 7.87 y) a�ending a yogic relaxation program at CYTER, MGMCRI.
Participants practised a series of techniques consisting of quiet si�ing, om chanting, mukha bhastrika,
nadi shuddhi, brahma mudra, pranava pranayama in si�ing posture and savitri pranayama in
shavasana. HR, systolic (SP) and diastolic pressure (DP) were recorded before and after the 60 minute
session using non-invasive blood pressure (NIBP) apparatus. Pulse pressure (PP), mean pressure (MP),
rate-pressure product (RPP) and double product (DoP) indices were derived from recorded parameters.
Student’s paired t test was used to compare data that passed normality testing and Wilcoxon matched-
pairs signed-ranks test for others. P values less than 0.05 were accepted as indicating significant
differences for pre-post comparisons.
Results: All recorded cardiovascular parameters witnessed a reduction following the session. This was
statistically more significant (p < 0. 0001) in HR, MP, RPP and DoP and significant (p = 0.002) in SP.
Conclusion: There is a healthy reduction in HR, BP and derived cardiovascular indices following
a single yogic relaxation session in a transgender population. These changes may be a�ributed to
enhanced harmony of cardiac autonomic function as a result of mind-body relaxation program. It
is suggested that an open and non-hostile environment is conducive for obtaining such a state of
psychosomatic relaxation and that such opportunities for transgender participants should be created
in all healthcare facilities.
Keywords: Yoga, cardiovascular, relaxation, transgender.
INTRODUCTION flowering of human potential across all human-made

barriers such as class, creed, religion, language,
The art and science of yoga has a lot to offer
nationality; and even across the natural divisions
all sections of society as it enables a wholesome
of gender and age. It is hence surprising that a
MEDLINE search conducted with the terms “yoga
Corresponding author
and transgender” didn’t come up with even a single
publication in this population. This statistic is quite a
Deputy Director, Centre for Yoga Therapy,
mind-opener as this population is under great stress
Education & Research (CYTER), Mahatma Gandhi
and at an increased risk of suicide, eating disorders
Medical College & Research Institute (MGMCRI),
and substance misuse. (1)
Pillayarkuppam, Pondicherry 607 402.
E mail: yoga@mgmcri.ac.in
It has been suggested that health care practitioners College of SBVU, ethical clearance was obtained from
need to improve awareness and take steps to create its IHEC. All the study participants were from the
an open, non hostile environment to overcome the SCOHD Society of Pondicherry. Informed consent
suboptimal provision of health care for transgender was obtained from participants and the yogic
individuals.(1) Sri Balaji Vidyapeeth (SBVU), a relaxation sessions carried out in CYTER Yoga hall
deemed to be university in Pondicherry, India has between 11am and 12 noon in a quiet environment,
taken innovative steps in creating such an open and with comfortable temperature and subdued lighting.
non-hostile environment through its community The participants had been advised to finish breakfast
outreach, education and research activities facilitated at least 2 hours earlier and come after emptying
through a special Transgender Clinic functioning bowel and bladder.
in Mahatma Gandhi Medical College and Research
HR and BP measurements were recorded from
Institute (MGMCRI). A half dozen transgender
106 participants (mean age of 23.86 ± 7.87 y), who were
individuals have been given administrative postings
a�ending this yogic relaxation program. Participants
as well as responsible duties thus enhancing their
were taught and practised under supervision a
status in society and also providing opportunities
protocol especially designed for them keeping in mind
for self growth and development. The Centre for
their health status and requirements. Each session
Yoga Therapy, Education and Research (CYTER) has
started with three minutes of quiet contemplative
been actively involved in providing yoga therapy for
si�ing and was followed by three rounds of om
many transgender individuals for the past four years.
chanting. The participants were then led through nine
The authors have received positive and appreciative
rounds each of mukha bhastrika (bellows breath) and
feedback on numerous occasions from these
nadi shuddhi (alternate nostril breathing). They then
participants who expressed their satisfaction with
practised nine rounds of brahma mudra turning the
physical and mental benefits they obtained through
head away from a neutral position in four directions
yoga.
(right, left, up and down) on inspiration, followed by
Though the multifaceted physiological and the movement of the head brought back to the centre
psychological health benefits of both short and long while producing audible sounds of aaa, ooo, eee,
term yoga training are quite well established, (2-4) very mmm respectively on expiration. This was followed
few studies have reported on the immediate effects of by pranava pranayama (sectional breathing with
a single session. We have earlier published reports on audible sounds of aaa, uuu and mmm on exhalation)
the significant reductions in cardiovascular parameters in the si�ing posture and finally savitri pranayama in
following a single yoga session in a retrospective shavasana (slow, deep, rhythmic breathing in a 2:1:2:
study of 1896 patients from CYTER (5) and also found 1 pa�ern of inspiration: held-in: expiration: held-out).
the same to be true in a geriatric population. (6) The Each session ended with another three rounds of om
magnitude of reductions in heart rate (HR) and blood chanting and a quiet si�ing period of three minutes.
pressure (BP) differed in different groups of patients
Non-invasive blood pressure (NIBP) apparatus
depending on pre-existing medical conditions as
was used to record HR, systolic pressure (SP) and
well as the specific yoga therapy protocol adopted
diastolic pressure (DP) readings before and after the
for them. Keeping all the above in mind, this pilot
60 minute session. To ensure objectivity, all recordings
study was done to assess the effects of a single 60-
were performed using non-invasive automatic BP
min session of yogic relaxation on cardiovascular
monitor (Omron HEM 7203, Kyoto, Japan) that uses
parameters in transgender individuals.
oscillometric method with an instrumental accuracy
of ± 5% for HR and ± 3 mm Hg for BP. The pre-session
MATERIALS & METHOD
recordings were taken after 5 min of quiet comfortable
The present study was conducted at CYTER si�ing while post-session recordings were taken at
functioning at MGMCRI under auspices of the SBVU, the end of the session. Pulse pressure (PP), mean
Puducherry, India. As it is part of the desertion project pressure (MP), rate-pressure product (RPP) and
of the fourth author who is completing his Masters double product (DoP) indices were derived from the
(MSc) degree in nursing at Kasturba Gandhi Nursing recorded parameters.
International Journal of Physiology, January-June, 2016, Vol. 4, No. 1 29
Data were assessed for normality using with mean HR and RPP. Hence decreases witnessed
GraphPad InStat version 3.06 for Windows 95, in our participants can be taken to imply a healthier
(GraphPad Software, San Diego California USA, HRV that may possibly prevent heart diseases in
www.graphpad.com). Student’s paired t test was transgender population who are already under
used to compare data that passed normality testing immense psycho-physiological stress (8)
by Kolmogorov-Smirnov Test (HR, MP and DoP)
An earlier study at SVYASA, Bangalore compared
and Wilcoxon matched-pairs signed-ranks test for
O2 consumption and respiration following four yoga
those that didn’t (SP, DP, PP and RPP). P values
postures interspersed with relaxation and supine
less than 0.05 were accepted as indicating significant
relaxation alone, and concluded that the combination
differences for pre-post comparisons.
of stimulating and relaxing techniques reduced
physiological arousal be�er than the mere practice
RESULTS
of relaxation techniques alone. (11) Even though the
All recorded cardiovascular parameters and practical performance of various yoga techniques
derived indices witnessed a reduction following the may seem to be stimulatory in nature, they suggested
single session of yogic relaxation and the results are that the ultimate physiological effect of such
given in Table 1. This was statistically more significant techniques is in fact more relaxatory. This hypothesis
(p < 0. 0001) in HR, MP, RPP and DoP and significant is also corroborated by another study from JIPMER,
(p = 0.002) in SP. It was however not statistically Pondicherry reporting that relaxation in shavasana is
significant in DP (p<0.0820) and PP (p< 0.1009). enhanced by the addition of savitri pranayama thus
resulting in a 26% reduction of O2 consumption. (12)
DISCUSSION
As our yogic relaxation session consisted
It has been suggested that the modulation of
primarily of pranayama, we hypothesize that this
stress response systems through yoga occurs by a
is producing a healthier cardiac autonomic balance
reduction of perceived stress and anxiety that in
in our subjects irrespective of their initial condition.
turn decreases physiological arousal resulting in
We also noticed that reductions were greater in those
lowered HR, BP and respiration. (7) Our present study
who had abnormal readings in the initial testing as
confirms this postulate as all participants reported a
opposed to those in whom the initial readings were
sense of being at ease, or at peace with themselves
within normal range. The yoga tradition extols
after the interactive session. This sense of inner peace
yoga as a state of harmonious balance (samatvam
(sukham) is vital for the relaxation response to ‘kick
yoga uchyate - Bhagavad Gita) and this restoration
in’ and produce the psychophysiological changes
of physical, mental, emotional and spiritual balance
witnessed in our study. Even a single session of yogic
may be a prime factor behind the positive changes
relaxation has significant cardiovascular effects in
seen in our participants.
a transgender population. This reflects a healthier
autonomic regulation of the heart due to either an Transgender individuals are often in turmoil with
overall increase of vagal parasympathetic tone and/or internal conflicts about gender identity or discomfort
a reduction in adrenergic sympathetic tone. in an assigned gender role, especially when they
desire transition. Such people who experience
RPP and Do P are indirect indicators of
discord between their gender and the expectations of
myocardial O2 consumption and thus reflects overall
others or whose gender identity conflicts with their
load on the heart. Hence, reductions in both of them
body, may benefit by talking through their feelings
signify a healthy lowering of the strain on the heart.
in depth. This can alleviate suffering and restore
(8,9)
Sympathetic activation is known to increase HR
functionality. (13) The fifth edition of the Diagnostic
and RPP and decrease overall heart rate variability
and Statistical Manual of Mental Disorders of the
(HRV). The RPP can also provide a simple measure
American Psychiatric Association refers to the topic
of HRV and is considered a surrogate marker in
as gender dysphoria and this may manifest clinically
situations where HRV analysis is not available. (10) It
as either depression or the inability to work and to
is worth noting that both SDNN and total power of
form healthy relationships with others. (14) We suggest
HRV have been reported to be inversely correlated
that a yogic relaxation programme can be offered on a

MP 87.37 84.97
regular basis in all health care facilities to enable such 0.0002
(mmHg) ± 8.37 ± 7.65
individuals to get a sense of positive inner relaxation.
This will help them live a happier and healthier life 92.14 84.75
RPP (units) <0.0001
± 14.97 ± 14.63
with a positive sense of self esteem.
67.43 62.29
Our present study is limited by the fact that we DoP (units) <0.0001
± 10.80 ± 10.77
have only taken into consideration the cardiovascular
effects of a single session of yogic relaxation. We plan Student’s paired t test was used to compare
further comprehensive short and long term studies to data that passed normality testing by Kolmogorov-
shed light on potential psycho-physiological health Smirnov Test (HR, MP and DoP) and Wilcoxon
benefits of yoga for transgender population as these matched-pairs signed-ranks test for those that didn’t
may help understand inherent mechanisms of action (SP, DP, PP and RPP). P values less than 0.05 were
be�er. accepted as indicating significant differences for pre-
post comparisons.
CONCLUSION
Conflict of Interest: None
There is a healthy reduction in HR, BP and derived
cardiovascular indices following a single session of Source of Funding: Mahatma Gandhi Medical
yogic relaxation in a transgender population. These College and Research Institute (MGMCRI) and
changes may be a�ributed to enhanced harmony of Kasturba Gandhi Nursing College (KGNC) of the Sri
cardiac autonomic function as a result of mind-body Balaji Vidyapeeth Deemed University, Pondicherry.
relaxation due to the specific program. It is imperative
Ethical Clearance: IHEC of KGNC approved the
that an open and non hostile environment is created
research study.
where such individuals can feel safe and at ease
with themselves. The authors commend Sri Balaji Acknowledgment: We thank the Yoga instructors
Vidyapeeth for having initiated such an innovative M Latha and Dhanushapnadeesh for conducting the
program in its university premises thus fulfilling this sessions and assistance during recording and data
felt need. We recommend that such an integrated yoga entry. We thank members of SCOHD SOCIETY for
program should be part of the heath care facilities for participating enthusiastically in this study and offer
transgender population as it can enhance their quality our gratitude to Sheethal Naayak for coordinating
of life and improve their overall health status. their participation effectively.
Table 1. Heart rate (HR), systolic pressure (SP),

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Health Status of Elderly Women Residing in a
Hospice in Pondicherry

1
Co-ordinator and Yoga Therapist, Centre for Yoga Therapy, Education and Research, 2Deputy Director,
CYTER, MGMCRI, Pillayarkuppam, Pondicherry
ABSTRACT
With advancing age, the body tends to slow down and becomes less efficient and elderly people are
prone to a few age-related health issues. The present study was undertaken to assess psycho-physical
health status of elderly women residing in a hospice in Pondicherry. After an introductory orientation
program, thirty women with mean age 68.67 ± 7.83 yrs, agreed to be subjects and after obtaining
informed consent, various parameters was recorded. Selected cardiovascular variables such as heart
rate (HR), systolic pressure (SP) and diastolic pressure (DP) and respiratory rate (RR) were measured.
Pulmonary function tests (PFT) were done using spirometer and reaction time (RT) measured using
RT apparatus. Select psychological variables including depression, anxiety and self-esteem were
assessed using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and Rosenberg Self-
Esteem scale respectively. We found HR, SP, DP values were as expected for age and gender and our
subjects performed be�er on PFT and RT as compared to earlier studies in similar groups. However
our subjects had lower psychological health status with increased depression, anxiety and lower self-
esteem. This may be due to being in hospice away from family who either do not want them or are
not there at all. Though physical health status seems satisfactory for age, this finding of inadequate
psychological health function may be first evidence of worsening physical health in future. We suggest
that older people must be acknowledged as integral members of society and provided opportunities to
enjoy good quality of life and easy access to health services. There is great scope for incorporation of
traditional health practices such as Yoga and other CAM modalities.
Keywords: Health, elderly, hospice, geriatry
INTRODUCTION and economic, social conditions, and spirituality

- the “determinants of health.” (2) Maintenance
Health can be understood as manifest level
and promotion of health is achieved through a
of functional and / metabolic efficiency of living
combination of physical, mental, and social well-
organisms. In humans, it is the general condition of a
being, together sometimes referred to as the “health
person’s mind and body... World Health Organization
triangle.” (3,4)
defined health in its broader sense as “a state of
complete physical, mental, and social well-being and With advancing age, body tends to slow down
not merely absence of disease or infirmity.” (1) and becomes less efficient. Elderly people are prone
to age-related health issues. Declining physical
A number of factors influence health status of
reserves, wear and tear, and fatigue set in as a result
individuals, including their background, lifestyle,
of which responses become slower and appearance
Corresponding author: changes. The prime task is to adjust to physical
Ananda Balayogi Bhavanani declines of aging, rather than become absorbed in
Deputy Director CYTER, MGMCRI, health problems. For some aging is very frightening
Pillayarkuppam, Pondicherry- 603402 or depressing, while others adapt well.(5) One needs
Email: yoga@mgmcri.ac.in to understands it as part of entire course of human
life, and this approach is called the life course or (FVC), Forced Expiratory Volume in the 1st sec
life-span perspective. (6) Geriatry is study pertaining (FEV1), FEV1/FVC, Forced Expiratory Flow at 25–
to geriatrics, old age or aged persons, relating to 75% (FEF25-75), Peak Expiratory Flow Rate (PEFR),
geriatric medicine. It is concerned with promotion Forced Inspiratory Vital Capacity (F1VC), Forced
of health, treatment and prevention of disability and Expiratory Flow after 25% of FVC has been expired
disease in old age. (7) (FEF 25%), Forced Expiratory Flow after 50% of FVC
has been expired (FEF 50%), Forced Expiratory Flow
Physical inactivity is a key risk factor contributing
after 75% of FVC has been expired (FEF 75%), and
to coronary heart disease, hypertension, obesity,
FVC% Predicted.
diabetes and other psychosomatic disorders, resulting
in increased mortality and morbidity and increased For PFT testing, each subject was instructed to
functional disability. Regular physical activity is do procedure in si�ing posture, with an erect spine,
essential for quality of life and wellbeing in old age without bending forward. They were asked to keep
and reduces the need for assistance. (8) mouth piece inside their mouth with lips closed over
it to avoid leakage of air while blowing and nose
The present study was undertaken to assess
closed with nose clip. They performed thrice with
psycho-physical health status of elderly women
gap of 3-5 minutes and were motivated to give their
residing in a hospice in Pondicherry and to determine
maximal effort. All parameters were noted and best of
whether they would benefit from health promoting
three readings recorded in data sheet.
behaviours and practices such as Yoga.
Reaction time (RT) was measured using RT
MATERIALS & METHOD apparatus manufactured by Anand Agencies, Pune.
Ethical clearance was obtained from IHEC of Instrument has built in 4 digit chronoscope with
MGMCRI and then we approached old age homes display accuracy of 1 ms. Simple ART was recorded
in Pondicherry to select subjects to volunteer for this for auditory beep sound stimulus and simple VRT for
study. Authorities and inmates of Hospice Convent red light stimulus. Subjects were instructed to release
Home for the Aged, Congregation of Saint Joseph response key as soon as they perceived stimulus.
of Cluny in Pondicherry willingly volunteered to Signals were given from front avoiding lateralised
take part in this study. stimulus and they used dominant hand while
responding to signal. All subjects were given adequate
An orientation program was given, explaining exposure on 2 different occasions to familiarize them
details of tests, purpose of study and their role with procedure. (9,10)
in detail to ensure proper understanding and
effective cooperation. After introductory program, To assess severity of depression, Hamilton Rating
thirty women with mean age 68.67 ± 7.83 yrs, agreed Scale for Depression (HRSD), also called Hamilton
to be subjects. After obtaining their informed consent, Depression Rating Scale (HDRS), abbreviated
recordings of various parameters was done. HAM-D was used. Individual interview sessions
were conducted and questionnaires administered.
Selected cardiovascular variables including Although HAM-D lists 21 items, scoring is based on
heart rate (HR), systolic pressure (SP) and diastolic first 17. (11) Hamilton Anxiety Rating Scale (HAM-A),
pressure (DP) were recorded using non-invasive was used to measure anxiety. (12) Subject was asked
automatic blood pressure (BP) monitor (Omron HEM to answer all 14 items honestly. To assess self-esteem,
7203, Kyoto, Japan) using oscillometric method with Rosenberg Self-Esteem Scale was used. The scale
accuracy of ± 5% for HR and ± 3 mm Hg for BP. HR consists of 10 items measuring both positive and
and BP were recorded after 5 min of supine rest. negative feelings about self, answered on a four-point
Respiratory rate (RR) was measured manually by scale from strongly agree to strongly disagree. (13)
observation of chest movement in supine position.
RESULTS AND DISCUSSION
Pulmonary function tests (PFT) were done using
R.M.S. Helios 401 Spirometer, version 1.0. Following Results are given in Tables 1, 2 and 3. HR was
parameters were recorded: Forced Vital Capacity 88.83 ± 13.94 with 16 subjects having > 90 bpm. SP was
153.70 ± 19.74 with only 3 subjects having < 120mmHg than younger individuals. Females had higher BMI
and 18 having values > 150 mmHg. Similarly DP was and longer reaction times than males. Longer reaction
90.73 ± 13.10 with only 5 of them having < 80mmHg times and higher BMI in females could be a�ributed
with 14 having values > 91 mmHg. to fluid and salt retention due to female sex hormones
affecting sensorimotor co-ordination. (19)
Elderly people should have BP measured
annually, and high levels (> 160/90 mm Hg) should As seen in Table 1, both VRT and ART were
be treated. Isolated systolic hypertension is more shorter in our subjects compared to previous reports.
common in elderly where only systolic reading is (19)
Mean VRT in our subjects was 301.70 ± 43.71 as
elevated. As arterial system stiffens with age, SP alone compared to 359.1 ± 38.75ms and ART was 288.33 ±
may be elevated to as high as 200 mm Hg or more 38.67 as compared to 341.3 ± 41.69ms in that study.
during ejection phase and the value of lowering it has However 11 of our subjects had ART > 300ms. VRT
been proved by Systolic Hypertension in the Elderly was > 350ms in only 4 subjects. Increases in RT with
Program (SHEP). (14) It has also been suggested that 70 age can be effect of ageing on myelination of neurones
mmHg is an “optimal” DP in subjects with isolated and they should be more cautious during general
systolic hypertension. In frail elderly, a value of DP movements and driving. (20) Hence our subjects were
< or = 60 mm Hg is associated with reduced survival, having be�er neurological health status as compared
independent from large artery stiffness and left to previous studies.
ventricular function, suggesting that more rational
As given in Table 3, 15 subjects were moderately
antihypertensive therapy, not only based on SP level,
depressed, 9 had severe depression and 6 were in
is needed. (15)
very severely depressed category. All 30 subjects
PFT values of the 30 geriatric women are given in were in moderate to severe anxiety status implying
the Table 2. When compared to predicted values, 20 lower psychological level of health further elucidated
had normal lung functioning while 4 had restriction, 5 by low self-esteem scores where all 30 subjects scored
had mild restriction and 1 had severe restriction. PFT less than 15 indicating a low level of self esteem.
is a valuable tool for evaluating respiratory function
The finding of lower psychological health status
and is a simple screening procedure. (16) A cross-
in our subjects with depression, anxiety and low self-
sectional study reported that all lung function tests
esteem may be correlated to being in hospice away
were found to be negatively correlated with age and
from family who either do not want them or are not
concluded that lung function significantly declined
there at all. Importance of having near and dear ones
with age. (17) In another cross sectional population-
with us cannot be over emphasised and no amount
based study decreased FEV1% predicted and FEV1/
of care even when it is of excellent quality seems to
FVC ratio were associated with smoking, increasing
alleviate mental and emotional turmoil in elderly.
age, and reported pulmonary and cardiovascular
Though their physical health status seems to be
diseases. They concluded that FEV1/ FVC ratios down
satisfactory for their age, this finding of inadequate
to 65% should be regarded as normal when aged 70
psychological health function may be first evidence of
years and older. (18) Mean FEV1/ FVC values in our
further worsening of physical health in near future.
subjects was 93.61 ± 6.01 and this is much higher than
values recorded in previous study. This may be due A recent WHO factsheet on mental health in older
to a healthier environment or nutrition and/ activity adults tells us, “Multiple social, psychological, and
in our study group. Interestingly respiratory rate of biological factors determine level of mental health
our subjects was < 18 bpm in only three while ten had of a person at any point of time.” (21) According to it,
rates between 18 to 20 and 17 had rates > 20 bpm. good general health and social care is important for
promoting older people’s health, preventing disease
RT indicates time taken to react to external
and managing chronic illnesses. Mental health can
stimulus and is an indirect method of assessing central
be improved through promoting active and healthy
neuronal processing. (9, 10) A previous study on effect
ageing involving creation of positive living conditions
of age, gender and Body Mass Index (BMI) showed
and environment that supports wellbeing and healthy
that VRT and ART were significantly higher in older
and integrated lifestyles. We plan to provide our
subjects an opportunity to have regular Yoga sessions Table 2: Pulmonary function tests in the study
at their hospice and document and publish further group subjects. Values are given as mean ± SD for
reports on possible improvements expected in their 30 subjects.
psycho-physical health and functioning.
Predicted Recorded
Parameters % predicted
Table 1: Demographic and anthropometric value value
details, cardiovascular parameters, respiratory rate, FVC 1.52 ± 0.37 1.43 ± 0.52 95.57 ± 29.22
reaction time and psychological parameters of the FEV1 1.24 ± 0.34 1.33 ± 0.44 111.10 ± 34.73
30 subjects in the study group. FEV1/FVC 80.76 ± 3.00 93.61 ± 6.01 116.57 ± 9.77
FEF25-75 1.97 ± 0.27 1.98 ± 0.69 101.87 ± 35.35
Mean ± SD (30
Parameters PEFR 4.00 ± 0.45 3.17 ± 1.30 79.47 ± 31.83
subjects)
FIVC 1.48 ± 0.38 1.39 ± 0.56 94.30 ± 31.40
Age (yrs) 68.67 ± 7.83
FEF25% 3.73 ± 0.30 3.01 ± 1.26 79.93 ± 32.90
Wt (kg) 59.23 ± 11.65
FEF50% 2.47 ± 0.27 2.27 ± 0.84 92.13 ± 32.52
Ht (m) 1.49 ± 0.07
FEF75% 0.77 ± 0.20 1.17 ± 0.44 163.10 ± 79.52
BMI (Kg/m2 ) 26.83 ± 5.41 Lung age 67.90 ± 8.62 59.47 ± 22.61 88.87 ± 34.71
Heart rate (Beats/min) 88.83 ± 13.94
Forced Vital Capacity (FVC), Forced Expiratory
Systolic pressure (mmHg) 153.70 ± 19.74
Volume in the 1st sec (FEV1), FEV1/FVC, Forced
Diastolic pressure (mmHg) 90.73 ± 13.10
Expiratory Flow at 25–75% (FEF25-75), Peak
Respiratory rate (breaths/min) 22.60 ± 4.54 Expiratory Flow Rate (PEFR), Forced Inspiratory Vital
Auditory reaction time (ms) 288.33 ± 38.67 Capacity (F1VC), Forced Expiratory Flow after 25% of
Visual reaction time (ms) 301.70 ± 43.71 FVC has been expired (FEF 25%), Forced Expiratory
Depression scores 20.43 ± 6.30
Flow after 50% of FVC has been expired (FEF 50%),
Forced Expiratory Flow after 75% of FVC has been
Anxiety scores 29.50 ± 0.63
expired (FEF 75%), and FVC% Predicted.
Self-esteem scores 6.60 ± 1.28
Table 3: Number of subjects falling in each of the three subsections of depression, anxiety and self-
esteem scores.
Moderate Severe Very severe

DEPRESSION
(14 - 18) (19 - 22) ( > 23)
Number of subjects 15 9 6
Mild
ANXIETY Mild to moderate (18 - 24) Moderate to severe (25 - 30)
( < 17)
Number of subjects none none 30
Low Moderate High
SELF ESTEEM
(< 15) (15 - 25) ( > 25)
Number of subjects 30 none none
CONCLUSION as integral members of society and provided

From the present study conducted on 30 elderly opportunities to enjoy good quality of life and have
women at a hospice in Pondicherry, we conclude that easy access to health services. Yoga and other CAM
a majority of them lacked adequate psychological therapies should be incorporated as health promoting
health and were on borderline regarding physical self-help systems. This will enhance self-esteem and
health status. Deterioration of psychological health provide self-accomplishment goals during sunset
was more pronounced than physical and this may be years.
due to various social, emotional and physical factors. Source of Funding: Self
We suggest that older people be acknowledged
Conflict of Interest: Nil
Acknowledgment: The authors thank a geriatric population. International Journal of

management of Sri Balaji Vidyapeeth University Physiology 2014; 2 (1): 59-63.
for se�ing up Centre for Yoga Therapy, Education 11. Hamilton M. Development of a rating scale for
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DOI: 10.7860/JCDR/2016/16306.7408
Original Article
Effect of Different Pranayamas on
Physiology Section
Respiratory Sinus Arrhythmia
Ananda Balayogi Bhavanani1, Jeneth Berlin Raj2, Meena Ramanathan3, Madanmohan Trakroo4
ABSTRACT and expiration: inspiration ratio (E:I) calculated by respective

Introduction: Respiratory Sinus Arrhythmia (RSA) is the formulae. Statistical analysis was carried out using repeated
differential change of Heart Rate (HR) in response to inspiration measures of ANOVA with Tukey-Kramer multiple comparisons
and expiration. This is a noninvasive sensitive index of test.
parasympathetic cardiac control. Results: There were significant differences between groups in
Aim: To evaluate changes in RSA by utilizing a simple and all five aspects namely: p= 0.0093 for mean Imax, p = 0.0009 for
cost-effective analysis of electrocardiographic (ECG) tracings mean Emin, and p < 0.0001 for ∆ HR (I-E), ∆% HR (I-E) and E:I
obtained during performance of four pranayama techniques. ratio. Pranava pranayama produced the greatest changes in all
five comparisons.
Materials and Methods: Fifty two trained volunteers performed
the following pranayamas with different ratios for inspiration Conclusion: We suggest that further short and long term
and expiration: sukha (1:1), traditional (1:2), pranava (1:3) studies be undertaken with pranava pranayama in patients
and savitri (2:1:2:1) and ECG was recorded while performing to further qualitatively and quantitatively evaluate inherent
the techniques with rest period of 5 minutes in-between. HR mechanisms of this simple technique. Addition of these cost-
was calculated and maximum HR during inspiration (Imax), effective techniques to the medical armory will help patients of
minimum HR during expiration (Emin), differences between Imax rhythm disorders and other cardiovascular conditions.
and Emin (∆), percentage differences between Imax and Emin (∆%)
Keywords: Yoga, ECG, Cardiovascular, Heart rate
Introduction respiratory rate, tidal volume as also the expiratory/inspiratory time

One of the discernable benefits of repeated regular yoga practice ratio [8]. The inspiration/expiration ratio may significantly influence
is the attainment of healthy life. It has been observed that yoga heart rate asymmetry thus playing a role in cardiovascular regulation
practitioners are physically and mentally healthier and have better and health [9].
coping skills in comparison to normal population [1]. It is the Different pranayamas of the yoga tradition utilize different ratios
responsibility of researchers to explore various techniques of yoga of inspiration and expiration and claim differential benefits of such
in a scientific manner as they are inexpensive, effective and easily techniques [10]. We postulated that pranayamas with differing ratios
administrable. Such an approach will enhance the possibilities of of inspiration and expiration may produce differing effects on HR
our achieving best possible states of physical, mental, spiritual and and RSA in healthy volunteers.
social health. Yoga has been documented to facilitate better neuro-
effector communication, improve strength, and enhance optimum
aim
functioning of all organ-systems while increasing resistance against
Hence, this study was undertaken to evaluate such changes
stress and diseases with resultant tranquility, balance, positive
utilizing a simple and cost-effective analysis of electrocardiographic
attitude and equanimity [2-4].
(ECG) tracings obtained during performance of four pranayama
Jerath et al., have suggested that practice of yogic breathing techniques.
techniques (pranayama) can help reduce the oxygen consumption
as well as the heart rate (HR) and blood pressure (BP) [5]. They
postulated that slow deep breathing may rest the autonomic nervous
The present cross-sectional study was conducted at the Centre for
system while synchronizing peripheral (heart and lungs) and central
neuronal connections (limbic system and cortex). Yoga therapy Education and Research (CYTER), Mahatma Gandhi
Medical College and Research Institute, Puducherry, India. It was
Slow deep breathing is known to have harmonizing effect on
done in April and May 2015 as part of a larger study on the effects
autonomic tone and studies have reported that it evokes short-term
of yoga training in nursing students for which ethical clearance had
plasticity of cardiorespiratory coupling [6]. In an earlier work we
been obtained from Institutional Human Ethics Committee. Fifty two
found that sukha pranayama at a rate of 6 bpm reduces HR and BP
in hypertensive patients within 5 minutes of practice by normalizing volunteers (35 female, 17 male), aged 25.85 ± 11.17 (SD) years,
autonomic cardiovascular rhythms as a result of increased vagal with body mass index of 22.36 ± 12.93 (SD) attending regular yoga
modulation and/or decreased sympathetic activity and improved training at CYTER were recruited for the study by convenience
baroreflex sensitivity [7]. sampling.
Respiratory sinus arrhythmia (RSA) is a noninvasive sensitive index Four yogic breathing techniques (pranayama) utilizing different ratios
of parasympathetic cardiac control. It is based on variation of HR for inspiration and expiration were selected and as the subjects were
with respiration wherein inspiration increases HR while expiration already receiving biweekly yoga training, they were well conversant
decreases it. Factors modulating RSA are known to be the with them. The following breathing techniques detailed by Swami
4 Journal of Clinical and Diagnostic Research. 2016 Mar, Vol-10(3): CC04-CC06

www.jcdr.net Ananda Balayogi Bhavanani et al., Pranayama on Sinus Arrhythmia
Gitananda Giri [10] were used in the present study: Sukha Traditional Pranava Savitri p-value
pranayama pattern pranayama pranayama
i. Breathing in for a count of four followed by breathing out for a
count of four (1:1 ratio) as done in sukha pranayama, Mean Imax 83.93 85.06 87.27 85.23 0.0093
± 11.00 ± 11.05 ± 11.78** ± 12.51
ii. Breathing in for a count of four followed by breathing out for a
Mean Emin 69.64 68.41 66.19 68.94 0.0009
count of eight (1:2 ratio) in traditional pranayama pattern, ± 8.72 ± 10.61 ± 11.24 ± 10.83
*** ^
iii. Breathing in for a count of four followed by breathing out for a
count of twelve (1:3 ratio) while making the audible sound of ∆ 14.29 16.65 21.08 16.29 < 0.0001
± 7.26 ± 7.12 ± 7.49 ± 6.42
aaa-uuu-mmm as done in pranava pranayama, and ***^^^ψψψ
iv. Savitri pranayama was performed by breathing in for a count ∆% 16.61 19.47 24.12 18.91 < 0.0001
of four holding in for count of two, breathing out for a count of ± 7.54 ± 8.03 # ± 7.79 ± 6.65
***^^^ψψψ
four and holding out for count of two (with a ratio of 2:1:2:1).
E:I 1.21 1.25 1.33 1.24 < 0.0001
All recordings were carried out in CYTER lab between 10 am and ± 0.11 ± 0.12 # ± 0.14 ± 0.11
12 noon, 2 hour after a light breakfast and after emptying bladder. ***^^^ψψψ
The environment was quiet, with a comfortable temperature and [Table/Fig-1]: Mean of maximum heart rate during inspiration(Imax), mean of minimum
subdued lighting. The subjects were briefed about the study protocol heart rate during expiration (Emin), differences between mean Imax and mean Emin(∆),%
differences between mean Imax and mean Emin(∆%) and expiration: inspiration ratio
and written informed consent was obtained from them. (E:I) in 52 subjects while performing sukha (1:1 ratio), traditional pattern (1:2 ratio),
The subjects were randomized into four groups of 13 each. Each pranava (1:3 ratio) and savitri (2:1:2:1 ratio) pranayamas.
Values are given as mean±SD. p-values are given for intergroup compassions done by repeated
group performed the four breathing techniques in a different measures of analysis of variance with Tukey-Kramer Multiple Comparisons Test (TKMCT).
**p<0.01 and ***p<0.001 for pranava versus sukha.
sequence in order to neutralize any ‘carry over’ effect from the ^p<0.05 and ^^^p<0.001 for pranava versus savitri
performance of the earlier techniques. ψψψ
p<0.001 for pranava versus traditional pattern.
#
p<0.05 for sukha vs traditional pattern.
• Group 1:Sukha Traditional Pranav Savitri
• Group 2: Savitri Pranava Traditional Sukha mean Imax was significant (p< 0.01) while it was highly significant (p<
• Group 3: Pranava Traditional Sukha Savitri 0.0001) for mean Emin, ∆ HR, ∆% HR and E:I ratio.
• Group 4:Traditional Sukha Savitri Pranava The differences between pranava and savitri in mean Emin was
significant (p< 0.05) while it was highly significant (p< 0.0001) for ∆
Prior instruction and adequate demonstration of the techniques
HR, ∆ % HR and E:I ratio. ∆ HR, ∆ % HR and E:I ratio comparisons
and procedure were given before starting recordings. Subjects
between traditional pattern and pranava were highly significant (p<
were seated comfortably in a semi reclining chair and instructed
0.0001) while ∆ % HR and E:I ratio differences between traditional
to breath slowly and deeply to their maximum capacity. One of the
pattern and sukha were also significant (p< 0.05).
investigators provided an audible count at the rate of one count/
second to provide guidance to the subject on inspiration and
expiration throughout the period of study. Discussion
Our results give evidence of the differential effects of pranayamas
VESTA 101 Single Channel ECG (Recorders & Medicare Systems,
performed with different ratios for inspiration and expiration. Though
Panchkula) was used for the study and after connecting limb leads,
the duration of inspiration was constant in all four techniques,
the subjects were asked to perform four rounds of each technique
modifications induced by changing the duration of expiration
in the order assigned for their group. The first two rounds were
produced changes that are in agreement with previous reports on
dummy rounds and then ECG was recorded during 3rd and 4th
pranayama and paced breathing [5,8,11-14].
rounds. A rest period of five minutes was given between each of the
techniques so as to avoid the influence of the preceding one on the Increased Imax, decreased Emin and greater changes in ∆ and ∆%
succeeding one. are indicative of greater RSA in the traditional ratio, Pranava and
Savitri pranayamas as compared to sukha ratio of 1:1 that may be
HR was calculated by taking average of two shortest and two
considered a control for inter group comparisons. The traditional
longest RR intervals obtained from Lead I of the ECG during
ratio of 1:2 produced greater changes than 1:1 breathing of the
inspiration and expiration phases respectively. These values were
sukha variety thus showing that there may be greater vagal activity
entered in excel sheet and maximum HR during inspiration (Imax), when the expiration is doubled. Such changes are usually attributed
minimum HR during expiration (Emin), differences between Imax and to influence respiratory centre and/or pulmonary stretch receptors
Emin (∆), percentage differences between Imax and Emin (∆%) and on vagal control of the heart.
expiration: inspiration ratio (E:I) calculated by respective formulae.
Jerath et al., postulated that pranayama induces hyperpolarizing
currents that propagate through both neural and non-neural tissue
statistical analysis and synchronize neural elements in heart, lungs, limbic system
After obtaining the study data, it was statistically analyzed using
and cortex [5]. As all the pranayamas in our study were done with
Graph Pad In Stat version 3.06 for Windows 95, (Graph Pad
same duration of inspiration it is plausible that these effects were
Software, San Diego California USA, www.graphpad.com). All data
meditated more by changes in the respiratory centre rather than
passed normality testing by Kolmogorov-Smirnov Test and hence
the pulmonary stretch receptors. When performing pranayama,
further analysis was done using repeated measures of ANOVA
there is a conscious change from normal breathing (with passive
followed by Tukey-Kramer multiple comparisons test between
expiratory effort) to a more consciously controlled expiration. This
groups.
may be enabling higher centers to override vagal inhibitory actions
of respiratory centre while stimulating the post inspiratory ones that
Results allow vagal activity to manifest. Though duration of respiration in
The results are given in [Table/Fig-1]. Statistical analysis by repeated
both traditional pattern and savitri pranayama is same (12 s), savitri
measures of ANOVA revealed significant differences between the
doesn’t seem to produce this effect and this may be because both
groups in all five aspects namely: p= 0.0093 for mean Imax, p =
expiration and inspiration are of equal duration in savitri. This is
0.0009 for mean Emin, and p < 0.0001 for ∆ HR (I-E), ∆% HR (I-E)
further corroborated by the earlier report by Telles and Desiraju that
and E:I ratio.
short kumbhak type of pranayamas may not cause a change in the
Pranava pranayama produced the greatest changes in all five mean HR [12].
comparisons and the differences between pranava and sukha in
Journal of Clinical and Diagnostic Research. 2016 Mar, Vol-10(3): CC04-CC06 5
Ananda Balayogi Bhavanani et al., Pranayama on Sinus Arrhythmia www.jcdr.net
The greatest changes were seen in the performance of pranava ACKNOWLEDGMENTS

where all comparisons were significantly greater than the other The authors thank the management and authorities of Sri Balaji
three pranayama ratios. The greater changes in RSA and E:I ratio Vidyapeeth for setting up the Center for Yoga Therapy, Education
produced in pranava signify greater role of the parasympathetic and Research (CYTER) in Mahatma Gandhi Medical College and
vagal activity that could be attributed to many factors. Research Institute (MGMCRI). We are grateful to Principal, faculty
Earlier studies on immediate effects of pranava pranayama in coordinator and 2nd year BSc Nursing students of the Kasturba
patients of hypertension (HT) and in patients with concomitant Gandhi Nursing College for their wholehearted support for this study
diabetes mellitus reported healthy reductions in cardiovascular and enthusiastic participation in the Yoga training at CYTER.
parameters and derived indices within five minutes [15,16]. This was
attributed to a normalization of autonomic cardiovascular rhythms References
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[11] Madanmohan, Saravanane C, Surange SG, Thombre DP, Chakrabarty AS. Effect
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conditions to manage their condition more effectively.

1. Deputy Director, Centre for Yoga Therapy, Education and Research (CYTER), Mahatma Gandhi Medical College and Research Institute,
Pillayarkuppam, Puducherry, India.
2. Associate Professor, Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India.
3. Co-ordinator and Yoga Therapist, CYTER, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India.
4. Professor and Head, Department of Physiology, and Director CYTER, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India.

Dr Ananda Balayogi Bhavanani,
Deputy Director, Centre for Yoga Therapy, Education and Research, Mahatma Gandhi Medical College and Research Institute,
Pillayarkuppam, Puducherry- 603402, India. Date of Submission: Aug 17, 2015
E-mail: yoga@mgmcri.ac.in Date of Peer Review: Oct 24, 2015
Date of Acceptance: Jan 01, 2016
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Mar 01, 2016
6 Journal of Clinical and Diagnostic Research. 2016 Mar, Vol-10(3): CC04-CC06

Journal of Intercultural Ethnopharmacology
Original Research
www.jicep.com
DOI: 10.5455/jice.20160331064758
A brief qualitative survey on the

utilization of Yoga research resources
by Yoga teachers
ABSTRACT
Introduction: Yoga has become popular worldwide with increasing research done on its therapeutic potential.
Centre for Yoga Therapy,
However, it remains to be determined whether such findings actually percolate down into teaching and practice
Education and Research,
Sri Balaji Vidyapeeth
of Yoga teachers/therapists. Materials and Methods: The aim of this survey was to document awareness
University, Mahatma of Yoga research findings in the Yoga community and find out how these were utilized. It was undertaken
Gandhi Medical College with a select group of 34 international Yoga teachers and therapists utilizing email and social media between
and Research Institute, August and December 2015. Majority of responders had well-established reputation in Yoga and were from
Pillayarkuppam, diverse lineages with 30 of them having more than 5 years of experience in the field. A set of eight questions
Pondicherry, India were sent to them related to essentiality of Yoga research, how they updated themselves on research findings
and whether such studies influenced their teaching and practice. Responses were compiled and appropriate
Address for correspondence: statistics determined for quantitative aspects while feedback, comments and suggestions were noted in detail.
Deputy Director, Centre for Results and Discussion: About 89% agreed that it was essential to be up-to-date on Yoga research but
Yoga Therapy, Education only 70% updated themselves regularly with average papers read fully per year being <10. Most accessed
and Research, Sri Balaji information through general news reports, emails from contacts, and articles on internet sites whereas only
Vidyapeeth University, 7% were through PubMed. About 60% felt these studies helped them in general teaching whereas 20% said
Mahatma Gandhi Medical
College and Research that such studies had not really influenced it in any way. Conclusion: This survey provides a basic picture
Institute, Pillayarkuppam, of a general lack of awareness of Yoga research amongst practicing Yoga teachers and therapists. Though
Pondicherry, India. a majority agree research is important, few seriously update themselves on this through scientific channels.
E-mail: yognat@gmail.com With regard to future studies, most wanted “proof” that could be used to convince potential clients and felt
that more qualitative methods should be applied.
Received: January 02, 2016
Accepted: March 20, 2016
Published: April 01, 2016 KEY WORDS: Health, survey, wellness, Yoga research
INTRODUCTION 3. Are they satisfied with past and current research being done?
4. What are “priority needs” they wish from researchers?
Yoga has become increasingly popular worldwide with many
taking it up professionally thus helping many more benefit This is important as a two-way dialog between them and
from this health enhancing ancient art and science of humanity. researchers would enhance the focus, objectives as well as
A number of scientific studies have been done in the past methods and ultimate direction of future research in the best
five decades, and a recent extensive review has reiterated its productive manner.
therapeutic potential with scientific evidence for a wide range
of psychosomatic conditions [1]. In an attempt to determine answers for these pertinent
questions, and foster understanding between “the lab and
However, it remains to be determined as to how much such
the field,” this survey was done by this author amongst his
research findings actually percolate down into the day-to-day
international contacts in the field of Yoga and Yoga therapy.
classroom teaching and clinical practice of the Yoga teachers/
therapists.
Aim and Objectives
Important questions that come to mind in this regard are:
1. Are Yoga teacher/therapists aware of recent updates in Yoga The aim of this survey was to understand the awareness of Yoga
research? research findings in the Yoga teacher/therapist community and
2. Are these updates influencing their day to day teaching/ to find out how these findings were utilized by them in their
clinical practice? day to day practice and teaching.
168 J Intercult Ethnopharmacol ● 2016 ● Vol 5 ● Issue 2

Bhavanani: Survey on utilization of yoga research resources
The secondary objective was to see what they felt would be Questions asked: The following questions were asked to the
more useful in the context of future research as this author participants in the survey and responses obtained from them
feels such research efforts should be guided by needs of those via email.
who are to use it the most.
1. Do you think it is essential for Yoga teachers to be up-to-date on
MATERIALS AND METHODS Yoga research?
2. Do you update yourself on research in Yoga regularly? If yes, how
many papers on an average do you read fully per year?
This survey was undertaken in the months between August 2015
3. Where/how do you access these studies?
and December 2015. Emails were sent to potential participants 4. Have these research studies influenced your teaching? If yes, how?
and awareness of the survey carried out through social media 5. Is/are there any specific study/studies that has/have influenced you the
including Twitter, Facebook, and SlideShare. most in the past 3-5 years? If yes, which one/s?
6. Are you satisfied with the quality of Yoga research at present?
7. What type of studies do you wish to see in the future?
Survey Participants 8. Any other comments?
This survey was conducted on a select group of 34 international

Compilation and analysis of responses: Responses from all
Yoga teachers and therapists known to the author and included
participants were compiled and statistics (percentage and
8 from India, 7 from Australia, 8 from North America, 7 from
mean ± standard deviation) determined for quantitative aspects
Europe, and 2 each from South America and the UK.
such as demographic parameters (country wised distribution,
age, gender, and years of teaching/therapy). Qualitative
analysis of important responses was done for other answers and
important feedback, comments, and suggestions noted in detail.
RESULTS AND DISCUSSION
All the participants were eager to take part in this survey and
expressed their support for such an endeavor. In this section,
we shall take a look at the important responses given by them
for each of the questions with appropriate details discussed in
detail.
The first of the questions was as follows:
1. Do you think it is essential for Yoga teachers to be up-to-date

on Yoga research?
The age of participants in the survey of which 18 were females
and 16 males ranged from 28 to 77 (51.08 ± 12.84) years. About 89% of the teachers/therapists agreed that it was essential
for Yoga teachers/therapist to be up-to-date on Yoga research.
Majority of responders had well-established reputation as Yoga Some felt that it was not essential for teachers but that it was
teachers/therapists and were from diverse lineages with 30 of for therapists.
them having more than 5 years of experience in the field. Four
of them had more than 30 years of professional standing in the As a Yoga therapist trainer of 18 years from North America put
field of Yoga. Five of the other respondents who had <3 years it, “To move the profession forward into modern culture? Yes.
of experience in the field were excluded from the survey. To maintain the highest level of Ahimsa? Yes. Can someone
support many people without doing so? Probably most of time.”
Four of the respondents were medical doctors, 4 nursing
professionals, 5 physical therapists, 3 psychologists, whereas Another Yoga therapist trainer of 15 years said, “My answer
the rest were all qualified Yoga teachers/therapists with to this is twofold. In the realm of what Dr. Bhavanani calls
diplomas/degrees in Yoga from eminent Yoga schools. Traditions Yogopathy [2], Yes I think it is essential. In today’s world of
represented included the Krishnamacharya-Desikachar “evidence-based medicine” being able to scientifically “prove”
tradition, Kaivalyadhama tradition, Gitananda tradition, Iyengar that Yoga Therapy is effective enables it to be more widely
tradition, and Satyananda tradition. accepted as a valid treatment. In my experience, sharing this
Yoga research as evidence is what opens both physicians and
How long have you been teaching Yoga? patients to trying it with respect versus skepticism. On the
<5 years 4 other hand, research whittles down factors to attempt to isolate
5-10 years 6 that which is clinically relevant. As we know, Yoga is beyond
10-20 years 13 the physical and is broad in its application and effects thus
20-30 years 7 it is difficult to “prove” what exactly is happening through a
More than 30 years 4
research study. We can hypothesize; however, how the effects
J Intercult Ethnopharmacol ● 2016 ● Vol 5 ● Issue 2 169

are obtained may be beyond current scientific understanding. Many started to talk about it in social media mentioning possible
Thus, we do not want to fall into a trap of narrowing our focus of benefits of humans sleeping on their side and how they did it or
approach to that which is scientifically provable. All of this said, did not do it. It seemed to this author that most had not even
my thoughts are that Yoga Therapist should be up-to-date on bothered to go to the original source and read the full paper as
Yoga research and have a clear understanding of its limitations. rodent models were used in the study and not humans. Speak
about how having access to more information may not actually
The right means produces the right end, hence outcome of result in our being better informed!
the Yoga practices become better “structured” said a senior
Australian Yogacharya while another respondent from the UK 4. Have these research studies influenced your teaching? If
suggested, “No, but it helps and is interesting.” yes, how?
A senior Yoga therapist from Australia mentioned that this About 60% felt that these studies had helped them in their
was most essential and that the Standards Committee in general teaching while 55%, 45%, and 40% stated that it
both International Association of Yoga Therapists (IAYT) and helped in their teaching of asanas, pranayama, and relaxation,
Australasian Association of Yoga Therapists (AAYT) had made respectively. About 20% said that such studies had not really
it part of their educational standards for Yoga therapists for the influenced their teaching in any way.
same reason [3].
General teaching 60%
The next question was as follows: Asana aspects 55%
2. Do you update yourself on research in Yoga regularly? If yes, Pranayama aspects 45%
how many papers on an average do you read fully per year? Relaxation aspects 40%
Safety aspects 20%
Scientific understanding 20%
Though a vast majority accepted the importance of research Confirmation of ancient wisdom 10%
in Yoga, only 70% said they updated themselves on research in Nutritional aspects 5%
Yoga regularly with the average papers read fully per year being Not really 20%
as follows. Only 9 of them read more than 10 papers a year,
whereas 14 said they read less than 5 papers a year. As one of the senior trainers noted, “When I can offer a patient
a study that “shows” positive benefits of Yoga (cancer research,
<5 papers per year 14 telomere research, etc.), they are much more open to following
5-10 papers per year 10 the recommendations I make to lifestyle changes and to our
10-20 papers per year 3 treatment approach [5-7].”
20-30 papers per year 2
More than 30 papers per year 4
It was also noted that showing patients the positive effects of
various techniques has encouraged them to be more compliant
3. Where/how do you access these studies?
with what they are taught. A special mention was made of a
recent study on the side plank pose (Vasisthasana), in idiopathic
It was found that most respondents were accessing their
and degenerative scoliosis by Fishman and colleagues [8].
information on Yoga research through the internet and that
general news reports, emails from their contacts, and articles
However, it was well brought out that one should look at the
on different internet sites were main sources. Only 7% were
methodology when it comes to safety precautions as some of the
accessing their information through PubMed, whereas 10% still
studies on asanas to avoid have methodology concerns. It was
relied on various books on the subject.
noted that an article states that Sarvangasana causes strokes.
However, when one reads the article fully we find that the person
General news reports, emails, and internet sites 72% held it with his head rotated [9]. As the therapist responded,
PubMed 7%
“I don’t know anyone who would do that so I disregard such
Google scholar 5%
Books 10% studies.” She, however, continued, “Osteoporosis studies have
Research Journals 4% influenced my approach with avoiding flexion [10].”
Research gate 2%
A senior Yogacharini from Berlin explained that the research
One has to be very careful with the information available on findings enabled clearer thinking for the teacher and therapist
the net and this overreliance on unverified sources is something and helped develop an ability to compare Yoga knowledge with
that needs correction as there is often a vast difference between allopathic medicine. It was also essential to understand and
what has been done in the actual study and what is popularized point out differences in the therapeutic principles.” She also
in the lay press. felt that it enabled the teachers and therapists to be, “on the
more safe side.”
An example is a recent study in the Journal of Neuroscience
on how sleeping on the side influences clean-up of brain’s An Indian Yoga teacher in the USA stressed the importance of
metabolic waste products and halts neurological diseases [4]. being clear in the aim of one’s research. The focus should be

Yoga, and this should be applied as per the tradition involved. 6. Are you satisfied with the quality of Yoga research at present?
“When it is done in such a manner, it becomes easier for me
as a teacher to serve ‘ready material’ to my clients when they The answers were equally divided between yes and no and a
have health problems” said she. “The bridge between Yoga and few actually said they were not sure. Some felt they did not
modern science as manifested through research and literary have the required expertise to comment on it. Comments
works of Swami Gitananda Giri and his successors strengthens received included the noting of more prolific research coming
our conviction. When such authentic knowledge is combined out in recent times but at the same time bemoaning mediocre
with the fact research has been done by medical doctors, it truly methodologies adopted. Though it was wholeheartedly accepted
helps us convince prospective and current clients about benefits that research is a valuable tool, some felt that it was really only
of Yoga” she continued. proving information handed down to us from the Yogis of yore.
Over emphasis of quantitative rather than qualitative aspects
A senior Yogacharya responded that he had personally applied of research were mentioned and a need felt for more studies
concepts of Swarodaya Vigjnan (study of nasal cycle) learned combing both aspects. Longterm longitudinal studies were also
about through his studies of research in Yoga and been suggested through it was at the same time mentioned that this
motivated to do a verified analysis of these concepts in relation may be highly ambitious.
to staying alert while driving his motor vehicle [11,12]. He
attached a detailed report of his personal study of the nostril As said by a senior Yoga therapist in the USA, “I’m satisfied with
dominance during different phases of the day and with regard the rapid trajectory but much more work is needed to bring in
to diverse activities, he was undertaking on a daily basis. He had mixed methods and participatory action research methodology
also practiced the right or left uni-nostril breathing techniques to capture local, community change as well versus the Asmita
and noted in detail the effects he felt immediately. This author of the individual “subject’s” suffering.
is personally heartened to see such feedback “from the field”
as this is actually the “spirit of research” that Yoga research An Indian Yoga therapist responded saying, “I am satisfied but
findings should be motivating in all sadhakas. They should be there are many Gurus and many traditions of Yoga. Whenever
motivated to “see for themselves” whether the findings of the we talk about Yoga education, therapy and especially research, a
research studies as “true or not” by applying the methodology question always arises about ‘which Yoga’ was done? This leads
in their own personal sadhana and life. to confusions in the minds of teachers, patients and students.
We should try and research a model syllabus that brings the
5. Is/are there any specific study/studies that has/have best of all traditions together” said she.
influenced you the most in the past 3-5 years? If yes, which
one/s? 7. What type of studies do you wish to see in the future?
Most of the respondents did not point out any specific study/ A senior leader in Yoga therapy from Australia responded
studies that has/have influenced them recently but gave more “well-designed case studies that allow for individualizing of the
generalized replies. The few that were mentioned by name protocol, and that can eventually be meta-analyzed.”
included recent publications from Kaivalyadhama (www.kdham.
com), SVYASA (www.svyasa.edu.in), Patanjali Yogpeeth (www. A senior trainer from Canada suggested that studies should
divyaYoga.com), ICYER at Ananda Ashram (www.icyer.com), look at supporting evidence for Yoga as an aid to overcoming
Krishnamacharya Yoga Mandiram (www.kym.org), ACYTER addictions, as well as the impact of physical postures in aiding
at JIPMER (www.jipmer.edu.in), and CYTER at Sri Balaji peace of mind and emotional stability. Populations that
Vidyapeeth (www.sbvu.ac.in) along with specific mention of meditate are said to have better grades, lower crime rates,
iRest in PTSD [13], GABA [14,15], neuroplasticity changes and selfless behavior and this aspect needs further study. He
after mindfulness [16], and telomerase studies [6,7]. Studies also suggested orienting research around benefits of Seva and
on fast and slow Surya namaskar, uninostril pranayamas, cancer, Karma Yoga.
depression, and dementia were also mentioned [15,17-19].
One of the most senior Yoga therapist trainers in India remarked,
An Australian Yogacharya passed on the feedback from his “Studies should be oriented toward finding out the risks
student who said that the use of well researched and scientifically attended with the practice of Yoga.” He went on to suggest that
explained protocol [12] used when she was pregnant gave her Yoga therapy research should be “individual specific” and look
a positive feeling of control up to and including the delivery at the individual and their tendencies leading to illness rather
of her baby. than being focused on “illness” per se.
As a Canadian Yogacharya responded, “hard to single one out, Another USA-based therapist mentioned, “With the increase
but studies on alternative nostril breathing [18,20-22], for in lifestyle diseases across the world and the positive effects
instance, have influenced my own practice, and have allowed Yoga has on reducing such diseases, producing more research
me to consider gradually incorporating these techniques, which to ‘prove’ what we know is critical for Yoga’s acceptance as an
I normally would have deemed too advanced, into some of my effective and valid and necessary treatment for a majority of
classes.” the population today.”

Another Australian Yoga teacher suggested, “I’d like to see lost in studies considering large samples and quantitative
comparative studies between traditional classical Yoga (as a statistical analyses.
health and wellness practice) and say the gym, Pilates, cross-
training, etc., and all the other new fads of ‘Yoga’ (Hot Yoga, The overall picture was well summarized by a dedicated Yoga
power Yoga, and the plethora of new wave so-called Yoga fads). therapy trainer from the USA when she said, “I feel it is ideal
It would be interesting to see how effective other exercise for Yoga teachers to follow research however not essential. My
modalities are in comparison to the ancient wisdom of Yoga: experience in teaching Yoga Therapy to Yoga Teachers is that
is the ancient wisdom holding its own in the modern world of most have no idea how to read a study and how to discern valid
technoexercise programs, gyms with so-called instructors, etc.? information. Thus, they often draw incorrect conclusions from
I would also like to see comparative analysis between Western reading simply the abstract or from not understanding the bigger
medicine and Yoga therapy and Ayurveda.” picture. In order for them to obtain value from reading Yoga
research, they need training in how to read research.”
8. Any other comments?
ACKNOWLEDGMENTS
A dedicated Yogacharya from Bangalore suggested Yoga teaching
and therapy curricula should include studies on characterization The author acknowledges with gratitude; the time and
of humans, ethical, and moral values, the study of Sanskrit as energy contributed by all respondents and thanks them for
part of life, the study of yogic as well as spiritual textbooks their wholehearted participation. The author also thanks the
written by the ancient Yogis and Rishis, as well as an overall management of Sri Balaji Vidyapeeth University for setting
spiritual education during adolescence. up the Centre for Yoga Therapy, Education and Research
(CYTER) in its Mahatma Gandhi Medical College and Research
A Swiss Yogacharini wisely commented, “If science really wants Institute (MGMCRI) in an innovative integration of Yoga with
to understand Yoga and its relationship with the human being, mainstream medicine.
it should not stick to just the pieces of the puzzle but attempt
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SMGr up Research Article
SM Journal of Yoga and Cardiovascular Health:

Cardiovascular Exploring Possible Benefits and
Disorders Postulated Mechanisms
Ananda Balayogi Bhavanani1*
Deputy Director, Centre for Yoga Therapy, Education and Research (CYTER), Mahatma Gandhi Medical
1
College and Research Institute (MGMCRI), India
Article Information Abstract
Received date: Apr 21, 2016 Background: Yoga as a mode of therapy has become extremely popular, and a great number of studies and
Accepted date: May 26, 2016 systematic reviews offer scientific evidence of its potential in treating a wide range of psychosomatic conditions.
Healthy life can be considered as a by-product of practicing yogic techniques since it has been observed that
Published date: Jun 05, 2016 yoga practitioners are physically and mentally healthier and have better coping skills to stressors than the normal
population.
Aims and objective: This review paper details some of the health promoting benefits of yoga with
Ananda Balayogi Bhavanani, Deputy regard to cardiovascular health and discusses mechanisms for such beneficial physiological, biochemical and
Director, Centre for Yoga Therapy, psychological effects. Psycho-neuro-endocrine changes including correction of Gamma Amino-Butyric Acid
(GABA) activity, and parasympathetic activation coupled with decreased reactivity of sympathoadrenal system
Education and Research (CYTER), and Hypothalamo-Pituitary-Adrenal (HPA) axis are highlighted.
Mahatma Gandhi Medical College and
Conclusion: Though most studies and reviews suggest a number of areas where yoga may be beneficial
Research Institute (MGMCRI), India; for cardiovascular health, more research is required to establish these benefits conclusively. It is important
Email: yognat@gmail.com to develop objective measures of various mind-body therapies and their techniques while including them in
intervention trials. In conclusion, we can say that yoga has preventive, promotive as well as curative potential as
Distributed under Creative Commons an adjunct therapy and that a yogic lifestyle confers many advantages to the practitioner.
CC-BY 4.0
Keywords Cardiovascular health; Introduction

Disease; Stress; Yoga Therapy
The popularity of yoga and its application as a therapy are increasing day by day all over the
world. Yoga maharishi Dr. Swami Gitananda Giri Guru Maharaj, the visionary founder of Ananda
Ashram at the International Centre for Yoga Education and Research (ICYER), Pondicherry, India
(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.” [1] Healthy 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 Organization to provide “physical,
mental, spiritual and social health” for all sections of human society.
When we recognize that cardiovascular disease is basically a lifestyle disorder, we realize
that the holistic science of yoga considered by many as the best life style has a definite role in its
prevention and management as well as rehabilitation [2]. Both modern medicine and yoga have
sound scientific basis and are, therefore, natural allies. The addition of yoga as an adjunct therapy
through integrative medicine enhances preventive, curative as well as rehabilitative potential of
both systems. The holistic action of yoga can be explained on the basis of its ability to modulate
autonomic functions, relieve stress, improve physiological functions including cardio-respiratory
fitness and improve quality of life
Research Findings
Many studies have tried to explore the mechanisms by which yoga modifies coronary artery
disease risk factors. Ornish et al [2], Manchanda et al [3] and Yogendra et al [4] 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.
How to cite this article Bhavanani AB. Yoga and Cardiovascular Health: Exploring
OPEN ACCESS Possible Benefits and Postulated Mechanisms. Sm J Cardiovasc Dis. 2016; 1(1):1003.
SMGr up Copyright  Bhavanani AB
Manchanda et al reported that a yoga lifestyle retards progression Mechanisms postulated include the restoration of autonomic
/ increases regression of coronary atherosclerosis in severe coronary balance as well as an improvement in restorative, regenerative and
artery disease. [3] They also found that it improves symptomatic rehabilitative capacities of the individual. A healthy inner sense of
status, functional class and risk factor profile. Another study by wellbeing produced by a life of yoga percolates down through the
Bijlani et al concluded that even a short lifestyle modification and different levels of our existence from the higher to the lower levels
stress management education program could lead to favorable producing health and wellbeing of a holistic nature. Streeter et al
metabolic effects and reduces risk factors for cardiovascular disease recently proposed a theory to explain the benefits of yoga practices
and diabetes mellitus [5]. in diverse, frequently co-morbid medical conditions based on the
concept that yoga practices reduce allostatic load in stress response
Comprehensive reviews by Innes et al have suggested that yoga
systems so that optimal homeostasis is restored [12]
reduces the cardiovascular risk profile by decreasing activation
of sympatho-adrenal system and hypothalamic-pituitary-adrenal They hypothesized that stress produces an:
axis and also by promoting a feeling of wellbeing along with direct
• Imbalance of the autonomic nervous system with decreased
enhancement of parasympathetic activity [6-7]. They also suggested
parasympathetic and increased sympathetic activity,
that yoga provides a positive source of social support that may also
be one of the factors reducing risk for cardiovascular diseases. In • Under activity of the Gamma Amino-Butyric Acid (GABA)
fact all the studies reviewed by them suggested that yoga improves system, the primary inhibitory neurotransmitter system, and
lipid profile, and as this is an important risk factor for heart disease,
• Increased allostatic load.
such a possibility needs further exploration in greater detail. Their
2005 review covered 70 eligible studies investigating the effects of They further hypothesized that yoga-based practices i) correct
yoga on risk indices associated with the insulin resistance syndrome, under activity of the parasympathetic nervous system and GABA
cardiovascular disease, and possible protection with yoga, and they systems in part through stimulation of the vagus nerves, the main
reported that most had a reduction of systolic and/or diastolic peripheral pathway of the parasympathetic nervous system, and ii)
pressure [6]. They however also noted that there were several noted reduce allostatic load.
potential biases and limitations that made it difficult to detect an
According to the theory proposed by them, decreased
effect specific to yoga.
parasympathetic nervous system and GABA ergic activity that
The cardiovascular health promoting benefits of yoga have been underlies stress-related disorders can be corrected by yoga practices
studied in a literature review that reported significant improvements resulting in amelioration of disease symptoms. A review by Bhavanani
in overall cardiovascular endurance of young subjects who were concluded that Heart Rate Variability (HRV) testing has a great role
given varying periods of yoga training [8]. Physical fitness increased to play in our understanding of the intrinsic mechanisms behind
as compared to other forms of exercise and longer duration of yoga such potential autonomic balancing effects of yoga [13] Innes et al
practice produced better cardiopulmonary endurance. Another had earlier postulated two interconnected pathways by which yoga
detailed review of yoga in cardiac health concluded that yoga is reduces the risk of cardiovascular diseases through the mechanisms
beneficial in the primary and secondary prevention of cardiovascular of parasympathetic activation coupled with decreased reactivity
disease and that it can play a primary or a complementary role in this of sympathoadrenal system and Hypothalomo-Pituitary-Adrenal
regard [9]. (HPA) axis [6].
A recent retrospective review of clinical data to determine Possible Mechanisms
cardiovascular effects of a single yoga session in 1896 normal subjects
The BP lowering ability of yoga training has been documented by
as well as patients of different medical conditions at the Centre for
Patel and North, Datey et al., Sundar et al. and Vijayalakshmi et al.
Yoga Therapy, Education and Research (CYTER), in the Sri Balaji
[14-17]. Yoga training blunts exercise-induced increase in HR and
Vidyapeeth at Pondicherry, India showed healthy reductions in Heart
BP [18]. while shavasan in particular has been found to reduce load
Rate (HR), Blood Pressure (BP) and derived cardiovascular indices
on the heart by blunting sympathetic response [19]. Shavasan and
following a single yoga session. The magnitude of this reduction
pranayama have also been found to be beneficial in patients having
depended on the pre-existing medical condition as well as the yoga
premature ventricular complexes and palpitations [20]. Udupa et al.,
therapy protocol adopted. These changes were attributed to enhanced
[21]. Reported that pranayama training decreased basal sympathetic
harmony of cardiac autonomic function as a result of coordinated
tone, increased basal parasympathetic activity and decreased load on
breath-body work and mind-body relaxation due to yoga [10].
the heart and such breathing exercises and relaxation training have
Managing Stress been documented to have beneficial effects in patients with previous
myocardial infarction [22].
It is well established that stress weakens our immune system.
Scientific research in recent times has shown that the physiological, Mechanisms for these changes have been suggested to be via
psychological and biochemical effects of yoga are of an anti-stress improvement of baroreflex sensitivity and attenuation of sympathetic
nature. A majority of studies have described beneficial effects of yoga and rennin angiotensin activity following yoga training [23] Decreased
interventions in stress with an Agency for Healthcare Research and BP, drug score and risk factors such as blood glucose, cholesterol
Quality (AHRQ) report stating that “Yoga helped reduce stress” [11]. and triglycerides as well as overall improvement in subjective well
Reductions in perceived stress following yoga are reported to be as being and quality of life with reduced sympathetic activity and
effective as therapies such as relaxation, cognitive behavioral therapy oxidant stress are some of the mechanism suggested for positive
and dance therapy. health promoting changes. It has been reported that Yoga improves
Citation: Bhavanani AB. Yoga and Cardiovascular Health: Exploring Possible

Benefits and Postulated Mechanisms. Sm J Cardiovasc Dis. 2016; 1(1):1003.
Page 2/4
Conclusion
The majority of studies on yoga and cardiovascular health show
positive trends and this augurs well for the future of healthcare in
general and the use of yoga as part of integrative health care system
in particular. The major benefits of yoga may occur due to its lifestyle
components (healthy diet, activity, relaxation and positive attitude)
as well as the psychosomatic harmonizing effects of pranayama and
yogic relaxation. According to tradition, yoga implies both the process
as well as the attainment of a state of psychosomatic, harmony and
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 all short term and long term
studies.
Figure 1: A Summary of the Effects of Different Pranayamas in Hypertensives.
Reference
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Copyright: © 2016 Bhavanani AB, et al.
Research Article Journal of Alternative Medical Research Open Access
Effects of an Intensive 3-Week Yoga Retreat on Sense of Well Being in

Cancer Survivors
Ananda Balayogi Bhavanani1*, Lee Majewski2, and Subodh Tiwari2
1
Centre for Yoga Therapy, Education and Research (CYTER), Sri Balaji Vidyapeeth, Pondicherry, India
2
Kaivalyadhama Yoga Institute, Lonavla, Maharashtra, India
Received Date: November 15, 2016, Accepted Date: December 21, 2016, Published Date: December 28, 2016.
*Corresponding author: Ananda Balayogi Bhavanani, Centre for Yoga Therapy, Education and Research (CYTER), Sri Balaji Vidyapeeth, Pillayarkuppam,
Pondicherry- 607403, India; E-mail: yoga@mgmcri.ac.in.
Cancer is not just one of the most severe of the life threatening
Abstract diseases, but also severely affects physically, mentally and
Introduction: Cancer survivors are often severely affected emotionally those who manage to survive it through modern
physically, mentally and emotionally after passing through modern medical treatments. The patient care and health information guide
medical treatments. As Yoga conjointly emphasizes body-mind-spirit
available online from Mayo Clinic states, “Recovering from cancer
thus enhancing physical, mental, social and spiritual well-being,
Kaivalyadhama Yoga Institute in Lonavla, India initiated a three week
treatment is not just about your body — it’s also about healing your
residential intensive retreat for cancer survivors to empower them in mind”. They further advise patients to take time to acknowledge
their journey, “back to health and wellbeing”. The aims and objectives the fear, grief and loneliness. They fear even after their extensive
of the present study is to evaluate the effects of this residential program medical treatment is over [2]. Though they sagely say, “take steps to
for cancer patients on their psychological well being, and determine if or understand why you feel these emotions and what you can do about
not these effects were sustained at follow up after three months. them”, few medical professionals seem to really do anything to help
Materials and Methods: The modes of reintegration used in this the patient ‘walk the talk’.
program were designed to specifically address the multidimensional
Most patients of cancer, typically undergo extensive
needs of cancer survivors and incorporated various Yogic techniques
including Asana, Pranayama, Mudra, Bandha, relaxation, silent
chemotherapy with or without surgery, and this is then followed
meditation and chanting as well as education given in a group setting. often by radiation that leads to a state of physical, mental and
Three standard psychological evaluation tools were used: WHO Quality of emotional exhaustion [3,4]. In most cases, once they complete
Life-BREF (WHOQOL-BREF), Profile of Mood States (POMS) and Hospital their therapy, they are told to go back to their “normal life” and
Anxiety and Depression Score (HADS). These were administered on first are regarded by society to be as “normal” as before. This only adds
(D1) and last days (D20) of the program and repeated at follow up three to the confusion and stress felt by the patient as it increases their
months later (3M). Pre and post retreat (D1-D20) data was analyzed for feeling of not being “understood”. Cancer survivors are confronted
26 subjects using Students paired t-test while RMANOVA was used to
by many intra-personal issues including the fear of recurrence,
compare pre-post retreat and follow up data of 19 subjects.
increased stress, a feeling of loneliness as well as depression and
Results: Significant improvements were seen in all domains of QOL with anxiety.
significant reduction in all negative psychological states and improvement
in vigour and total POMS score. There was significant decrease in anxiety, Yoga, an ancient system of health and healing is unique as it
depression and overall rating on HADS with marked decrease in anxiety conjointly emphasizes body-mind-spirit, thus enhancing physical,
compared to depression. In pre-post and follow-up (D1, D20 and 3M) mental, social and spiritual wellbeing. A review by Levine and
comparisons for 19 subjects, all components showed significant changes Balk concluded that Yoga benefits emotional functioning during
except social QOL. Though some of the benefits of the retreat are lost during and after breast cancer treatment [5]. Physical activity, breathing,
follow up, none of the values reached level of significance except in anger
meditation, and group support were quoted as being the most
subscale and even that was still lower than at start of retreat.
helpful components from the perspective of participants.
Discussion and Conclusion: The present study offers evidence
of the beneficial psychological changes occurring after a three week Keeping this in mind and other reports on possible effectiveness
intensive retreat for cancer survivors. This is in tune with previous of Yoga, meditation and mindfulness as rehabilitative/palliative
reports. One of the biggest benefits may actually lie in the empowerment therapy in cancer, [6–14] Kaivalyadhama Yoga Institute in Lonavla,
of the participants as they are given tools, which make them feel in India initiated a three week residential intensive retreat for cancer
control of their health and wellbeing. Changes are maintained in those survivors to enable them to regain their health and wellbeing [15].
who continue the practices even at three months follow up but are
The comprehensive curriculum of this “ Rejuvenation Retreat for
lost slowly in those who discontinued them. Even then, all parameters
at three months follow up are still positive as compared to pre-retreat
Cancer Patients” includes an integrative approach utilising Asana,
values. More rigorous and randomized controlled studies are required Pranayama, meditation, mindfulness, chanting, Yoga Nidra as well
to validate these results in the future. as Kirtan Kriya. It utilises a judicious blend of sister life-sciences
of Yoga and Ayurveda along with sessions of self-education to help
Keywords: Cancer; Rehabilitation; Wellbeing; Yoga
participants in their psycho-physical-spiritual recovery.
The present study was undertaken to evaluate psychological effects
Introduction of this three week intensive Yogic program for cancer patients on their
According to the latest GLOBOCAN report it was estimated in sense of wellbeing as measured by quality of life indices, profile of
2012 that there were 14.1 million new cases of cancer, 8.2 million mood states, and anxiety and depression scores. For further analysis,
cancer deaths and 32.6 million people living with cancer (within 5 possible post-program ‘carry over’ effects and enhance validity of the
years of diagnosis) worldwide. A further dire statistic is that this is study, a subsequent follow up monitoring of all parameters were done
expected to rise to 24 million by 2035 [1]. three months after completion of the program.
J Alt Med Res Page 1 of 6

J Alt Med Res Vol. 2. Issue. 2. 4000116
Thus the aims and objectives of the present study were to: to healing. A sense of ‘being in the present moment’ is created
when one chants and this enables a healthy development of self-
1. Evaluate effects of the 3-week residential program for cancer
awareness with regards to the individual’s thoughts, feelings and
patients on their psychological well being, and
actions [23]. In the first week, the Ra Ma Da Sa chant from the
2. Determine if or not these effects were sustained at follow up Kundalini Yoga tradition was used and then in the second week
after three months. chanting of 108 rounds was done of the Maha Mrityunjaya (Om
Trayambakam) Mantra. 108 rounds of the Omkara were used in the
Materials and Methods third.
Modes of Reintegration Education: For healing to manifest, it is essential that
an internal change occurs in the mindset and attitude of the
A multidimensional, integrative approach was adopted
individual. One needs to grow from a negative state of victimhood
to address specific physical, mental, emotional and psychic/
to a positive one of self-empowerment. The educational component
spiritual needs of cancer survivors. As many studies have reported
of the retreat enabled participants to know more about potential
effectiveness of Asana-Pranayama as well as silent meditation and
carcinogenic factors in their life and facilitated this internal change
chanting these were used to enhance natural, inherent healing
in their view of life. As the IAYT definition of Yoga therapy includes
processes [5,7,8,10,13,16].
the empowerment of the individual [24], this was considered a vital
Everyone loves to be loved, valued and feel respected as an component and every afternoon, the participants spent 90 minutes
individual. This support from the near and dear as well as society learning about Yogic values, environmental toxicity, diet and healthy
creates a positive sense of self esteem that enables healing to lifestyle as well as the impact of Yoga on the body, emotions and
manifest in a natural manner. Patients of cancer and survivors thought process. “Change must come from within” and this was the
have identified social support as a crucial element for coping with goal; to reduce such a positive change from within the participants
illness and for achieving adequate quality of life (QOL) [17–19]. themselves.
Social support has been positively associated with promotion of
Therapy: As the retreat was based on an integrative model,
survival in both the early as well as the late stages of cancer [20].
participants were offered opportunities to consult qualified
Group Yoga sessions create a sense of positive social support that in
specialists in Naturopathy, Ayurveda and modern medicine.
turn facilitate self-healing through stress reduction and a positive
Towards the end, they were also given special individual sessions
sense of ‘being valued’. This has been well brought out in a study
where they learnt to create personal Mandalas (dynamic shapes)
that reported effects of a 6-week Yoga program for patients with
that helped them develop a new sense of direction in life.
Stage II/Stage III breast cancer undergoing adjuvant radiotherapy
where Yoga participants reported improved social support relative Parameters Tested
to controls [21,22].
Following questionnaires were administered on the first (D1)
It has been previously noted that group Yoga classes provide and last days (D20) of the retreat and then repeated at the follow
participants with a positive peer-community and an open minded up of three months later (3M). Three standard psychological
forum in which they can share their personal experience and evaluation tools were used: namely the WHO Quality of Life-BREF
journey [5]. Hence the present intensive retreat consciously adopted (WHOQOL-BREF), Profile of Mood States (POMS) and Hospital
primarily the group class pattern to facilitate such social and Anxiety and Depression Score (HADS). These standardized tools
interpersonal empowerment. In addition, one-on-one counselling are commonly used to document of the state of mind, levels of
based on Yogic philosophy and values was offered throughout anxiety and depression and evaluate subjective feelings of the
the retreat for those who were interested in it. The schedule and participants [5,7-9,12]. They are used regularly in both in-patient
practices of the intensive retreat have been detailed in an earlier and out-patient scenarios to understand psychological affects of
publication by Majewski and Bhavanani [15] [Table1]. different treatment modalities and hence they provide us objective
Asana-Pranayama-Mudra-Bandha: Simple stretching quantitative evidence of the subjective, qualitative changes.
postures, breathing practices and energy channelizing techniques WHOQOL-BREF: This instrument comprises 26 items,
were used, often modifying them to specific needs of the different which measures the following broad domains: physical health,
participants. These Yoga techniques enable the development psychological health, social relationships, and environment. It is a
of better ‘body sense and create positive awareness of the link shorter version of the original instrument and is more convenient
between one’s breath and body movements. for use in research studies and clinical trials.
Chanting: Chanting is widely used in the Yoga tradition and is One of the important aspects of human life is mood, and hence
known to induce an inner sense of peace and calm that is conducive assessment of it is an important indicator when evaluating effects of
any intervention. POMS (Educational and Industrial Testing Service,
San Diego, CA) questionnaire was administered to all participants.
Daily schedule Monday to Saturday POMS questionnaire is a widely used self-reported instrument used
6:45-8:15 Yoga - asana/pranayama to measure mood [25]. It includes sixty five items which assess six
8:30 Breakfast mood subscales namely: tension, depression, anger, vigour, fatigue
9:30-11:00 Naturopathic treatments and confusion. The questions refer to the time period of the “last
11:00-12:00 Yoga - Pranayama and Meditation week including today” while the response scale is divided into five
12:30 Lunch
categories ranging from “not at all” to “very strong”. A good mood
or emotion is found to be reflected in higher vigor scores and/
3:00-4:30 Education/Therapeutic Group Activity
or low scores in the other subscales. To compute the total mood
5:00-6:15 Yoga Nidra
disturbance score, the five negative subscale scores (tension,
6:30 Dinner depression, anger, vigor, fatigue, and confusion) are added and then
8:15-9:00 Yoga - Chanting and silent meditation vigor score is subtracted from the total. Lower scores are indicative
Table1: The schedule and practices of the intensive retreat. of the participant having a more stable mood profile. Nyenhuis and
Citation: Bhavanani AB, Majewski L, Tiwari S (2016) Effects of an Intensive 3-Week Yoga Retreat on Sense of Well Being in Page 2 of 6
Cancer Survivors. J Alt Med Res 2(2): 116.
Yamamoto [26] have reported a good concordance of POMS with Statistical Analysis
depression and anxiety instruments Beck Depression Inventory
(BDI) and State-Trait Anxiety Inventory (STAI), respectively while All the data were assessed for normality using GraphPad InStat
previous studies indicated good psychometric results. version 3.06 for Windows 95, (GraphPad Software, San Diego
California USA, www.graphpad.com). As all data passed normality
HADS is a reliable self-assessment scale for detecting states of testing by Kolmogorov‑Smirnov Test, pre and post retreat (D1-D20)
depression and anxiety in outpatient clinic settings [27]. It is a fourteen data was analyzed for 26 subjects using Students paired t-test in
item scale with seven of the items relating to anxiety and seven to all parameters. Repeated measures of ANOVA was used to compare
depression. Each item is scored from 0-3 with a minimal and maximal the pre-post retreat and three months follow up data of 19 subjects
score between 0 and 21 for either anxiety or depression. as data of 7 subjects was not available for the follow-up period.
Tukey‑Kramer multiple comparisons test was used to compare
Parameter Before retreat After retreat Delta p-value differences between groups and P values of less than 0.05 were
WHOQOL-BREF accepted as indicating significant differences for pre-post (D1-D20),
Quality of Life 6.12 ± 1.56 8.00 ± 1.23 1.88 ± 1.42 < 0.0001 pre-follow up (D1-3M) and post- follow up (D20-3M) comparisons.
Physical health 19.64 ± 3.35 22.72 ± 3.56 3.08 ± 3.94 0.001
Results
Psychological
19.56 ± 3.58 21.76 ± 2.57 2.20 ± 2.47 < 0.0001
health Pre-post (D1-D20) comparisons for 26 subjects in WHOQOL-
Social relationships 10.28 ± 2.26 11.04 ± 1.99 0.76 ± 1.90 0.057 BREF, POMS and HADS are given in table 2. Significant improvements
Environment 29.92 ± 5.07 33.52 ± 4.20 3.60 ± 1.42 < 0.0001 were seen in all domains of physical health, psychological health,
POMS and environment as well as total QOL (p < 0.0001). Only in the case
Tension 14.73 ± 8.07 4.88 ± 4.53 - 9.85 ± 8.26 < 0.0001 of social relationships were the changes just missing significance
(p = 0.057). There was significant reduction in all negative
Depression 17.00 ± 12.89 5.23 ± 6.70 - 11.77 ± 11.47 < 0.0001
psychological states and improvement in vigour as well as total
Anger 11.85 ± 7.57 5.27 ± 5.65 - 6.57 ± 5.93 < 0.0001
score of the POMS (p < 0.0001). There was significant decrease
Vigor 14.38 ± 5.15 20.77 ± 23.91 6.39 ± 4.56 < 0.0001 in anxiety, depression and overall rating on HADS with marked
Fatigue 13.58 ± 5.16 5.38 ± 3.45 - 8.19 ± 5.94 < 0.0001 decrease in anxiety compared to depression (p < 0.0001).
Confusion 11.65 ± 5.84 5.88 ± 4.88 - 5.77 ± 5.33 < 0.0001
Total 50.00 ± 31.84 5.00 ± 3.79 - 45.00 ± 29.80 < 0.0001
Pre-post and follow-up (D1, D20 and 3M) comparisons for 19
subjects in WHOQOL-BREF, POMS and HADS are given in table 3.
HADS
All the components showed significant changes (p < 0.001) over the
Anxiety 9.12 ± 3.36 4.69 ± 2.85 - 4.42 ± 3.13 < 0.0001
time period except social QOL (p = 0.1256).
Depression 6.00 ± 3.97 3.08 ± 2.33 - 2.92 ± 5.60 < 0.0001
Total 15.12 ± 6.44 7.77 ± 4.03 - 7.35 ± 5.22 < 0.0001 The major findings with regard to pre-post and follow up
comparisons were as follows: In WHOQOL-BREF, there was
Table 2: Comparisons of the WHO Quality of Life-BREF (WHOQOL-BREF), significant improvement in total quality of life as well as all
Profile of Mood States (POMS) and Hospital Anxiety and Depression Score
subscales except social QOL on follow up as compared to the pre-
(HADS) questionnaire scores in 26 participants before and after the retreat.
Values are given as Mean ± SD for 26 participants. P values are given for retreat baseline values. In POMS, there was significant reduction
compassions done by Students' paired t test between pre and post retreat in confusion, fatigue and total POMS score with increased vigour
values. while in HADS, there was significant reduction in both anxiety and
Parameter Before the retreat After the retreat At 3 months follow up p-value
WHOQOL-BREF
Quality of Life 6.06 ± 1.51 8.06 ± 1.21*** 6.67 ± 2.30 ψ 0.0011
Physical health 19.72 ± 3.50 22.22 ± 3.52 23.51± 3.78 ▲ 0.0064
Psychological health 19.28 ± 3.44 21.44 ± 2.68 ** 20.56 ± 3.20 0.0098
Social relationships 10.01 ± 2.45 11.11 ± 2.19 10.44 ± 2.09 0.1256
Environment 30.67 ± 4.62 33.06 ± 4.52 * 32.56 ± 4.59 0.0097
POMS
Tension 16.05 ± 8.29 5.05 ± 5.07 *** 9.21 ± 7.89 ▲ 0.0001
Depression 18.68 ± 12.79 5.58 ± 7.58 *** 11.63 ± 13.08 0.0004
Anger 12.79 ± 7.76 5.37 ± 6.31 *** 9.47 ± 7.93 ψ 0.0003
Vigor 14.16 ± 4.65 20.26 ± 3.25 ** 18.79 ± 7.89▲ 0.0012
Fatigue 13.21 ± 5.89 5.47 ± 5.44 *** 7.63 ± 6.60 ▲ 0.0005
Confusion 13.05 ± 5.82 6.79 ± 3.38 *** 8.58 ± 5.81 ▲▲ 0.0003
Total 59.63 ± 34.51 8.01 ± 26.02 *** 27.79 ± 45.79 ▲▲ < 0.0001
HADS
Anxiety 9.74 ± 3.26 5.32 ± 2.73 *** 6.47 ± 4.38 ▲▲ < 0.0001
Depression 6.42 ± 3.70 2.89 ± 1.94 ** 3.84 ± 3.89 0.0058
Total 16.16 ± 6.20 8.21 ± 3.94 *** 10.32 ± 7.67 ▲▲ 0.0002
Table 3: Comparisons of the WHO Quality of Life-BREF (WHOQOL-BREF), Profile of Mood States (POMS) and Hospital Anxiety and Depression Score (HADS)
questionnaire scores in 19 participants before and after the retreat as well as at 3 months follow-up. Values are given as Mean ± SD for 19 participants. P
values are given for intergroup compassions done by repeated measures of analysis of variance with Tukey-Kramer Multiple Comparisons Test (TKMCT).
*p < 0.05 , **p < 0.01 and *** p < 0.001 for pre-retreat vs post-retreat comparisons
▲ p < 0.05 and ▲▲ p < 0.01 for pre-retreat vs follow up comparisons
ψ p < 0.05 for post-retreat vs follow up comparisons
depression as well as the total score. Though some of the benefits of inflammation”. Immediately post-treatment, vitality was higher in
the retreat seem to be lost during the follow up, none of the values the Yoga group and at three months post-treatment, Yoga group’s
reached level of significance (p > 0.05) except in the case of the fatigue was lower, vitality higher, and IL-6, TNF-α, and IL-1β lower.
anger subscale of POMS (p < 0.05) and even that value (9.47 ± 7.93) As in our study, more frequent practice produced greater benefits
was lower than that of the start program (12.79 ± 7.76). in fatigue, vitality, and inflammation. It was suggested that by
dampening or limiting fatigue and inflammation, the regular
Discussion practice of Yoga could produce substantial health benefits. Yoga
A factsheet from the National Cancer Institute states that emphasises conscious breath-body work and this can enhance the
emotional and social support can help cancer patients learn to cope feeling of wellness through the release of ‘feel good’ hormones and
with psychological stress [28]. According to it, such support can transmitters such as GABA [35]. Pranayamas used in our program
reduce levels of depression, anxiety, disease and treatment-related were Ujjayi, Sitali, Bhramari, Nadi Shuddhi as they all induce a
symptoms among patients. Suggested approaches include training sense of calm and serenity that enables healing. Kapalabhati was
in relaxation, meditation, or stress management, counselling or used in select participants to create a sense of energy to combat the
talk therapy, cancer education sessions, social support in a group feeling of depression. Basic introductory practice of Bandhas with
setting, medications for depression or anxiety and exercise. Ashwini Mudra and Brahma Mudra were also given to tone up the
energy flows.
The present study offers evidence of the beneficial psychological
changes occurring after a three week intensive residential retreat Chanting induces a sense of inner peace and calm that may
for cancer survivors. This is in tune with the review by Levine and facilitate healing. It also enables the development of mindfulness
Balk that emphasised positive health benefits of Yoga in bringing of the ‘present moment’ thus potentiating self-control over one’s
about an optimisation of emotional functioning with decreased thoughts, feelings and actions [23]. A novel study by Kalyani et al.
anxiety and depression as well as enhanced cognitive functioning [36], studied hemodynamic correlates of ‘OM’ chanting and reported
during and after treatment of breast cancer [5]. They noted that that it produced limbic deactivation. They observed significant
“patients cite physical activity, breathing, meditation, and group deactivation bilaterally during ‘OM’ chanting in comparison
support as particularly helpful components of Yoga”. Another trial to the resting brain state in orbito-frontal, anterior cingulate,
showed that Cognitive Problems Scale scores were 23 % lower in parahippocampalgyri thalami and hippocampi. In addition the
Yoga participants than wait-list participants at 3-month follow- right amygdala demonstrated significant deactivation. The present
up [29]. Those who practiced Yoga more frequently were found to studyused healing mantras culled from different traditions and
report significantly fewer cognitive problems at 3-month follow-up it was noticed that, even those who did not usually like chanting,
than those who practiced less frequently. This is true of the present could not resist the beautiful music and Mantra intonations. In the
study too as improvements during the 3-week residential retreat third week emphasis was placed on chanting the Omkara as the
were sustained and enhanced in those who reported that they Pranava AUM has been found to be useful in stress management
continued the practices daily during the follow-up period. On the and relaxation [37].
other hand, significant reductions were seen in those who didn’t Cerebral blood flow changes have been studied during Kirtan
keep to the practices citing various personal and social issues for Kriya (a type of chanting meditation) that has been shown to
not continuing their practice during follow up. Derry et al. [29], significantly increase regional cerebral blood flow (rCBF) in the
concluded that “Yoga can effectively reduce breast cancer survivors’ right temporal lobe and posterior cingulate gyrus, while significantly
cognitive complaints” and suggested further research on mind-body reducing rCBF in the left parietotemporal and occipital gyri [16].
and physical activity interventions for improving cancer-related This may be an important contributing factor to the changes in
cognitive problems. Similarly notable cognitive improvements our participants as it has been suggested that “meditation has
were reported by Vadiraja [21,22] and Culos-Reed et al. [11] who the capacity for intentionally changing both the architecture and
reported decreased cognitive disorganization and confusion in function of the human brain” [37]. It has also been reported that
participants of Yoga programs. Galantino and colleagues went on to Kirtan Kriya improves cognitive functioning and lowers levels of
even suggest that “Yoga as a mind-body intervention may stave off depressive symptoms while increasing telomerase activity thus
chemotherapy-related cognitive impact” [30]. suggesting potential delaying of the stress-induced cellular aging
These psychological changes may also be linked to changes at [39]. Detailed qualitative analysis of participant feedback during
the molecular level as evidenced by Banerjee et al. [31] who studied follow up period revealed that significant changes continued to
effects of an integrated Yoga program in 68 patients of breast cancer manifest at follow up in 10 participants who followed the practices
who were undergoing radiotherapy. Yoga group showed significant for a minimum of 1-2hours/ 3-6 days / weekly after going back
decreases in HADS scores, whereas control group displayed home. In five participants who stopped doing the practices, positive
increases. Mean PSS decreased in Yoga group, whereas control changes obtained during the intensive retreat were lost and in
group had no change and the post radiotherapy DNA damage was two cases parameters worsened due to social, health and family
less in Yoga group when compared to control. tensions that prevented them from continuing a home practice.
This qualitative finding serves to reiterate an important point that
It has been suggested that Yoga may have a role in managing the benefits of Yoga will only manifest when we do the practices
psychological stress and modulating circadian patterns of stress and such benefits will only continue to manifest as long as we do
hormones in patients with breast cancer and Vadiraja et al. [21] the practices. It is quite evident that such benefits will be lost over
reported marked decreases in anxiety and morning salivary cortisol a period of time if the participant stops doing the practices, as
in those receiving Yoga instruction compared with controls. It has
evidenced in the follow up data.
been suggested that Yoga practices could reduce pro-inflammatory
cytokine and increase anti-inflammatory cytokine and this Healthy life can be considered as a by-product of practicing
beneficial effect has been primarily attributed to reductions in yogic techniques since it has been observed that Yoga practitioners
the stress levels [32,33]. A randomized controlled 3-month trial are physically and mentally healthier and have better coping
with 200 breast cancer survivors by Kiecolt-Glaser JK et al. [34] skills to stressors than the normal population [40]. Knowledge of
reported that “Yoga practice substantially reduced fatigue and inexpensive, effective and easily administrable yogic techniques by
health professionals will go a long way in helping us achieve the 2. Cancer survivors: Managing your emotions after cancer treatment. Mayo
goal of the World Health Organisation to provide “physical, mental, Clinic Staff. [Cited 2016 Sep 09]; Available from: www.mayoclinic.org/
spiritual and social health” for all sections of human society. Yoga diseases-conditions/cancer/in-depth/cancer-survivor/art-20047129.
and other eastern mind-body techniques bring about better neuro- 3. Patient and Caregiver Resources. The National Comprehensive Cancer
effector communication, improve strength, and enhance optimum Network (NCCN). [Cited 2016 Sep 09]; Available from: www.nccn.org/
functioning of all organ-systems while increasing resistance against patients/resources/life_after_cancer.
stress and diseases with resultant tranquillity, balance, positive 4. Shaw G. Breast cancer survivors: life after the treatments end. [Cited
attitude and equanimity [40]. 2016 Apr 04]. Available from: www.webmd.com/breast-cancer/guide/
life-after-breast-cancer-treatment.
It is worth mentioning the feedback received from a doctor who
had referred one of the participants who showed great improvement 5. Levine AS, Balk JL. Yoga and quality-of-life improvement in patients with
during the retreat but died of his cancer related complications four breast cancer: A literature review. Int J Yoga Therap. 2012;(22):95-9.
weeks after the retreat. “You have given him the best present he 6. Bower JE, Woolery A, Sternlieb B, Garet D. Yoga for cancer patients and
could get at the end of his life” said he. “You have enabled him to survivors. Cancer control. 2005;12(3):165-71.
leave his body in a much better state of mind and spirit than would
7. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress
have happened if he had not attended your retreat. Therapy is not
reduction in relation to quality of life, mood, symptoms of stress,
just about curing people of their illnesses, but in such terminal and immune parameters in breast and prostate cancer outpatients.
illnesses is more importantly about helping them endure it and die Psychosom Med. 2003;65(4):571-81.
with peace, courage and dignity”.
8. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress
Conclusion reduction in relation to quality of life, mood, symptoms of stress and levels
of cortisol, dehydroepiandrosteronesulfate (DHEAS) and melatonin in
This is a short report on the psychological effects of a three breast and prostate cancer outpatients. Psychoneuroendocrinology.
week intensive Yogic retreat for cancer survivors and is limited 2004;29(4):448-74.
by the lack of a control group and was limited to only the use of 9. Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A.
different questionnaires. However, our preliminary results indicate Psychological adjustment and sleep quality in a randomized trial of the
that such a Yoga based program has beneficial psychological effects effects of a Tibetan Yoga intervention in patients with lymphoma. Cancer.
for those recovering from cancer and anti-cancer therapies. One of 2004;100(10):2253-60.
the biggest benefits of the program is actually the empowerment
10. Coker KH. Meditation and prostate cancer: integrating a mind/
of the participants who are given tools to regain control over their body intervention with traditional therapies. Semin Urol Oncol.
health and wellbeing. Many of them arrive with long drawn faces, 1999;17(2):111-8.
and are often beset with immense pain and suffering. During the
retreat their faces slowly start to light up, their moods change, their 11. Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study
of Yoga for breast cancer survivors: physical and psychological benefits.
friendships become stronger and their outlook on life becomes Psychooncology. 2006;15(10):891-7.
more optimistic. They leave as different people with new, health
enhancing attitudes and often values. These changes are maintained 12. Harder H, Parlour L, Jenkins V. Randomized controlled trials of Yoga
in those who continue the practices even at three months of follow interventions for women with breast cancer: a systematic literature
review. Support Care Cancer. 2012;20(12):3055-64. doi: 10.1007/
up but are lost slowly and steadily in those who discontinue them.
s00520-012-1611-8.
Even then, the parameters at three months follow up are still quite
positive as compared to the pre-retreat values. More rigorous 13. Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body
and randomized controlled studies are required to validate these medical therapies. J Gen Intern Med. 2004;19(1):43-50.
results in the future. 14. Zhang J, Yang KH, Tian JH, Wang CM. Effects of yoga on psychologic
function and quality of life in women with breast cancer: a meta-
Acknowledgments analysis of randomized controlled trials. J Altern Complement Med.
2012;18(11):994-1002. doi: 10.1089/acm.2011.0514.
The authors thank the management of Kaivalyadhama Yoga
Institute and, especially, Swami Maheshananda for sparking the idea 15. Majewski L, Bhavanani AB. A novel rejuvenation program for cancer
and supporting this intensive retreat for Cancer Patients. They are patients at Kaivalyadhama, India. Yoga-Mimaṃsa. 2014;46(1):20-24.
grateful to Shri OP Tiwari for his constant motivation and supportive 16. Khalsa DS, Amen D, Hanks C, Money N, Newberg A. Cerebral blood
guidance. They also thank all the participants for their whole hearted flow changes during chanting meditation. Nucl Med Commun.
cooperation during the intensive. A thank is also for all faculty and 2009;30(12):956-61. doi: 10.1097/MNM.0b013e32832fa26c.
staff members of Kaivalyadhama, especially Dr SD Bhalekar for their
17. Al-Azri M, Al-Awisi H, Al-Moundhri M. Coping with a diagnosis of breast
cooperative support throughout the intensive retreat. We thank Dr G cancer-literature review and implications for developing countries.
Ezhumalai, Senior Statistician and Research Consultant of Sri Balaji Breast J. 2009;15(6):615-22. doi: 10.1111/j.1524-4741.2009.00812.x.
Vidyapeeth for assistance in data analysis. This multi-institutional
collaboration would not have been possible but for the signing of 18. Landmark BT, Bohler A, Loberg K, Wahl AK. Women with newly
diagnosed breast cancer and their perceptions of needs in a health-
a historic MoU between Sri Balaji Vidyapeeth, Pondicherry and
care context. J Clin Nurs. 2008;17(7B):192-200. doi: 10.1111/j.1365-
Kaivalyadhama Yoga Institute, Lonavla, Maharashtra in January 2016 2702.2008.02340.x.
that brought together one of the oldest Yoga institutions of India
with a pioneering modern medical institution, a Deemed University 19. Nosarti C, Roberts JV, Crayford T, McKenzie K, David AS. Early
accredited with A Grade by the NAAC. psychological adjustment in breast cancer patients: a prospective study.
J Psychosom Res. 2002;53(6):1123-30.
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34. Kiecolt-Glaser JK, Bennett JM, Andridge R, Peng J, Shapiro CL, Malarkey
24. Taylor MJ. What is Yoga Therapy? An IAYT definition. Yoga Therapy in WB, et al. Yoga’s impact on inflammation, mood, and fatigue in
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26. Nyenhuis DL, Yamamoto C, Luchetta T, Terrien A, Parmentier A. Adult
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*Corresponding author: Ananda Balayogi Bhavanani, Centre for Yoga Therapy, Education and Research (CYTER), Sri Balaji Vidyapeeth, Pillayarkuppam,
Pondicherry- 607403, India; E-mail: yoga@mgmcri.ac.in.
Received Date: November 15, 2016, Accepted Date: December 21, 2016, Published Date: December 28, 2016.
Copyright: © 2016 Bhavanani AB, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Citation: Bhavanani AB, Majewski L, Tiwari S (2016) Effects of an Intensive 3-Week Yoga Retreat on Sense of Well Being in Cancer Survivors. J Alt Med
Res 2(2): 116.
RESEARCH ARTICLE
Comparative study on the effect of yogic relaxing asanas and pranayamas
on cardiovascular response in healthy young volunteers
Vasanthan S1, Madanmohan T1, Bhavanani A B2, Hanifah M3, Jaiganesh K1

1
Department of Physiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India, 2Deputy Director
of Center for Yoga Therapy Education and Research, Sri Balaji Vidyapeeth, Puducherry, India, 3Department of Medicine, Mahatma Gandhi
Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India
Correspondence to: Vasanthan S, E-mail: svasanthphysio@gmail.com
Received: August 06, 2016; Accepted: August 18, 2016
ABSTRACT
Background: Cardiovascular morbidity is increasing recently in India. Stress and autonomic dysfunction are associated
with cardiovascular morbidity. Yoga is the best lifestyle ever designed. Based on limited scientific research, yoga
(meditation, asanas, and pranayamas including relaxation) therapy is known to improve cardiovascular autonomic functions.
Aims and Objective: To study and compare the effect of 6 months of training in relaxing asanas and pranayamas on
blood pressure (BP), pulse pressure (PP), heart rate (HR), and rate-pressure product (RPP) in young healthy volunteers.
Materials and Methods: A total of 109 healthy volunteers aged 20-25 years were divided into 3 groups consisting of
asan (n = 38), pranayam (n = 38), and control group (n = 33). The Yoga training was given 25 min/day for 6 days/week
for 6 months. Pranayam group received relaxing pranayam (pranav, savitri, nadi shuddhi and chandra nadi), asan group
received relaxing asan (pawanmuktasana, balasan, dharnicasan, and shavasan) and waiting list were kept as a control group.
The results were statistically compared between groups by analysis of variance and intra-group pre-post comparisons
by paired t-test. Results: Post training analysis showed significant decreases in systolic BP and diastolic BP as well as
PP, mean arterial pressure and RPP in both asan and pranayam group as compared with control. There was, however,
no significant difference between asan and pranayam group. Conclusion: Practising either relaxing asan or pranayam
enhances parasympathetic activity and decreases sympathetic activity.
KEY WORDS: Pranayam; Asan; Blood Pressure
INTRODUCTION of stress and stress related disorders such as hypertension and

diabetic mellitus. Yoga practitioners are physically and mentally
Yoga is the best lifestyle ever designed by our ancient India healthier and have better capability to cope up the stress than the
culture, an eternal gift to the world, achieves the union of our normal population. Among the eight-fold path of Astanga Yoga,
mind, body and soul. The term “yoga” derived from the Sanskrit asan (firm and comfortable postures) and pranayam (slow,
root “Yuj” which means union. Modern lifestyle is a challenge deep, conscious, rhythmic breathing) are mainly practiced
by many people and also it is given as yoga therapy. Stress
Access this article online and autonomic dysfunction associated with cardiovascular
Website: www.njppp.com Quick Response code morbidity are seen as upward trend in India in recent years.
Based on scientific research, yoga (meditation, asanas, and
pranayamas including relaxation), therapy is known to improve
DOI: 10.5455/njppp.2017.7.0824018082016 cardiovascular autonomic functions and reduces stress. Yoga
has a role in prevention, management, and rehabilitation
in stress-induced lifestyle disorder like hypertension.[1-3]
National Journal of Physiology, Pharmacy and Pharmacology Online 2016. © 2016 Vasanthan S et al. This is an Open Access article distributed under the terms of the Creative Commons
Attribution 4.0 International License (http://creative commons.org/licenses/by/4.0/), allowing third partiesto copy and redistribute the materialin any medium or for mat and to remix,
transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
1 National Journal of Physiology, Pharmacy and Pharmacology 2017 | Vol 7 | Issue 1 (Online First)
Vasanthan et al. Yogic relaxing asanas and pranayamas on cardiovascular response
Pranayam and asan reduce basal sympathetic tone and enhance Table 1: Group 1-pranayam training protocol
basal parasympathetic tone while reducing rate-pressure
Name of pranayams Repetition Duration (min)
product (RPP).[4] A combined protocol of pranayam and
Prayer 5 5
asan improves cardiovagal activity[5,6] and decreases systolic
Pranav 5 5
blood pressure (SBP), diastolic BP (DBP), and pulse pressure
(PP).[7-10] Minimum of 3 months practice of pranayam improves Savitri 5 5
autonomic functions.[11] Practicing uijayi pranayama and Nadi shuddhi 5 5
shavasan for 6 weeks decrease heart rate (HR), SBP, DBP, PP, Chandra nadi 5 5
mean arterial pressure (MAP), and RPP.[12] 5 min of bhramari Total 25
pranayam has been shown to decrease SBP, DBP, MAP, and
HR.[13] Alternate nostril breathing (naadishudhi) improves
parasympathetic activity.[14,15] Adhomukhasvanasana decreases Table 2: Group 2 - Asan training protocol
BP, body mass index, and HR.[16] Suchitra et al. found that a Name of asanas Repetition Duration (min)
set of asan decreases BP and improves exercise tolerance.[17] Prayer 5 5
However comparative study on asan and pranayam has not been Pawanmuktasana 5 5
reported in world literature, thereby this study seems to be the Balasan 5 5
first of its kind to be reported in literature. Moreover in our busy Dharmikasan 5 5
lifestyle, practicing asan requires time, space, and comfortable Shavasan 5 5
clothes. It is practically difficult to practice asan by old aged
Total 25
people, physically challenged, and bed-ridden patients. Thus, to
overcome these practical difficulties, this study was planned to
compare the effect of 6 months training in asan and pranayam The average of 3 trials with 5 min interval were taken for
on cardiovascular parameters. our calculation. PP was determined by PP = SBP-DBP.
MAP and RPP were determined using respective formulae,
MAP = DBP + (PP/3); RRP = (HR x SBP)/100. All the
MATERIALS AND METHODS above-mentioned parameters were recorded before and after
6 months of yoga training program.
Before commencement of the study, approval from Institute
Research Committee and Institute Human Ethical Committee
approval was obtained. Statistical Analysis
After obtaining the study data, it was statistically analyzed
A total number of 120 subjects aged between 20 and 25 years using SPSS version 16.0. All data passed normality testing
were selected through Centre for Yoga Therapy Education by Kolmogorov-Smirnov test and hence further analysis was
and Research in Sri Balaji Vidyapeeth, Puducherry, and an done between groups using one-way analysis of variance
informed consent obtained from them. They were randomly (ANOVA) and using Students paired t-test for intra-group
divided into three Groups: Group 1 received pranayam (pranav, pre-post comparisons.
savitri, nadi shuddhi and chandra nadi), Group 2 received asan
(pawanmuktasana, balasan, dharmikasan and shavasan), and
Group 3 was wait listed as a control. Two subjects dropped out RESULTS
from Group 1, two from Group 2, and seven from Group 3.
Pranayam and asan techniques were taught to the respective The results are given in Table 3. Relaxing pranayam and asan
groups for 3 days, and they were familiarized with the resulted in significant decreases in resting HR and PP (P < 0.05),
techniques and made comfortable to the yoga training hall SBP and MAP (P < 0.01), and DBP and RPP (P < 0.001) after
atmosphere. Yoga training protocol for each group is given training. The means of pre and post training values of all groups
in Tables 1 and 2. A total of 25 min training program was were compared by one-way ANOVA. There were no significant
given to each group for 6 days a week for 6 months under our differences between groups at pre training. Post training
supervision. During this period, waiting list control group was comparison showed significant differences in HR (P < 0.05),
given study time for group discussion on academic activities. SBP and MAP (P < 0.01), DBP, PP and RPP (P < 0.001) for
the means of both pranayam and asan to control group after
Subjects were explained about the method of recording training. However, there were no significant differences
and were familiarized with the laboratory environment. between pranayam and asan group after yoga training.
Recordings were obtained between 8 AM and 10 AM without
any stimulants in pre-recording period. The laboratory DISCUSSION
temperature was maintained at comfortable level for the
subject. After 15 min of rest in supine, SBP and DBP were In this study, it was found that 6 months of either pranayam
obtained from the subjects using sphygmomanometer. or asan training decreases HR, SBP, DBP, PP, MAP, and
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Table 3: Effect of 6 months of pranayamas and asanas training on HR, SBP, DBP, PP, MAP and RPP
Parameters Pranayam Asan Control
Pre Post Pre Post Pre Post
HR (bpm) 77.88±5.8 74.13±3.6*# 78.62±5.9 73.71±6.3*# 79.54±10.7 77.84±11.5
SBP (mmHg) 118.9±4.8 112.79±5.9**## 115.34±4.2 112.79±5.4**## 116.3±6.8 116.67±5.9
DBP (mmHg) 72.59±2.0 69.68±3.4*** ###
73.14±2.6 69.51±2.4*** ###
72.63±3.0 72.31±3.0
PP (mmHg) 43.37±5.2 40.66±5.1*### 42.24±5.7 39.84±5.2*### 43.76±4.91 44.48±5.1
MAP (mmHg) 85.99±2.74 82.59±2.8** ##
87.18±2.9 82.70±2.7** ##
87.13±2.9 87.01±3.1
RRP (units) 90.24±7.5 83.63±6.4***### 90.69±7.6 83.02±6.99***### 92.52±6.5 90.83±6.5
Data are expressed as Mean±SD. *P<0.05, **P<0.01 and ***P<0.001, difference between pre and post training. P<0.05, P<0.01 and
# ##
###
P<0.001, difference between pranayam, asan and control by using one-way ANOVA. HR: Heart rate, SBP: Systolic blood pressure,
DBP: Diastolic blood pressure, PP: Pulse pressure, MAP: Mean arterial pressure, RPP: Rate-pressure product
RPP. Findings of this study are collaborated by reports where yoga has been shown to be an effective adjunct
from Streeter et al. who proposed that yoga may help therapy. These changes were attributed to a normalization of
to reduce allostatic load in stress response systems thus autonomic cardiovascular rhythms as a result of increased
restoring optimal homeostasis.[18] They hypothesized that vagal modulation and/or decreased sympathetic activity and
stress produces an imbalance of autonomic nervous system improved baroreflex sensitivity along with an augmentation
with decreased parasympathetic and increased sympathetic of endogenous nitric oxide production. The prolonged
activity. They also suggested that yoga may help correct such exhalation phase of pranava pranayam was hypothesized
parasympathetic under activity through stimulation of vagus to mimic Valsalva maneuver resulting in decreased venous
nerves as well as a reduction in allostatic load. Innes et al. have return, cardiac output and SBP. Pranayam has been shown to
also postulated two interconnected pathways through which decrease oxygen consumption as well as the basal metabolic
yoga may reduce cardiovascular and metabolic risk. They rate. Hence, the set of pranayam techniques used in this study
suggested that this was through parasympathetic activation may be a useful adjuvant to medical therapy in patients of
coupled with decreased reactivity of sympathoadrenal system hypertension and aid in cardiac rehabilitation post-myocardial
and hypothalomo-pituitary-adrenal axis.[19,20] infarction. Pranayam is relatively easier to perform than asan
and requires less space than asan that involves different body
The de-stressing effect of pranayam may be reducing postures requiring greater space for performance.
sympathetic arousal, resulting in lesser release of adrenaline,
thus bringing about a fall in HR and SBP as reported in the The strength of this study is the strict adherence to the practice
previous study.[21] Slow deep breathing stimulates stretch schedule and near perfect attendance by all subjects. The
receptors in the lungs that stimulate Hering-breuer inflation duration of the study as well as the regularity of the practice
reflex. This causes a withdrawal of sympathetic tone that make it stand out when compared to most yoga studies
in turn leads to vasodilation and reduced DBP.[12] One of where compliance is much lower. The study is limited to non
the more useful non-invasive methods of determining load invasive measurements of HR and BP and doesn’t allow for
on the heart is the RPP that is an indicator of myocardial ambulatory measurements that would be more accurate. As
oxygen consumption.[22,23] This was significantly reduced in other more exhaustive autonomic tests were not done exact
both the asan and pranayam groups. The slow and conscious mechanisms of action of yoga training is more hypothetical
performance of the relaxing asanas in our subjects may be and cannot be substantiated fully.
contributing to the cardiovascular changes evidenced this
study. The benefits of asan may be attributed to intra-thoracic
and intra-abdominal pressure changes that occur while CONCLUSION
performing these practices. The mechanisms for positive
changes may also be an improvement of baroreflex sensitivity This study offers further evidence of the cardiovascular
and attenuation of sympathetic and renin-angiotensin activity relaxation afforded by yoga. It also has studied the differential
following Yoga training.[8] It has been reported that yoga effects of asan and pranayam training and found that both
improves “heart friendly” status of lipid profile in peri and have similar beneficial effects as compared to a wait-listed
post-menopausal DM[24] and Damodaran et al.[9] suggested control group. This may be attributed to the enhancement of
that yoga can play an important role in risk modification for parasympathetic tone and reduction in sympathetic activity in
cardiovascular diseases. the autonomic nervous system. Pranayam is relatively easier
to perform and hence the findings of this study give us scope
Aseries of studies at Puducherry, India,[24,25-31] have documented for further research in clinical and geriatric population as
immediate effects of various pranayam in hypertension well as those who are physically challenged.
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16. Satyanarayana P, Benerji GV, Dulala RK, Meka FB,
How to cite this article: Vasanthan S, Madanmohan, Bhavanani AB,
Kummari NR. Effect of yoga on heart rate blood pressure,
Hanifah M, Jaiganesh K. Comparative study on the effect of yogic
body mass index. IOSR J Dent Med Sci. 2013;8(2):36-9.
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18. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP.
Source of Support: Nil, Conflict of Interest: None declared.
Effects of yoga on the autonomic nervous system,
Volume
2017 | Vol
2 | 7Issue
| Issue
4 | 1Sep-Oct
(Online2015
First) National Journal of Physiology, Pharmacy and Pharmacology 4
Original Article
Effect of a 12‑week yoga therapy program on mental health

status in elderly women inmates of a hospice
Meena Ramanathan, Ananda Balayogi Bhavanani, Madanmohan Trakroo1
Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth University, MGMCRI Campus, 1CYTER and Department of Physiology,
Sri Balaji Vidyapeeth University, MGMCRI Campus, Puducherry, India

Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth,
MGMCRI Campus, Pillayarkuppam, Puducherry ‑ 603 402, India.
E‑mail: yoga@mgmcri.ac.in
ABSTRACT
Aim and Objectives: This study was undertaken to evaluate the effectiveness of yoga on the mental health status of elderly
women inmates residing in a hospice in Puducherry.
Materials and Methods: Forty elderly women were randomly divided into yoga and wait‑listed control group. A yoga therapy
program of 60 min was given twice a week for 12 weeks. This protocol was specially designed for senior citizens, keeping in
mind their health status and physical limitations that included simple warm‑up and breath–body movement coordination practices
(jathis and kriyas), static stretching postures (asanas), breathing techniques (pranayamas), and relaxation. Hamilton anxiety
scale for measuring anxiety, Hamilton rating scale for depression, and Rosenberg self‑esteem scale to measure self‑esteem
were administered to both groups before and after the 12‑week study period. Data were assessed for normality, and appropriate
parametric and nonparametric statistical methods were applied for intra‑ and inter‑group comparisons.
Results: Overall, intra‑ and inter‑group comparison of prepost data showed statistically significant (P < 0.001) differences for
all three parameters. There was an overall improvement in the scores indicating decreased levels of depression and anxiety
coupled with an increase in the level of self‑esteem after the yoga therapy program.
Discussion: The influence of yoga in the reduction of depression and anxiety scores and improvement in self‑esteem
scores in elderly women subjects is evident from this study. As reported in earlier studies, this may be attributed to changes
in central neurotransmitters such as gamma‑aminobutyric‑acid coupled with increased parasympathetic tone and decreased
sympatho‑adrenal activity.
Conclusion: It is recommended that yoga should be a part of health‑care facilities for elderly as it can enhance the quality of
life by improving their overall mental health status. It could provide a healthy and positive alternative from depressing negative
thoughts, and give them a sense of purpose and hope.
Key words: Elderly; hospice; psychological wellbeing; yoga therapy.
INTRODUCTION According to the latest factsheet on depression from

the World Health Organization (WHO), it is estimated
Mental health problems such as depression, anxiety, that globally, 350 million people of all ages suffer from
and insomnia are among the most common reasons depression.[2] Depressive disorders now rank second in
for individuals to seek treatment with complementary terms of global disability burden according to a 2010 global
therapies, and yoga appears to be a promising intervention
as it is cost‑effective and easy to implement.[1]
This is an open access article distributed under the terms of the Creative
Access this article online Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
Quick Response Code others to remix, tweak, and build upon the work non‑commercially, as long as the
Website: author is credited and the new creations are licensed under the identical terms.
www.ijoy.org.in
For reprints contact: reprints@medknow.com
DOI: How to cite this article: Ramanathan M, Bhavanani AB, Trakroo M.

10.4103/0973-6131.186156 Effect of a 12-week yoga therapy program on mental health status in
elderly women inmates of a hospice. Int J Yoga 2017;10:24-8.
24 © 2017 International Journal of Yoga | Published by Wolters Kluwer - Medknow

Ramanathan, et al.: Yoga on mental health in elderly women
burden of disease (GBD) study. Previous GBD studies in take part and after obtaining informed consent from them,
2000 and 1990 had ranked depression as third and fourth, prerecording of psychological parameters was done using
respectively.[3] respective questionnaires.
Yoga has consistently yielded encouraging results in Forty female subjects were randomly divided into yoga
the treatment of generalized anxiety disorder and panic and control groups of 20 each by block randomization
disorder and has also been shown to be effective in with block sizes of 4 each. Mean age of the subjects in
improving mood, decreasing symptoms of depression and experimental group was 68.90 ± 7.55 years and that of the
trait anxiety in young and old patients.[4] Physical activity wait‑listed control group was 68.20 ± 8.78 years.
has powerful mood‑boosting effects and research suggests
that it may be just as effective as antidepressants in Individual health records of each participant were
relieving mental conditions without adverse side effects.[5‑7] maintained at the hospice with regular check‑up at the
local Government Hospital. Three of them reported normal
According to Hathapradipika, a traditional text on yoga, health status, whereas others reported that they were on
yoga can be done by people of any age and physical regular treatment for one or more medical conditions such
condition with beneficial results occurring from dedicated as hypertension (21), hypothyroidism (3), type 2 diabetes
efforts (yuvavrddho ativrddho va vyadhito durbalo api va mellitus (19), knee pain (4), low back pain (11), asthma
abhyasat siddhimapnoti sarvayogesvatandrita).[8] (5), dyslipidemia (9), and insomnia (12). None of the
participants were receiving any specific medical treatment
Javnbakht et al. evaluated the influence of yoga in relieving for either depression or anxiety as such.
symptoms of depression and anxiety in women and found
a significant reduction in perceived levels of anxiety.[9] The yoga group subjects underwent group yoga therapy
Joshi and De Sousa have also emphasized the benefits of sessions of 60 min, twice weekly for a period of 12 weeks
incorporating yoga practice in the management of anxiety conducted in the hospice. The wait‑listed control subjects
and depressive disorders.[10] did not receive yoga therapy and continued their normal
routine activities in the hospice. Since all subjects were
During literature review, it was noticed that there are not inmates of the hospice, they all had a similar routine with
many relevant qualitative research reports of the effect of regard to their day‑to‑day activities.
yoga in elderly female population. As the WHO factsheet
stated that more women are affected by depression than Baseline assessments were done prior to starting the yoga
men and that exercise programs for elderly can also be program and after the completion of the 12 weeks of
effective in depression prevention, the present study was therapy. Assessments were carried out by administering
planned in elderly women of a hospice.[1] A previous study Hamilton Anxiety Rating Scale (HAM-A), Hamilton
by Ramanathan and Bhavanani assessed psycho‑physical Depression Rating Scale (HAM-D), and Rosenberg
health status of elderly women residing in the same hospice self‑esteem scale (RSES) to measure self‑esteem.
in Puducherry and found that majority of them lacked
adequate psychological health and were on borderline The HAM‑A questionnaire scale consists of 14 items, and
regarding physical health status.[11] The deterioration of measures both psychic anxiety and somatic anxiety.[12]
psychological health was more pronounced than physical Subjects were instructed to select one of the five responses
health. for each of the 14 questions that is then scored on a scale
of 0 (not present) to 4 (severe), with a total score range of
With the above considerations in mind, the present 0–56, where <17 indicates mild severity, 18–24 indicates
randomized controlled trial was planned to determine mild to moderate severity, and 25–30 indicates moderate
the efficacy of yoga in modifying depression, anxiety, and to severe.
self‑esteem that influences mental health status of the
elderly female inmates residing in a hospice. HAM‑D scale has 21 items, of which 8 items are scored
on a five‑point scale ranging from 0 to 4 (0 – absent;
MATERIALS AND METHODS 1 – mild; 2 – moderate; 3 – severe; and 4 – very severe)
and 9 items are scored on a scale ranging from 0 to 2
After obtaining ethical clearance from Institutional Human (0 – absent; 1 – mild; and 2 – definite).[13] The last four
Ethics Committee of Mahatma Gandhi Medical College and items are not scored. Scores between 0 and 7 indicate no
Research Institute, the authors approached the authorities depression, between 8 and 13 indicate mild depression,
and inmates of Hospice Convent Home for the Aged, between 14 and 18 indicate moderate depression, between
Congregation of Saint Joseph of Cluny, Puducherry, to 19 and 22 indicate severe depression, and scores equal to
conduct the proposed study. They willingly volunteered to or over 23 indicate very severe depression.
International Journal of Yoga • Vol. 10 • Jan-Apr-2017 25

The RSES scale has 10 items and is a Likert‑type scale respectively. For data that did not pass normality testing,
with items answered on a four‑point scale from strongly Wilcoxon matched‑pairs signed‑ranks test was used
agree to strongly disagree. Five items have positively for intragroup comparison and Mann–Whitney test for
worded statements and five have negatively worded ones. intergroup comparison. P <0.05 was accepted as indicating
The scale ranges from 0 to 30, and scores between 15 and significant differences between compared data.
25 are considered to be within normal range whereas scores
below 15 suggest low self‑esteem.[14] RESULTS
Randomization and analysis were done by one investigator The results are given in Table 2. Overall, intra‑ and
while training was given by another to avoid bias. inter‑group comparison of prepost data showed statistically
Psychological assessment was done by a clinical significant (P < 0.001) differences for all the three
psychologist with a team of assistants. A senior statistician parameters. No significant change was observed in the
of the university aided in data analysis. control subjects.
Participants practiced a yoga therapy protocol that DISCUSSION

was specially designed for senior citizens, keeping in
mind their health status and physical limitations. This Chen et al. developed a yoga program (Silver Yoga)
protocol used routinely, at the Centre for Yoga Therapy, for institutionalized older adults in Taiwan and tested
Education, and Research (CYTER) and at the Advanced it in cluster randomized studies. [16,17] They reported
CYTER (ACYTER) in JIPMER, included simple warm‑up that yoga improved flexibility, walking speed, sleep
and breath–body movement coordination practices (jathis quality, depression, and quality of life (QOL) among
and kriyas), static stretching postures (asanas), breathing yoga participants. It was recommended that such a
techniques (pranayamas), and relaxation. The complete program should be incorporated as an activity program
protocol is given in Table 1. in assisted living facilities to promote the physical fitness
of transitional frail elders. Another recent study of the
The program was conducted in a group setting as it benefits of yoga in lower‑income older adults reported
has been previously reported that group mindfulness positive changes in pain frequency, functional status,
meditation training program can effectively reduce the depression, fatigue, and health‑related QOL.[18]
symptoms of anxiety and panic.[15] Further, the authors
have found in earlier work that the elderly participants In line with the earlier studies mentioned above, results
enjoy a feel of companionship and comparative assessment of the present study re‑iterate the efficacy of yoga in
that manifests in group sessions. Such experiences are enhancing QOL in elderly women. Yoga is a conventional
perceived to be lacking during individual therapy sessions. long‑established, time‑tested art and therapeutic science
that contributes positively to the maintenance of health,
Data entry was done and assessed for normality happiness, and general wellbeing. The influence and
using GraphPad InStat version 3.06 for Windows the efficacy of yoga therapy in reducing the levels of
95 (GraphPad Software, San Diego California USA, www. depression and anxiety and improving self‑esteem scores
graphpad.com). In data that passed normality testing by in elderly women are documented by our results.
Kolmogorov–Smirnov Test, Student’s paired and unpaired
t‑tests were used for intra‑ and inter‑group comparisons, The finding of lower psychological health status in our
subjects with depression, anxiety, and low self‑esteem
Table 1: Components of yoga therapy program may be correlated to their being in a hospice away from
Jathis and Kriyas (warm up techniques) the family. This may be the cause of inadequate state of
Standing asanas psychological health that may be the first evidence of
Tala asana further worsening of physical health in near future.
Ardhakati chakra asana
Kati chakra asana
Sitting asanas An earlier report by Bhavanani et al. reported healthy
Vakra asana improvements in cardiovascular parameters and indices
Paschimottana asana in geriatric subjects following a single yoga session.[19] This
Purvottana asana
was attributed to enhanced harmony of cardiac autonomic
Pranayamas
Chandra nadi function facilitated by co‑ordinated breath–body work
Vyagraha and mind–body relaxation in the yoga session. The
Pranava yoga therapy protocol applied in the present study is of
Relaxation in Shava asana similar nature and thus may be producing the manifesting
26 International Journal of Yoga • Vol. 10 • Jan-Apr-2017

Table 2: Depression, anxiety, and self‑esteem scores in geriatric women at the beginning (B) and after (A) the 12‑week
study period in control and yoga groups with intergroup comparisons
Control group (n=20) Yoga group (n=20) Intergroup comparison (P)
B A B A B A
Depression 19.5 (17-33) 20.5 (16-35) 17.5 (14-37) 15 (7-22)*** 0.12 0.0006
Anxiety (somatic) 14.5 (14-15) 14 (13-15) 15 (14-15) 10.5 (3-13)*** 0.59 <0.0001
Anxiety (psychic) 15 (14-15) 15 (13-15) 15 (14-15) 11 (9-12)*** 0.40 <0.0001
Anxiety (total) 29.5 (28-30) 29 (26-30) 30 (29-30) 21 (12-25)*** 0.33 <0.0001
Self‑esteem 6.30±1.13 7.10±1.25 6.75±1.33 23.20±1.24*** 0.256 <0.0001
Values are given as median (range) for data not passing normality (depression and anxiety). ***P<0.001 by Wilcoxon matched‑pairs signed‑ranks test for intragroup
comparison. Actual P values are given for intergroup comparison by Mann–Whitney U‑test in the last column. Values are given as mean±SD for data passing
normality (self‑esteem). ***P<0.001 by Student’s paired t‑test for intragroup comparison. Actual P values are given for intergroup comparison by Student’s unpaired
t‑test in the last column. SD = Standard deviation
psychological changes through similar mechanisms. This positive outlook toward the end of the study period. This
is supported by a previous report that yogic practices may be attributed to a modulation of the stress response
enhance body flexibility, promote and improve respiratory systems by a reduction in perceived stress and anxiety,
and cardiovascular function, promote recovery from which in turn, decreases physiological arousal.[26] This is
addiction, reduce stress, anxiety, depression, and chronic further supported by the finding of enhanced self‑esteem
pain, improve sleep pattern, and enhance overall wellbeing in our yoga group at the end of the program. Enhanced
and QOL.[20] self‑esteem gives an optimistic outlook toward life and
further enables one to face the challenges of life more
Imbalances of important neurotransmitters are implicated efficiently and effectively. This, in turn, leads to a decrease
in depression, and researchers have shown that of anxiety and depression resulting in a positive spiral of
hormones directly affect brain chemistry that in turn healthy thought, word, and action.
influence emotions and mood.[21] Previous studies have
suggested a close association between increased thalamic Although a wide range of different therapeutic approaches
gamma‑aminobutyric‑acid levels as well as increased are available for the management of anxiety and depressive
parasympathetic activity (enhanced vagal tone) with disorders, complementary therapies such as yoga are
improvements in mood and decreased anxiety. [22,23] unique as they attempt to address the root cause of
Similar inherent “self‑healing” mechanisms may have problems and are not merely limited to symptomatic
been brought into play through the practices done in management. Further, yoga offers a healthy philosophy that
our yoga therapy program. This may have resulted in the enhances the whole perspective of life, is cost effective,
present subjects’ self‑reported sense of “feeling” better that and produces beneficial effects without any unwanted
enhanced their self‑esteem, and consequently manifested side effects.
through reductions in both anxiety and depression.
The present study is limited by the smaller sample size
Relaxation was an important component of this program, and the fact that the protocol was not validated by external
and brief periods of relaxation were given between experts though it was being used extensively at CYTER
the practice of different techniques. At the end of the and earlier at ACYTER in JIPMER, Puducherry. It was also
session, a 15 min period of relaxation was given in limited to a single center and used only questionnaires.
shavasana with simple breath awareness. This may Further, multicentric studies that explore functional
be contributing to enhanced autonomic balance by changes in the nervous system with correlations between
increasing parasympathetic drive while simultaneously such changes, psychological variables, and biochemical
reducing sympatho‑adrenal over activity. The resultant markers may deepen our understanding of intrinsic
calming effect on the stress response system could bring mechanisms by which these positive psychological changes
down the levels of anxiety and relieve depression as are occurring in yoga therapy programs. This would help
suggested by earlier reports on Sudarshan Kriya yoga and strengthen our conclusion about the psycho‑physiological
Vipassana meditation.[24] These postulates are supported by benefits of yoga in a geriatric population.
previous evidence that integrated yoga practice produces
multi‑dimensional, immediate benefits on physical and
CONCLUSION
mental health by homeostatic regulation of hypothalamic–
pituitary–adrenal axis and sympathetic nervous system.[25] This study offers evidence of yoga’s potential as a
complementary and adjunct therapy in the integrative,
It is also important to state the changes in attitude brought holistic management of elderly with depressive and
about by the yoga program as all participants reported that anxiety symptoms who were living in a hospice. It is
they “felt” better, were more energized, and had a more an attractive option because it is nonpharmacological,
International Journal of Yoga • Vol. 10 • Jan-Apr-2017 27

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moods on treatment outcome. Evid Based Complement Alternat Med comparison studies. J Altern Complement Med 2010;16:3‑12.
2007;4:493‑502. 26. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga
2. World Health Organisation Fact Sheet on Depression. Fact Sheet No. 369; on the autonomic nervous system, gamma‑aminobutyric‑acid, and allostasis
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fs369/en. [Last accessed on 2015 Dec 19]. 2012;78:571‑9.
28 International Journal of Yoga • Vol. 10 • Jan-Apr-2017

ejpmr, 2017,4(1), 256-262 SJIF Impact Factor 3.628
Review Article
Bhavanani et al. EUROPEAN JOURNAL OF PHARMACEUTICAL
European Journal of Pharmaceutical and Medical Research
AND MEDICAL RESEARCH ISSN 2394-3211
www.ejpmr.com EJPMR
UNDERSTANDING HOW YOGA WORKS: A SHORT REVIEW OF FINDINGS FROM

CYTER, PONDICHERRY, INDIA.
Meena Ramanathan1 and Ananda Balayogi Bhavanani2*

1
Coordinator, Yoga Therapist, CYTER, SBV, Puducherry.
2
Deputy Director, CYTER, SBV, Puducherry.
*Corresponding Author: Dr. Ananda Balayogi Bhavanani

Article Received on 03/11/2016 Article Revised on 24/11/2016 Article Accepted on 14/12/2016
ABSTRACT
The Centre for Yoga Therapy Education and Research (CYTER) has been functioning at Mahatma Gandhi Medical
College and Research Institute (MGMCR & RI) under the auspices of the Faculty of Allied Health Sciences of Sri
Balaji Vidyapeeth, Puducherry, for the past six years (2010-2016). More than 30,000 patients have benefited from
Yoga therapy consultations and have attended individual and group therapy sessions at CYTER. Numerous
research projects are being conducted as collaborative efforts between CYTER and various departments of
MGMCRI, as well as KGNC and CIDRF. This review summarizes some of the important findings from 14
research works done at CYTER and published between 2010 and 2016. These studies provide preliminary evidence
of the therapeutic potential of Yoga and induce further studies exploring physiological, psychological and
biochemical mechanisms as well as beneficial clinical effects.
KEYWORDS: CYTER, MGMCRI, KGNC and CIDRF.
INTRODUCTION relatively low-risk, high-yield approach to improving

Integrative medicine is gaining in popularity and yoga overall health and wellbeing.[4, 5, 6]
has the potential to make a significant contribution. The
art and science of yoga has been practised for thousands The Centre for Yoga Therapy Education and Research
of years. Yoga is a popular means of relieving stress and (CYTER) has been functioning at Mahatma Gandhi
improving fitness as it decreases stress and anxiety and Medical College and Research Institute (MGMCR & RI)
improves health status. The application of Yoga as a under the auspices of the Faculty of Allied Health
therapy is simple and inexpensive and can be easily Sciences of Sri Balaji Vidyapeeth, Puducherry, for the
adopted in most patients without any complications.[1] past six years (2010-2016). More than 30,000 patients
Yoga is qualitatively different from other modes of have benefited from Yoga therapy consultations and
physical activity as it has a unique combination of have attended individual and group therapy sessions at
isometric muscular contractions, stretching exercises, CYTER. Numerous research projects are being
relaxation techniques, and breathing exercises. It must be conducted as collaborative efforts between CYTER and
emphasized that Yoga therapy or more correctly Yoga the Departments of Physiology, Medicine, Neurology,
Chikitsa, encompasses the use of asana, pranayama and Nephrology, Ophthalmology, Psychiatry, Anaesthesia
relaxation techniques along with dietary advice and and Biochemistry as well as KGNC and CIDRF. This
Yogic counseling that address the root cause of the paper summarizes some of the important findings from
problem rather than merely providing symptomatic 14 research works done at CYTER and published
relief[2] Yoga may be considered the original mind-body between 2010 and 2016. These studies provide
medicine; its philosophy and practice are highly effective preliminary evidence of the therapeutic potential of Yoga
in producing psycho-somatic and somato-psychic re- and induce further studies exploring physiological,
integration. Yoga improves mood and reduces stress by psychological and biochemical mechanisms as well as
emphasizing every-moment body awareness involving beneficial clinical effects.
attentional focus on one‟s breathing, emotions, thoughts
or specific parts of the body.[3] The practice of yoga has REVIEW OF SELECTED STUDIES
been shown to have preventive, curative as well as Study 1: Immediate effects of suryanamaskar on
rehabilitative potential that can be explained on the basis reaction time and heart rate in female volunteers[7]
of modulation of autonomic functions, stress reduction, Suryanamaskar (SN), a yogic technique is composed of
improvement in physiological functions and enhanced dynamic muscular movements synchronised with deep
quality of life. It has become quite apparent that yoga is a rhythmic breathing. As it may have influence on CNS,
www.ejpmr.com 256
Bhavanani et al. European Journal of Pharmaceutical and Medical Research
this study planned to investigate immediate effects of SN attributed to enhanced harmony of cardiac autonomic
on reaction time (RT) and heart rate (HR). 21 female function as a result of coordinated breath-body work and
volunteers attending yoga classes were recruited for mind-body relaxation due to yoga.
study group and 19 female volunteers not participating in
yoga were recruited as external-controls. HR, auditory Study 3: Hematological, biochemical and
reaction time (ART) and visual reaction time (VRT) psychological effects of a yoga training programme in
were recorded before and after three rounds of SN in nursing students.[9]
study group as well as 5 minutes of quiet sitting in both We were granted the opportunity to impart a 6 month
groups. Performance of SN produced immediate comprehensive course of yoga training for nursing
decrease in both VRT and ART (P<0.001). This was students. The aim of this study was to analyse the effects
significant when compared to self-control period of the training on the participants´ health and quality of
(P<0.001) and compared to external control group, it life (QoL). 60 healthy nursing students (12 M, 48 F)
decreased significantly in ART (p=0.02). This was aged 18.60 ± 0.67 (SD) y were recruited, and 60 min of
pronounced when Δ% was compared between groups yoga training was given twice weekly, for 6 months.
(P<0.001). HR increased significantly following SN Selected biochemical and hematological parameters were
compared with both self-control (p=0.025) and external- recorded along with Ferrans and Powers QoL index
control group (p=0.032). Faster reactivity may be due to before and after the training period. QoL was also tested
intermediate level of arousal by conscious at mid term. Because we were not able to establish a
synchronisation of dynamic movements with breathing. separate control group, we correlated changes with the
Rise in HR is attributed to sympathetic arousal and subjects´ frequency of attendance. Post-intervention
muscular exertion. We suggest that SN may be used as statistical analysis (repeated measures of ANOVA)
an effective training means to improve neuro-muscular revealed highly significant and beneficial changes in
abilities. most hematological and biochemical parameters. Major
findings are enhanced bone marrow function, reduced
Study 2: Immediate cardiovascular effects of a single allergic tendency, alkalization of urine, metabolic
yoga session in different conditions.[8] reconditioning (with special emphasis on liver function)
This retrospective review of clinical data was done to and improvement in all QoL indices. These changes
determine cardiovascular effects of a single yoga session correlated positively with the subjects´ frequency of
in normal subjects as well as patients of different medical attendance, as evidenced by Pearson‟s linear correlation
conditions. Data of 1896 patients (1229 female, 633 male testing. There were also significant improvements in
and 34 transgender) with mean age of 36.28 ± 12.64 y QoL index and its subscales, both at mid training and
who attended yoga therapy sessions at CYTER between post training. These improvements also correlated
November 2010 and September 2012 was used for positively with attendance. The present study provides
analysis. Heart rate (HR), systolic (SP) and diastolic evidence of the beneficial psychological and physical
pressure (DP) had been recorded using non-invasive effects of yoga training amongst graduate nursing course
blood pressure (NIBP) apparatus before and after 60 students. We suggest that yoga be made an integral part
minute yoga sessions at CYTER and indices like pulse of medical and paramedical collegiate education.
pressure (PP), mean pressure (MP), rate-pressure product
(RPP) and double product (DoP) were derived from Study 4: Differential effects of uninostril and
recorded parameters. Participants were undergoing alternate nostril pranayamas on cardiovascular
appropriate yoga therapy protocols as per their individual parameters and reaction time.[10]
condition while normal subjects had a general schedule Recent studies have reported the differential
of practice. Typical yoga sessions included simple warm physiological and psychological effects of yogic
ups (jathis and suryanamaskar), breath body movement uninostril breathing (UNB) and alternate nostril
coordination practices (kriyas), static stretching postures breathing (ANB) techniques. This study aims to
(asana), breathing techniques (pranayama), relaxation determine differential effects of these techniques on
and chanting. There were statistically significant reaction time (RT), heart rate (HR), and blood pressure
(p<0.001) reductions in all the studied cardiovascular (BP). Twenty yoga‑trained subjects came to the lab on
parameters following the yoga session. The magnitude of six different days and RT, HR, and BP were recorded
reductions differed in the groups, it being more randomly before and after nine rounds of right UNB
significant in those having hypertension (n=505) and less (surya nadi [SN]), left UNB (chandra nadi [CN]), right
significant in those having endocrine/skin (n=230) and initiated ANB (surya bhedana [SB]), left initiated ANB
musculoskeletal (n=120) conditions. It was moderately (chandra bhedana [CB]), nadi shuddhi (NS), and normal
significant in the normal subjects (n=582) as well as breathing (NB). Overall comparison of Δ % changes
patients having psychiatric (n=302) and respiratory showed statistically significant differences between
(n=157) conditions. There is a healthy reduction in HR, groups for all parameters. There was an overall reduction
BP and derived cardiovascular indices following a single in HR‑ and BP‑based parameters following CB, CN,
yoga session. The magnitude of this reduction depends and NS with concurrent increases following SB and SN.
on the pre-existing medical condition as well as the yoga The differential effects of right nostril initiated (SB and
therapy protocol adopted. These changes may be SN) and left nostril initiated (CB, CN, and NS) UNB and
www.ejpmr.com 257
ANB techniques were clearly evidenced. Changes Study 6: Immediate effect of chandra and suryanadi
following NB were insignificant in all respects. The pranayamas on cardiovascular parameters and
overall comparison of Δ % changes for RT showed reaction time in a geriatric population.[12]
statistically significant differences between groups that Previous studies have reported differential physiological
were significantly lowered following both SB and SN. and psychological effects of exclusive right and left
Our study provides evidence of sympathomimetic effects nostril breathing. Though potential health benefits have
of right nostril initiated pranayamas with been postulated, further clinical research is required to
sympatholytic/parasympathomimetic effect following prove immediate and sustained efficacy of these
left nostril initiated pranayamas. We suggest that the techniques. This study evaluated immediate effects of
main effect of UNB and ANB techniques is determined exclusive right (SNP) and left (CNP) nostril breathing on
by the nostril used for inspiration rather than that used cardiovascular (CV) parameters and reaction time (RT)
for expiration. We conclude that right and left yogic in a geriatric population. 26 subjects attending regular
UNB and ANB techniques have differential yoga sessions at a senior citizen hospice were recruited
physiological effects that are in tune with the traditional for this self-controlled study. They were instructed to sit
swara yoga concept that air flow through right nostril in any comfortable posture and relax for 5 min before
(SN and pingala swara) is activatory in nature, whereas taking the pre-intervention recordings of Heart rate (HR),
the flow through left nostril (CN and ida swara) is blood pressure (BP), auditory and visual RT (ART and
relaxatory. VRT respectively). They then performed the selected
technique and parameters were recorded immediately
Study 5: Immediate effect of alternate nostril after performance of 9 rounds of either SNP or CNP. The
breathing on cardiovascular parameters and reaction entire sequence of recordings was randomised to avoid
time.[11] any bias. Intra and inter group statistical analysis was
This study evaluated immediate effects of 27 rounds of carried out using Student's paired t test for data that
left nostril initiated alternate nostril breathing (ANB) passed normality testing and Wilcoxon matched-pairs
technique of nadi shuddi (NS) and right nostril initiated signed-ranks test applied for the others. Overall intra-
ANB of aloma viloma (AV) pranayama on group comparison of pre-post data and inter-group Δ %
cardiovascular (CV) parameters and reaction time (RT) comparisons showed statistically significant (p < 0.05)
in a trained population. 16 subjects attending regular differences for all parameters. There was an overall
yoga sessions were recruited and each subject performed reduction in HR and BP based parameters following both
27 rounds of either technique, selected randomly on SNP and CNP. However, inter-group Δ % comparisons
different days. Heart rate (HR), systolic pressure (SP), revealed a significantly greater reduction after CNP for
diastolic pressure (DP), auditory and visual reaction time all parameters. Inter-group comparisons revealed highly
(ART and VRT) were recorded before and after significant decreases (p < 0.001) in VRT and ART after
pranayamas. NS was done by breathing in through left SNP. In conclusion, our study sheds new light on the
nostril and out through right followed by breathing in physiological changes occurring after SNP and CNP in a
through right and out through left. AV was done by geriatric population. While both techniques reduce HR
breathing in through right nostril and out through left and BP, CNP does it more significantly. There is
followed by breathing in through left and out through shortening of RT following SNP and this may be
right. All data passed normality testing and statistical attributed to enhance sensory motor function that is of
analysis was carried out using Student‟s paired t test. great significance in the elderly. We suggest that Yoga
HR, SP and DP reduced significantly (p < 0.05 to 0.001) should be part of the heath care facilities for the elderly
after NS while they increased after AV. Post intervention as it can enhance their quality of life and improve their
differences as well as Δ% between groups was overall health status.
significant (p < 0.05 to 0.001) for HR, SP and DP. ART
and VRT were significantly (p < 0.05 to 0.001) shortened Study 7: Comparative immediate effect of different
after AV and significantly prolonged after NS. Post yoga asanas on heart rate and blood pressure in
intervention differences as well as Δ% between groups healthy young volunteers.[13]
was very significant (p < 0.001) for both ART and VRT. This study planned to compare immediate cardiovascular
Significant reductions of HR, SP and DP after NS and effects of different yoga asanas in healthy young
their increase after AV may be attributed to modulation volunteers. Heart rate (HR), systolic pressure (SP), and
of autonomic tone. Right nostril initiated ANB technique diastolic pressure (DP), blood pressure (BP), were
produces autonomic arousal, whereas left nostril initiated recorded using the non invasive blood pressure ( NIBP)
ANB technique induces relaxation/balance. These can be apparatus in 22 healthy young subjects, before and after
selectively applied in various therapeutic settings. the performance of Dhanurasana (DA), Vakrasana (VA)
Further studies in various clinical conditions and settings (both sides), Janusirasasana (JSA) (both sides),
can enable us to understand their therapeutic applications Matsyasana and Shavasana for 30 s. HR and BP were
better. further recorded during supine recovery at 2, 4, 6, 8, and
10 min. A repeated measure of ANOVA was used for
statistical analysis. There were significant changes in HR
and BP both immediately after the Asanas as well as
www.ejpmr.com 258
during the recovery period. Overall comparisons of Δ% indicating significant differences for pre-post
changes immediately after the performance of the Asanas comparisons. All parameters witnessed a reduction
revealed significant differences with regard to HR that following the single session. This was statistically more
increased significantly after DA. In the recovery phase, significant (P < 0. 0001) in HR, RPP and DoP while it
there were significant intergroup differences from 2 min was also significant (P < 0.01 and P < 0.05) in SP and
onward in both SP and DP. The decrease of SP after VA PP, respectively. The decrease in MP just missed
(right side) (VA‑R) was significantly greater than significance (P = 0.054) while it was not significant in
Shavasana (4th, 6th, and 8th min) and JSA (left side) DP. There is a healthy reduction in HR, BP and derived
(JSA‑L) at 6th and 8th min. DP decreased significantly cardiovascular indices following a single yoga session in
after performing JSA‑L compared to VA‑R at the 6th geriatric subjects. These changes may be attributed to
and 8th min. The cardiovascular changes immediately enhanced harmony of cardiac autonomic function as a
after the Asanas and during the recovery phase reveal result of coordinated breath-body work and mind-body
inherent differences between the selected postures. The relaxation due to an integrated “Silver Yoga” program.
rise of HR in DA may be attributed to increased
sympathetic response due to the relative difficulty of the Study 9: Effects of a single session of yogic relaxation
posture as well as abdominal compression occurring in it. on cardiovascular parameters in a transgender
The effect of supine relaxation is more pronounced after population[15]
the performance of the Asanas as compared to mere This pilot study was done to determine effects of a single
relaxation in Shavasana. This may be attributed to a session of yogic relaxation on cardiovascular parameters
normalization and resultant homeostatic effect occurring in a transgender population. Heart rate (HR) and blood
pressure (BP) measurements were recorded in 106
due to a greater, healthier de‑activation of the autonomic
transgender participants (mean age of 23.86 ± 7.87 y) a�
nervous system occurring towing to the presence of prior
ending a yogic relaxation program at CYTER,
activation. There were also subtle differences between
MGMCRI. Participants practised a series of techniques
the right sided and left sided performance of VA and
consisting of quiet sitting, om chanting, mukha bhastrika,
JSA that may be occurring due to the different internal
nadi shuddhi, brahma mudra, pranava pranayama in
structures being either compressed or relaxed on either
sitting posture and savitri pranayama in shavasana. HR,
side. Our study provides initial evidence of differential
systolic (SP) and diastolic pressure (DP) were recorded
cardiovascular effects of Asanas and subtle differences
before and after the 60 minute session using non-
between right and left sided performance. Further,
invasive blood pressure (NIBP) apparatus. Pulse pressure
cardiovascular recovery is greater after the performance
(PP), mean pressure (MP), rate-pressure product (RPP)
of the Asanas as compared to shavasan; thus, implying a
and double product (DoP) indices were derived from
better response when effort precedes relaxation.
recorded parameters. Student‟s paired t test was used to
compare data that passed normality testing and Wilcoxon
Study 8: Single session of integrated ‘silver yoga’
matched pairs signed-ranks test for others. P values less
program improves cardiovascular parameters in
than 0.05 were accepted as indicating significant
senior citizens.[14]
differences for pre-post comparisons. All recorded
This pilot study was carried out to determine
cardiovascular parameters witnessed a reduction
cardiovascular effects of a single session of an integrated
following the session. This was statistically more
“silver yoga” program in senior citizens of Serene
significant (p < 0. 0001) in HR, MP, RPP and DoP and
Pelican Township, Pondicherry. Heart rate (HR) and
significant (p = 0.002) in SP. There is a healthy reduction
blood pressure (BP) measurements were recorded in 124
in HR, BP and derived cardiovascular indices following
senior citizens (75 female, 49 male) with mean age of
a single yogic relaxation session in a transgender
67.19 ± 10.61 year who attended an integrated “Silver
population. These changes may be attributed to enhanced
Yoga” program at Centre for Yoga Therapy, Education
harmony of cardiac autonomic function as a result of
and Research from August to October 2014. Participants
mind-body relaxation program. It is suggested that an
practiced the protocol that was specially designed for
open and non-hostile environment is conducive for
senior citizens, keeping in mind their health status and
obtaining such a state of psychosomatic relaxation and
physical limitations. This included simple warm-ups
that such opportunities for transgender participants
(jathis), breath body movement coordination practices
should be created in all healthcare facilities.
(kriyas), static stretching postures (asanas), breathing
techniques (pranayamas), relaxation and simple chanting.
Study 10: Health status of elderly women residing in
Non-invasive BP apparatus was used to record the HR,
a hospice in Pondicherry.[16]
systolic (SP) and diastolic pressure (DP) before and after
With advancing age, the body tends to slow down and
the 60 min sessions. Pulse pressure (PP), mean pressure
becomes less efficient and elderly people are prone to a
(MP), rate-pressure product (RPP) and double product
few age-related health issues. The present study was
(DoP) indices were derived from the recorded
undertaken to assess psycho- physical health status of
parameters. Student‟s paired t-test was used to compare
elderly women residing in a hospice in Pondicherry.
data that passed normality testing by Kolmogorov–
After an introductory orientation program, thirty women
Smirnov Test and Wilcoxon matched-pairs signed-ranks
with mean age 68.67 ± 7.83 yrs, agreed to be subjects
test for those that did not. P < 0.05 were accepted as
www.ejpmr.com 259
and after obtaining informed consent, various parameters Study 12: A brief qualitative survey on the utilization
was recorded. Selected cardiovascular variables such as of Yoga research resources by Yoga teachers.[18]
heart rate (HR), systolic pressure (SP) and diastolic Yoga has become popular worldwide with increasing
pressure (DP) and respiratory rate (RR) were measured. research done on its therapeutic potential. However, it
Pulmonary function tests (PFT) were done using remains to be determined whether such findings actually
spirometer and reaction time (RT) measured using RT percolate down into teaching and practice of Yoga
apparatus. Select psychological variables including teachers/therapists. The aim of this survey was to
depression, anxiety and self-esteem were assessed using document awareness of Yoga research findings in the
Hamilton Depression Rating Scale, Hamilton Anxiety Yoga community and find out how these were utilized. It
Rating Scale and Rosenberg Self- Esteem scale was undertaken with a select group of 34 international
respectively. We found HR, SP, DP values were as Yoga teachers and therapists utilizing email and social
expected for age and gender and our subjects performed media between August and December 2015. Majority of
better on PFT and RT as compared to earlier studies in responders had well-established reputation in Yoga and
similar groups. However our subjects had lower were from diverse lineages with 30 of them having more
psychological health status with increased depression, than 5 years of experience in the field. A set of eight
anxiety and lower self-esteem. This may be due to being questions were sent to them related to essentiality of
in hospice away from family who either do not want Yoga research, how they updated themselves on research
them or are not there at all. Though physical health status findings and whether such studies influenced their
seems satisfactory for age, this finding of inadequate teaching and practice. Responses were compiled and
psychological health function may be first evidence of appropriate statistics determined for quantitative aspects
worsening physical health in future. We suggest that while feedback, comments and suggestions were noted in
older people must be acknowledged as integral members detail. About 89% agreed that it was essential to be up-
of society and provided opportunities to enjoy good to-date on Yoga research but only 70% updated
quality of life and easy access to health services. There is themselves regularly with average papers read fully per
great scope for incorporation of traditional health year being <10. Most accessed information through
practices such as Yoga and other CAM modalities. general news reports, emails from contacts, and articles
on internet sites whereas only 7% were through PubMed.
Study 11: Effect of different pranayamas on About 60% felt these studies helped them in general
respiratory sinus arrhythmia.[17] teaching whereas 20% said that such studies had not
Respiratory Sinus Arrhythmia (RSA) is the differential really influenced it in any way. This survey provides a
change of Heart Rate (HR) in response to inspiration and basic picture of a general lack of awareness of Yoga
expiration. This is a non-invasive sensitive index of research amongst practicing Yoga teachers and
parasympathetic cardiac control. To evaluate changes in therapists. Though a majority agree research is
RSA by utilizing a simple and cost-effective analysis of important, few seriously update themselves on this
electrocardiographic (ECG) tracings obtained during through scientific channels. With regard to future studies,
performance of four pranayama techniques. Fifty two most wanted “proof” that could be used to convince
trained volunteers performed the following pranayamas potential clients and felt that more qualitative methods
with different ratios for inspiration and expiration: sukha should be applied.
(1:1), traditional (1:2), pranava (1:3) and savitri (2:1:2:1)
and ECG was recorded while performing the techniques Study 13: Comparative study on the effect of yogic
with rest period of 5 minutes in-between. HR was relaxing asanas and pranayamas on cardiovascular
calculated and maximum HR during inspiration (Imax), response in healthy young volunteers.[19]
minimum HR during expiration (Emin), differences Cardiovascular morbidity is increasing recently in India.
between Imax and Emin (Δ), percentage differences Stress and autonomic dysfunction are associated with
between Imax and Emin (Δ%) and expiration: cardiovascular morbidity. Yoga is the best lifestyle ever
inspiration ratio (E:I) calculated by respective formulae. designed. Based on limited scientific research, yoga
Statistical analysis was carried out using repeated (meditation, asanas, and pranayamas including
measures of ANOVA with Tukey-Kramer multiple relaxation) therapy is known to improve cardiovascular
comparisons test. There were significant differences autonomic functions. To study and compare the effect of
between groups in all five aspects namely: p= 0.0093 for 6 months of training in relaxing asanas and pranayamas
mean Imax, p = 0.0009 for mean Emin, and p < 0.0001 on blood pressure (BP), pulse pressure (PP), heart rate
for Δ HR (I-E), Δ% HR (I-E) and E:I ratio. Pranava (HR), and rate-pressure product (RPP) in young healthy
pranayama produced the greatest changes in all five volunteers. A total of 109 healthy volunteers aged 20-25
comparisons. We suggest that further short and long term years were divided into 3 groups consisting of asan (n =
studies be undertaken with pranava pranayama in 38), pranayam (n = 38), and control group (n = 33). The
patients to further qualitatively and quantitatively Yoga training was given 25 min/day for 6 days/week for
evaluate inherent mechanisms of this simple technique. 6 months. Pranayam group received relaxing pranayam
Addition of these cost-effective techniques to the (pranav, savitri, nadi shuddhi and chandra nadi), asan
medical armoury will help patients of rhythm disorders group received relaxing asan (pawanmuktasana, balasan,
and other cardiovascular conditions. dharmicasan, and shavasan) and waiting list were kept as
www.ejpmr.com 260
a control group. The results were statistically compared physiological, psychological and biochemical
between groups by analysis of variance and intra-group mechanisms behind such beneficial effects. The strength
pre-post comparisons by paired t-test. Post training of our work is the excellent compliance of our patients in
analysis showed significant decreases in systolic BP and addition to the fact that these studies were been done in
diastolic BP as well as PP, mean arterial pressure and actual patient populations as well as in normal subjects
RPP in both asan and pranayam group as compared with and other sectors of people such as the transgender and
control. There was, however, no significant difference the geriatric populations too. We also suggest that yoga
between asan and pranayam group. Practising either be made an integral part of medical and paramedical
relaxing asan or pranayam enhances parasympathetic collegiate education as there is great scope for
activity and decreases sympathetic activity. incorporation of yoga and other CAM modalities.
Study 14: Effect of a 12 Week Yoga Therapy ACKNOWLEDGEMENTS

Program on Mental Health Status in Elderly Women The authors thank the benevolent management and
Inmates of a Hospice[20] visionary administrators of Sri Balaji Vidyapeeth
This study was undertaken to evaluate the effectiveness University for setting up the Centre for Yoga Therapy,
of yoga on the mental health status of elderly women Education and Research (CYTER) in Mahatma Gandhi
inmates residing in a hospice in Puducherry. Forty Medical College and Research Institute (MGMCRI). We
elderly women were randomly divided into yoga and thank our Chairman, Chancellor, Vice-chancellor, Dean
wait-listed control group. A yoga therapy program of 60 of Research & Allied Health Sciences and Registrar SBV
min was given twice a week for 12 weeks. This protocol for their constant support encouragement at every step.
was specially designed for senior citizens, keeping in We are grateful to Prof Madanmohan, Director CYTER
mind their health status and physical limitations that and Ammaji Yogacharini Meenakshi Devi Bhavanani,
included simple warm-up and breath-body movement Director ICYER for their constant motivation and
coordination practices (jathis and kriyas), static supportive guidance. The authors thank Prof AR
stretching postures (asanas), breathing techniques Srinivasan (Registrar SBV and Prof, Dept of
(pranayamas), and relaxation. Hamilton anxiety scale for Biochemistry), Dr K Jaiganesh (Prof, Dept of
measuring anxiety, Hamilton rating scale for depression, Physiology), Dr M Hanifah (Prof, General Medicine), Dr
and Rosenberg self-esteem scale to measure self-esteem Jenith Berlin Raj (Associate Professor, Dept of
were administered to both groups before and after the 12- Physiology), Sri S Vasanthan (Tutor, Dept of
week study period. Data were assessed for normality, Physiology), Dr R Balaji and Mrs D Pushpa of CYTER,
and appropriate parametric and nonparametric statistical Sri S Thirusangu (MSc student of KGNC) for their active
methods were applied for intra- and inter-group involvement in planning, conducting and reporting on
comparisons. Overall, intra- and inter-group comparison various studies. Thanks are due to the Lecturer of
of prepost data showed statistically significant (P < CYTER Sri G Dayanidy, Yoga instructors Mrs. M
0.001) differences for all three parameters. There was an Sangeetha, Mrs G Sarulatha, Mrs M Latha and Mr.
overall improvement in the scores indicating decreased Dhanushapnadeesh and ANM Ms Kavitha for
levels of depression and anxiety coupled with an increase conducting the therapy sessions and for their valuable
in the level of self-esteem after the yoga therapy assistance during recording sessions and data entry.
program. The influence of yoga in the reduction of
depression and anxiety scores and improvement in self- REFERENCES
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Int J Pharm Bio Sci 2017 Apr ; 8(2): (P) 71-76
Original Research Article Physiology
International Journal of Pharma and Bio Sciences ISSN

0975-6299
EFFECT OF YOGIC RELAXING ASANS AND PRANAYAMS ON HEART

RATE VARIABILITY AND PERCEIVED STRESS IN HEALTHY
YOUNG VOLUNTEERS - A COMPARATIVE STUDY
*1
VASANTHAN S , MADANMOHAN2, BHAVANANI AB3, HANIFAH M 4, JAIGANESH K5
1,2,5
Department of Physiology, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India.
3
Centre for Yoga Therapy, Education and Research (CYTER), Sri Balaji Vidyapeeth, Pondicherry, India.
4
Department of Medicine, Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India.
ABSTRACT
The present study offers evidence of the cardiovascular relaxation and harmonisation of the cardiac
autonomic tone through aspects of yoga such as asan and pranayam. A total of 109 healthy volunteers
aged 20-25 years were randomly divided into asan, pranayam and wait-listed group. Yoga training was
given 25 min/day for 6 days/week for 6 months, in which Pranayam group received relaxing pranayam,
asan group received relaxing asans and third group was wait list control group. Pre and post HRV results
of each group were statistically compared by paired ‘t’ test and between the group was compared by
One-way ANOVA. Pre-post analysis revealed that High frequency (HF) significantly increased (p<0.05)
and Low frequency component (LF), LF/HF ratio, PSS significantly decreased (p<0.05) in asan and
pranayam group but no significant difference was found in control group (p>0.05). Inter group comparison
analysis by ANOVA revealed that LF, LF/HF ratio, PSS significantly decreased and HF significantly
increased in asan and pranayam group as compared to controls. There was no significant difference
between asan and pranayam groups.
KEYWORDS: Asana, pranayama, HRV, perceived stress, shavasan, salutogenesis
VASANTHAN S
Department of Physiology, Mahatma Gandhi Medical College & Research
Institute, Sri Balaji Vidyapeeth, Pondicherry, India.
Received on: 03-01-2017

Revised and Accepted on 22-02-2017
DOI: http://dx.doi.org/10.22376/ijpbs.2017.8.2.p71-76
This article can be downloaded from www.ijpbs.net

P-71
INTRODUCTION optimizes autonomic functions with reduction in stress.

Punitha et al found that twelve weeks of yoga therapy
Salutogenesis the term introduced by Antonovsky, reduced both systolic pressure (SP) and diastolic
which focuses primarily on the factors that promote the pressure (DP) in yoga group. Furthermore, yoga therapy
health rather than the usual focus on risk factors and increased the heart rate variability and vagal tone while
1
disease. It is concerned with relationship between reducing sympathetic tone in subjects with
11
health, stress and coping. Undoubtedly, yoga is the best hypertension. Raghuraj et al reported the comparative
lifestyle ever designed originated from ancient Indian effects of kapalabhati and nadi shuddhi thus becoming
culture promotes health and well being. Yoga
2 the first ones to use HRV analysis to differentiate effects
harmonizes mind and body and also reduces stress and of slow and fast pranayams and their effects on the
12
enhances relaxation, thereby contributing to autonomic nervous system (ANS). HRV was used to
salutogenesis. Change in the modern lifestyle increases analyses results of shavasan training in students by
the prevalence of stress induced hypertension in young Madanmohan et al and this was soon followed by
adult population in recent years. Yoga promotes another study discussing the correlation between short-
psychosomatic relaxation reduces the stress and term HRV indices and heart rate, blood pressure
decreases one’s perception of stress. Among the eight indices, pressor reactivity to isometric handgrip in
6,13
limbs of Ashtanga Yoga, asans (firm and comfortable healthy young male subjects.
postures) and pranayams (slow, deep, conscious,
rhythmic breathing) are practiced commonly and also MATERIALS AND METHODS
utilised in yoga therapy. Based on limited scientific
research, yoga (meditation, asans and pranayam) A prospective comparative Hospital based study was
including relaxation therapy is known to improve conducted in the Department of Medicine and Centre for
cardiovascular autonomic functions and stress. Yoga Yoga Therapy Education and Research of Sri Balaji
has a role in prevention, management and rehabilitation Vidyapeeth, Pondicherry. Considering the duration of
3-5
in stress induced lifestyle disorders like hypertension. study and persons visiting in past 2 years, a total
Heart rate variability (HRV) is non-invasive and well number of 120 subjects, aged between 20-25 years
established physiological parameter used to assess were selected through Centre for Yoga Therapy
sympathovagal balance, an index of cardiac autonomic Education and Research (CYTER) in Sri Balaji
14
function. HRV is quantified in two domains, namely Vidyapeeth, Pondicherry and informed consent obtained
time and frequency. Time domain measures include the from them. They were randomly divided into 3 groups:
assessment of variations, as done in statistics. Time Group I received pranayam (pranav, savitri, nadi
domain analysis is a simple method to quantify overall shuddhi and chandra nadi), Group II received asan
HRV whereas power spectral analysis provides a means (pawanmukthasan, balasan, dharmikasan and
of studying different mechanisms responsible for shavasan) and group III was wait listed as control. Two
6
variability in instantaneous heart rates. Finer aspects of subjects dropped out from group I, two from group II and
variations may not be appreciated in time domain and seven from group III. Pranayam and asan techniques
hence variations in the instantaneous HR can be were taught to the respective groups for 3 days and they
assessed spectrally using frequency domain analysis. were familiarized with the yoga techniques and made
An RR tachogram is plotted using RR intervals obtained comfortable to the yoga training hall atmosphere. A total
from a 5–10 min recording of lead II electrocardiography of 25 minutes training program was given to each group
(ECG). The RR tachogram is considered as a for 6 days a week for 6 months under our supervision.
nonperiodic signal, which is transformed to its frequency During this period wait list control group was given study
spectrum using Fast‑Fourier transformation (FFT) time for group discussion on academic activities. Ethical
14
algorithm or autoregressive modelling. The biggest permission to conduct study was obtained from Institute
advantage of this complex mathematical transformation Human Ethical Committee (IHEC) before
is that the distribution of magnitude of variations in commencement of the study.
different frequency bands corresponds to activity of
different physiological systems. Increase in HRV is Yoga training program
associated with decreased sympathetic and increased Relaxing pranayam training
vagal tone influence on the sino atrial (SA) node of • Pranav, savitri, nadi shuddhi and chandranadi
heart. Decreased HRV and sympathovagal balance pranayam were practised in an erect sitting position
have been reported to be associated with cardiovascular (vajrasan or sukhasan). Each pranayam technique
7,8
morbidity and mortalities. In yoga relaxation was practised six times interspersed with short
techniques, the sympathetic discharge is inhibited and periods of rest. All pranayam technique were
parasympathetic discharge is facilitated. Yoga practices characterised by slow, deep, rhythmic inspiration
including meditation, relaxation, yoga postures, using adham - lower chest breathing, madhyam -
breathing and integrated practices improves autonomic middle chest breathing and adhyam - upper chest
regulation and enhances vagal dominance as reflected breathing followed by controlled expiration in the
8
in HRV measures. In a recent study by Ramkumar et same order (adham-madhyam-adhyam).
al. it was reported that pre-hypertensive patients had • Pranava pranayam is slow, deep and rhythmic
10
decreased HRV values. A combined protocol of asan, breathing where emphasis is placed on making the
pranayam and meditation may increase all HRV sound AAA, UUU and MMM while breathing out for
measures except low frequency (LF), low frequency and duration of two to three times the duration of the
high frequency (HF) ratio (LF/HF) components where inhaled breath. It is a four part technique consisting
decreases provide evidence that yoga practice of adham Pranayam (lower chest breathing with the

P-72
sound of AAA), madhyam Pranayam (mid-chest the floor and visualize anything that they wish to
breathing with the sound of UUU), adhyam remember well such as study materials etc. When
Pranayam (upper chest breathing with the sound of ready they slowly lifted the head on an in breath
MMM) and then the union of the earlier three parts and came back to the vajrasan.
in a complete yogic breath known as mahat yoga • Shavasan was performed by the subjects while
pranayam with the sound of AAA, UUU and MMM. lying down supine on the ground with head and
• Savitri pranayam is a slow, deep and rhythmic body in a straight line and arms kept relaxed by the
breathing, each cycle having a ratio of 2:1:2:1 side with palms facing upwards. Feet were brought
between inspiration (purak), held-in breath together and then let to fall away into a ‘v’ shape
(kumbhak), expiration (rechak), and held out breath with the heels as close together as possible.
(shunyak) phases of the respiratory cycle. Count of Conscious relaxation was induced by tensing body
six was used for the inspiration and expiration, with parts (spanda) from tow to head with deep
a three count for the retained breaths (6x3x6x3). inspiration followed by relaxation (nishpanda) of the
• Nadi shuddi pranayam is slow, rhythmic, alternate same parts with prolonged expiration.
nostril breathing. One round consisted of inhaling
through left nostril, exhaling through right nostril Recording of heart rate variability (HRV)
and then repeating the same procedure from right HRV was recorded in research lab, Department of
to left nostril. Physiology, MGMCRI. Subjects were explained about
• Chandranadi pranayam is slow deep breathing with the method of recording ECG and were familiarized with
equal duration of inspiration and expiration and the laboratory environment. Recordings were obtained
performed exclusively through the left nostril. between 8 and 10 AM without any stimulants in pre-
recording period. The laboratory temperature was
Relaxing asan training maintained at comfortable level with subdued lighting.
• Each asan was practiced for three to five minutes Subjects were made in supine position on couch and
with interspersed rest between rounds. Emphasis allowed to relax for 10 min. Lead II ECG and respiration
was placed on moving body parts slowly with were recorded at the 500 samples per sec by using
conscious breathing in a mindful manner. INCO Polyrite-D for 5 min. R-R interval data were
• Pawanmuktasan was done from the supine extracted by RMS polyrite software, then HRV was
shavasan by bending the right leg at the knee while analyzed from R-R interval by Kubios HRV, version 2.0,
breathing in and simultaneously lifting head. After Department of Physics, University of Kuopio, Finland.
catching hold of the knee with the hands, the HRV data analysis and signal processing followed
subject tried to touch their knee to forehead. The guidelines defined by “Task Force of the European
position was held for a few seconds and then while Society of Cardiology and the North American Society of
14
breathing out the position was slowly released by Pacing and Electrophysiology”. Time domain
lowering the head and simultaneously bringing the components consisted mean HR, mean RR, standard
foot back to the ground. This was repeated three deviation of RR intervals (SDNN), square root of the
times and then after a short rest in shavasan was mean of the sum of the squares of differences between
performed on the left side. After a short relation in adjacent RR intervals (RMSSD), adjacent RR interval
shavasan the double legged differing more than 50 ms (NN50) and NN50 counts
dwipadpawanmuktaasan was done by bending and divided by all the RR intervals (pNN50). Frequency
lifting both knees while breathing in and brought the domain components consisted very low frequency (VLF)
knees as close to forehead as possible while component (0.003 to 0.04 Hz), low-frequency (LF)
simultaneously raising their head. This was held for component (0.04 to 0.15 Hz), and high-frequency (HF)
a few seconds and then while breathing out, the component (0.15 to 0.5 Hz) and LF/HF ratio; Low
head was lowered and simultaneously feet brought frequency power in normalized units (nu) (LF nu) = (LF x
back to the ground. This was repeated three times 100) / (TP–VLF), and similarly HF (nu) was calculated.
before relaxing in shavasan for a short while. HF, HF (nu), SDNN, RMSSD, NN50, and pNN50 reflect
• Balasan was done from the four footed cardiovagal tone; LF reflects both the sympathetic and
chatuspadasan by relaxing the elbows to the floor, parasympathetic tones; VLF component’s interpretation
and placing the chest flat down in between the is not clear, and it cannot be interpreted using short-
elbows. Once this position was attained, the head term HRV recordings; LF (nu) and HF (nu) represent a
was turned to face to the right side with the subject relative tone of sympathetic and parasympathetic
resting like a baby. They were instructed to breathe nervous system (PSNS).
deeply in and out three to six times while
concentrating the breath into the high lobes and Cohen’s Perceived Stress Scale (PSS) questionnaire
then turn the head to the left and repeat the Most widely used psychological questionnaire for
breathing in and out three to six times before subject’s perception of stress. A 10 item Cohen’s PSS
retracing step-by-step back to vajrasan. questionnaire were used to score feeling and thoughts
• Dharmikasan was performed from vajrasan by during last month in this study. All the questions were
slowly bending forward until the forehead touched explained to the subjects and requested to answer. PSS
the floor with nose between both knees. Arms were scores were obtained by reversing responses (e.g., 0 =
kept alongside the body with the hands catching 4, 1 = 3, 2 = 2, 3 = 1 & 4 = 0) to the four positively stated
hold of the heels and elbows kept on the floor in a items (items 4, 5, 7, & 8) and then summing across all
relaxed manner. The subjects were asked to scale items. A short 4 item scale is made from questions
concentrate on the point of the forehead touching 2, 4, 5 and 10 of the PSS 10 item scale.

P-73
STATISTICAL ANALYSIS increase (p<0.05) in Mean RR, RMSSD and HF,

(P<0.01) in SDNN, (P<0.001) in pNN50 after training.
Relaxing pranayam causes significant decrease (P<
Data obtained in our study are tabulated and statistical
0.01) in Mean HR, LF and LF/HF, (P<0.001) in PSS
analysis were done in Microsoft excel 2007, Pre and
after training. Relaxing asan causes significant decrease
post training of each group were statistically compared
(p<0.05) in LF, (P<0.01) in Mean HR, LF/HF and PSS
by paired ‘t’ test. The mean of all the groups before and
after training. There is no significant difference in control
after yoga training were compared by one way ANOVA.
group after training. The mean of all the groups before
The data were presented as Mean ± Standard deviation,
and after yoga training were compared by one way
P<0.05 was considered as statistical significance.
ANOVA. It was found that there was no significant
difference between pranayam, asan and control group
RESULTS before yoga training but there was significant increase
(P<0.05) in Mean RR and PSS(P<0.01) in SDNN,
Data is given in table:1. Pre and post training of each RMSSD, pNN50 and HF, significant decrease (P<0.05)
group were statistically compared by paired ‘t’ test. in Mean HR, (P<0.01) in LF and (P<0.001) in LF/HF.
Relaxing pranayam causes significant increase (P<0.05) Moreover we found that there is no significant difference
in RMSSD and HF, (P<0.01) in mean RR, SDNN and between pranayam and asan group after yoga training.
pNN50 after training. Relaxing asan causes significant
Table1
Effect of 6 month pranayam and asan training on heart rate
variability (HRV) and Perceived Stress Scale (PSS)
Pranayam Asan Control

Parameters
Pre Post Pre Post Pre Post
Mean RR 764.024±79 812.98±65.5**# 773.33±100.39 813.31±68.72*# 770.16±102.86 771.64±97.51
Mean HR 77.88±5.85 74.13±3.65**# 78.62±5.98 73.71±6.38**# 79.54±10.74 77.84±11.54
**##
SDNN 46.53±14.15 54.67±15.06 47.22±12.66 54.52±13.69**## 43.28±16.36 43.93±18.86
RMSSD 37.23±13.26 54.671±15.06*## 47.229±12.66 54.53±13.70*## 43.29±16.36 43.93±18.86
**##
pNN50 10.52±3.86 12.90±3.86 10.89±1.58 12.24±2.24***## 10.53±4.12 10.25±3.80
LF (ms2) 446.87±53.95 401.92±46.95**## 457.84±54.38 401.76±80.32*## 441.97±36.02 458.33±27.89
2 *## *##
HF (ms ) 195.94±70.28 234.07±69.23 204.84±43.96 229.89±58.79 211.75±64.67 192.09±61.42
LF/HF 2.49±0.96 1.89±0.63**### 2.30±0.79 1.86±0.65**### 2.37±0.94 2.59±0.80
LF (n.u) 69.20±8.14 63.75±7.00**### 67.84±8.15 63.62±6.57**### 76.61±8.85 69.95±8.10
**###
HF (n.u) 30.17±8.14 36.25±7.50 32.15±8.15 36.37±6.57**### 34.70±6.67 30.04±8.15
PSS 24.31±5.13 20.79±3.75***# 23.68±4.24 21.52±2.60**# 23.27±4.52 23.18±5.19
Data are expressed as Mean±SD. *P<0.05, **P<0.01 and ***P<0.001, difference between pre and post training.
#
P<0.05, ##P<0.01 and ###P<0.001, difference between pranayam, asan and control by using one-way ANOVA
DISCUSSION suggest excessive sympathetic and/or insufficient

parasympathetic tone that are, in turn, strong
In the present study, after six months of yoga training independent predictors of cardiovascular morbidity and
program, time domain measures such as mean RR, mortality. In contrast, high HRV and baroreflex
Mean HR, SDNN, RMSSD, pNN50 increased in both the sensitivity are generally considered to indicate good
pranayam and asan groups. Frequency domain cardiovagal adaptability and SVB, permitting greater
measures such as HF component increased while LF responsivity and sensitivity to changing environmental
15
and LF/HF ratio decreased in both pranayam and asan demands. Sympathetic and vagal output from the brain
groups, with no significant changes in control group. mainly occurs from the limbic‑hypothalamic‑medullary
This provides evidence that practicing yoga for six axis. Vasomotor center and vagal nuclei in the medulla
months improves cardiac autonomic functions while of brain are the sympathetic and parasympathetic
enhancing sympathovagal balance of the heart. The outflow nuclei respectively which are controlled by
post training shift of cardiac autonomic tone towards the anterior and posterior nuclei of hypothalamus.
parasympathetic in both asan and pranayam groups is Pranayam (Slow and deep breathing) through by lung
supported by an earlier review that identified 42 studies proprioceptors send impulses to
with over 85% of them offering some evidence that yoga limbic‑hypothalamic‑medullary to enhances the vagal
17
promotes a reduction in sympathetic activation, tone on heart rate. According to the hypothesis put
enhancement of cardiovagal function, and a shift in ANS forward by Jerath and colleagues voluntary slow deep
balance from primarily sympathetic to breathing functionally resets autonomic nervous system
15
parasympathetic. The increase in HRV power in both through stretch-induced inhibitory signals and
groups is an important finding that reflects the health hyperpolarization currents propagated through both
promoting benefits of yoga. This assumes significance neural and non-neural tissue synchronizing neural
18
when we realise that reduced HRV is a predictor of elements in heart, lungs, limbic system and cortex.
hypertension, development of diabetic neuropathy, They suggested that the stretching of lung tissue during
cerebrovascular disease, congestive heart failure, and such inspiration produces inhibitory signals by action of
lethal arrhythmic complications after an acute slowly adapting stretch receptors (SARs) and
16
myocardial infarction. Low HRV and baroreflex hyperpolarization current by action of fibroblasts. Both
sensitivity reflect impaired cardiovagal adaptability and the inhibitory impulses and the hyperpolarization

P-74
currents can synchronize neural elements leading to associated with a significant increase of cardiac vagal
23
modulation of nervous system and decreased metabolic modulation. In contrast, Chaya et al., reported that
activity indicative of a parasympathetic state. Our study subjects who had practiced yoga for a year had higher
gives evidence to support the above hypothesis as in resting sympathetic activity compared with controls as
both groups, breathing was done in a conscious manner evidenced by significantly higher LF power, lower HF
24
and with above tidal volume breathing. A recent study power and higher LF/HF ratio. Another randomized
reported that pranayama performed with differing ratios control trial in Brazil reported significant decreases in LF
of inspiration and expiration produce differential effects as well as LF/HF ratio following 4 months of respiratory
19 25
on HR and respiratory sinus arrhythmia (RSA). This yoga training. It has been suggested by Bhavanani that
was attributed to enhanced vagal activity due to knowledge of inexpensive, effective and easily
conscious changes in higher centers that override the administrable yogic techniques by health professionals
lower respiratory centre in the brain stem. Pranava will go a long way in helping us achieve the goal of the
pranayama produced greatest changes in HR, RSA and World Health Organisation to provide “physical, mental,
expiration to inspiration ratio (E:I). A recent randomized spiritual and social health” for all sections of human
26
controlled trial (RCT) by Sharma et al compared effects society. In the same review it was hypothesised that
of 12 weeks of thrice weekly training in fast and slow yoga and other eastern mind-body techniques bring
pranayama on perceived stress scale (PSS) and about better neuro-effector communication, improve
20
cardiovascular parameters. They reported significant strength, and enhance optimum functioning of all organ-
decrease in PSS scores in both groups and attributed it systems while increasing resistance against stress and
to reduction in stress due to better autonomic tone diseases with resultant tranquillity, balance, positive
26
(higher parasympathetic and lesser sympathetic tone). attitude and equanimity.
This may also be due to an internalisation that occurs
through the introspective performance of all yoga CONCLUSION
practices that enables the attainment of a more holistic
2
perspective towards life. This is substantiated by an Our present study offers evidence that practising yoga
Agency for Healthcare Research and such as pranayam and asan causes cardiovascular
Quality (AHRQ) report states that “Yoga helped reduce relaxation and harmonisation of the cardiac autonomic
stress” and reductions in perceived stress following tone. It also aimed to compare the differential effects of
yoga are reported to be as effective as therapies such asan and pranayam training but found that both
as relaxation, cognitive behavioral therapy and dance pranayam and asan training have similar beneficial
21
therapy. Streeter et al recently proposed a theory to effects as compared to a wait-listed control group. The
explain the benefits of Yoga practices in diverse, positive changes in HRV and PSS may be attributed to
frequently comorbid medical conditions based on the an enhancement of parasympathetic tone and reduction
concept that Yoga practices reduce allostatic load in in sympathetic activity with decreased perception of
stress response systems such that optimal homeostasis stress. Pranayam is relatively easier to perform and
22
is restored. They hypothesized that Yoga-based hence the findings of this study give us scope for further
practices correct under activity of the parasympathetic research in clinical situations where patients, geriatric
nervous system and GABA systems in part through population and the physically challenged may not be
stimulation of the vagus nerves, the main peripheral able to perform the asans but can do the pranayam.
pathway of the parasympathetic nervous system, and
reduce allostatic load. This has been the finding of our
study too as both the slow and fast pranayams are seen
CONFLICT OF INTEREST
to improve the cardiac autonomic tome with
Conflict of interest declared none.
parasympathetic balance. Khattab et al., have reported
that relaxation by yoga after 5 weeks of training is
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DOI: 10.1159/000479816 © 2017 The Author(s)
Received: March 9, 2017 Published by S. Karger AG, Basel
Accepted after revision: July 12, 2017 www.karger.com/imi
Published online: November 29, 2017
This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 Interna-
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tion for commercial purposes as well as any distribution of modified material requires written permission.
Review
Can Yoga-Based Diabetes Management

Studies Facilitate Integrative Medicine in
India? Current Status and Future Directions
Deepak Kumar Pal a Ashish Bhalla b Sridhar Bammidi a Shirley Telles c
Adarsh Kohli d Saurabh Kumar a Pooja Devi e Navneet Kaur f Kiran Sharma e
Raman Kumar e Neeru Malik g Vishakha Thakur a Garima Goswami Bhargava e
Atul Kumar Goyal a, h Geeta Devi i Shalini Chauhan e Gurpreet Singh j
Subzar Ahmad e Mamta Joshi k Sharmila Narwal e Kaushal Sharma a, l
Rahul Tyagi a Shweta Modgil a, m Parul Bali a, n Vinod Bhatt a Jagdeep Sharma o
Amit Singh o Jyoti Negi e Sasidharan K. Rajesh p Guruprasad Sharmaq
Purnandu Sharmar Ramphal Vatss R. Nagarathnao Ananda Balayogi Bhavananit
Krishna Manasa Burugupallio Rathinavelu Vetrivendanu H.R. Nagendrao
Akshay Ananda
a
Neuroscience Research Lab, Department of Neurology, PGIMER, and b Department
of Internal Medicine, PGIMER, Chandigarh, c Patanjali Research Foundation, Haridwar,
d Department of Psychiatry, PGIMER, Chandigarh, e Yoga Federation of India, Chandigarh,
f Department of Physical Education, Panjab University, g Dev Samaj College of Education,
h Department of Otolaryngology and Head Neck Surgery, PGIMER, and i Drug Addiction
Rehabilitation Centre, Chandigarh, j Art of Living Foundation, Bengaluru, k Department of

Public Administration, Panjab University, l Centre for Systems Biology and Bioinformatics,
Panjab University, Departments of m Zoology and n Biophysics, Panjab University,
Chandigarh, o Swami Vivekananda Yoga Anusandhana Samsthana, and p Division of Yoga
and Physical Sciences, S-VYASA, Bengaluru, q SDS Hira Nagar, Jammu, r Vishwa Yoga Bharti,
Sriganganagar, Rajasthan, s Brahman Sabha, HMT, Pinjore, t Center for Yoga Therapy,
Education and Research, SBVU, Pondicherry, and u Goverment Hospital Vembadithalam,
Tamilnadu, India
Keywords
Diabetes · Prediabetes · HbA1c · Yoga · Type 2 diabetes · Indian Diabetes Risk Score ·
Cognitive dysfunction
Abstract
Background: India is fast becoming the diabetic capital in the world according to a recent
report. Patients with diabetes are at increased risk of mortality due to diabetic complications,
which has enormous implications for the health budget. Objectives: The main objective of
this review is to provide an overview of the work carried out in the world, including modern
and traditional approaches for the prevention and management of diabetes and reducing the
Postgraduate Institute of Med. Education and Research
Akshay Anand, PhD

14.139.56.194 - 11/29/2017 8:44:37 AM
Neuroscience Research Lab

Department of Neurology
PGIMER, Chandigarh 160012 (India)
E-Mail akshay1anand @ rediffmail.com
Downloaded by:
Integr Med Int 2017;4:125–141 126
DOI: 10.1159/000479816 © 2017 The Author(s). Published by S. Karger AG, Basel
www.karger.com/imi
Pal et al.: Can Yoga-Based Diabetes Management Studies Facilitate Integrative
Medicine in India? Current Status and Future Directions
chances of onset of further complications via cost-effective lifestyle interventions and inte-
grative medicine. Material and Methods: We performed a literature search from various da-
tabases like PubMed, Scopus, Google scholar, etc., using the keywords diabetes, prediabetes,
MCI and prediabetes, diabetes and yoga, diabetes. Results: Upon reviewing the published
articles, it was noticed that one of the most neglected complications of diabetes, namely cog-
nitive dysfunction, which is characterized by a pattern of vascular dementia and Alzheimer
disease (AD), has been largely ignored, and there has been no large study investigating the
role of yoga intervention in diabetes and/or associated cognitive impairment. Conclusion:
The review article opens new paradigms for researchers to evaluate the connection between
diabetes and AD through a yoga-based national campaign on diabetes. This paves the way
towards the goal of integrative medicine. © 2017 The Author(s)
Published by S. Karger AG, Basel
Introduction
Diabetes mellitus (DM) is a metabolic disorder which affects and alters carbohydrate
metabolism leading to hyperglycemia. In the hyperglycemic condition, there is deficiency of
insulin production (type 1 diabetes, T1DM) or improper action of insulin (type 2 diabetes,
T2DM) from islets of Langerhans (β-cells) of the pancreas along with the altered counter
mechanism in response to insulin secretion. The risk for developing DM increases with age,
sedentary lifestyle, obesity-promoting environment, energy imbalance, and also with the
onset of obesity that may impact brain health during the progression of the disease; its onset
may convert a healthy (normal) person to the intermediate stage, i.e. prediabetes mellitus
(PreDM) with the propensity to develop DM. PreDM is one of the leading causes of the
increased prevalence of DM around the world. The PreDM condition is the reflection of
impaired glucose tolerance (IGT) measured as postprandial blood sugar (PPBS [140–199
mg/dL]). Another parameter, which also signifies PreDM, is impaired fasting glucose (IFG)
measured as fasting blood sugar (FBS [100 to 125 mg/dL]). PPBS, fasting blood glucose (FBG),
or both are considered as markers in the screening for PreDM in a healthy population [1].
There is a 70% transition rate of PreDM to DM, if not detected earlier [2]. PreDM is charac-
terized by insulin resistance (IR), impaired insulin secretion [3, 4], and low-grade inflam-
mation associated with progression of PreDM to T2DM [5], micro- and macrovascular compli-
cations [6], and poor cardiovascular outcomes [7]. Blood HbA1c level, ranging from 5.7 to
6.4% (according to the 2010 ADA suggestion), is another potent marker in testing for PreDM.
The prevalence of T2DM is increasing at an alarming rate and will affect 592 million indi-
viduals (according to the International Diabetes Federation) by the year 2035 globally [8].
The genetic factors that participate in the pathway for maintenance of glucose homeostasis
and insulin control play a pivotal role in the stimulation of increased risk of diabetes, and
some of them may be common to brain metabolism. Several genome-wide association studies
put forward some candidate genes like INSR, IRS1, CDKN2A, TCF7L2, and FTO [9, 10].
Treatment of DM includes insulin administration (type 1 or type 2) via various methods (like
use of syringe, insulin pen, external insulin pumps, injection port, injection aids, and the arti-
ficial pancreas). The enthusiasm for and utilization of complementary and alternative
medicine has recently increased in many nations around the globe. Therefore, this review
provides an insight of assessing the effectiveness of yoga in the community-based management
of DM via cost-effective lifestyle interventions. A supplement was published by Integrative
Medicine International highlighting the importance of yoga and its effect on naive healthy
volunteers and experienced yoga trainers [11, 12].
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Cognitive Dysfunction and Diabetes
The onset of a cognitive deficit manifests during 2 phases of the lifespan; first, early years
(5–7 years) which signify the period of development of the brain systems; and the second,
late years (>60 years), the most vulnerable period denoting neurodegeneration which char-
acterizes the process of aging. Across the world, cognitive dysfunction affects most of the
elderly population [13]. Cognitive dysfunction, thought to be a complication of diabetes,
makes it a risk factor for developing dementia and Alzheimer disease (AD). The cognitive
dysfunction results from decline in cognitive function of amygdala and hippocampus that are
affected as a result of neurodegeneration, as seen in the case of dementia and AD. Most of the
problems associated with increasing age are linked to the decline in cognitive abilities. HbA1c,
as the gold standard diagnostic method from ADA, is used to diagnose the prediabetes state
and is inversely related to cognitive function [14–17]. Cognitive functions are the outcomes
of different anatomical structures that are involved in various cognitive domains accessed by
various standard test batteries used for measuring intelligence, learning and memory, exec-
utive functioning, and psychomotor functioning [18–26]. Since glycemic control is neuropro-
tective, as found in a study in T2DM patients [27], alterations in insulin and glucose metab-
olism are critical in the progression of AD pathology (tau and amyloid-β [Aβ]) [28]. A post-
mortem change that contains large amounts of Aβ and NT in T2DM confirms the association
of diabetes with AD [23]. Other psychological domains that affect the cognitive action are
stress, anxiety, and depression [29]. These domains enhance the cognitive functioning when
they are in equilibrium, but when they are not in equilibrium, they accelerate the decline in
cognitive function. It is, therefore, attractive to examine the correlation between biochemical,
epigenetic, molecular, and neuropsychological markers that mediate or are associated with
the transition of PreDM to T2DM and the rate of change of clinical transition between “pre-
T2DM/T2DM with comorbidities” and “pre-T2DM/T2DM without comorbidities” by yoga
intervention.
Detecting It Earlier in Communities Rather Than Hospitals: PreDM
PreDM is defined as a borderline demarcation between diabetes and normal individuals

having high blood glucose level but not as significantly high that they would fall into the range
of diagnostic criteria for DM as per clinical recommendations. Both of the parameters (FBS
and PPBS) are considered to be effective biomarkers that have been used for the screening of
PreDM in the population [1]. There is a possibility of misinterpretation of the results based
on the values of blood glucose before (FBS) and after (PPBS) the intake of a meal even if this
is done through camps in communities. In 2010, the Diabetic Association of America recom-
mended another parameter, i.e. glycated hemoglobin (HbA1c), which is estimated through
HPLC and the screening rate for PreDM ranges between 5.7 and 6.4%. The earlier detection
and treatment of prediabetes reduces the risk of cardiovascular changes associated with
macroangiopathy in patients showing both IGT and IFG [30] and also reduces the chances of
developing DM. There is also a concomitant need to examine experimental biomarkers which
probe the causes that underlie this conversion. Whether yoga can alter it will only be tested
if Integrative Medicine Centers are installed in premier medical institutes to generate compar-
ative data between modern medicine and yoga intervention. Different guidelines or recom-
mendations of various organizations around the world, like Diabetic Association (DA) and
Association of Clinical Endocrinologists (ACE) in America, Health Services (IHS) in India,
Diabetes Association of Canada (CDA), and Diabetic Society (ADS) of Australia, suggest the
treatment regime to follow and get rid of PreDM at various time points. The ADA and AACE
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Table 1. The diagnostic criteria for screening normal, prediabetic, and diabetic individuals
Diagnostic test Normal Prediabetes Diabetes Units of

mellitus mellitus measurement
1 Glycated hemoglobin level (Hb1Ac) <5.7 5.7 – 6.4 ≥6.5 %

2 Impaired fasting blood/fasting blood sugar <100 100 – 125 ≥125 mg/dL
3 Impaired glucose tolerance/
postprandial blood sugar <140 140 – 199 ≥199 mg/dL
recommend lifestyle modifications along with metformin [31]. The organizations like IHS,
CDA, and ADS strongly recommend the use of certain oral antidiabetes drugs (OADs) as a
therapeutic approach (thiazolidinedione, alpha glucosidase inhibitor, etc.) and also advocate
the utility of lifestyle modification as a preventive approach for managing and reducing the
chances of progression of PreDM to DM [32]. In the context of several randomized clinical trial
studies, a well-established fact is that lifestyle modification plays an important role in delaying
the abnormal parameters (FBS/PPBS/HbA1c) in blood for screening and detection of DM.
Lifestyle modification is effective and devoid of side effects (vomiting, nausea, diarrhea,
gastritis, hypoglycemia, etc.) as shown by OADs. It is also proven to be effective in those on
various combinations of OADs (metformin, acarbose, voglibose, and troglitazone) [27, 33,
34]. There are several changes at the cellular level that form the main characteristics: impaired
insulin secretion and IR [3, 4], onset of low inflammation that represents the progression of
PreDM to T2DM [5], complications in the vasculature at the micro- and macrolevel [6], and
also a poor output of the cardiovascular system [7] in PreDM. The clinical diagnostic criteria
for differentiation between normal, PreDM, and DM individuals [35] based on parameters
like IGT, IFG, and HbA1c according to ADA recommendations are summarized in Table 1.
Are There Cases of Undetected DM in the Communities in India?
DM is not a disease but a combined effect of disturbed metabolic functions (altered

metabolism of carbohydrates, proteins, fats, etc.) required for carrying out vital body
processes. Disturbances in metabolic functions are characterized by various conditions such
as dyslipidemia, hyperglycemia (disturbed glucose metabolism), etc. Hyperglycemia arises
from a disturbed functioning of β-cells (insulin production/insulin action or sometimes both).
A prolonged hyperglycemic condition results in changes in the micro- and macroenvironment
of blood vessels and impaired functioning of various tissues, which ultimately leads to failure
of various organ systems like eyes (retinopathy), kidney (nephropathy), nerves (neuropathy),
and heart (cardiomyopathies). Hence, an early detection of T2DM program focuses on taking
the blood tests to households and proposing them a lifestyle intervention program consisting
of Yoga and conventional medication.
What Is the Burden of DM?
As the number of deaths from DM and associated complications increases, it may compel
WHO to declare DM as the 7th mortality factor when we enter into the year 2030 [36, 37]. The
main concerning noncommunicable disease of the world is DM. India is ranked as one of the
countries (China, USA, etc.) vying for the top spot as the diabetic capital. It contributes the
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majority of increased cases of morbidity and mortality, poor quality of life along with the
economic burden on the existing healthcare systems independently for management and
preventive approaches. The highly susceptible populations which show differences in the diag-
nostic criteria for DM are Mexican American [38], Pacific Islanders [39], South African Indians
[40], Egyptians [41], Malaysians [42], and Americans in the United States [43]. Asian Indian
phenotypes (abnormal clinical and biochemical disturbances seen in Indians) include IR,
greater abdominal adiposity (waist circumference, WC), low body mass index (BMI) and occur-
rence of T2DM onset at an earlier age compared with Caucasians [44, 45]. The Asian Indians
show IR (adolescence [46]) and hyperinsulinemia (at birth). A study on the South Asian popu-
lation shows an increased prevalence rate of diabetes [47], higher level of blood insulin [48],
more cases of IR [49], and early signs of decreased activity of pancreatic β-cells [45, 50, 51].
Genes That Predispose to Higher Risk of Diabetes
Genome-wide association studies have revealed several candidate genes (INSR, IRS1,
CDKN2A, TCF7L2 and FTO) [9, 10] that help in the maintenance of glucose homeostasis, and
the polymorphic forms of those genes play an important role in increasing the risk of diabetes.
Similarly, SLC16A8 is a transmembrane protein that can regulate the transportation of mono-
carboxylic acids like pyruvate, lactate, etc. A study in SLC16A8 knockout mice has shown
altered visual response due to changes in alpha waves and histology of the retinal layer.
Recently, Sharma et al. [46] have also demonstrated the increased serum levels of SLC16A8
AMD in comparison to control, suggesting the importance of this regulatory molecule for
cellular function and in maintenance of pH in the cell. Therefore, protein expression in
diabetes and AD (age-related disease) can bridge the genetic gap between 2 genetically and/
or phenotypically different diseases.
It is difficult to ascertain whether certain genotypes are resistant to yoga-based lifestyle
intervention. Such studies are impossible without establishment of Integrative Medicine
Centers in premier medical institutes.
Factors Promoting Risk of Diabetes
Environmental/Epigenetic Contributors
There are several factors other than genes (epigenetic) which are directly under the
influence of the environment. The surrounding of an individual is known as its environment,
which includes habits (smoking, drinking, etc.), quality of nutrients, food intake timing
(disturbed routine due to heavy work load), quality of sleep, being more inclined to consume
fast food, lack of physical activity, age, increased blood pressure, abnormal changes in the
lipid profile, but also overweight and obesity (metabolic disturbances), i.e. these are the
major contributors to the increased risk of developing PreDM and progression to T2DM [52,
53]. Future studies should focus on the effect of yoga intervention on other factors.
Obesity
Obesity is an indicator of T2DM progression [54, 55] that results from the interaction of
genetic and environmental factors that show a particular type of metabolic characteristics,
physical inactivity, and intake of high-calorie diet [54]. A study shows the interconnection of
one of anthropometric variables, i.e. BMI, with the occurrence of T2DM in the population.
Individuals with a high BMI have a greater T2DM incidence in their early age as compared to
individuals with a low BMI who may develop the disease late in their life. Children with a
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greater BMI have higher chances of late onset of DM or metabolic syndrome than their coun-
terparts with a lower BMI [56]. There are several other studies which compared various
anthropometric variables, like WC or WHR, and BMI, and found WC/WHR a better option for
predicting diabetic risk in the population [57, 58].
Lack of Physical Activity

Individuals living in the postmodern era are prone to diabetes due to the lack of physical
activity. Lack of physical activity promotes the initiation and progression of diabetes, which
is associated with increased morbidity and mortality. The incidence rate of prediabetes and
diabetes is increased in children and adolescents due to their zest for spending more time in
front of TV, laptops, video games rather adopting a habit of regular physical activity. A study
showed a comparative risk assessment for diabetes between individuals who prefer a
sedentary lifestyle versus individuals who perform heavy workouts (physical activity). The
study found that sedentary lifestyle individuals have a 3 times greater risk than physically
active group [59]. The various protocols of physical activity have to be documented in the
future studies on diabetes which is also the basis of the Indian Diabetes Risk Score criteria.
Composition of Dietary Intake

Dietary intake is an important aspect that brings the vital force, i.e. energy for carrying
out various metabolic processes. A good composition of diet consists of all the nutrients in
proper amounts and proportion that constitutes a balance diet. A balance diet contains basic
constituents like carbohydrates, protein, fat, vitamins and minerals in a quantity which is
necessary for proper functioning and maintaining energy homeostasis. The amount and
quality of the fat content in a diet is a decisive factor that plays an important role in modifying
the conditions like glucose tolerance and insulin sensitivity pertaining to an individual [60,
61]. Increased dietary fat content leads to the impairment of glucose tolerance via various
mechanisms like reduced affinity of insulin for its receptor; it also hampers glucose transport
via glucose transporter (less uptake), reducing enzymatic (glycogen synthase) conversion of
glucose to glycogen, thus promoting the accumulation of triglycerides in the skeletal system
(muscles) [62]. Moreover, there are very few prospective studies examining the effect of
yoga-based diet on the development of diabetes.
Adaptation to Stress
Stress is considered as a stimulus that brings the physiological processes into disequi-
librium state due to the action of various agents of stress. Stress is also associated with
changes in the functioning of neuroendocrine glands which reads the signals and is converted
into signals, i.e. easily detected through pathophysiology of affected tissue or cells involved
in the disease [63]. Human body has a unique feature for maintaining the homeostasis and
coping with the stressful environment. During stress, the main hormone adrenalin comes into
play. The oversecretion of adrenalin is controlled by the hypothalamus. There are 2 systems
which take care of coping strategies in response to stress. One forming an axis that includes
the series of different interrelated organs (hypothalamus, pituitary, and adrenal glands)
called the hypothalamic-pituitary-adrenal (HPA) axis. The nervous system is another modality
that controls our body and other physiological activities through the action of nerve
conduction. The nervous system is divided into 3 parts, the first part is the central nervous
system (the brain and spinal cord), the second is the peripheral nervous system (cranial and
spinal nerves), and the third, autonomic nervous system (sympathetic and parasympathetic).
The sympathetic nervous system (SNS) is another stress coping modality that comes into play
when cells or tissues or individuals are in a stressful situation. Stress triggers a series of spon-
taneous events that lead to changes in physiological, behavioral, and psychological aspects
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due to imbalance in cortisol and catecholamine levels (epinephrine or nor epinephrine)

during the onset of disease. When both modalities (HPA and SNS) work in a regulated manner
there is balance with stress, coping strategies, and normal psychophysiological activities, but
when they work in an unregulated manner, this results in a variety of diseases like auto-
immune diseases, disturbed metabolism, which leads to obesity, depression, risk of drug
abuse for relief from stress, and it also increases the risk of developing various cardiovascular
diseases in susceptible persons [29]. A study demonstrates the involvement of anxiety and/
or depression as a major risk factor which contributes to the progression of diabetes [61, 64,
86, 87] and vice versa [65, 66]. The HPA axis is the first modality that senses and encounters
a stress condition for a cell or tissue; then, it triggers a series of hormones to counteract the
stress condition. During a hyperglycemic condition, a hallmark of T2DM, the HPA axis fails to
control the secretion, and a study demonstrated an increase in the level of certain releasing
hormones from the hypothalamus like corticotropin-releasing hormone, growth hormone,
cortisol, epinephrine, norepinephrine, insulin, glucagon, and neuropeptide Y, which
contributes to a great extent to T2DM development. The second modality, SNS, also triggers
a disturbed HPA axis during a stress condition leading to impaired eating habits, which results
in obesity and thus increases the risk of developing DM. A study shows the relationship
between chronic stress and development of visceral obesity, which provides a positive corre-
lation with the prevalence of T2DM. Another study validates the association of stressful
events with new cases of DM [67]. How this can be alleviated by yoga intervention has to be
investigated in the future studies.
Circadian Rhythms
There are several studies which advocate the doctrine of circadian rhythms as major
contributors of risk factors associated with diabetes [68] due to the altered CLOCK gene
which causes disturbed pattern of glucose tolerance and insulin sensitivity. The suprachias-
matic nucleus (generator of circadian rhythms) and melatonin (hormone) play a pivotal role
in the regulation of circadian rhythms. A study demonstrates the low level of circulating levels
of melatonin [69] and upregulated expression of melatonin membrane receptors [70]. There
is an association of the allelic variants of melatonin membrane receptor with the level of FBG
that shows an increased risk of T2DM. This shows the role of melatonin in glucose homeo-
stasis in blood [71–73]. Whether these are impacted by yoga intervention has not been inves-
tigated; however, the data from future studies may provide new clues about the impact of
sleeping patterns.
Age-Related Cognitive Decline
The most neglected complication of DM is the occurrence of cognitive deficit, mainly in

early years of life (5–7 years) that corresponds to the development of the brain system and
also in later years of life (>60 years), which corresponds to the neurodegenerative phase due
to aging. The scientific community has shifted its attention towards the investigation of the
most neglected part of diabetic complications (cognitive dysfunction and dementia). Cognitive
dysfunction represents a highly prevalent and very serious problem faced by the majority of
the elderly population worldwide [13]. DM is proving to be a potent risk factor for the devel-
opment of dementia (vascular) and neurodegenerative disease (AD). Several studies show
structural changes in the brains [74–79] of patients with T1DM and T2DM, and also show a
decline in multiple domains of cognitive functioning. These cognitive functions show a decline
in specific cognitive domains like intelligence, attention, memory, executive functioning, and
processing speed. The main domain of cognitive deficits lies mainly in psychomotor and
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processing speed [21–26]. A study shows the role of glycemic control in preserving cognitive
performance in patients with T2DM. Another study shows an inverse relationship between
serum HbA1c and cognitive functioning (learning [14], executive functioning [15], working
memory [15, 16], and complex psychomotor performances [17, 80]). An MRI-based compar-
ative study showed alteration of the amygdala and hippocampal regions in T2DM patients as
compared with control subjects. These 2 areas play an important role in memory and behavior,
and were found to deteriorate in neurodegenerative disease (AD) [28]. The emerging yoga
intervention studies should probe the cognitive dysfunction and its presentation in diabetes.
Diabetes Mellitus and AD
The main connecting domains of cognitive dysfunction in DM correspond to hypergly-

cemia, vascular disease, IR, and hypoglycemia [81]. DM promotes the atrophy in the cerebral
structures and interferes with cognitive reserves and threshold parameters (cerebral amyloid
and tau metabolism [82]) that reflect the symptoms of AD. Altered insulin and glucose me-
tabolism affects insulin receptors in the brain and its functioning that promotes the oligo-
merization of β-amyloid and stimulates hyperphosphorylation of the tau protein. Another
component that accelerates biological aging is IR through formation of advanced glycation
end-products and reactive oxygen species [83]. A study shows heavy deposition of β-amyloid
and neurofibrillary tangles in the brain sections of T2DM patients. Another study shows an
increased amyloid deposition of patients having both (APOE-4 genotype and DM) [79, 82].
Treatments and Lifestyle Interventions
The HIS, CDA, and ADS strongly recommend the use of certain OADs like thiazolidine-
dione and alpha glucosidase inhibitors. The use of OADs provides relief to an extent, but its
side effects may include gastrointestinal disturbance which includes vomiting, nausea,
diarrhea, gastritis, hypoglycemia, and accumulation of gas in the alimentary canal. The onset
of DM may be delayed by adopting the lifestyle modifications with or without the use of
various drugs in combination like metformin, acarbose, voglibose, and troglitazone [27, 33,
34]. Lifestyle interventions associated with increased physical activity followed by adapting
healthy eating habits (dietary advices) have proven to be effective in preventing diabetes [14,
15, 85]; however, they seem to be a failure due to the rising numbers of PreDM individuals,
which are contributing to the increase in the cases of T2DM. One of the most popular and
economic lifestyle intervention tools is yoga. The description of word yoga is found in Sanskrit.
In Sanskrit, Yuj means to unite one’s body breath and mind [80] to the universal power. Yoga
is an ancient practice that emphasizes balancing of various aspects (like physical, mental,
emotional, and spiritual) of an individual. Yoga focuses on the general well-being of an indi-
vidual by following the path of physical postures (asanas), breathing exercises (pranayamas),
and meditation (dhyana) [85]. Yoga therapy consists of a specialized set of asanas, pranayamas
along with meditation depending on different health problems. Certain sets of asana that have
proven to be beneficial for the abdominal area cause rejuvenation/ regeneration of the
pancreas, which promotes glucose metabolism along with its utilization through several
tissues like peripheral tissues, liver, and adipose tissue via enzymatic activity [86–88]. A case-
control study showed the effect of yoga in T2DM patients reducing the requirement of insulin
and also a significant decrease in various parameters (FBS, PPBS, HbA1c) [89]. Several studies
show an association of altered autonomic function with diabetes and obesity [25, 26]. Studies
also show improved cardiac autonomic functions of patients between the groups (yoga
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breathing group and standard therapeutic group) [90, 91]. Another randomized control trial
by McDermott et al. [25] demonstrated the effectiveness of yoga in reducing weight validated
by reduced WC, reduction in systolic and diastolic blood pressure, and reduced level of total
cholesterol in lipid profiling. There is also a significant decrease in the levels of anxiety,
depression, and stress perception in both groups (yoga and walking intervention) [92]. Yoga
plays a pivotal role in reducing the expression of the inflammatory marker C-reactive protein
and cytokines (interleukin-6 and lymphocyte-1B) [93, 94]. Another study has shown an
increased level of the anti-inflammatory marker adiponectin in yoga practitioners [95]. There
are several studies which emphasize the role of yoga in reducing the risk factors for T2DM
development through reduction in weight, and also promoting mental and holistic well-being,
i.e. required for happy and healthy living of an individual [92]. Many other studies favor yoga
as an effective tool for reduction of stress, facilitated by the regulation of SNS-HPA. Another
study has reported the usefulness of yoga in reducing cortisol level, glucose level (in blood),
level of rennin (in plasma) and also reduced level of catecholamines (norepinephrine and
epinephrine) in urine within 24 h [96].
Guidelines, Organizations, and Management
The guidelines issued by the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK) describe treatment of diabetes in different ways. The individuals who
suffer from diabetes will be required to take insulin through different methods like injecting
subdermally (with the help of a syringe, pen, injection aid, and injection port), external insulin
pumps, and the last method is artificial pancreas. Other organizations like HIS, CDA, ADS that
work for the eradication of diabetes, in their guidelines refer to the clinician for prescribing
OADs (thiazolidinedione, alpha glucosidase inhibitors, etc.). The onset of DM is delayed by
adopting lifestyle modifications alone or with the use of various combinations of metformin,
acarbose, voglibose, and troglitazone [10, 52, 53]. Another aspect of management is a
preventive aspect that concerns regular monitoring of cholesterol level and blood pressure,
blood glucose, etc. The report published by the WHO advocates the use and promotion of
healthy habits like healthy food (less fast food), not smoking, and regular physical activity to
maintain normal body weight, and also advises to screen early for diabetes-associated reti-
nopathy, neuropathy and kidney disease [97].
Yoga as a Lifestyle Modification Tool

The comfort zone of an individual is his/her lifestyle, and it follows a particular pattern
during his/her lifespan. Therefore, lifestyle is a way of doing things in a way that is comfortable
for an individual. Today, teenagers are used to spending luxurious life pertaining to outing
with friends late at night, consuming fast food very often, developing irregular dietary habits
and, most importantly, neglecting physical activity required for proper physiological and
metabolic functioning. The central target for any lifestyle modification strategy is to motivate
individuals to take up physical activity, directing them to avoid fast food on a regular basis as
suited to one’s lifestyle and energy consumption. The main cause of the increase in the prev-
alence of diabetes is partly because PreDM remains undetected due to asymptomatic features
even though the lifestyle modifications appear to be ineffective in prevention and devel-
opment of diabetes. Lifestyle modification seems to be effective through promotion of physical
activity followed by dietary suggestions from clinicians as a preventive tool for management
of diabetes [98–101]. There are several studies on lifestyle modification programs which
show its worth and support prevention of diabetes, i.e. Diabetes Prevention Study (DPS)
[102], US Diabetes Prevention Program (UDPP) [103], Indian Diabetes Prevention Programme
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(IDPP) [104, 105], and Da Qing IGT and Diabetes Study (DQS) [106] from Finland, USA, India,
and China, respectively. Lifestyle modification seems to be the most effective way for
preventing and managing the rate of progression from PreDM to DM in high-risk individuals
[98]. This is why the Indian PM has advocated the yoga intervention in the lives of Indian
diabetics.
Yoga as a Possible Solution for Prevention and Management

One of the most popular and economic lifestyle intervention tools in the management of
diabetes and its complications is yoga. In the ancient sacred scriptures like patanjali yogsutra
or hatyogpradipika entitled Yogaschittavritti Nirodhaha, the main body of the text signifies
the importance of yoga as a union of healthy mind, body, and soul to the supreme soul of the
universe. Yoga focuses on the general well-being of all the individuals via following the 8-fold
path as described in hatyoga practitioners which puts emphasis on various aspects; some of
them include physical postures (asanas), breathing exercises (pranayamas), and meditation
(dhyana) [85]. In our modern era, the scriptures that advocate the usefulness of yoga as a
remedy for various ailments now reveal its medical importance in terms of its therapeutic
application which comprises of various standardized techniques like panchkarma therapy,
Sherodhara, vamana, nauli, accupressure, etc. So, yoga therapy [107, 108] comprises a set of
yogic exercises that an individual performs on his/her own after an orientation class. An indi-
vidual may attend a yoga module regardless of his/her previous experience. A yoga module
ranges from gentle warming exercises to complex practices of asanas and pranayama. An
important component of yoga is asanas, which provide strength for the musculoskeletal
system through the balance between the relaxing and stretching components of muscular
tissue. It helps in the mobilization of skeletal joints and postural stability required for the
stability and equilibrium of the physiological and psychological components of an individual.
Another important component of yoga is pranayama. It is believed that when practicing
hatyoga, if a person controls the breathing rhythm, they will control their own mind and body.
Controlling breathing seems to be difficult because one has to connect one’s unconsciousness
to consciousness for maintaining a uniform flow of energy which is regulated by different
energy chakras in our body that help to maintain a homeostasis and promote a holistic,
healthy, and happy living.
Effect of Yoga on the Biochemical Profile

Asanas focus on stretching exercises which promote balanced glucose metabolism along
with effective enzymatic activities in peripheral organs (liver, adipose tissue, etc.) [85–87]. A
study has shown a reduction in the level of blood sugar (a biochemical parameter) [109] and
improved metabolic activity (measured as triglyceride uptake by adipose tissues) [110, 111].
Yoga postures (asana and pranayama) also improve β-cell sensitivity to glucose signaling and
insulin secretion [112] and help in the regulation of body homeostasis [113]. Another study
compared the baseline biochemical parameters (FBG, serum total cholesterol, LDL, VLDL, and
their ratios) before and after assessment of an 8-day yoga practice and found them to be
significantly reduced [114]. Another case-control study shows its effectiveness in lowering
biochemical parameters (FBS, PPBS, HbA1c) along with reducing the need of insulin in T2DM
[115]. The limitation of the study was small sample size (n = 44) and short duration of inter-
vention (3 months). Another study has shown the effectiveness of yoga practice (40 days) and
found a significant reduction in some of the biochemical parameters (insulin and FBG level),
and taking into consideration WHR as one of the anthropometric variables [116]. Yoga
practice also significantly improved biochemical parameters (adiponectin, lipid levels
[serum]) along with a reduced risk of the metabolic syndrome in obese individuals (post-
menopausal women) [117].
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Effect of Yoga on Cognitive Functions

Current studies provide evidence for the involvement of T2DM in cognitive dysfunction
and structural changes that take place in the brain [118]. Brain is considered as the master of
the body owing to its role in the regulation of the normal glucose level in the body and the
development of T2DM. Certain studies show the involvement of higher centers of the brain in
lowering blood glucose in an insulin- and non-insulin-dependent manner [119]. There are
several cohort studies which demonstrate the progression of PreDM cases to T2DM around
the world [120–125]. A study showed a close relationship between brain insulin sensitivity
and visceral adipose tissue changes brought about during lifestyle intervention [125]. Another
study showed the effectiveness of yoga in improving the cognitive function of T2DM patients.
The main lacunae in the study is its small sample size (n = 60) and short duration (45 days)
[126].
Yoga and Neurophysiology

The micro- and macrovascular complications are considered as a hallmark of diabetes
and other associated complications. A study by Dunstan et al. [127] showed the appearance
of these complications (micro- and macrovascular) in PreDM. The risk of IFG and IGT along
with cardiovascular complications differs between individuals [128–130]. A number of
studies show an association of altered autonomic function with diabetes and obesity [131,
132]. Early detection of altered cardiac autonomic function acts as a diagnostic marker for
screening of cardiovascular risk in PreDM and has been laid down as the foundation of
preventive measures against the progression to DM. Another cross-sectional study found a
combination of various factors (altered cardiac autonomic function, hyperinsulinemia, IR,
oxidative stress, inflammatory response, and IFG) that contributes and ultimately leads to the
progression of diabetes [133]. A study compared the level of cardiac autonomic functions and
found it to be improved in patients of the yoga breathing group [90, 91]. Another study
showed yoga as effective in reducing the heart rate, and systolic and diastolic blood pressure
[134]. A recent study put emphasis on disturbances in autonomic function which were posi-
tively correlated with poor control of glucose metabolism, an increase in lipid peroxidation,
and a decrease in NOx– levels, which signifies greater chances for development of vascular
dysfunction and cardiac disease in T1DM patients. The major limitation of the study was its
small sample size (n = 19, CT = 10 and T1DM = 9), and only males participated in the study.
Another randomized control study showed the effect of yoga on various parameters, i.e.
anthropometric (weight, WC, systolic blood pressure, diastolic blood pressure), biochemical
(total cholesterol), and some psychological parameters (stress, anxiety, and depression), and
found yoga to reduce them significantly [92]. Imaging can be included in future studies and
campaigns against diabetes.
Yoga and the Immune System

A study showed an immunomodulatory effect of yoga on stress through the increased
level of immunoglobulin A along with natural killer cells. Another study demonstrated a
pivotal role of yoga in reducing the inflammatory marker C-reactive protein and cytokine
(interleukin-6 and lymphocyte-1B) expression [93, 94], and an increased level of the anti-
inflammatory marker adiponectin [95]. Yoga has also been shown to be effective in reducing
weight in relation to obesity, which is associated with the risk of developing T2DM, and also
provide a feeling of wellbeing in an individual from the psychological point of view. The limi-
tations of the study is its small sample size (n = 41, yoga = 21 and walking control = 20) and
its short duration (8 weeks) [92]. A study found the usefulness of yoga in reducing cortisol
(examined through saliva), glucose (in blood), rennin (in plasma), and catecholamine (norepi-
nephrine and epinephrine) in urine within 24 h [96]. There are about 25 studies which
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advocate the association of decreased blood glucose, HbA1c, and IR, and improved insulin
sensitivity [132, 136] along with improved values for oral glucose tolerance test through a
yoga intervention lasting 8–12 months. A study showed how yoga affects the physiological
and psychological aspects by assessing various anthropometric (weight, BMI, WHR) and
psychological parameters (mood, self-esteem, and QOL) [115] and found yoga to reduce the
anthropometric variables and improve the psychological variables. Yoga shows its benefits
for improving nerve conduction and cognitive functions in diabetic patients leading to
effective management of diabetic complications [137]. Yoga has been gaining in popularity in
recent years as an intervention with the potential of preventing the occurrence and progression
of metabolic deterioration and comorbidities. On the basis of the cited literature, the major
focus is on prevention for the reduction of healthcare costs that can be borne by an individual
for the treatment of the disease. According to the study conducted by ICMR, the prevalence
of diabetes and prediabetes is 11.1 and 13.2%, respectively, in Chandigarh. Yoga has the
potential for managing DM in an effective manner as proven by the cited literature so far, but
the greatest lacunae of the cited literature is that no one has attempted to investigate the
effect of yoga on the prevention and management of PreDM and its progression to further
diabetic complications (especially cognitive decline as a hallmark of neurodegenerative
disease) with cognitive changes.
National Campaign for Yoga-Based Diabetes Management
The current review has highlighted the potential benefits of yoga-based lifestyle modi-
fication for the management of diabetes, which has to be explored further in future studies.
A systematic population-based multicenter study evaluating yoga-based lifestyle modifi-
cation would provide future directions. The need of the hour is a national campaign targeting
various regions of India and identifying the population at risk. Further, the risk factors such
as dietary habits, addictions, lifestyle, physical activity level, sleep quality and stress level
would need to be assessed. The anthropometric parameters, cognitive functions, and
biochemical indices such as fasting glucose, postprandial glucose levels, HbA1c, and lipid
profile would also provide valuable insight in more objective assessments. The campaign
would help in validating a yoga-based lifestyle program and provide policy makers with
directions.
Conclusions
It is expected that this systematic review will attract many researchers across the world,
especially in developing countries, to perform further studies on yoga-based lifestyle
management in diabetes. Multicenter studies will be useful in establishing centers of inte-
grative medicine as these will be cost effective.
Acknowledgment
Authors would like to acknowledge: Dr. Subhash Varma, Dean PGIMER; Sh. Vineet Joshi,
President, Joshi Foundation, Chandigarh; Sh. Ajit Balaji Joshi, Deputy Commissioner, Chan-
digarh; Dr. Anil Bhansali, Head of Endocrinology, PGIMER; and Dr. Roshan Lal Dahiya,
Department of Psychology, Panjab University, for their support and valuable suggestions.
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Disclosure Statement
The authors declare that there are no conflicts of interest.
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Original Article
Article
A Comparative Study of the Differential Effects of Short

Term Asana and Pranayama Training on Reaction Time
Ananda Balayogi Bhavanani*, Meena Ramanathan, Dayanidy G, Madanmohan Trakroo, Renuka K
Sri Balaji Vidyapeeth, Mahatma Gandhi Medical College & Research Institute, Pondicherry, India
Corresponding author: Abstract

Sri Balaji Vidyapeeth, Mahatma Gandhi Background: Numerous studies have reported long and short term effects of Yoga training
Medical College & Research Institute, on reaction time (RT), but few have evaluated differential effects of training in asana and
Pondicherry, India,
pranayama. Hence the present study was done to elucidate effects of such differential training
Tel: +91-413-2615449;
E-mail: yoga@mgmcri.ac.in on RT in health professions students attending Yoga training. Materials: 134 healthy young
adults studying BSc Nursing at KGNC were recruited for the study and informed consent
obtained from them. 89 from 1st year were randomly divided into two groups and 44 of them
received one week of training in asana while 45 received parallel training in pranayama.
45 control subjects were recruited from 2nd year that didn’t receive Yoga training but were
coming to CYTER for clinical posting. Auditory and visual RT (ART and VRT) were measured
before and after the one week study period and appropriate statistical methods applied for
intra and inter group comparisons. Results: Both asana and pranayama training resulted
in significant (p<0.001) shortening of ART and VRT, while ART was significantly (p<0.05)
prolonged in controls with no significant change in VRT. Intergroup comparisons revealed that
these changes were more pronounced following pranayama training especially with regard
to VRT. Discussion: The present study provides evidence that even a short term, one week
training in asana and pranayama can shorten RT in novices and that this is more pronounced
in case of pranayama training. These changes may be attributed to enhanced central processing
ability resulting from better sense of perception, sensitivity, alertness and awareness occurring
as a result of Yoga practice. As pranayama practice tends to be more introspectional (with
eyes closed), this may have more pronounced effects than asana where awareness is more
externalized in novices. It is also plausible that the conscious alterations of respiratory patterns
may influence ascending pathways resulting in more pronounced changes after pranayama. It
is suggested that Yoga training of even a short duration can enhance central processing ability
and that such training especially in pranayama may be utilized to enhance learning capabilities
in students of health professions education.
Keywords: Asana; Pranayama; Yoga; Training
Introduction combinations and few have compared effects of differential

training in asana and pranayama. Trakroo and colleagues [9]
Reaction time (RT) is described as the interval between onset
reported on differential effects in police trainees following 6
of a signal (stimulus) and the resultant motor response. [1] It is
months of training while Biswas reported effects of 4 weeks
an indirect index of central neuronal processing and provides
training in asana, pranayama and raja yoga meditation in
objective evidence of sensory-motor association, performance,
medical students [10]
and cortical arousal. [2] It depends on the state of alertness of an
individual and is vital in professions such as drivers, military Studies by Bhavanani and colleagues have reported on
personnel, sportspeople, medical and nursing staff, etc., as pranayama with significant and immediate decrease of RT,
they require quicker, and more efficient responses to deal both auditory (ART) and visual (VRT), following nine rounds
with emergencies. [3] While it is independent of socio-cultural of mukha bhastrika, in normal school children [11] and mentally
influences, prolonged RT denotes a decreased performance challenged adolescents [12] as also following suryanamaskar.
that may be due to physical, mental, emotional, social or other [2]
Others have evaluated differential effects of slow and fast
environmental factors. [4] pranayamas [7,13] or right and left uni-nostril breathing. [14]
Numerous studies have reported effects of Yoga training on Regular training in Yoga is being imparted for students of
shortening of RT and these have included those evaluating
immediate effects of techniques, as well as those reporting on This is an open access article distributed under the terms of the Creative Commons
Yoga training for durations varying from a few weeks to a few Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix,
tweak, and build upon the work non‑commercially, as long as the author is credited
months. [5-8] and the new creations are licensed under the identical terms.
Most of these previous studies have only looked at generalized How to Cite this Article: Bhavanani AB, et al. A Comparative Study of
the Differential Effects of Short Term Asana and Pranayama Training on
Yoga training consisting of different techniques and their Reaction Time. Ann Med Health Sci Res. 2017; 7: 80-83
80 © 2017 Annals of Medical and Health Sciences Research
Bhavanani AB, et al.: Asana and Pranayama on Reaction Time
Kasturba Gandhi Nursing College (KGNC) since 2012, initially dominant hand while responding to the click sound or red
as an optional extracurricular activity and later as a co-curricular light signals that were given only from their front to avoid any
activity. Based on positive changes experienced and expressed confounding effect of lateralized stimulus.
by students, [15] teachers and administrators, Yoga was officially
included as part of nursing curriculum in 2016. [16] This inclusion On two days prior to the actual testing all subjects were
was done through a specialized course of 90 hours namely familiarized with the procedure and equipment as RT is found
“Foundation in Yoga Therapy” having lectures and practical to be more consistent when subjects have had adequate practice.
training of 45 hours during 1st year BSc (N), followed by 30 [17]
Eight to ten trials were recorded for both auditory and visual
and 15 hours under Medical Surgical Nursing during 2nd and signals and average of the lowest three similar observations
3rd year respectively. The training for the first batch of students was taken as a single value as per established norms. [6,7,11,12,14]
commenced in August 2016 and 45 hours were completed over Yoga techniques utilized in the present study were based on
a period of 3 months via bi-weekly classes at CYTER. the Gitananda Yoga tradition [18-20] are given in Table 1. Group
A and Group B received training (5 sessions of 60 min each)
In order to scientifically validate effects of such training in exclusively in asana and pranayama respectively during the
young health professions students, we planned various studies week while control subjects (Group C) didn’t receive training
evaluating anthropometric, cardiovascular, musculoskeletal and but participated in routine activities at CYTER. Data was
neurological parameters. In this paper we are reporting the short recorded from subjects in all groups on 1st and 7th day of the
term effects of differential training in asana and pranayama on week-long study.
auditory (ART) and visual (VRT) reaction time.
Table 1: Asana and pranayama techniques performed in the
study.
Group B: Pranayamas
Group A: Asanas (postures done
The present study was conducted at the Centre for Yoga Therapy, (breathing techniques to
and held with awareness)
enhance vitality)
Education and Research (CYTER) of Sri Balaji Vidyapeeth in
Tala (palmyra), ardhakati chakra
Pondicherry, India. It was done between August and October (lateral stretch), trikona (triangle), Vyagraha (tiger), surya nadi
2016 as part of a larger study on the effects of yoga training in pashchimottana (posterior stretch), (sun channel), chandra nadi
nursing students for which ethical clearance had been obtained purvottana (anterior stretch), (moon channel), pranava
chatushpada (four footed), (AUM chanting), nadi
from Institutional Human Ethics Committee. baddhakona (bound angle/cobbler), shuddhi (alternate nostril),
vakra (twist), makara (crocodile), brahma mudra (gesture of
134 healthy young adults (99 F and 35 M) studying BSc Nursing bhujanga (cobra), ardha shalabha creation) and bhramari (bee)
at KGNC were recruited for the study and informed consent (half locust), eka and dwi pada pranayama. All were done in
uttana (single and double leg lifting), sitting posture with spine erect
obtained from them. 89 of them studying in 1st year were viparitakarani (inverted) and shava and well aligned.
randomly divided into two groups and 44 of them (age 18.48 (corpse) asana.
± 0.66 yrs and BMI 22.45 ± 5.19 Kg/m2) received one week
of training in asana while 45 (age 18.33 ± 0.72 yrs and BMI of Statistical Analysis
20.83 ± 4.52 Kg/m2) received parallel training in pranayama. 45
Study data obtained was analyzed using Graph Pad In Stat
control subjects (age 18.69 ± 0.73yrs and BMI 23.50 ± 6.23 Kg/
version 3.06 for Windows 95, (Graph Pad Software, San Diego
m2) were recruited from 2nd year batch that didn’t receive Yoga
California USA, www.graphpad.com). Nonparametric tests
training but were coming to CYTER for clinical postings.
were utilized for analysis as data failed normality testing by
Kolmogorov-Smirnov Test. Wilcoxon Matched pairs Signed
Anthropometric data was taken at the beginning of the training in
ranks Test was used for intra-group pre-post training comparison
the Yoga Hall of CYTER. Individual height was measured to the
while intergroup comparison was done by Kruskal-Wallis
nearest mm by a wall mounted stadiometer and weight measured
Test (Nonparametric ANOVA). Post hoc testing was done by
with a weighing scale (Krups scale). BMI was calculated by
Dunn’s Multiple Comparisons Test. P values of less than 0.05
Quetelet’s index that is weight (in kg)/(height in m2 ) .
were taken to be indicating statistically significant differences
ART and VRT were recorded in all subjects before and after the between data.
study period of one week. Seminar cum Lecture Hall of CYTER
Results
between 11am and 1 pm in a quiet environment with temperature
between 22°C and 25°C. The subjects were advised to come at The results are given in Table 2. At baseline ART and VRT
least two hours after breakfast with empty bowel and bladder. values were comparable for all three groups. ART decreased
from a median 204 to 189.50 after asana and from 201 to 179
RT apparatus having built in 4 digit chronoscope with display after pranayama.
accuracy of 1 ms manufactured by Anand Agencies, Pune was
used for the present study. Auditory click sound stimulus was In both cases the changes were statistically significant (p<
used to evaluate simple ART while red light stimulus was used 0.001). On the contrary ART significantly increased (p<0.05)
for simple VRT. Each subject was evaluated separately and from a median of 206 to 209 in control group. In case of VRT,
instructed to release the response key as soon as respective there was a decrease from a median of 206 to 198.5 in asana
stimulus was perceived by them. The subjects used their group (p<0.01) and from 204 to 187 in pranayama group
Annals of Medical and Health Sciences Research | November 2017 | Vol 7 | Special Issue 3 | 81
(p<0.001). Changes in control group were not significant. there was no significant difference between groups on ANOVA
Intergroup comparisons of post values showed highly significant testing. The major difference between that study and the present
(p<0.0001) differences between groups for both ART and VRT. one is that all subjects in that study were undergoing regular
and intensive police training. As exercise is known to influence
Table 2: Comparison of auditory (ART) and visual (VRT) reaction RT, this may be considered a confounding factor that may have
time in normal, healthy volunteers before and after one week diluted/enhanced the actual effect of yoga on RT itself.
exclusive training in asana, pranayama or control period.
Asana Pranayama Control
Parameter
(n=44) (n=45) (n=45)
P value The other study by Biswas compared asana, pranayama and raja
204 201 206 yoga meditation and reported significant changes in pranayama
Pre 0.9994
(160,260) (158,345) (158,271) and meditation groups for both ART and VRT. [10] ART changes
189.50 179
209 were only significant in the pranayama group while they were
Post (158,237) *** (148,216) *** <0.0001
ART (165,261) * not in the asana and meditation groups. This is similar to the
♦♦♦ ●●● Ψ
-8.24 -10.87 1.59
results of our present study where changes are more significant
Δ% (-24.90, 26.88) (-42.03, 15.70) (-16.87, <0.0001 in pranayama than asana. Biswas had suggested that the
♦♦♦ ●●● 27.14) relaxation response evoked by yoga practice, potentiated the
206 204 201 anterior cingulate, hippocampal formation and amygdale; the
Pre 0.6440
(176,269) (173,299) (161,384)
brain areas related to emotions, motivation and memory. The
187
Post
198.50
(152,279) *** ●●●
200
<0.0001 major limitation of the study by Biswas was that intergroup
VRT (163,255) ** (174,406)
ΨΨ comparisons by ANOVA were not done and merely paired t
-4.66 -10.10 0.00 tests done for intra group comparison. The present study has
Δ% (-22.78, 12.20) (-35.12, 31.60) (-14.84, <0.0001 gone further and done intergroup comparison thus providing
♦ ●●● 25.12)
evidence that though both asana and pranayama shorten RT,
Values are given as median (range).
*p<0.05, ** p<0.01,***p<0.001 by Wilcoxon Matched‑pairs Signed‑ranks pranayama is more effective than asana.
Test for intra-group pre-post comparison.
Actual p values are given for intergroup comparison by Kruskal-Wallis The findings of the present study evidence that shortening
Test (Nonparametric ANOVA) in the last column.
♦ p<0.05 and ♦♦♦p<0.001 for asana vs. control by Dunn’s Multiple
of RT occurs both after training exclusively in asana or
Comparisons Test. pranayama for a short period of one week. The differences
●●●p<0.001 for pranayama vs. control by Dunn’s Multiple Comparisons between both groups were however not too apparent through
Test.
pranayama seems to have an edge over asana. Such greater
Ψ p<0.05 and ΨΨ p<0.01 for pranayama vs. asana by Dunn’s Multiple
Comparisons Test. improvements in pranayama groups may be attributed to a
few factors. All the subjects were novices to yoga and hence
Post hoc analysis by Dunn’s multiple comparisons test showed
the asana practice may have been more externalized with them
changes to be significantly more significant in asana and
focusing on the positioning of the limbs and movements rather
pranayama versus control and such changes were significantly
than internally. Such internalization is more prevalent amongst
more in pranayama group when compared to asana group.
the experienced practitioners who express that asana practice
Discussion becomes contemplative and meditative. However in the case
of pranayama training, the internalization is possibly easier for
The practice of yoga has been reported to enhance an individuals’ the novice as most practices are done with eyes closed and in a
ability to react faster and more efficiently to stimuli and sitting position. Hence the internalization through pranayama,
numerous studies have evidenced enhanced central processing may be favouring better central processing through an enhanced
and sensory-motor functioning effected by such training. [2,5-7, ability to ignore extraneous stimuli and detach one’s self from
14, 21,22]
The present study was planned to evaluate any potential sensory distractions in the environment. [23] Pranayama has been
differential effects between short term (one week) exclusive shown to enhance RT and this has varied between fast and slow
training in either asana or pranayama as such work has only pranayama as well as those done through right or left uninostril.
been done in two earlier studies. [7,13,14,22]
In the present study, the pranayama training was given
based on a balanced set of practices that included both the right
The earlier study by Trakroo et al. was done in police trainees and left uninostril breathing as well as slow and fast pranayama.
and for a duration of 6 months with RT as one of many
parameters. [9] It reported a post-training decrease in RT in all Sharma et al. have suggested that pranayama enhances the
the yoga groups that was significant for VRT in asan group, participants’ ability to concentrate and that the resultant changes
ART in pranayama group, and VRT as well as ART in the asan- in mental processing (e.g., focused attention and reduced stress)
pranayama group. They attributed the faster reactivity following are then rapidly expressed in the body via the autonomic and
yoga training to an “intermediate level of arousal brought neuro endocrine systems. [13] It has been further suggested
about by a conscious synchronization of dynamic muscular that such changes brought about by consious regulation of
movements with slow, regular, and deep breathing”. They had the respiration, may improve bidirectional communication
also recommended that RT be used as a simple, quantitative, between the cerebral cortex (the seat of conscious activity)
objective, and non-invasive method for monitoring beneficial and the limbic/autonomic/neuro-endocrine systems (the seat of
effects of yoga training. However, unlike our present study unconscious/automatic activity. [24] Telles et al. have postulated
that yogic consciously regulated breathing brings about a and wellness score of peri and post-menopausal diabetic patients. In-
generalized alteration in information processing at thalamo- ternational Journal of Yoga 2012; 5: 10-15.
cortical level through modifications in neural mechanisms that 9. Trakroo M, Bhavanani AB, Pal GK, Udupa K, Krishnamurthy N.
regulate respiratory system activity. [21] A comparative study of the effects of asan, pranayama and asan-
pranayama training on neurological and neuromuscular functions of
Pondicherry police trainees. International Journal of Yoga 2013; 6:
Conclusion 96-103.
The present study provides evidence that even a short term, 10. Biswas DA. Effects of short term yoga training on pulmonary & reac-
one week training in asana and pranayama can shorten RT in tion time in students of rural medical institution. JIMSA 2010; 23:
71-72
novices and that this is more pronounced in case of pranayama
training. These changes may be attributed to enhanced central 11. Bhavanani AB, Madanmohan, Udupa K. Acute effect of Mukh Bhas-
trika bellows breathing) on reaction time. Indian J Physiol Pharmacol
processing ability resulting from better sense of perception, 2003; 47: 297-300.
sensitivity, alertness and awareness occurring as a result of Yoga
12. Bhavanani AB, Ramanathan M, Harichandrakumar KT. Immediate
practice. As pranayama practice tends to be more introspectional effect of mukha bhastrika (a bellows type pranayama) on reaction
(with eyes closed), this may have more pronounced effects time in mentally challenged adolescents. Indian J Physiol Pharmacol
than asana where awareness is more externalized in novices. 2012; 56: 174-180.
It is also plausible that the conscious alterations of respiratory 13. Sharma VK, Rajajeyakumar M, Velkumary S, Subramanian SK, Bha-
patterns may influence ascending pathways resulting in more vanani AB, Sahai MA. Thangavel D. Effect of fast and slow pranaya-
ma practice on cognitive functions in healthy volunteers. Journal of
pronounced changes after pranayama. It is suggested that Yoga Clinical and Diagnostic Research 2014; 1: 10-13.
training of even a short duration can enhance central processing
14. Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Differential ef-
ability and that such training especially in pranayama may be fects of uninostril and alternate nostril pranayamas on cardiovascular
utilized to enhance learning capabilities in students of health parameters and reaction time. Int J Yoga 2014; 7: 60-65.
professions education. 15. Bhavanani AB, Ramanathan M, Madanmohan P, Srinivasan AR. He-
matological, biochemical and psychological effects of a yoga training
Conflict of Interest programme in nursing students. Int Res J Pharm App Sci 2013; 3:
17-23
All authors disclose that there was no conflict of interest.
16. Bhavanani AB. Integrating yoga in health professional education: The
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International Journal of Advances in Medicine
Dutta A et al. Int J Adv Med. 2018 Apr;5(2):xxx-xxx
http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933
DOI: http://dx.doi.org/10.18203/2349-3933.ijam20180955
Original Research Article
Effect of yoga therapy on fasting lipid profile in chronic kidney

disease: a comparative study
Anirban Dutta1, Siva R. Green2*, Ananda B. Balayogi3, Hemachandar R.4,
Dhivya P.5, Kadavanu Tony Mathew5
1
Resident, 2Associate Professor, Department of Medicine, Department of General Medicine, Mahatma Gandhi Medical
College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India
3
Director of CYTER, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University,
Pondicherry, India
4
Department of Nephrology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth
University, Pondicherry, India
5
Assistant Professor, Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Sri
Balaji Vidyapeeth University, Puducherry, India
Received: 03 February 2018

Accepted: 19 February 2018
*Correspondence:
Dr. Siva R. Green,
E-mail: srgreen@mgmcri.ac.in
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Lipid abnormalities are common among patients with chronic kidney disease (CKD) and it tends to
persist/worsen even after initiating treatment. The cardiovascular mortality and morbidity remains significantly high
in this population. The present study was carried out to assess the effect of yoga therapy on fasting lipid profile in
CKD patients.
Methods: It was an interventional case control study on CKD patients with and without yoga in a tertiary care
hospital. About 60 CKD patients aged >18 years were enrolled for the study and were divided into 2 groups of 30
each. Subjects in Group 1 who underwent yoga therapy. Group 2 subjects did not do yoga and they served as controls.
Serum lipid profile, RFT and BP were estimated for all patients. Chi-square test, Paired and unpaired t test, mean and
delta change were used for comparison. A p-value of <0.05 was considered statistically significant.
Results: Out of 60 patients, males were predominant. There was significant reduction in Triglycerides, LDL and
VLDL in the yoga group. Total cholesterol also reduced but was not statistically significant. HDL also increased but
insignificant statistically.
Conclusions: Yoga therapy can be a new added adjuvant and cost effective to the standard lipid lowering agent to
reduce the lipid levels in CKD patients.
Keywords: Chronic kidney disease, Dyslipidaemia, Yoga
INTRODUCTION function of the kidneys, there is accumulation of

dangerous levels of waste and fluid in the body. The
Chronic kidney disease is a non-communicable disease, morbidity and mortality due to cardiovascular disease
which is characterised by slow progressive loss of kidney (CVD) associated with all stages of chronic kidney
function over a period of several years ultimately leading disease remains extremely high. Patients are more at risk
to permanent kidney failure. With rapidly declining of dying due to cardiovascular disease than due to end
International Journal of Advances in Medicine | March-April 2018 | Vol 5 | Issue 2 Page 1

stage renal disease (ESRD) as CVD onset is much before cholesterol parameters which was above or below the
the onset of ESRD.1 normal range in our laboratory was considered
dyslipidemic. Serum urea was measured by GLDH
Dyslipidemia is defined as a disorder of lipoprotein method in Hitachi 902 auto-analyzer in the Biochemistry
metabolism, including lipoprotein overproduction or laboratory, MGMCRI.
deficiency. Dyslipidemia is commonly associated with
CKD. Among all the lipid parameters it is the triglyceride Serum creatinine was estimated by JAFFE KINETIC
level (TGL) that remains elevated in CKD individuals.2,3 method in Hitachi 902 auto-analyzer in our hospital.
The serum level of triglyceride rich proteins shows high Patients with CKD had raised renal parameters.
values in ESRD patients as stated in few studies.4,5 Creatinine clearance was calculated by Cockcroft-Gault
Dyslipidemia itself presents with serious complications Equation and staging was done accordingly for all
like CVD or CVA. So, lipid levels should be lowered patients.
either by drugs or by lifestyle modification.
Yoga therapy module for CKD patients in group 1 was
Yoga is an ancient art of harmonizing system of as follows
development for the body, mind and spirit. Continued
yoga practice leads to a sense of peace and well-being • Individual counselling with life style modifications
with feeling of being at one with their environment. Yoga • Warming up practices (Jathis)
is one of the ancient traditional science having yogic • Breath body coordination techniques (kriyas)
physical postures (asanas), yogic breathing practices • Energizing breathing techniques (pranayama)
(pranayama), meditations and relaxation techniques. • Mental focusing and contemplation (dharana-
According to multiple scientific studies, yoga has shown dhyana)
to reduce the blood pressure, heart rate, respiratory rate, • Relaxation (shaithilya karana)
oxidative stress, psychological stress and inflammatory
conditions.6-8 Ten to 12 supervised sessions over 3 months with home
practice diary and telephonic follow up was done for each
Yoga has shown to reduce lipid levels in diabetics and patients to ensure more than 60% compliance. Data was
obese individuals.9,10 Not many studies has been collected and tabulated accordingly. Comparison of
conducted to observe the effect of yoga on dyslipidemia fasting lipid profile was done between group 1 and group
in CKD. Hence this study was conducted. 2 after a follow-up of 3 months. Author also compared
the initial and final BP for each subject.
METHODS
Statistical method
The study was conducted in MGMCRI, Pondicherry from
November 2015 to May 2017. 60 patients who had raised Statistical analysis was carried out using SPSS version
renal parameters and confirmed by Ultrasonography 19.0 (IBM SPSS, US) software with Regression Modules
KUB to be having shrunken kidneys (less than 8.5 cm installed.
bilaterally) were taken for study. Patients with previous
history of CVD or renal transplant and pregnant ladies Descriptive analyses were reported as mean and standard
were excluded from the study. Study population was deviation of continuous variables. Independent sample t
divided into 2 groups of 30 each. Group 1 included CKD test was used to compare the age, BMI, pulse rate, BP
patients who practiced yoga exercises. Group 2 patients (systolic and diastolic), RFT (Urea and Creatinine) and
did not practice yoga. A questionnaire designed for the FLP.
study was fulfilled by each candidate. BMI was
calculated. BMI of 18-24.9kg/m2 was considered normal. The end line results for dyslipidemia in both the groups
BMI less than 18kg/m2 was considered malnourished. was compared by Chi square test. Staging of CKD was
BMI more than 25kg/m2 was considered overweight. done for all 60 patients and p value was calculated based
History of smoking, physical activity, diet and alcohol on Chi square test. The difference in Initial and end point
consumption was taken. Personal and family medical values in FLP, RFT and BP was calculated by Delta
history of obesity, hypertension, diabetes mellitus and change. Delta change was calculated by the difference in
renal disease was recorded. Blood pressure of each the end line and base line values divided by the initial
patient was recorded by Sphygmomanometer. Fasting baseline value.
lipid profile, serum urea, serum creatinine was taken for
all patients. Fasting lipid profile was measured in RESULTS
MGMCRI Biochemistry laboratory. Total cholesterol was
measured by CHOD-PAP method. Serum triglyceride Demographic data
level was measured by GPO method. HDL Cholesterol
was measured by DIRECT method. Hitachi 902 auto-
All 60 patients had a complete evaluation for co-
analyzer was used for estimation of Fasting Lipid profile.
morbidities and complications. All data were collected
Any patient having abnormal triglycerides or any of the
and tabulated.

Each group had 8 females (26.7%) and 22 males (73.3%) calculated. The mean BMI for patients in group 1 was
each (Table 1). The mean age in group 1 was 55.1±11.6 22.7±3kg/m2. And in group 2 the mean BMI was
years and 55.6±11.2 years in group 2. The height and 23.3±2.5kg/m2 (Table 1).
weight were calculated for each subject and BMI was
Table 1: Baseline features of both groups.
Group 1 (N=30) Group 2 (N=30)

Features p value#
Mean (SD)
Gender
Female 8 (26.7) 8 (26.7)
Male 22 (73.3) 22 (73.3)
Age in years 55.1 (11.6) 55.6 (11.2) 0.87
BMI in kg/m2 22.7 (3) 23.3 (2.5) 0.41
Pulse rate in bpm 78.9 (8.4) 80.2 (9.1) 0.56
SBP in mm of Hg 164.9 (14.1) 159.9 (14.2) 0.17
DBP in mm of Hg 97.6 (10.1) 94.5 (10.5) 0.25
Smoking 6 (20) 8 (26.7)
Consume Alcohol 14 (46.7) 14 (46.7)
Among the group 1, the average baseline pulse rate of were diabetics compared to 22(73.3%) in group 2. In
78.9±8.4 bpm compared to group 2 which was 80.2±9.1 group 1, 21 (70%) were known hypertensive whereas in
bpm. The initial mean SBP between group 1 and group 2 group 2, 23 (76.6%) were known hypertensive. Ten
were 164.9±14.1mm of Hg and 159.9±14.2 mm of Hg patients (33.3%) were known dyslipidemic in group 1
respectively (p value 0.17). The mean DBP between whereas 9 (30%) were dyslipidemic in group 2 (Table 1).
group 1 and group 2 were 97.6±10.1 mm of Hg and In group 1 there were 2 (6.7%) patients in stage I,
94.5±10.5 mm of Hg respectively (p value 0.25) (Table 1(3.3%) in Stage II, 5 (16.7%) in Stage III, 9(30%) in
1). In group 1, 6 were smokers (20%) and 14 were stage IV and 13 (43.3%) in Stage V. In the second group
alcohol consumer (46.7%). In group 2 there were 8 there were 1 (3.3%) patients in stage I, 1(3.3%) in Stage
smokers (26.7%) and 14 consumed alcohol (46.7%) II, 5 (16.7%) in Stage III, 11(36.7%) in stage IV and 12
(Table 1). Among the patients 20 (66.7%) in group 1 (40%) in Stage V (Table 2).
Table 2: Baseline details of CKD stage of both study groups.
Stage Group 1 (N=30) N (%) Group 2 (N=30) N (%) P value#

I 2 (6.7) 1 (3.3)
II 1 (3.3) 1 (3.3)
III 5 (16.7) 5 (16.7) 0.96
IV 9 (30) 11 (36.7)
V 13 (43.3) 12 (40)
Table 3: Comparison between intergroup baseline and end line FLP, BP and RFT.
Group 1 Parameters Group 2 Parameters

P
Features Mean (Standard deviation) Mean (Standard deviation)
Value
Baseline Baseline Baseline Baseline End-line Diff
TC (in mg/dl) 165.7 (39.1) 162.9 (31.8) 2.7 (20) 158.8 (34.9) 171.4 (35.7) -12.5 (10) 0.001*
TGL (in mg/dl) 168.6 (73.1) 159.1 (58) 9.5 (23) 158.9 (64.2) 168.9 (53.6) -9.9 (20) 0.001*
HDL (in mg/dl) 41.9 (10.3) 42.6 (9.8) -0.73 (0.43) 40.6 (7.6) 41.4 (7.9) -0.73 (0.28) 0.99
LDL (in mg/dl) 90.3 (26) 89.6 (21.8) 0.7 (4.3) 85.6 (26) 95.8 (26.8) -10.1 (8.4) 0.004*
VLDL (in mg/dl) 33.5 (14) 31.4 (11.2) 2.2 (4.6) 31.7 (12.8) 33.4 (10.5) -1.6 (4.4) 0.002*
Urea (in mg/dl) 76.2 (22.2) 83.7 (21.6) -7.3 (8.9) 73.5 (19.9) 80.7 (20) -7.1 (4.5) 0.94
Creatinine (in
3.99 (1.8) 4.39 (2) -0.4 (0.4) 4.01 (1.9) 4.6 (1.9) -0.6 (0.5) 0.15
mg/dl)

The baseline and end line FLP and RFT was compared al, showed very high prevalence of dyslipidaemia in
between the two groups. Delta change was calculated CKD patients (84.9%).14 A study done by Lokesh et al, in
between the two initial and end point results after 3 a tertiary care hospital in South India on ESRD patients
months. There was a reduction in mean Total cholesterol showed very less evidence of dyslipidaemia which is
by 2.7±20mg/dl in group 1 and an increase in similar to my study.13 This lower level of dyslipidaemia
12.5±10mg/dl during the same period in group 2 compared to foreign studies may be attributed to racial
(p=0.001). Mean reduction in Triglycerides in group 1 variation, geographical variation, and increased frequency
was 9.5±23 mg/dl where as it increased in group 2 by of infections malnutrition among the Indian population.
9.9±20mg/dl (p value 0.001). Mean HDL increased by
0.73+/-0.43mg/dl and 0.73±0.28mg/dl in group 1 and 2 The prevalence of CKD stages 3 to 5 in this study was
respectively (p=0.99). Mean LDL reduction in group 1 more than that reported from other developed countries.
was 0.7±4.3mg/dl whereas in group 2 there was an There might be few probable reasons for this
increase in mean LDL by 10.1±8.4 mg/dl (p value 0.004). discrepancy. First, the risk factors of CKD including
Mean VLDL in group 1 showed reduction by diabetes and hypertension in our population were more
2.2±4.6mg/dl and in group 2 there was an increase by than in other countries. Furthermore it is possible that
1.6±4.4mg/dl (p value 0.002). Mean Serum urea in group definition of CKD based on calculation using MDRD
1 increased by 7.3±4.6mg/dl and in group 2 there was an formula is not reliable in Asian populations because this
increase by 7.1±4.5mg/dl (p= 0.94). Mean serum formula has not been validated in these populations.11
creatinine in group 1 increased by 0.4±0.4mg/dl whereas This may have lead to the prevalence of CKD being
in group 2 there was an increase by 0.6±0.5mg/dl (p= overestimated in our study.
0.15). The serum HDL, urea and creatinine were almost
similar (Table 3). Hypertension can be a cause as well as a complication of
CKD. In our study there were 44 patients (73.3%) who
DISCUSSION were known hypertensive. The mean systolic BP in group
1 was 164.9±14.1 mm of Hg and mean diastolic BP was
60 patients with chronic kidney disease were taken up for 97.6±10.1 mm of Hg. In group 2, mean SBP was 159.9
the study. Present study population had more male +/- 14.2 mm of Hg and mean DBP was 94.5±10.5 mm of
population compared to females with males forming 44 Hg. In a study done by Lokesh et al the mean systolic BP
out of the 60 study subjects (73.3%). Studies by was 156.25±22.152 mm of Hg and Diastolic BP was
Hosseinpanah F et al, and Chung CM et al. showed lower 93.75±13.90 mm of Hg.13 The values in both the studies
male population in the study with 41.9% and 44.1% male were similar. Another study done by Rajendra Kumar
preponderance respectively.11,12 Another study done on Pandey on CKD patients showed initial systolic BP of
ESRD patients in Pondicherry by Lokesh et al. revealed 147.80±17.47 mm of Hg and diastolic BP of 90.56±10.98
high male prevalence with 33 males out of 40 (82.5%) mm of Hg which was lower than our study population.15
which was similar to our study.13 This may be attributed
to the fact that male patients seek more medical attention In our study 20 (66.7%) patients in group 1 and 22
compared to women in India. (73.3%) in group 2 were diabetics. In a study done by
Lokesh etal. on dialysis patients,36 out of 40(90%) were
In our study population the mean BMI for patients were diabetics which was more than our study.13
22.7±3kg/m2 and 23.3±2.5kg/m2 in both group 1 and
group 2 respectively. In a similar study done by Lorenzo In Group 1, serum total cholesterol level decreased by
Gordon etal., the mean BMI of the patients in the control 2.7±20mg/dl and increased by 12.5±10mg/dl in group 2
group was 25.74±0.50kg/m2 while that of the Yoga (p=0.001). Serum triglyceride level reduced in group 1 by
exercise group was 25.550±2.2kg/m2 which was more 9.5+/-23 mg/dl and increased by 9.9±20 mg/dl in group 2
than our study population.14 Study done by Lokesh etal. (p=0.001). There was increase in the HDL levels by
on hemodialysis patients in a tertiary care hospital in 0.73±0.43mg/dl 0.73±0.28mg/dl in group 1 and 2
South India showed BMI of 20.76±4.249kg/m2.13 This respectively (p=0.99).
low BMI in Indian population can be explained on the
low socioeconomic status &malnourishment in the Indian The serum LDL level reduced by 0.7±4.3mg/dl in group
populations. 1 and in group 2 it increased by 10.1±8.4mg/dl
(p=0.004). The VLDL level dropped by 2.2±4.6mg/dl in
Low BMI in Indian population can be because of group 1 and increased by 1.6±4.4mg/dl in group 2
nutritional deficiency. (p=0.002). Findings were similar to a study done by
Gordon et al.14
There were 10(33.3%) patients with dyslipidaemia in
group 1 and 9(30%) patients with dyslipidaemia in group Limitation: Many patients were already on lipid lowering
2. The overall prevalence of dyslipidaemia in our study drugs so the solo lipid lowering effect of yoga could not
was 19 (31.7%) out of 60 which is low compared to be calculated. As the LDL level of all patients were found
studies done by Hosseinpanah F et al, where the evidence to be normal or low in our study, the factors effecting the
of dyslipidaemia was 44%.11 Study done by Gordon L et lowering of LDL cholesterols could not be assessed.

CONCLUSION on renal function in patients with dyslipidemia and

chronic kidney disease: assessment of clinical
Based on the results and the methodology employed, we usefulness in CKD patients with atorvastatin
have concluded that the prevalence of dyslipidemia (ASUCA) trial. Clin Exp Nephrol. 2017;21(3):417-
among the CKD patients (31.7%) attending MGMCRI 24.
was lower compared to studies done on western 5. Lanktree MB, Thériault S, Walsh M, Paré G. HDL
population probably due to malnourishment. In our study Cholesterol, LDL Cholesterol, and Triglycerides as
population, few patients had increased triglycerides and Risk Factors for CKD: A Mendelian Randomization
VLDL all patients had normal or subnormal levels of Study. Am J Kidney Dis. 2018 Feb 1;71(2):166072.
total cholesterol, LDL and HDL which could be probably 6. Chauhan A, Semwal DK, Mishra SP, Semwal RB.
explained by the malnourishment state of Indian Yoga Practice Improves the Body Mass Index and
population. CKD was more common in males (73.3%) Blood Pressure: A Randomized Controlled Trial. Int
than females which was also different from other studies. J Yoga. 2017;10(2):103-6.
Yoga has significantly improved the lipid parameters 7. Bhavanani AB, Ramanathan M, Balaji R, Pushpa D.
such as Triglycerides, VLDL and LDL levels. Yoga is a Comparative immediate effect of different yoga
very effective non-pharmacological method of treating asanas on heart rate and blood pressure in healthy
blood dyslipidemia. It should be applied on a larger study young volunteers. Int J Yoga. 2014;7(2):89-95.
population to confirm benefits. 8. Kashinath GM, Hemant B, Praerna C, Nagarathna
R, Nagendra HR. Role of Yoga in Chronic Kidney
ACKNOWLEDGEMENTS Disease: A Hypothetical Review. J Nephrol Ther.
2014;4:167.
Authors would like to acknowledge guide Dr. Siva 9. Shantakumari N, Sequeira S, El deeb R. Effects of a
Ranganathan Green (Associate Professor, Department of yoga intervention on lipid profiles of diabetes
Medicine) and Co-guides- Dr. Hemachandar R. DM patients with dyslipidemia. Indian Heart J.
(Associate Professor, Department of Nephrology), Dr 2013;65(2):127-31.
Ananda Balayogi Bhavanani (Director of CYTER, 10. Cramer H, Langhorst J, Dobos G, Lauche R. Yoga
MGMCRI), Dr. Dhivya P. MD (Assistant Professor, for metabolic syndrome: A systematic review and
Department of General Medicine) or their valuable meta-analysis. Eur J Prev Cardiol.
suggestions, continued guidance, support and 2016;23(18):1982-93.
encouragement in doing this study. I am thankful to our 11. Hosseinpanah F, Kasraei F, Nassiri AA, Azizi F.
Vice Chancellor, Professor Dr. K. R. Sethuraman for High prevalence of chronic kidney disease in Iran: a
helping me and providing valuable suggestions for this large population-based study. BMC Public Health.
study. I would like to specially thank Dr. Kadavanu Tony 2009;9:44.
Mathew (Assistant Professor, Department of General 12. Chung C-M, Lin M-S, Hsu J-T, Hsiao J-F, Chang S-
Medicine) for his immense help. Author is also indebted T, Pan K-L, et al. Effects of statin therapy on
to HOD, Dr. Jayasingh K. for all the advice and support cerebrovascular and renal outcomes in patients with
throughout the study. predialysis advanced chronic kidney disease and
dyslipidemia. J Clin Lipidol. 2017;11(2):422-31.
Funding: No funding sources 13. Lokesh S, Kadavanu TM, Green SR, Dutta TK,
Conflict of interest: None declared Hemachandar R, Ramachandrappa AK, et al. A
Ethical approval: The study was approved by the comparative study of lipid profile and
institutional ethics committee cardiovascular risk biomarkers among chronic
haemodialysis patients and healthy individuals. J
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Jun;13(6S):6S16-16S24. kidney disease. Int J Yoga. 2017;10(1):3-8.
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Dyslipidemia Associated with Chronic Kidney Cite this article as: Dutta A, Green SR, Balayogi
Disease. Open Cardiovasc Med J. 2011;5:41-8. AB, Hemachandar R, Dhivya P, Mathew KT. Effect
4. Kimura G, Kasahara M, Ueshima K, Tanaka S, of yoga therapy on fasting lipid profile in chronic
Yasuno S, Fujimoto A, et al. Effects of atorvastatin kidney disease: a comparative study. Int J Adv Med
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RESEARCH ARTICLE
Effects of overnight sleep deprivation on autonomic function and perceived
stress in young health professionals and their reversal through yogic
relaxation (Shavasana)
Raghul S1, Vasanthan S2, Ananda Balayogi Bhavanani3, Jaiganesh K2, Madanmohan T2
1
II MBBS Student, Mahatma Gandhi Medical College and Research Institute, Puducherry, India, 2Department of Physiology, Mahatma
Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India, 3Center for Yoga Therapy Education and Research,
Sri Balaji Vidyapeeth, Puducherry, India
Correspondence to: Vasanthan S, E-mail: svasanthphysio@gmail.com
Received: April 25, 2018; Accepted: May 03, 2018
ABSTRACT
Background: Extensive research has been done to demystify the effects of sleep deprivation on cognitive functions, memory,
and reasoning ability. However, there is a lacuna in regard to the effects on autonomic function and perceived stress as well as
its modulation through yogic relaxation. Healthcare professionals often work at night, and the effect of acute overnight sleep
deprivation on their performance is crucial. Aims and Objectives: The present study was undertaken to study the effects
of overnight sleep deprivation on autonomic function and perceived stress in health-care professionals and to determine its
modulation through yogic relaxation (Shavasana). Materials and Methods: A total of 35 healthcare professionals, aged between
20 and 25 years, were recruited from emergency services wing (casualty) of MGMC and RI, Puducherry, and taught yogic
relaxation. Heart rate (HR), blood pressure (BP), and HR variability (HRV) were recorded and Cohen’s perceived stress scale
(PSS) administered before the commencement of day duty. Parameters were again recorded after overnight sleep deprivation
due to night shift work and then after they practiced yogic relaxation (Shavasana). As data passed normality testing, Student’s
paired t-test was used to compare the changes after sleep deprivation and then after yogic relaxation. Results: Overnight sleep
deprivation resulted in statistically significant (P < 0.05) increases in systolic BP (SBP), low frequency (LF), LF/high frequency
(HF), diastolic BP (DBP), PSS, and mean HR. This was coupled with significant decreases in mean RR, SDNN, pNN50, HF,
and RMSSD. Following yogic relaxation, these changes were reversed, and significant decreases were witnessed in LF, LF/
HF, SBP, mean HR, DBP, and PSS with significant increases in mean RR, pNN50, HF, RMSSD, and SDNN. Conclusion: The
findings of our study reiterate the negative effects of sleep deprivation on cardiac autonomic status. Such deleterious effects
may be partially reversed by practicing yogic relaxation (Shavasana). Such conscious relaxation may be able to help correct
imbalance of autonomic nervous system by enhancing parasympathetic tone and reducing sympathetic overactivity.
KEY WORDS: Overnight Sleep Deprivation; Heart Rate Variability; Perceived Stress Scale; Yogic Relaxation; Shavasana
Access this article online INTRODUCTION

Website: www.njppp.com Quick Response code
A person’s quality of life can be disrupted due to many
different reasons, and one important yet underestimated
DOI: 10.5455/njppp.2018.8.0415003052018 cause for that is sleep loss.[1] Professions such as health
care, security, and transportation often require working at
night, and the deleterious effect of acute overnight sleep
National Journal of Physiology, Pharmacy and Pharmacology Online 2018. © 2018 Vasanthan S, et al. This is an Open Access article distributed under the terms of the Creative Commons
Attribution 4.0 International License (http://creative commons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix,
transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
Raghul et al. Sleep deprivation on autonomic function and perceived stress and reversal by Shavasana
deprivation on performance is crucial. Increased blood b. HR and resting BP (systolic BP (SBP) and diastolic
pressure (BP), heart rate (HR), and urine catecholamine DBP), and
levels have been associated with acute sleep deprivation, and c. Perceived stress scale (PSS).
it has been linked to potentially serious changes to emotion, 3. To compare the differential effect of overnight sleep
mood states, and their regulation.[2-4] It has been reported deprivation and normal sleep on the above-mentioned
that sleep deprivation increased subjective stress, anxiety, parameters.
and anger ratings with elevated negative mood by lowering 4. To study the effect of Shavasana on overnight sleep-
the psychological threshold for the perception of stress.[5] It deprived subjects.
is also well known that sleep deprivation may increase the
incidence of cardiovascular events, with a high incidence
of sudden death, myocardial infarction, and stroke in the MATERIALS AND METHODS
early morning attributed to sympathetic overstimulation.[6-9]
Although extensive research has been done to demystify Before commencement of the study, the Institute Research
the effect of sleep deprivation on cognitive functions, Committee (IRC) and IHEC approval were obtained. A total
memory, and reasoning ability, there is a lacuna in its effects number of 35 healthcare professionals in the age group between
on autonomic function and perceived stress as well as the 20 and 25 years were recruited from casualty and ICU unit
modulation of such responses to yoga. of Mahatma Gandhi Medical College and Research Institute,
Puducherry. All parameters were recorded in the Research
Yoga is the best lifestyle ever designed and is increasing in Laboratory of the Department of Physiology, MGMCRI.
popularity worldwide with a recent report suggesting that Subjects were explained about the method of recording
15 million Americans have practiced yoga at least once in and were familiarized with the laboratory environment.
their lifetime.[10] Yoga facilitates psychosomatic relaxation, Recordings were obtained between 8 and 10 am without any
and earlier studies have shown that Shavasana and Savitri stimulants in pre-recording period. The laboratory temperature
pranayama in trained subjects cause a significant decrease was maintained at a comfortable level with subdued lighting.
in oxygen consumption, HR, and diastolic BP (DBP) while
Shavasana alone has been shown to be effective in the Basal recordings were done before the commencement of
treatment of hypertension.[11-13] It is also known that sleep day duty. In the same subjects, all parameters were again
duration in long-term experienced meditators is lower than recorded after overnight sleep deprivation due to night shift
in non-meditators and general population norms, with no work. Yogic relaxation (Shavasana) was performed by the
apparent decrements in vigilance.[3] subjects on the day after overnight duty and parameters
recorded post-relaxation phase.
HR variability (HRV) is non-invasive and well-established
physiological parameter used to assess sympathovagal Technique of Yogic Relaxation (Shavasana)[12]
balance, an index of cardiac autonomic function.[14] Increase
in HRV is associated with decreased sympathetic and The subjects were asked to lie down in a calm and quiet room in
increased vagal tone influence on the sinoatrial SA node of the supine position with the hands and legs fully extended. The
heart while decreased HRV and sympathovagal balance have feet were kept side by side with the toes directed outwards. The
been reported to be associated with cardiovascular morbidity arms were kept close to the body at an angle of approximately 15
and mortalities.[15,16] with the trunk, keeping the forearms in mid prone position and
fingers relaxed. The eyes were closed lightly, and the subjects
Yogic relaxation (Shavasana) is known to induce were asked to perform slow rhythmic breathing. They were
psychosomatic relaxation and enhance one’s ability to instructed to keep their attention to the sensation of breathing
combat stress.[11,12] However, to the best of our knowledge, no at the nostrils only. The devitalization of group of muscles was
study has been done to determine the effectiveness of yogic carried out in the following order: First, the lower limbs, then the
relaxation (Shavasana) of short duration on physiological upper limbs, neck, face, and finally, the trunk. During this, the
functions, especially on mitigating the effect of overnight subjects were suggested to feel that a particular group of muscle
sleep deprivation. is completely relaxed and has become non-impressional to both
the afferent and efferent stimuli. The subjects were asked to
With the above background in mind, the present study was retain this posture for about 30 min, after which the revitalization
designed with the following aims and objectives: is done in the same order in which the muscles were devitalized.
Then, they were asked to sit up for a minute before standing.
1. To study the effect of overnight sleep deprivation on
autonomic function test and perceived stress in young
Recording of HRV
healthy volunteers.
2. To provide evidence for the same through: Subjects were asked to relax in a supine position on the
a. HRV measures (time and frequency domain), couch and allowed to relax for 10 min. Lead II ECG and

2018 | Vol 8 | Issue 9 (Online First) National Journal of Physiology, Pharmacy and Pharmacology 2
respiration were recorded at the 500 samples per sec RESULTS

using INCO Polyrite-D for 5 min. R-R interval data were
extracted by RMS Polyrite software, and then, HRV was The results are given in Tables 1 and 2. Comparison of BP,
analyzed from R-R interval by Kubios HRV, version 2.0, PSS, and HRV recordings before day duty and post night
Department of Physics, University of Kuopio, Finland. duty revealed significant increases in SBP, LF, and LF/HF
HRV data analysis and signal processing followed (P < 0.05) and DBP, PSS, and mean HR (P < 0.01), with
guidelines defined by “Task Force of the European Society
of Cardiology and the North American Society of Pacing
Table 1: Comparison of BP, PSS, and HRV parameters
and Electrophysiology”
recorded before day duty and post night duty in 35 young
Time domain components are mean HR, mean RR, standard healthcare professionals
deviation of RR intervals SDNN, square root of the mean Parameters Before day duty Post night duty
of the sum of the squares of differences between adjacent SBP (mmHg) 112.16±7.22 116.16±7.48*
RR intervals RMSSD, adjacent RR interval differing more DBP (mmHg) 75.44±8.48 79.38±7.36***
than 50 ms (NN50), and NN50 counts divided by all the RR PSS 18.30±3.44 20.36±3.76***
intervals (pNN50). Mean HR 73.88±3.85 76.13±4.65**
Mean RR 874.24±115.43 841.91±106.3*
Frequency domain components consisted of very low-
SDNN 56.31±8.51 49.47±9.46*
frequency (VLF) component (0.003–0.04 Hz), LF component
RMSSD 53.43±12.70 45.32±13.66**
(0.04–0.15 Hz), and high-frequency (HF) component
pNN50 26.62±8.50 21.20±4.57*
(0.15–0.5 Hz) and LF/HF ratio; the ratio of LF power to HF
power, LF power in normalized units (LF nu) = (LF × 100)/ LF (ms2) 495.54±59.28 522.62±44.15*
(TP-VLF), and similarly HF nu was calculated. HF, HF nu, HF (ms2) 214.07±43.23 165.94±60.28*
SDNN, RMSSD, NN50, and pNN50 reflect cardiovagal LF/HF 2.31±0.45 3.14±0.32*
tone; LF reflects both the sympathetic and parasympathetic Values are given as mean±SD. *P<0.05 **, P<0.01 ***,
tones; VLF component’s interpretation is not clear, and it P<0.001 by students paired t‑test comparing parameters before
cannot be interpreted using short-term HRV recordings; LF day duty and post night duty. SD: Standard deviation, BP:
nu and HF nu represent a relative tone of sympathetic and Blood pressure, PSS: Perceived stress scale, HRV: Heart rate
variability, SBP: Systolic blood pressure, DBP: Diastolic blood
parasympathetic nervous system PSNS.
pressure, LF: Low frequency, HF: High frequency
Recording of BP
Table 2: Comparison of BP, PSS, and HRV
After 15 min of rest in supine, SBP and DBP were obtained parameters before and after performance of yogic
from the subjects using sphygmomanometer. The average of relaxation (Shavasana) after post night duty in 35 young
three trials with 5 min interval was taken for calculation. healthcare professionals
Parameters Before yogic relaxation After yogic
Cohen’s PSS Questionnaire (post night duty) relaxation
(post night duty)
It is most widely used psychological questionnaire for
SBP (mmHg) 116.16±7.48 112.83±8.16**
subjects’ perception of stress. A 10-item Cohen’s PSS
DBP (mmHg) 79.38±7.36 74.55±7.24***
questionnaire was used to score feeling and thoughts during
PSS 20.36±3.76 17.44±3.50***
last month in this study. All the questions were explained
to the subjects and requested to answer. PSS scores were Mean HR 76.13±4.65 72.67±3.56**
obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 Mean RR 841.91±106.3 862.02±90.22*
= 1, and 4 = 0) to the four positively stated items (items 4, SDNN 49.47±9.46 59.63±10.04 ***
5, 7, and 8) and then summing across all scale items. A short RMSSD 45.32±13.66 52.98±10.4 **
4-item scale is made from questions 2, 4, 5, and 10 of the PSS pNN50 21.20±4.57 25.97±7.01 *
10-item scale. LF (ms2) 522.62±44.15 489.78±49.43 *
HF (ms2) 165.94±60.28 202.16±54.14 *
Statistical Analysis
LF/HF 3.14±0.32 2.78±0.45 *
After obtaining the study data, it was statistically analyzed Values are given as mean±SD. *P<0.05, **P<0.0,1 ***P<0.001
by students paired t‑test comparing parameters before and after
using SPSS version 16.0. All data passed normality testing
yogic relaxation done following night duty. SD: Standard deviation,
by Kolmogorov–Smirnov Test, and then, Students paired BP: Blood pressure, PSS: Perceived stress scale, HRV: Heart rate
t-test was used to compare the differences in the subjects variability, SBP: Systolic blood pressure, DBP: Diastolic blood
before and after the relaxation. pressure, LF: Low frequency, HF: High frequency
significant decreases in mean RR, SDNN, pNN50, and HF Benson.[19] This is further evidenced through increases in
(P < 0.05) and RMSSD (P < 0.01). Comparison of BP, PSS, time domain parameters with decreases in frequency domain
and HRV taken before and post Shavasana after the night duty parameters (except HF) of HRV. This study correlates with
revealed significant decreases in LF and LF/HF (P < 0.05); the findings of Vasanthan et al, who reported that yogic
SBP and mean HR (P < 0.01); and DBP and PSS (P < 0.001) practices decrease BP indices and increase HRV except
with significant increases in mean RR, pNN50, and HF LF shows enhancement of parasympathetic activity on the
(P < 0.05); RMSSD (P < 0.01); and SDNN (P < 0.001). heart.[20,21]
Our findings are collaborated by earlier reports from Streeter

DISCUSSION
et al. who proposed that yoga may reduce allostatic load in
stress response systems, thus restoring homeostasis.[22] They
It has been well documented that sleep is an important
hypothesized that stress causes an imbalance of autonomic
cause of disruption of the individual’s quality of life. This
nervous system with decreased parasympathetic and
is, especially, true in those professions that have extensive
increased sympathetic activity.
night duty where increased HR and BP as well as urine
catecholamine levels have been associated with acute sleep
Similarly, Innes et al. postulated two interconnected pathways
deprivation.
through which yoga may reduce cardiovascular and metabolic
risk.[23] They suggested, in this paper and a subsequent report,
Yoga facilitates psychosomatic relaxation and Shavasana
that this was through parasympathetic activation coupled
has been suggested to be an antidote to the stress response
with the decreased reactivity of sympathoadrenal system and
by previous studies.[11,12] However, most of the previous
hypothalamic-pituitary-adrenal axis.[24,25]
studies are based on training of longer duration, and to the
best of our knowledge, no study has been done to determine
As the yogic relaxation (Shavasana) is performed with
the effectiveness of yogic relaxation (Shavasana) training
conscious deep rhythmic breathing, this may be reducing
of short duration on overnight sleep deprivation in medical
sympathetic arousal, thus bringing about a fall in HR and
profession. This study was planned to determine if yogic
SBP as reported in the previous study.[26,27] It is well known
relaxation (Shavasana) training of short duration can
that slow deep breathing stimulates the stretch receptors in
modulate cardiac autonomic activity and cardiovascular
the lungs that induce the Hering–Breuer inflation reflex. This
response to stress caused by overnight sleep deprivation.
in turn causes a withdrawal of sympathetic tone leading to
vasodilatation and reduced DBP.[28]
In the present study, comparison of parameters before day
duty and post night duty showed significant decreases in
The enhanced parasympathetic activity and reduction in
mean RR, SDNN, pNN50, HF as well as RMSSD. It was
sympathetic arousal may be probably due to the influence of
also found that there were significant increases in SBP,
yogic relaxation at the level of reticular formation of the brain
DBP, mean HR, LF, LF/HF as well as PSS. These findings
stem. There are three feedback mechanisms which are said to
give evidence that overnight sleep deprivation produces
influence the activity of reticular formation: I) from cerebral
increased sympathetic activation coupled with a decreased
cortex, ii) from peripheral receptors and iii) from adrenal
vagal tone as well as an increased perception of stress. The
medulla. From peripheral receptors, pain and proprioceptive
decrease in time domain parameters of HRV and increase
impulses are said to be more important than others. In yogic
in the frequency domain parameters (except HF) can be
relaxation, the marked relaxation of muscles may be reducing
attributed to the same increased sympathetic activation as a
the numbers of proprioceptive impulses to a certain extent.
result of the overnight sleep deprivation. Our results are in
As the subject is asked to concentrate on the breath flowing
tune with those of Tockikubo et al., who found that overnight
through the nostrils into the chest, such a mindful and conscious
sleep deprivation increased BP,[17] while Kato et al. found
focus may help the subject to momentarily forget their usual
a heightened sympathetic nervous system activation due to
stresses during the relaxation period, thus providing mental
sleep restriction.[18]
relaxation. Due to these two factors, probably undue activity
of reticular formation during awakened condition might be
On the other hand, comparison of parameters before and after
reduced, and as a result of this, de-stressing manifests in the
the practice of yogic relaxation showed the reversal of this
subject after overnight sleep deprivation.
unhealthy trend. There were significant increases of mean
RR, pNN50, HF, RMSSD as well as SDNN, coupled with
significant decreases in LF, LF/HF, SBP, mean HR, DBP CONCLUSION
as well as PSS. These findings provide valuable evidence
of the de-stressing effect of yogic relaxation. It is also The findings of the present study reiterate the negative
interesting that such a positive effect can be evidenced even effects of sleep deprivation on cardiac autonomic status. It
with just 30 min of yogic relaxation. This may be attributed is also seen that such deleterious effects may be partially
to the induction of the relaxation response as postulated by reversed through yogic relaxation (Shavasana) of 30 min.

This finding has a great potential in those who are working Cardiol 1987;60:801-6.
night shifts on a regular basis as increased allostatic load in 8. Lusardi P, Zoppi A, Preti P, Pesce RM, Piazza E, Fogari R,
stress response systems can lead to chronic cardiovascular et al. Effects of insufficient sleep on BP in hypertensive
and metabolic disorders such as coronary artery disease patients: A 24-h study. Am J Hypertens 1999;12:63-8.
9. Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of
and metabolic syndrome. By reducing allostatic
insufficient sleep on BP monitored by a new multibiomedical
load and restoring normal homeostasis, yogic relaxation recorder. Hypertension 1996;27:1318-24.
(Shavasana) may be able to help correct the imbalance of 10. Saper RB, Eisenberg DM, Davis RB, Culpepper L, Phillips RS.
autonomic nervous system by enhancing parasympathetic Prevalence and patterns of adult yoga use in the united
tone and by reducing sympathetic overactivity. Further states: Results of a national survey. Altern Ther Health Med
studies with larger populations and with longer duration 2004;10:44-9.
of training may be useful in helping us to understand the 11. Madanmohan, Rai UC, Balavittal V, Thombre DP, Gitananda S.
mechanism by which these changes are brought about in Cardiorespiratory changes during savitri pranayama and
such a short time. Shavasana. Yoga Rev 1983;3:25-34.
12. Madanmohan T, Udupa K, Bhavanani AB, Krishnamurthy N,
Pal GK. Modulation of cold-pressor induced stress by
ACKNOWLEDGMENTS Shavasana in normal healthy volunteers. Indian J Physiol
Pharmacol 2002;46:307-12.
The authors thank the management and administrators of 13. Datey KK, Deshmukh SN, Dalvi CP, Vinekar SL. Shavasan:
Sri Balaji Vidyapeeth for setting up CYTER, thus enabling A yogic exercise in the management of hypertension.
yoga to reach all sections of society in a scientific and holistic Angiology 1969;20:325-33.
14. Madanmohan T, Bhavanani AB, Prakash ES, Kamath MG,
manner. We thank all the healthcare professionals for their
Amudhan J. Effect of six weeks of Shavasana training on
kind cooperation during the study. spectral measures of short term HRV in young healthy
volunteers. Indian J Physiol Pharmacol 2004;48:370-3.
FUNDING SOURCES 15. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of
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This work was supported by Indian Council of Medical
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Research ICMR as part of the Short-Term Studentship dysfunctions and sympathovagal balance in hypertension and
Program sanctioned to Raghul at that time pursuing 1st MBBS prehypertension: Physiological prospectus. Future Cardiol
at MGMCRI (Reference ID: 2016-06997). 2013;9:53-69.
17. Tochikubo O, Ikeda A, Miyajima E, Ishii M. Effects of
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28. Madanmohan T, Bhavanani AB, Sanjay Z, Vijayalakshmi L,

Original Research Article DOI: 10.18231/2393-8005.2018.0005
Enhancing awareness of yoga in health professions education students through a

single interactive session: A pretest-post test study
Dayanidy G.1, Ananda Balayogi Bhavanani2,*, Meena Ramanataan3
1Lecturer, 2Director, 3Deputy Director, Center of Yoga Therapy, Shri Balaji Vidyapeeth University, Puducherry, India
*Corresponding Author:
Email: yoga@mgmcri.ac.in
Abstract
Aim and objective: All students enrolled in Health Professions Education (HPE) at Sri Balaji Vidyapeeth, Pondicherry, receive
introductory yoga sessions during orientation programs conducted by their respective medical, dental and nursing colleges at the
beginning of their first year of training. We conducted a pre-test-post-test study to evaluate initial yoga awareness amongst HPE
students (pre-test) and to assess the changes after a single interactive session of yoga theory and practice (post-test).
Material and Methods: 367 HPE students (196 F, 171 M) were divided into seven batches for participation in yoga sessions at
the Centre for Yoga Therapy Education and Research (CYTER). The identical, validated Yoga Awareness Questionnaire (YAQ)
was given to them before and after the sessions to evaluate the changes in understanding / knowledge about yoga and yoga
therapy.
Results: Post-test scores increased significantly (p < 0.001) over both pre-test scores. The differences were significant for all
batches of the medical, dental and nursing students analysed separately, as well as for the overall comparisons of HPE students.
Conclusion: Even a single interactive session of yoga theory and practice can result in significant improvements in the awareness
and knowledge about yoga and yoga therapy, thus setting the stage for future short and long term studies on the benefits for such
students.
Keywords: Yoga, Health professions education, Pretest-post test.
Introduction constituent Nursing College in 2012. Then, in 2016,

"All life is Yoga, " says Sri Aurobindo,1 while Dr. pursuant to a report from CYTER on the psychological
Swami Gitananda Giri states that "Yoga is a way of and physical benefits of such training,4 it was adopted
conscious living that enables us to regain our health and formally into the curriculum, and 90 hours of yoga
happiness!"2 It is thus imperative that the life-enhancing therapy education are now imparted during the 3 year
art and science of yoga be integrated into the modern course. Yoga was also made compulsory for all medical
health care system if we are to progress from a disease- and dental students of the constituent colleges in 2014
oriented (pathogenic) to a health-oriented (salutogenic) and 2015, respectively.
model of health care. All HPE students of SBV receive introductory
One of the innovations of our Deemed to be yoga sessions during the orientation programs
University in Pondicherry, India, is to integrate yoga conducted by their respective colleges at the beginning
into Health Professions Education (HPE) in all of its of their first year. To evaluate the impact of these yoga
constituent institutions.3 Thanks to the foresight of its sessions, this pretest-posttest study was designed to
management and administrators, the Centre for Yoga determine changes in the students' awareness of yoga
Therapy, Education and Research has been functioning after a single theoretical and practical session at
within the university since 2010. During this time, this CYTER.
unique centre has provided yoga therapy to more than
43,000 participants in individual and group settings, as Materials and Methods
well in a larger group salutogenic model at the Context and participants
Mahatma Gandhi Medical College and Research This study was conducted at the CYTER of SBV.
Institute (MGMCRI). It has also worked to combine A total of 367 students (196 F, 171 M), aged 19.05 ±
traditional healing modalities such as yoga with 1.79 (mean ± SD) years, enrolled in HPE curricula and
empirical science. As a result, all medical, dental and attending yoga orientation programs participated. There
nursing students of a health care university are were 243 students (113 F, 130 M) from the MBBS
receiving theoretical and practical instruction in the course at MGMCRI, 25 students (23 F, 2 M) from the
application of yoga as a therapy. The authors made a BDS course at IGIDS, and 99 students (60 F, 39 M)
comprehensive search of literature online and no other from the BSc (Nursing) course at KGNC. Since all
such studies were found, and hence this may be participants were attending the first-year orientation
considered to be happening for probably for the first programs organized by their respective colleges, and
time anywhere in the world. since yoga awareness was part of these orientation
This training was introduced as an optional programs, they were recruited for our study by
component in the BSc nursing curriculum of our convenience sampling.
Journal of Education Technology in Health Sciences, January-April, 2018;5(1):20-24 20
Dayanidy G. et al. Enhancing awareness of yoga in health professions education students through a single…
Yoga Awareness Questionnaire and incorrect answers were once again logged in an
We created a 10-item, objectively-structured, Excel sheet. Pre-test and post-test scores were then
questionnaire to evaluate the students' current calculated separately for each student.
knowledge of yoga and yoga therapy. This Yoga
Awareness Questionnaire (YAQ) was pre-validated by Adjusted pre-test scores
ten experts with vast experience in the fields of yoga, Test-takers often correctly respond to multiple-
yoga therapy, medicine, psychology and HPE. choice questions whose answers they don't really know-
Responders were required to choose the one correct -in the case of four possible answers, roughly 25 % of
response from the four provided for each question. the time. To preclude such false positives in our pre-
test, adjusted pre-test scores were determined as
The objectives of the YAQ were: follows. The pre-test and post-test answers were
1. To help students understand the holistic meaning of scrutinized for each responder. If the answer was
yoga and to dispel prevalent misconceptions about incorrect in the pre-test and correct in the post-test, then
it. this was considered a true change. If a responder
2. To introduce technical concepts and terminology answered correctly in the pre-test and incorrectly in the
used in yoga. post-test, it was considered a false positive in the pre-
3. To enhance understanding of the Ashtanga Yoga of test. The pre-test score of each responder was then
Maharishi Patanjali. revised using this method to yield an adjusted pre-test
4. To enhance understanding of yoga as a therapy and score.
correct common misconceptions, including the
belief that yoga is a "cure all". Statistical Analysis
5. To introduce widely-used, simple yoga techniques. Statistical analysis of pre-test and post-test scores
was done using GraphPadInStat version 3.05 for
Procedure Windows 95, GraphPad Software, San Diego California
We divided the 367 students into seven batches for USA, www.graphpad.com. Because the data didn't pass
the yoga sessions, since space constraints at CYTER normality testing with the Kolmogorov–Smirnov test,
limited class size to 60. Four batches were from the Wilcoxon matched-pairs signed-ranks test was used
MGMCRI, two from KGNC and one from IGIDS. The for pre-post comparisons. P values less than 0.05 were
sessions were carried out in the CYTER yoga hall accepted as indicating significant differences between
between 2 pm and 4 pm, in a quiet environment with a pre-test and post-test scores.
comfortable temperature and subdued lighting.
When each batch of students arrived for the Result
session, they were arranged in an organized manner in a Our results are presented in Table 1 and Fig 1.
sitting position and then instructed to perform quiet, There was an overall significant (p < 0.001) increase in
normal breathing with closed eyes for a few minutes. post-test scores over pre-test and adjusted pre-test
The validated YAQ was then distributed and scores. The differences were significant for all batches
instructions were given on how to fill it in. At the end of the medical, dental and nursing students when
of the 15-minute pre-test, volunteers collected the analysed separately, as well as for the overall
completed questionnaires, and data about correct and comparisons of all HPE students combined together for
incorrect answers were logged in an Excel sheet. SBV.
The pre-test was then followed by a 90-minute
class that consisted of a short theoretical lecture Table 1: Comparison of pre-test, adjusted pre-test
followed by a practice session led by the lecturer. The and post-test scores of a yoga awareness
lecture included the foundations of yoga history and questionnaire answered by students of Health
philosophy, as well as the benefits, strengths and Professions Education (HPE) before and after a
limitations of yoga and yoga therapy. The practice single session of yoga theory and practice
session included basic warm-ups; asanas, such as Pre- Adjusted Post-
Students (n)
arthakatichakra, tala, danda, paschimottana and test pre-test test
purvottana; and pranayams, such as pranava and 7
4
bhramari. The session ended with relaxation in Medical 243 4 (1,8) (3,10)***
(1,8) ###
shavasana with savitri pranayama.
6
After the practice session, the students were once 4
Nursing 99 3 (0,7) (1,10)***
again instructed to sit comfortably with eyes closed and (0,7) ###
perform quiet, normal breathing for a few minutes. A 5 7 (4,10)
fresh copy of the YAQ (post-test) was then distributed Dental 25 4 (1,7) *** ###
(1,8)
and instructions on how to fill it in were repeated. At 7
the end of this 15-minute post-test, volunteers collected Overall 4
367 4 (0,8) (1,10)***
HPE (0,8) ###
the completed questionnaires, and data about correct
Values are given as median (range). ***p<0.001 by ###p< 0.001 by Wilcoxon Matched‑pairs Signed‑ranks
Wilcoxon Matched‑pairs Signed‑ranks Test for Test for comparisons between corrected pre-test and
comparisons between pre-test and post-test scores. post-test.
Fig 1: Comparison of pre-test, adjusted pre-test and post-test scores of a yoga awareness questionnaire
answered by overall HPE (n=367), first year medical (n=243), nursing (n=99), dental (n=25) students before
and after a single session of yoga theory and practice
Values are given as median (range).***p<0.001 by (median of 5; range of 1 to 8), although the smaller
Wilcoxon Matched‑pairs Signed‑ranks Test for batch size may also have skewed the results. As
comparisons between pre-test and post-test scores. evidenced in all batches and streams, even a single
###p< 0.001 by Wilcoxon Matched‑pairs Signed‑ranks session was able to nearly double the pre-test scores to
Test for comparisons between corrected pre-test and a post-test median of 7, with a range of 1 to 10. This
post-test. dramatic, across-the-board increase demonstrates the
appropriateness of the single session course design for
Discussion all HPE students, irrespective of their particular stream.
It has been stated that yoga enables the individual Moreover, the differences between pre-test and post-
to attain and maintain a balance between exertion and test were comparable to those between adjusted pre-test
relaxation, and that this results in a healthy and and post-test, thus implying that the true transferral of
dynamic state of homeostatic equilibrium.5 It has also knowledge was significant.
been suggested that a healthy life can be considered a
by-product of practicing yoga, since yoga practitioners As suggested by Henderson, "creating a climate of
are often physically and mentally healthier than the interest and motivation" is a strong psycho-social factor
population as a whole and cope with stress better.6 that influences learning in students. Keeping this factor
Nonetheless, few HPE institutions have introduced in mind, we took pains to conduct the sessions in a
yoga into their curricula--despite the ancillary function lively and student-friendly manner.8 If students are not
of health care providers to act as role models for brought together with the subject matter in a manner
healthy living. SBV thus represents an innovator in this that induces the 'spirit of learning,' it is more likely that
regard, having introduced yoga into its HPE curricula in teaching efforts will be in vain. Hence our instructors
a comprehensive manner. need to be trained to use such a positive, motivating
It is important to evaluate the immediate, short- approach if we are to succeed in our endeavour.
term and long term benefits of such innovations, and In the student feedback compiled by the colleges,
this study represents a simple and effective evaluation the yoga sessions received ratings of 84% excellent,
of the immediate effects. The pre-test-post-test format 15% good and 1% average. Personal responses from the
promotes understanding of the changes arising from students on their experiential learning and
any intervention and allows health professionals to transformations through the sessions were also
quickly grasp the effects of specific interventions.7 compiled, and these comments were also generally very
Before the session, participant awareness about positive (Table 2).
yoga was on the lower side for all streams (median of 4; The Government of India is attempting to build
range of 0 to 8). Dental students scored slightly higher bridges between the traditional systems of AYUSH and
modern allopathic medicine. (9)We who support these
efforts can make a contribution by identifying the "best practice can produce such dramatic immediate
practices" for integrating yoga into the educational improvements in awareness and knowledge about yoga,
training of health professionals. This study is one of the then short and long term benefits may also reasonably
first to provide evidence in this regard, and the authors be expected. Studies that seek to identify and quantify
hope that it will stimulate further research in the near these benefits for HPE students are therefore likely to
future. If even a single session of yoga theory and bear a rich harvest.
Table 2: Personalized feedback from students to the yoga sessions
a. Really helpful and felt relieved from stress and tension.

b. Gave us a refreshing feel.
c. Awesome class and we are looking forward to more.
d. Was a good stress relieving session.
e. Had a good experience though it was a bit challenging initially.
f. It will be useful if we practice it regularly. Thank you for these classes.
g. So helpful as I felt refreshed and my mind was relaxed.
h. It was a very good experience.
i. The stretching exercise was especially very useful for me.
j. This yoga session was very useful. And for me, I enjoyed doing it.
k. Thank you for this wonderful experience.
l. Very useful sessions involving various relaxation techniques required by us in our day to day
activities.
m. Sessions involves several stretching exercise required for body functioning.
n. The yoga classes have been very useful to reduce my stress and anxiety.
o. Looking forward to more classes in the future.
p. The practice was very easy and comfortable to do, they are also very useful.
q. Yoga is meant for relaxation of mind, body and soul. It is the best therapy for everybody.
r. Yoga therapy was very interactive session in which I learnt many breathing techniques and
Asana.
s. I learnt many new things about yoga which I didn’t know before.
t. Yoga relieve us from both physical and mental stress.
u. It makes us feel free and energetic.
v. The yoga session was helpful and energetic.
w. Yoga is very useful. No negative feedback. Thank you so much sir.
x. It gave a very good time to relax and loosen our body. Since, we are hostlers we had no
physical exercise but this gave us some. I hope this continues every week.
y. The session was useful and informative.
z. The exercise and pranayama taught were explained properly.
aa. After the yoga class I felt good, and also found it very interesting.
bb. Shavasana is really good. I liked it very much.
cc. It was very essential.
dd. I felt some silence inside my body.
ee. I felt very fresh and enthusiastic.
ff. A nice kind of relaxation.
gg. I felt really good.
Acknowledgments Integration of Yoga in medical, dental and nursing

Support of the benevolent management and curriculum was possible with the support of the
visionary administrators of Sri Balaji Vidyapeeth who respective faculty Deans and Vice-Principals of the
setup the CYTER in 2010 is gratefully acknowledged. constituent colleges as well as faculty of Allied Health
Heartfelt gratitude is offered to our Hon’ble Chairman Sciences. We thank Dhanushapnadeesh, Sarulatha G,
& Chancellor, Vice-chancellor, Dean of Research & Vidhyasri Ravichandran, Lakshman Prathap and
Allied Health Sciences and Registrar SBV for their Shvetika Kaul for their valuable assistance during the
constant support and encouragement. The CYTER team study. We thank Billy Uber of BadenBaden Germany
is ably guided by Prof. Madanmohan, Honorary for having given the manuscript a thorough language
Advisor CYTER and blessed by Ammaji Yogacharini and grammar overhaul.
Meenakshi Devi Bhavanani, Director ICYER.
Funding sources: Though the present work didn't

receive any special funding, Sri Balaji Vidyapeeth
funds the CYTER and all of its activities in yoga
therapy, education and research.
Other disclosures: None.

Disclosure of ethical approval: N/A
References
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DOI: 10.7860/JCDR/2018/35949.11924
Original Article
A 12-Week “Silver Yoga” Program

Alternative Medicine
Complementary/
Section
Enhances Lung Function in Elderly

Women Residents of a Hospice
ABSTRACT study data were done using Student’s paired and unpaired t-test
Introduction: “Silver Yoga” program has been devised by respectively. A p-value less than 0.05 was considered to indicate
Centre for Yoga Therapy, Education and Research (CYTER) of significant differences between means.
Sri Balaji Vidyapeeth, Pondicherry. Participants practiced the Results: After the 12 weeks of Silver Yoga, both weight and
protocol that was specially designed for senior citizens, keeping BMI showed significant reduction (p<0.05) in Group A, whereas
in mind their health status and physical limitations. there was an insignificant increase in Group B. Lung function
Aim: The present study was planned to evaluate possible tests such as FVC, FEV1, PEFR, and FIVC increased significantly
changes in lung functioning assessed through Pulmonary (p<0.05) after yoga training, whereas FVC decreased significantly
Function Test (PFT) in senior citizens following 12 weeks of an (p<0.05) in the Group B. Group A showed significant decrease
integrated Silver Yoga programme. in both Respiratory Rate (RR) (p<0.01) and Lung Age (p<0.001)
while FEF25-75 increased significantly in both groups.
Materials and Methods: In this comparative pre-post study,
40 elderly women inmates of the hospice were randomised Conclusion: Results of this pilot study give preliminary evidence
into two groups of 20 each. Yoga group (Group A) received that incorporation of Yoga as part of senior’s lifestyle can help
training in the integrated Silver Yoga programme while control in promoting health thereby, modifying age related disorders.
group (Group B) did not receive any yoga training. Both the It is however, limited by the smaller sample size, also limited
groups however participated in all the routine activities of the to a single centre. Further multi-centric studies with larger
Hospice. Anthropometric data, respiratory rate and lung function populations can deepen understanding of intrinsic mechanisms
parameters were recorded before and after the 12-week study by which these changes are occurring in Silver Yoga.
period. Intra-group and inter-group comparisons of pre and post
Keywords: Ageing, Lifestyle, Pulmonary function test, Respiratory parameters, Senior women
INTRODUCTION component of "Silver Yoga" helps to rejuvenate body and mind

Ageing is a progressive, generalised impairment of functions, and facilitate inherent healing mechanisms [6].
resulting in a loss of adaptive response and is at a high risk of age- An earlier pilot study by the authors assessed health status of
related deterioration [1]. The United Nations defines elderly as those elderly women residing in a hospice in Pondicherry and reported
who are older than 60 years of age, however, in many developed that although the physical health status was satisfactory for their
countries; the age of 65 is used as a reference point for older persons age but their psychological health status was impaired due to a life
[2]. Ageing causes corresponding physiological modifications in the in a hospice abandoned by their families or with no family at all [7].
respiratory system which shows decreased static elastic recoil of The present study was taken up as a follow up to that pilot study
the lung, respiratory muscle performance and compliance of chest and planned to evaluate the possible changes in lung functioning as
wall, due to which process of breathing becomes more strained [3]. assessed through PFT of such a population following 12 weeks of
Assessment of defects and abnormalities of the respiratory system an integrated Silver Yoga programme.
are identified and measured by PFT which provides important clinical
information useful for treatment [4]. Important variable affected MATERIALS AND METHODS
by Ageing is the lung functioning which varies from individual to This comparative pre-post study of 12 weeks was done during
individual [5]. August-November 2014 at the Hospice Convent Home for the
Health concerns in seniors are often due to sedentary lifestyle Aged, Congregation of Saint Joseph of Cluny in Pondicherry.
adopted by them as a result of ageing and yoga has the Ethical clearance was obtained from Institutional Human Ethics
potential to bring about positive changes in their lives. As part Committee (IHEC: Faculty/2014/03) of MGMCRI, Sri Balaji
of its outreach activities for the local community, Centre for Vidyapeeth, Puducherry. Authorities and inmates of Hospice
Yoga Therapy, Education and Research (CYTER) of Sri Balaji Convent Home for the Aged willingly volunteered to take part in
Vidyapeeth, Pondicherry has designed a “Silver Yoga” program this study. An orientation program was conducted for the women
for senior citizens keeping in mind their health status and physical inmates of the hospice to explain details of tests, purpose of
limitations. This program consists of simple jathis and kriyas that study and their role in this study to ensure proper understanding
are warming up practices to induce flexibility, body awareness and effective cooperation. Those who were willing to participate
and enhance energy (prana) circulation. Asanas, isometric passive in yoga therapy and who would be able to perform the techniques
stretching postures of yoga that are non-strenuous, non-fatiguing in the protocol were included for the study. Unwilling inmates
can be performed comfortably even at an advanced age are were excluded from this study. Informed consent was obtained
also included. Conscious deep breathing in pranayama is done from the subjects and acceptance obtained from the authorities
to harmonize the cardio-respiratory function while the relaxation of the hospice.
Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): KC01-KC04 1
Meena Ramanathan and Ananda Balayogi Bhavanan, Silver Yoga Program Enhances Lung Function in Elderly Women www.jcdr.net
Forty elderly women (68.55±7.96 years) volunteered for the Silver Yoga sessions were conducted for 60 minutes, twice a week
present study. Eight of them reported normal health status, for 12 weeks. The training schedule consisted of the Silver Yoga
whereas others reported that they were on regular treatment protocol used routinely at CYTER and included simple warm‑up
for one or more medical conditions including hypertension (14), and breath–body movement coordination practices, static
hypothyroidism (3), type 2 diabetes mellitus (22), knee pain (14), stretching postures (asanas), breathing techniques (pranayamas),
low back pain (3), asthma (12), dyslipidemia (7) and insomnia (5). and relaxation [6]. The complete protocol is given in [Table/Fig-1].
After this assessment, they were randomised into two groups of There were no dropouts and all the 40 women completed the study.
20 each, by random sample generator app which allows to select Those involved in the yoga programme were involved in regular
a sample from an ordered list. The co-morbidities of the subjects discussion both individually and in groups regarding their health
were comparable at baseline. status and appropriate guidance given throughout training period.
The yoga group (Group A) received 12 weeks of an integrated None of them reported any discomfort, pain or injuries during the
Silver Yoga programme [Table/Fig-1] developed by CYTER of Sri study period or in the follow up interactions over the next 6 months.
Balaji Vidyapeeth as part of its best practices. Group B consisted Though some mild muscle soreness and stiffness was self-reported
of control group who did not receive any yoga training. Both the in the initial week, this was found to subside over the next weeks
groups however, participated in all the routine activities of the with regular practice.
Hospice which included wake up at 5.30 am followed by prayer Data for all parameters were recorded before and after the 12 weeks
in the chapel and breakfast. Then they help with cooking, washing study period.
vessels, clothes followed by lunch, rest for two hours and in the Anthropometric data: Individual height was measured to the
evening they do some gardening, handwork, knitting etc., (according nearest mm by a wall mounted stadiometer and weight measured
to the individual interest) followed by prayer and dinner. The age, with a weighing scale (Krup’s scale). BMI was calculated by
height, weight and BMI of both groups were comparable at baseline Quetelet’s index quantified as weight (kg)/height2 (m).
and is given in [Table/Fig-2].
Respiratory Rate (RR) in breaths/minute: The subjects were
Duration instructed to relax in the supine position for three minutes after
Practices Repetitions
(min) which the investigator held the wrist of the subject as if taking the
Jathis and Kriyas (Warming up practices) 3 each 12 pulse and at the same time observed the rising and falling of the
Asanas (static postures)
chest wall for 60 seconds. The number of breaths per minute was
counted manually and noted down.
Tala Asana 3 rounds 3
PFT: Lung function parameters selected for study were: Forced
Ardhakatichakra Asana 2 rounds on each side 4
Vital Capacity (FVC) in Litres (L), Forced Expiratory Volume in the 1st
Katichakra Asana 2 rounds on each side 4
second (FEV1) in Litres (L), FEV1/FVC, Peak Expiratory Flow Rate
Paschimottana Asana 3 rounds 3 (PEFR) in Litres per second (L/s), Forced Inspiratory Vital Capacity
Vakra Asana 2 rounds on each side 4 (FIVC) in Litres (L), Forced Expiratory Flow between 25 and 75%
Bhujanga Asana 3 rounds 3 (FEF 25-75) in Litres per second (L/s) and Lung age in years.
Pranayama (energy modulation through conscious breathing) RMS Helios 401 Spirometer, version 1.0, (EN ISO 13485: 2003)
Chandranadi Pranayama 9 rounds 4 manufactured by Recorders and Medicare Systems Pvt. Ltd.,
Haryana was used having a turbine sensor working on infrared
Vyagraha Pranayama 9 rounds 3
interruption principle. All measurements in Spirometry were done by
Pranava Pranayama comprising of the
akara, ukara and makara components
3 rounds of each
10
chief clinical lab technician of an ISO 9001-2008 certified laboratory,
component and assisted by the investigator. Relevant data such as name, age,
followed by omkara.
Relaxation sex, height, weight, occupation, lab temperature were entered into
the computer and subjects were made familiar with the instrument
Shavasana - 10
and procedure for performing PFT. Tests were done on the subjects
Total 60 who were seated comfortably in an upright position with an erect
[Table/Fig-1]: List of yogic techniques given as part of the “Silver Yoga” program spine, without bending forward. The subjects were instructed to
for elderly women. take the disposable mouthpiece inside their mouth with lips closed
Group A (n=20) Group B (n=20) Comparison (p-values)

Parameter
Before After Before After Before After
Age (y) 68.90±7.55 68.20±8.54 0.78
Height (m) 1.49±0.07 1.47±0.07 0.36
Weight (Kg) 58.15±10.27 57.01±10.30* 59.80±14.45 60.50±13.50 0.68 0.36
BMI (Kg/m ) 2
26.31±4.87 25.78±4.79* 27.62±6.42 27.98±5.99 0.47 0.21
RR (bpm) 22.75±4.67 19.85±4.02** 23.20±4.44 24.00±2.60 0.76 <0.001
FVC (L) 1.44±0.53 1.91±0.35*** 1.42±0.44 1.31±0.45* 0.88 <0.001
FEV1 (L) 1.32±0.46 1.82±0.30*** 1.34±0.42 1.29±0.42 0.92 <0.001
FEV1/FVC 92.50±6.31 95.77±5.96 95.82±4.81 99.14±2.65** 0.06 0.02
PEFR (L/s) 3.00±1.28 3.76±1.15** 3.52±1.30 3.65±1.82 0.21 0.82
FEF 25-75% (L/s) 1.89±0.61 2.55±0.72*** 2.16±0.81 2.51±0.90** 0.24 0.90
FIVC (L) 1.44±0.53 1.78±0.33* 1.29±0.60 1.16±0.31 0.29 <0.001
Lung age (y) 59.60±23.71 28.75±33.40*** 59.20±20.87 62.10±20.40 0.96 <0.001
[Table/Fig-2]: Effect of 12 Weeks of Silver Yoga programme on Body Mass Index (BMI), Respiratory Rate (RR), Forced Vital Capacity (FVC), Forced Expiratory Volume in the 1st
Sec (FEV1), FEV1/FVC, Peak Expiratory Flow Rate (PEFR), Forced Expiratory Flow (FEF) 25-75%, Forced Inspiratory Vital Capacity (F1VC), and Lung Age in 20 elderly women
(Group A) and 20 matched controls (Group B) before and after study period.
Values are given as Mean±SD. *p<0.05, **p<0.01 and ***p<0.001 by paired t-test for intra group comparisons and actual p-values given for unpaired t-test between groups.
2 Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): KC01-KC04

www.jcdr.net Meena Ramanathan and Ananda Balayogi Bhavanan, Silver Yoga Program Enhances Lung Function in Elderly Women
over it to avoid the leakage of air while blowing. Nose clip was and concluded that the increase was due to significant increase
applied during the entire manoeuvre. Test manoeuvre was repeated in vital capacity [19].
for three times with gap of 3-5 minutes between each manoeuvre In another report by Nayar HS et al., it was suggested that increased
and the subjects were adequately encouraged to perform at their FEV1 in yogic practitioners may be because of improved potency of
optimum level applying maximal effort and the best manoeuvre was airways [20]. Buffalo health study revealed FEV1 as an independent
considered for analysis. predictor of overall long term survival rates and suggested that it
could be used as a tool in general health assessment [21]. They
STATISTICAL ANALYSIS also recommended that yoga could help in enhancing efficiency of
All data passed normality testing by Kolmogorov-Smirnov (KS) test lung function especially with respect to FEV1 as part of an essential
and hence, intra-group comparisons of pre and post study data was preventive strategy [21]. Yoga asanas involve isometric contraction
done using Student’s paired t-test while intergroup comparisons that contributes to enhanced skeletal muscle strength and this in
between groups was done using Student’s unpaired t-test. A p-value turn improves lung function parameters [14,15]. Such practices also
less than 0.05 were considered to indicate significant differences enable lungs to inflate and deflate to fullest possible extent leading
between the means. to maximum efficiency of respiratory apparatus [13].
The measurement of PEFR helps assess degree of opening of small
RESULTS airway passages and previous studies have shown improvements
The results are given in [Table/Fig-2]. At baseline all values were due to enhanced respiratory muscle conditioning that are also
comparable between groups A and B. After the 12 weeks of Silver evidenced in Group A [22,23]. There were some insignificant
Yoga, both weight and BMI showed significant reduction (p<0.05) in improvements in PEFR of Group B, however the inter group
Group A, whereas there was an insignificant increase in Group B. comparisons resulted in no significant statistical differences.
Lung function tests such as FVC (p<0.001), FEV1 (p<0.001), PEFR Improvement in FVC, FEV1 and PEFR may be due to regular
(p<0.01), FEF25-75% (p<0.001), and FIVC (p<0.05) increased slow and forceful inspiration and expiration during yoga practice,
significantly in Group A after yoga training. FEV1/FVC increased in leading to strengthening of respiratory muscles and increased
Group A but it was not statistically significant. There was a significant release of surfactant [24]. Yoga with its calming effect on the mind
decrease in both RR (p<0.01) and Lung Age (p<0.001) in Group A. can reduce and release emotional stresses, thereby withdrawing
FEV1 and PEFR increased slightly and FIVC decreased in Group broncho-constrictor effect [19]. Relaxation is an integral part of any
B. FVC decreased significantly (p<0.05) because of which there yoga training and was part of our Silver Yoga program as it de-
was a statistically significant increase of FEV1/FVC in Group B stresses and enhances self-healing in the practitioner as reported
(p<0.01). There was an insignificant increase in both RR and Lung earlier [25].
Age in Group B. In this protocol, brief periods of relaxation were given between
practice of different techniques and also during shavasana with
DISCUSSION breath awareness. This may be contributing to enhanced autonomic
The present study provides evidence of improvements in PFT of balance by increasing parasympathetic activity and simultaneously
geriatric hospice women population after 12 weeks of a Silver decreasing sympatho‑adrenal over activity. The resultant calming
Yoga program. There were significant differences between groups effect on the stress response system enables to bring down the
for parameters such as FVC, FEV1, FIVC and lung age and these levels of anxiety and depression [7].
were significantly greater in Group A than in Group B. The seemingly RR decreased significantly in Group A and this is similar to previous
positive change seen in FEV1/FVC in Group B can however be reports by Upadhyay K et al., who reported decreased respiratory
neglected as an artefact as it can be attributed to an unequal rate after four weeks of alternate nostril breathing as well as Doijad
reduction in FVC as compared to FEV1. Reduced FVC suggests VP et al., who found significant decreases after 12 weeks of yoga
a restrictive abnormality and small airway closure and gas trapping [26,27]. Yogic practices especially pranayama provides focus,
and the negative changes in control group and positive changes helps internalisation by withdrawing attention from worldly worries
in Group A provide evidence of the benefits of yoga in such a and hence de-stresses the practitioner, decreasing sympathetic
population [8-11]. activity, leading to a corresponding decrease in heart rate, blood
The positive and significant changes seen in Group A clearly indicate pressure, RR etc., [28,29]. Joshi LN et al., has hypothesised
improvements in lung function in our subjects and these findings are that during pranayama the basic activity of medullar and pontine
consistent with previous studies [12-15]. respiratory centres is slowed down, prolonging phases of inspiration
and expiration by stretching and utilising to the fullest extent the
These findings are important considering the age group of our
efficiency of lungs [13]. Others have also postulated that while
subjects as Knudson RT et al., reported that ageing results in
practicing pranayama, reflex mechanisms that control respiratory
changes in pulmonary mechanics, respiratory muscle strength, gas
centre may be modified by conscious use of the higher cortical
exchange and ventilatory control with increased rigidity of chest wall
centres thereby, increasing breath holding time and decreasing
and decrease of respiratory muscle strength evidenced by reduction RR [20,30]. Our findings are consistent with earlier reports that
in FVC and FEV1 [16]. Others including Woo J et al., have shown asanas and pranayama reduce resting RR, while increasing vital
that FVC declined by 28.61%, FEV1 by 28.54% and PEFR by capacity, breath holding time, as well as the maximum inspiratory
24.86% with advancement of age and that women showed greater and expiratory pressures [31].
age related decline in FVC than men [17].
Improvement in vital capacity may be attributed to the strengthening LIMITATION
of respiratory musculature associated with regular practice of The present study is limited by the smaller sample size and the fact
yoga as reported by Bhole MV [18]. It was also suggested that that the protocol was not validated by external experts though it is
the respiratory apparatus is emptied completely after prolonged being routinely used at CYTER. It was also limited to a single centre.
exhalation and thus the subsequent inhalation is more complete Further, multi-centric studies that explore functional changes with
and efficient, which then reflects in terms of increased FVC [18]. correlations between such changes, psychological variables, and
Joshi LN et al., reported significant increase in FVC and PEFR other biochemical markers may deepen the understanding of
following six weeks of pranayama practice [13] while Makwana K intrinsic mechanisms by which these changes are occurring in yoga
et al., showed increased FEV1 after 10 weeks of yogic practice therapy programs.
Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): KC01-KC04 3
Meena Ramanathan and Ananda Balayogi Bhavanan, Silver Yoga Program Enhances Lung Function in Elderly Women www.jcdr.net
CONCLUSION [8] Singh S, Soni R, Singh KP, Tandon OP. Effect of yoga practices on pulmonary
function tests including transfer factor of lung for carbon monoxide (TLCO) in
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[11] Rao YC, Kadam A, Jagannathan A, Babina N, Rao R, Nagendra HR. Efficacy
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Physiol. 1983;64:899-905.
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psychological functioning in a positive manner. Considering all 1992;36(2):105-08.
[14] Madanmohan, Jatiya L, Udupa K, Bhavanani AB. Effect of yoga training on
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as an important lifestyle intervention and physical activity for the Pharmacol. 2003;47(4):387-92.
elderly in the prevention of many diseases as prescribed by the [15] Dinesh T, Gaur GS, Sharma VK, Madanmohan T, Harichandra Kumar KT,
Bhavanani AB. Comparative effect of 12 weeks of slow and fast pranayama
WHO especially where rigorous physical exercise is not advisable. training on pulmonary function in young, healthy volunteers: A randomized
It is recommended that yoga should be a part of health‑care controlled trial. Int J Yoga. 2015;8:22-26.
facilities for elderly as it can enhance quality of life by improving [16] Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal
maximal expiratory flow-volume curve with growth and ageing. Am Rev Respir
their overall health status. It can provide a healthy and positive Dis. 1983;127:725-34.
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sunset years of life. [18] Bhole MV. Treatment of bronchial asthma. Yoga Mimansa. 1967;9:33.
[19] Makwana K, Khirwadkar B, Gupta HC. Effect of short-term yoga practice on
ventilatory function tests. Indian J Physiol Pharmacol. 1988;32:202-08.
Acknowledgements [20] Nayar HS, Mathur RM, Kumar RS. Effects of yogic exercises on human physical
The authors thank the management and administrators of Sri Balaji efficiency. Indian J Med Res. 1975;63:1369-76.
[21] Schünemann HJ, Dorn J, Grant BJ, Winkelstein W Jr, Trevisan M. Pulmonary
Vidyapeeth for setting up CYTER thus, enabling yoga to reach all function is a long-term predictor of mortality in the general population: 29-year
sections of society in a scientific and holistic manner. We offer our follow-up of the Buffalo Health Study. Chest. 2000;118(3):656-64.
gratitude to Ilavarasi, D Pushpa, G Sarulatha, Imma Sivaraj, and [22] Mamatha SD, Gorkal AR. Effect of Savitri Pranayama practice on peak expiratory
flow rate, maximum voluntary ventilation and breath holding time. IJRRMS.
Visalakshi, for their valuable assistance with data collection. Sincere 2012;2(1):09-10.
gratitude is also offered to inmates and authorities of Hospice of [23] Prakash S, Meshram S, Ramtekkar U. Atheletes, yogis and individuals with sedentary
Saint Cluny, Puducherry for their wholehearted and generous lifestyle; Do their lung functions differ. Indian J Physiol Pharmacol. 2007;51:76-80.
[24] Chakraborty T, Das KS, Samajdar K. Effect of yogic exercise on selected
co‑operation. pulmonary function tests in apparently healthy elderly subjects. IOSR Journal of
Dental and Medical Sciences (IOSR-JDMS). 2013;9(1):01-05.
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[2] UNFPA and Help Age International. Ageing in the twenty-first century: a [26] Upadhyay K, Malhotra V, Sarkar D, Prajapati R. Effect of alternate nostril breathing
celebration and a challenge. 1st ed. New York, USA: United Nations Population exercise on cardio respiratory functions. Nepal Med Coll J. 2008;10(1):25-27.
Fund (UNFPA). 2012; pp. 20. [27] Doijad VP, Surdi AD. Effect of short term Yoga practice on cardio-respiratory
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[4] Wallace RK, Benson H, Wilson AF. A wakeful hypometabolic physiologic state. Pondicherry, India: Dhivyananda Creations. 2013; pp. 95-97.
Am J Physiol. 1971; 221:795-99. [29] Bhavanani AB, Ramanathan M. Yoga therapy for chronic diseases: psychosomatic
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obstruction. Canada: Hamilton. 1999;2(1):128-31. Puducherry. 19-23, June 2017. pg 57-63.
[6] Bhavanani AB, Ramanathan M, Trakroo M. Single session of integrated “Silver [30] Bhargava R, Gogate MG, Mascarenhas JF. Autonomic Responses to breath-
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1. Deputy Director, CYTER, Sri Balaji Vidyapeeth, Puducherry, India.
2. Director, CYTER, Sri Balaji Vidyapeeth, Puducherry, India.

Dr. Meena Ramanathan,
Deputy Director, CYTER, Sri Balaji Vidyapeeth, Pillayarkuppam-607402, Puducherry, India. Date of Submission: Feb 09, 2018
E-mail: yoga@mgmcri.ac.in Date of Peer Review: Apr 19, 2018
Date of Acceptance: May 24, 2018
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Aug 01, 2018
4 Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): KC01-KC04

ntegrativ
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Sharma et al., Altern Integr Med 2018, 7:2
Alternativ
Me
DOI: 10.4172/2327-5162.1000265
dicine Alternative and Integrative Medicine

ISSN: 2327-5162
Research Article Open Access
Impact of Fast and Slow Pranayam on Cardio Vascular Autonomic

Function among Healthy Young Volunteers: Randomized Controlled Study
Sharma VK 1, Dinesh T2, Rajajeyakumar M3*, Grrishma B4 and Bhavanani AB5
1Department of Physiology, Government Institute of Medical Sciences, Uttar Pradesh, India
2Department of Physiology, Government Thiruvarur Medical College, Thiruvarur, Tamilnadu, India
3Department of Physiology, Trichy SRM Medical College Hospital and Research Centre, Tiruchirappalli, Tamilnadu, India
4Department of Physiology, Yenepoya Medical College, Mangalore, Karnataka, India
5CYTER, Sri Balaji Vidyapeeth University, Puducherry, India
*Correspondingauthor: Rajajeyakumar M, Department of Physiology, Trichy SRM Medical College Hospital and Research Centre, Tiruchirappalli, Tamilnadu, India, Tel:
9751382650; Email:rajakumar60@gmail.com
Received date: 13 August 2018; Accepted date: 31 August 2018; Published date: 07 September 2018
Copyright: ©2018 Sharma VK, 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.
Abstract
Background: Pranayama refers to the conscious manipulation of the breath in order to modulate the cosmic
energy (prana) from the air in the environment. The techniques of Pranayam include practices that are performed in
a slow or fast type.
Aim: Investigate and correlate the impact of three months practice of fast and slow pranayam on cardiovascular
autonomic function among healthy young volunteer.
Materials and Methods: Total of 75 volunteer subjects were randomized into control group (Group1: n=25), fast
pranayama group (Group 2: n=25) and slow pranayama group (Group 3: n=25). The pranayam practice (Slow
Pranayam Group-Savitri, Pranav and Nadisodhana: Fast Pranayam Group-Bhastrika, Kukkuriya and Kapalabhati,
were practiced 30 minutes per day, 3 days per week for 3 months either slow or fast pranayam by a certified yoga
teacher. The recording of Short term Heart Rate Variability (HRV) was done at the before and after 3 months of
study period.
Result: The LF/HF ratio which is the best indicator of Sympathovagal balance was reduced significantly in slow
pranayam group showing a shifting of balance towards parasympathetic tone. The RMSSD which is considered to
be the best predictor of parasympathetic tone significantly increased in slow pranayam group. A significant increase
(HF) nu and decrease (LF) nu was noted in slow and fast pranayam respectively after yoga intervention.
Conclusion: Results of our study demonstrates that slow and fast pranayam practices are more effective to
maintain sympatho-vagal balance by modulating sympathetic and parasympathetic division of autonomic nervous
system.
Keywords Fast pranayam; Heart rate variability; Sympathovagal strain on the body in addition to improving physical and mental health
balance; Slow pranayam; Young adults [4-6]. Heart Rate Variability (HRV) is an index of autonomic balance
of an individual. It is defined as oscillations between consecutive
Introduction heartbeats and it is considered as a physiological phenomenon [7].
Existing scientific literature proves the short term practice of slow
Yoga is the ancient scientific and cultural heritage of India and dates pranayama enhances the vagal tone and reduces the adrenergic tone of
back for more than 6000 years. The techniques of Yoga include an individual. There are also evidences stating that shot term practice
conscious stretching and holding of different poses (asanas), of fast pranayama increases sympathetic tone [8,9]. Very few available
contemplative meditation and conscious expansion of energy (prana) scientific literatures were investigate and to correlate the impact of
in various breathing techniques (pranayama) [1]. Most popular paths three months practice of fast and slow pranayam on cardio vascular
of Yoga worldwide, include hatha yoga, raja yoga, bhakthi yoga, karma autonomic function among healthy young volunteer.
yoga, tantra yoga and integral yoga [2].
Pranayama refers to the conscious manipulation of the breath in Materials and Methods
order to modulate the cosmic energy (prana) from the air in the
This study was a collaborative work between the Advanced Centre
environment. The techniques of Pranayama include practices that are
for Yoga Therapy Education and Research (ACYTER) and Department
performed in a slow or fast manner [3]. The practice of pranayama on
of Physiology, Jawaharlal Institute of Postgraduate Medical Education
a regular basis improves cardio-vascular and respiratory functions by
and Research (JIPMER), Puducherry.
increasing parasympathetic tone, decreasing the effect of stress and
Altern Integr Med, an open access journal Volume 7 • Issue 2 • 1000265

ISSN: 2327-5162
Citation: Sharma VK, Dinesh T, Rajajeyakumar M, Grrishma B, Bhavanani AB (2018) Impact of Fast and Slow Pranayam on Cardio Vascular
Autonomic Function among Healthy Young Volunteers: Randomized Controlled Study. Altern Integr Med 7: 1000265. doi:
10.4172/2327-5162.1000265
Page 2 of 6
Study design Group 2 (n=25): Volunteers of this group practiced the following
slow pranayam techniques:
After obtaining approval from the JIPMER scientific advisory and
human ethics committee this study was started. Total 75 convenient Nadishodhana
healthy volunteers between the age group of 18-25 years, from medical Pranava
and paramedical courses in JIPMER, were recruited by simple random
technique using student’s attendance register as sampling frame after Savitri
meeting inclusion and exclusion criteria. Subjects who practiced yoga Group 3 (n=25): Volunteers of this group practiced the following
before, athletes and volunteers with recent or past known organic fast pranayama techniques:
diseases were excluded from this study. The benefits of pranayam
training were explained to the study volunteers, motivated to Kapalabhati
participate and written, informed consent was taken from all of them. Bhastrika
Volunteers were requested to report to the autonomic function Kukkriya
testing laboratory, department of Physiology, at JIPMER between 8-9
am, two hours after light breakfast with loose clothing. The volunteers
were requested to avoid physical activity for at least one day prior to
Pranayama training
HRV recording, alcohol consumption, nicotine, caffeinated beverages The details of the pranayam training have been explained in our
and drugs known to influence the cardiovascular autonomic functions. previous publications [10,11]. Volunteers were practiced pranayam in a
The study procedure was briefly explained to all the volunteers in the well-ventilated and illuminated room maintained at the temperature of
recording of HRV. A room temperature of 25°C ± 2°C was maintained. 25°C ± 2° C. Certified yoga teacher administered the pranayam
Recording of short-term HRV was done in the following manner: sessions to Group 2 and Group 3 volunteers for 30 minutes per day, 3
participants were asked to lie in supine position on a couch and to times per week for the duration of 3 months in the Department of
completely relax with comfortable lighting and temperature. The ACYTER (Guidelines of Morarji Desai National Institute of Yoga, New
subjects were informed to relax for 10 minutes. They were connected Delhi was followed). An attendance register was maintained for the
with appropriate transducers and ECG (lead II), digital pulse same. Rests of the days, the study volunteers were motivated to
waveforms and respiration were recorded at 500 samples/ second using practice at their home. The yoga instructor gave 1 week of practice
BIOPAC-MP-100 data acquisition system with Acknowledge 3.8.2 sessions to both Group 2 and 3 volunteers, before starting the
software and Nihon Kohden polygraph. The obtained 5 minute resting pranayam practice to familiarize them. The techniques used for fast
lead II ECG was filtered using band pass filters and carefully analyzed and slow types of pranayam were as described in the literature [10-13].
for ectopics and artifacts which, if present were removed manually. The The pranayam practice session were conducted for Group 2 and Group
detection of R waves was done with a threshold algorithm of Lab chart 3 volunteers as follows:
pro software. From the RR tachogram both the time domain and the 1. Control Group did not practice any type of pranayam technique
frequency domain measures were computed using HRV analysis during the 3 months study period.
software (Kubio’s HRV, version 1.1 Finland).
2. Fast Pranayama: Each cycle consists of 6 minutes duration, it
Power spectral analysis was done by Fast Fourier Transformation includes 1 minute of Bhastrika, Kapalabhati, and Kukkuriya pranayam
and the frequency domain indices obtained includes high frequency in-between 1 minute of rest of each pranayam practice. Volunteers
(HF 0.15 to 0.4 Hz), low frequency (LF 0.04 to 0.15 Hz), very low were requested to complete 3 cycles in each session
frequency (VLF 0.003 to 0.04 Hz), and both in absolute powers given
as ms2 and in normalized unit (nu). • Bhastrika pranayam (thoracic breathing): Volunteers were
instructed inspire deeply followed by forced expiration following
The time domain measure consists: one another in a rapid succession. This is known as ‘bellow’ type of
1. Mean and standard deviation of RR intervals (SDNN in ms) breathing. One round consists of 10 such ‘bellows’.
2. Square root of the mean of the sum of the squares of differences • Kapalabhati pranayam: Volunteers were asked to perform
between adjacent RR intervals (RMSSD in ms) Vijarasana and exhale forcefully. It consists of active expiration but
the inspiration was passive.
3. Adjacent RR interval differing more than 50 ms in the entire
recording (NN50), • Kukkriya pranayam (dog panting with Vijarasana posture): The
volunteers were instructed to open the mouth wide and the tongue
4. Percentage of NN50 counts (NN50 divided by total number of all
was pushed out as far as possible. Then, they inhaled and exhaled
the RR intervals) (pNN50).
at a rapid rate with their tongue hanging out of their mouth. After
HF, SDNN, RMSSD, NN50, and pNN50 reflect cardio vagal tone. LF 10 such rounds, relaxation was done in same Vajrasana posture.
interpreted and reflects both parasympathetic and sympathetic
3. Slow Pranayam: One round consists of practicing 2 minutes of
nervous system. VLF component’s interpreted using 24 hours HRV
Savitri, Nadisodhana, and pranava pranayam with 1 minute rest in
recordings and LF/HF ratio denotes autonomic balance. [7].
between each pranayam. Volunteers were asked to perform nine
Thereafter, all the volunteers were divided into Group 1 (n=25), rounds according to their capacity with comfortable posture
Group 2 (n=25) and Group 3 (n=25) by simple randomization method (sukhasana).
using random number tables. Out of 75 volunteers, 38 females and 37
• Savitri pranayam is a slow, deep and rhythmic breathing. Each
males were included for this study.
cycle has a ratio of 6:3:6:3 between inhalation (purak), held-in
Group 1 (n=25): Control group volunteers were not practiced breath (kumbhak), exhalation (rechak) and held out breath
pranayam. (shunyak) phases of the respiratory cycle.

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Page 3 of 6
• Nadishodhana pranayam is slow, rhythmic and alternate nostril Parameters Group 1 Group 2 Group 3 P value
breathing. Each round consisted of inspiration through one nostril,
expiration through other nostril and viceversa. 18.68 ±
Age 18.64 ± 0.95 1.03 18.56 ± 1.32 0.927
• Pranava pranayam is a slow, deep and rhythmic breathing, where
emphasis is placed on making the sound AAA, UUU and MMM n (%) n (%) n (%)
while breathing out for two to three times the duration of the
inhaled breath. This technique consisting of Adham Pranayam or Male 11(44) 14 (56) 12 (48)
lower chest breathing (sound of AAA), Madhyam Pranayam or Femal
mid-chest breathing (sound of UUU), Adhyam Pranayam or upper Gender e 14(56) 11(44) 13 (52) 0.668
chest breathing (sound of MMM) and final the union of all the
three parts in a complete yogic breathing (Mahat Yoga Pranayam). One way ANOVA was done to analyze the intergroup difference in age; Group
1: control; Group 2: underwent fast pranayama yoga training; Group 3:
At the end of the session, both Group 2 and 3 volunteers were underwent slow pranayama yoga training
instructed to lie down in shavasana and relax for 10 minutes.
Chi square distribution was done to compare the gender difference among the
All the parameters were recorded before and after 3 months of study groups; *P<0.05 , ** P<0.01, ***P<0.001
period.
Table 1: Demographic variables and baseline parameters.
Table 2 shows that, there was no baseline significant difference
Data analysis was done with Statistical Package for Social Sciences between all the parameters among three groups before the pranayam
version 19.0 for Windows (SPSS Inc., Chicago, Illinois, USA). One way practice except pNN50% which was statistically significant between
ANOVA was performed to compare the baseline age distribution group 1 and 3 and 1 and 2. We found that, there were significant
between the groups. Gender distribution between the groups was difference in all other HRV parameters among 1 and 3 and 2 and 3
compared by the Chi-square test. groups after pranayam practice except SDNN which was statistically
significant between group 1 and 2 and 2 and 3. The RMSSD which is
Since the outcome variables followed non normal distribution,
considered as the best predictor of parasympathetic tone significantly
nonparametric test was used as test of significance. Kruskal-wallis test
decreased in fast pranayam groups (2) when compared to the control
was used to compare the difference of the pre and post-test variables.
group (1). The HF (ms2) was increased followed by slow pranayam
To compare between the pre and post-test variables Wilcoxon signed
training (Group 3) compared to control group. No significant
rank test was done.
difference was seen with total power. LF (ms2) was decreased
significantly in slow pranayam groups. The LF/HF ratio was decreased
Results in slow pranayam groups following yoga intervention with compare to
The mean age of the volunteers was 18.58 ± 2.27 years. the control group. The LF/HF ratio which is considered as the best
indicator of Sympathovagal balance was increased significantly in fast
Table 1 shows the baseline demographic data such as age and pranayam groups indicates a shift of the autonomic balance towards
gender showing that there is no age or gender difference between the sympathetic tone.
groups.
Parameters Group 1 Group 2 Group 3 P
Time domain parameters
pre 80.08 ± 5.82 77.58 ± 8.85 78.14 ± 4.92 0.207
SDNN(ms) post 79.89 ± 4.34## 71.71 ± 12.66 79.49 ± 4.18** 0.002
pre 80.95 ± 4.60 84.4 ± 11.35 80.82 ± 7.84 0.981
RMSSD(ms) post 78.27 ± 5.45$$ 80.08 ± 11.46 89.64 ± 6.29*** <0.001
pre 34.18 ± 1.93$$$ 33.72 ± 2.72 24.72 ± 2.54*** <0.001
pNN50(%) post 34.23 ± 2.15$$$ 32.81 ± 2.59 28.94 ± 4.2*** <0.001
Frequency domain parameter
pre 4471 ± 366.39 4423 ± 422.53 4535 ± 346.46 0.35
TP(ms2) post 4439 ± 553.30 4366 ± 375.16 4660 ± 399.70 0.06
pre 1593.01 ± 342.91 1221 ± 315.13 1595.15 ± 357.11 0.55
LF(ms2) post 1565 ± 380.75$$$ 1499.34 ±308.67 1227 ± 241.35*** <0.001
HF(ms2) pre 1641 ± 334.08 2081 ± 241.59 1703 ± 266.16 0.824

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Page 4 of 6
post 1644 ± 350.94$$$ 1603 ± 274.35 2204 ± 277.90*** <0.001
pre 43.65 ± 2.18$ 44.64 ± 1.67 44.96 ± 2.23 <0.04
LFnu post 42.95 ± 2.68$$ 46.31 ± 1.40## 40.97 ± 1.67** <0.002
pre 56.34 ± 2.18$ 55.35 ± 1.67 55.03 ± 2.23 <0.04
HFnu post 57.04 ± 2.68$ 53.68 ± 1.40# 59.02 ± 2.64* <0.01
pre 1.04 ± 0.44 0.89 ± 0.17 0.97 ± 0.33 0.65
LF/HF ratio post 1.01 ± 0.42$$$ 0.913 ± 0.25 0.56 ± 0.14*** <0.001
Kruskal-wallis test was used to compare the pre and post HRV parameters and relevant post hoc test was performed for the significant values. Group 1 control; Group
2: underwent fast pranayama yoga training; Group 3: underwent slow pranayama yoga training. SDNN: Standard deviation of NN intervals; RMSSD: Square root of
mean squared differences of successive NN intervals; pNN50: percentage of NN50; VLF: LF: low frequency; HF: high frequency; TP: total power; LF nu: Low
frequency in normalized units, HF nu: High frequency in normalized units.
*P<0.05 , ** P<0.01, ***P<0.001; #: Comparison between group 1 and 2; *: Comparison between group 2 and 3; $: Comparison between group 1 and 3
Table 2: Comparison of HRV pre and posttest parameters between the groups.
Table 3 shows the comparison of pre and post-test HRV parameters groups after 3 months of study period when compared to the control
between all three groups. There was no significant difference in pre and group but this increase was not statistically significant. Statistically
post pranayam practice in the control group (I). LF (ms2), LF nu were significant decrease in LF (ms2) was noted with slow pranayam group
significantly increased (p<0.001) and HF (ms2), HF nu decreased after the practice. Increased HF (ms2) was observed for slow pranayam
(p<0.001) in Group 2 (Fast pranayam group). LF (ms2), LF nu were group and no such improvement was seen in control group. This was
significantly (p<0.001) decreased and HF (ms2), HF nu increased reflected in their normalized units with a notable decrease in LF nu
(p<0.001) in Group 3 (slow pranayam group). pNN50 (%) increased and marked increase in HF nu in slow pranayam group. The LF/HF
and LF/HF ratio was decreased in group 3. These difference being were ratio which is considered as the best indicator of Sympathovagal
statistically significant (p<0.001). This indirectly reflects predominance balance was reduced significantly in slow pranayam groups indicates a
of parasympathetic activity of autonomic nervous system. However, shift of the autonomic balance towards parasympathetic tone.
there was an increase in total power of both slow and fast pranayam
Parameters Group 1 p Group 2 p Group 3 p

(n=25) (n=25) (n=25)
SDNN(ms) pre 80.08 ± 5.82 0.896 77.58 ± 8.85 0.063 78.14 ± 4.92 0.3
post 79.89 ± 4.34 71.71 ± 12.66 79.49 ± 4.18
RMSSD(ms) pre 80.95 ± 4.60 0.708 84.4 ± 11.35 0.874 80.82 ± 7.84 0.384
post 78.27 ± 5.45 80.08 ± 11.46 89.64 ± 6.29
pNN50(%) pre 34.18 ± 1.93 0.931 33.72 ± 2.72 0.231 24.72 ± 2.54 0.001&&&
post 34.23 ± 2.15 32.81 ± 2.59 28.94 ± 4.2
LF (ms2) pre 1593.01 ± 342.91 0.785 1221 ± 315.13 0.002@@ 1595.15 ± 357.11 0.001&&&
post 1565 ± 380.75 1499.34 ± 308.67 1227 ± 241.35
HF (ms2) pre 1641 ± 334.08 0.975 2081 ± 241.59 0.001@@@ 1703 ± 266.16 0.001&&&
post 1644 ± 350.94 1693 ± 274.35 2204 ± 277.90
Total pre 4471 ± 366.39 0.815 4423 ± 422.53 0.616 4535 ± 346.46 0.243
power
post 4439 ± 553.30 4366 ± 375.16 4660 ± 399.70
LF/HF pre 1.04 ± 0.44 0.806 0.89 ± 0.17 0.742 0.97 ± 0.33 0.001&&&
ratio
post 1.01 ± 0.42 0.913 ± 0.25 0.56 ± 0.14
LFnu pre 43.65 ± 2.28 0.304 44.64 ± 1.76 0.002@@ 55.03 ± 2.23 0.001&&&

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Page 5 of 6
post 42.95 ± 2.08 46.31 ± 1.94 59.02 ± 2.64
HFnu pre 56.34 ± 2.18 0.316 55.35 ± 1.67 0.004@@ 55.03 ± 2.37 0.001&&&
post 57.04 ± 2.68 53.68 ± 1.40 59.02 ± 2.96
The data was expressed in median (interquartile range) Wilcoxon signed rank test was done to compare the pre and post values between the groups ; P<0.05 is
considered to be significant; Group 1: control; Group 2: underwent fast pranayama yoga training; Group 3 : underwent slow pranayama yoga training; SDNN: Standard
deviation of NN intervals; RMSSD: Square root of mean squared differences of successive NN intervals; pNN50: percentage of NN50;VLF: LF: low frequency; HF: high
frequency; TP: total power ; LF nu : Low frequency in normalized units, HF nu: High frequency in normalized units.*P<0.05 , ** P<0.01, ***P<0.001; @: Comparison
between pre post of group 2; &: Comparison between pre post of group 3
Table 3: Comparison of difference in HRV parameters between the groups.
Discussion propagated through neural and non-neural tissues and both of them
cause synchronization of neural elements in heart, lungs, limbic system
Pranayam acts as a connection between the body and mind. It and cortex. Inhibitory current synchronizes rhythmic cellular activity
involves alter the breathing pattern, which consists of three phases: between cardiopulmonary center and central nervous system that
purak (inspiration), kumbhak (holding) and rechak (expiration) that regulates excitability of nervous tissues indicates a state of relaxation.
can be practiced either in a slow or fast pranayam [14]. HRV is Hyperpolarization of tissues usually manifests in a parasympathetic
considered as a non-invasive marker of cardiac autonomic activity. like change. Synchronization within the hypothalamus and the brain-
Decreased HRV is considered as a significant cardiovascular risk factor stem is mainly responsible for the parasympathetic response.
which occurs due to autonomic dysfunction [15]. It is also associated Modulation of the nervous system that leads to a decrease in metabolic
with early onset of pre hypertension and other cardiovascular diseases. activity is an indicative of the parasympathetic state [23].
Furthermore, increased sympathetic and decreased parasympathetic
modulations are markers of poor cardiovascular health as evidenced The effect of pranayam on stress reduction might be mediated by
from various previous studies on patients with myocardial infarction the bidirectional vagal system. Vagal afferents from peripheral
[16,17]. Results of our study indicate that there was an increase in all receptors are connected with the nucleus tractus solitarius from where
the parasympathetic parameters in slow pranayam group and all the fibers ascend to the thalamus, limbic areas and anterior cortical areas.
sympathetic parameters were significantly increased in the fast At different levels of the neuraxis the descending projections then
pranayam group. Findings in our study are in line with the previous modulate autonomic, visceral, and stress arousal mechanisms
studies by Khattab et al. [18] and Pinheiro et al. [19] which showed a [12,13,24-26]. The bottom-up mechanisms of pranayam practice may
significant increase in these parameters. be induced through the stretch of respiratory muscles, specifically the
diaphragm.
RMSSD, NN50, and pNN50 are the measurements of short-term
variation to estimate the parasympathetic activity, showed a significant Though not statistically significant (p=0.07), there was a greater
increase in slow pranayam group when compared with the control magnitude of change shown in the slow pranayama group with respect
group. Previous studies by Khattab et al. [18] and Punita et al. [20] also to HF and overall power. It is possible that this would attain statistical
showed a significant increase in RMSSD and NN50, which is in significance in the future studies with more number of volunteers and
consistent with our present study. In contrast to our findings, Telles et with long term training.
al. [21] showed a significant decrease in NN50 and pNN50 with high
frequency breathing, which is associated with an increased Conclusion
sympathetic tone. Other studies have reported by Raghuraj et al. [22]
and Telles et al. [21] a significant increase in LF:HF ratio immediately The results of our present study demonstrates that slow pranayam
after pranayama practice (high frequency breathing), suggesting an practices are more effective in reducing the sympathetic over activity
increase in sympathetic tone. and produces a parasympatho-dominance state by enhancing vagal
tone and vice versa.
Slow pranayam are deep breathing exercises performed at different
frequencies of respiration. In the training of both slow and fast Limitations
pranayam practices, participants intentionally focus on breathing and
intend to relax and attention is drawn away from the external Beat-to-beat noninvasive BP recording was not done. Hence, BP
distracting stimuli. With regular pranayam practice, the ability of the variability and baroreflex sensitivity could not be determined in our
participants to concentrate will be enhanced and it changes mental volunteers. In future, we have planned to include biochemical
processing (e.g., focused attention and reduced stress) which can be parameters such as vanillylmandelic acid, metanephrines, which can
rapidly expressed in the body via the autonomic and neuro-endocrine substantiate the reduction in sympathetic activity after slow pranayam
systems [23]. A study by Jerath et al. [24] has hypothesized about the training. Since, this study was conducted only on healthy young
interaction of pranaya breathing with the nervous system affecting volunteers, we recommend that, new research studies should broaden
metabolism and autonomic functions. During the above, tidal the current research and to include clinical populations such as
inspiration (as seen in Hering Breuer’s reflex), stretch of the lung tissue patients with diabetes and hypertension.
produces inhibitory signals by stimulating the slowly adapting stretch
receptors. Stretch of the connective tissue (fibroblasts) localized
around the lungs generates hyperpolarization currents. This will be

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Acknowledgement 14. Sharma VK, Rajajeyakumar M, Velkumary S, Subramanian SK,

Bhavanani AB, et al. (2014) Effect of fast and slow pranayama practice on
The authors thank Sri G Dayanidy, yoga instructor ACYTER for cognitive functions in healthy volunteers. J Clin Dia Res 8: 10-13.
giving pranayama training to the subjects. Authors feel deep gratitude 15. Chodzinski J (2000) The effect of rhythmic breathing on blood pressure
for all the subjects who volunteered for the present study. We also in hypertensive adults. J Undergrad Res 1: 78-98.
thank Director of JIPMER and Director of Morarji Desai National 16. Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, et al. (1996)
Institute of Yoga, New Delhi for their support. Impact of reduced heart rate variability on risk for cardiac events. The
Framingham Heart Study. Circulation 94: 2850-2855.
17. Bigger JT Jr, Fleiss JL, Rolnitzky LM, Steinman RC, Schneider WJ (1991)
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2. Pal GK (2011) Physiology of aging, oxidative stress, prevention of aging Iyengar yoga increases cardiac parasympathetic nervous modulation
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ISSN: 2327-5162
Original Article
Effect of Adjuvant Yoga Therapy on Pulmonary Function and

Quality of Life Among Patients with Chronic Obstructive
Pulmonary Disease : A Randomized Control Trial
Soccalingam Artchoudane1, Pajanivel Ranganadin2, Ananda Balayogi

Bhavanani3,*, Meena Ramanathan3, Trakroo Madanmohan1
1
Centre for Yogic Sciences,
Aarupadai Veedu Medical ABSTRACT
College & Hospital, Background and Objectives: Previous studies have suggested that yoga positively
Vinayaka Mission’s Research impacts lung function and quality of life (QoL). The present prospective two-arm,
Foundation, Kirumampakkam, single-blinded and controlled study evaluated the effect of adjuvant yoga therapy on
Puducherry-607402 pulmonary function and QoL in patients of Chronic Obstructive Pulmonary Disease
2
Department of Pulmonary
(COPD).
Medicine , MGMCR&I, Sri Balaji Material and Methods: Seventy two COPD patients were recruited and randomized
to yoga group who received adjuvant yoga therapy in addition to standard medical
Vidyapeeth, Pillayarkuppam,
management and control group who received only medical management. Yoga
Puducherry-607402 therapy protocol included loosening exercises, postures, breathing techniques and
3
Centre for Yoga Therapy, relaxation. Forced vital capacity (FVC), forced expiratory volume in first second
Education and Research (FEV1) and FEV1/FVC were measured using computerized pulmonary function
(CYTER), Sri Balaji test ‘Trueflow (ndd)’. Saint George Respiratory Questionnaire (SGRQ) was used
Vidyapeeth, Pillayarkuppam,
to asses QoL. Changes in parameters were correlated with symptoms, activity,
impacts and quality scores. Intra-group comparisons were done using Student’s
Puducherry-607402.
paired ‘t’ test and intergroup comparisons using unpaired ‘t’ test.
Results: There was significant improvement (p < 0.001) in FVC and FEV1 after four
weeks of adjuvant yoga therapy while controls showed decline in all parameters.
QoL scores, namely: symptoms , activity , impacts and quality improved significantly
in yoga group with no significant changes in controls. Significant correlation was
found between pulmonary function and QoL in Yoga group.
Conclusion: Significant improvements of lung function with adjuvant yoga
therapy can be attributed to comprehensive yoga therapy package administered to
participants resulting in decreased airway resistance and better lung compliance
attributed to nonspecific broncho-protective / broncho-relaxing effect. Significant
improvement in QoL scores can be attributed to improved vital capacity as well as
enhanced self-confidence /self-reliance. We conclude that there is a positive and
For Correspondence additive role of adjuvant therapy with standard medical management of COPD.
*Dr.Ananda Balayogi Bhavanani
Keywords:
Lung function, Saint George Respiratory Questionnaire, yoga therapy
Date of
Submisssion: 15-06-2018
Acceptance: 05-08-2018
INTRODUCTION worldwide, whereas its social burden
Chronic Obstructive Pulmonary will rank fifth.2 The Global Initiative
Disease (COPD) is an important cause for Chronic Obstructive Lung Disease
of morbidity and mortality and it is (GOLD) management includes a
Access this article online a major public health problem.1 The reduction in symptoms, complications,
Quick Response Code condition is characterized by irreversible
and exacerbations, improved exercise
airflow obstruction, a gradual decline
tolerance, improved health status
in lung function, loss of lung tissue,
and reduced mortality.3 Dyspnea, the
reduced quality of life, and high rate
hallmark symptom of COPD is the
of mortality. reason for which most patients seek
medical attention and is a major cause
By 2020, COPD is predicted to of disability and anxiety associated with
https://www.jbcahs.org
rank as third leading cause of death the disease.4
SBV Journal of Basic, Clinical and Applied Health Science - Volume 2 | Issue 3 | July - September 2018 117
Soccalingam Artchoudane et al,:Effectiveness of adjuvant yoga therapy in COPD
Prana, the life force, promotes mind-body was also registered on the Clinical Trial Registry-India
harmony. Yoga practices, especially pranayama help (CTRI: ctri/2017/11/010597).
in restoring the harmony thereby promoting health
and well being.5 Prana vitalizes organs responsible for Inclusion and exclusion criteria: COPD patients
respiration. Asthma, COPD and airway restrictions with lung function less than 70% of predicted values
are the most troublesome chronic diseases for lifetime. and who were willing to participate and able to
Drug therapy alone does not work because it does not perform techniques given in the protocol (Table 1) were
deal with the problem.6 Yoga helps to maintain the recruited for the study after obtaining their informed
state of equilibrium whereby the health and strength consent. Those with active infection of lungs especially
of body and mind are acquired by enhanced prana. pulmonary tuberculosis and evidence of complications
were excluded.
Yoga therapy has a positive impact on lung function
and exercise capacity and can be used as an adjunct Table 1: Components of yoga therapy protocol for COPD
pulmonary rehabilitation program for COPD patients
which are a known cause to increase the level of stress, S. No. Name of practice Duration
emotional vulnerability and physical inactivity. A 1 Prayer 3 min
comprehensive yoga program can have a salutary effect 2 Loosening exercises 7 min
on general health and respiratory health increasing a
person’s ability to perform activities. 3 Matsyasana 3 min
4 Shashahasana 3 min
Vedanthan observed that one of the most important 5 Mahamudra 3 min
aspects of yoga for asthma and COPD patients is 6 Chiri kriya 3 min
that they develop an increased capacity to relax and
control their breathing, which is more effective with 7 Sharabhasana 3 min
regular practice.7 Brain’s cortico-limbic-hypothalamic 8 Vibhaga pranayama 5 min
systems get modulated by pranayama, asana and 9 Bhastrika pranayama 5 min
meditation, which enhances the autonomic, endocrine 10 Bhramari pranayama 5 min
and somatic responses correlated with homeostatic
11 Kaya kriya 3 min
response to negate the undesirable effects of stress.7
Yoga therapy improves Quality of life (QoL) and lung 12 Spanda nishpanda 2 min
function even on a short-term basis.8 Donesky and 13 Makarasana 3 min
colleagues also reported an improvement in health 14 Shavasana 10 min
related QoL and psychological well-being after yoga
15 Prayer 2 min
therapy.9
Practice duration 60 min
Though a few studies have been done on yoga and
COPD, the novelty of the present study is that it A total of 100 COPD patients were assessed for
throws light on improvements in QoL of the patients eligibility and then72 patients (mean ± SD age, 53.04 ±
and correlates it with the changes in lung function 9.71 years) who satisfied inclusion criteria were allocated
through adjuvant yoga therapy. to two groups by random selection and block allocation
(blocks of 4)/ Zelen’s design. Thirty six patients were
MATERIAL AND METHODS allocated to yoga group (22M and 14F with mean age of
52.12 ± 9.89 years) and received adjuvant yoga therapy
This prospective two-arm, single-blinded and in addition to medical management while 36 were
controlled study was undertaken as an interdisciplinary allocated to control group (20M and 16F with mean
collaborative work between the Centre for Yoga age of 53.97 ± 9.53 years) and received only medical
Therapy, Education and Research (CYTER) and management with no yoga therapy.
the department of Pulmonary Medicine, Mahatma
Gandhi Medical College and Research Institute In yoga group, four dropped out during study
(MGMC&RI), Puducherry. Approval was obtained period due to inconvenience and age factor and 32 of
from Institutional Research Council and Institutional them completed the four week yoga therapy. The study
Human Ethics Committee of Sri Balaji Vidyapeeth parameters were recorded in all the subjects before and
(P.G Dissertation/2017/05/77, 04/05/2017). The study after intervention of both groups.
118 SBV Journal of Basic, Clinical and Applied Health Science - Volume 2 | Issue 3 | July - September 2018
Table 2: Anthropometric parameters in yoga and control groups before (pre) and after (post) four weeks study period.
Yoga (n=32) Control (n=36)
Anthropometric
Parameters
Pre Post Pre Post
Height (cm) 158.62 ± 8.82 158.59 ± 8.79 161.50 ± 10.11 161.52 ± 10.10
Weight (kg) 63.66 ± 11.73 63.13 ± 11.43 62.72 ± 10.65 62.91 ± 10.87
BMI 25.43 ± 4.94 25.22 ± 4.79 24.06 ± 3.53 24.12 ± 3.56
Values are mean ± SD.
Anthropometric: BMI was calculated by Quetelet’s and the outcome variables were determined with
index, which is weight (kg)/height (m)2. correlations. P value less than 0.05 were considered
to indicate significant differences between the means.
Pulmonary Function: Forced vital capacity (FVC),
forced expiratory volume in first second (FEV1) and RESULTS
ratio of forced expiratory volume in first second to
forced vital capacity (FEV1/FVC) were measured using The anthropometric parameters of study participants
a standard computerized pulmonary function test before and after yoga therapy are given in Table 2.
‘Trueflow (ndd)’. The calibration is factory set and is Both groups were comparable at baseline with respect
not affected by temperature change, pressure change to anthropometric parameters, pulmonary functions
and condensation.10 and QoL.
Subject was seated comfortably in upright position Intra-group comparisons (Table 3): Changes in
with an erect spine, without bending forward. They pulmonary functions showed significantly better
were then instructed to take the disposable mouthpiece improvement of both FVC and FEV1 (p<0.001) among
inside their mouth with lips closed over it to avoid yoga group subjects after four weeks of yoga therapy.
leakage of air while blowing. It was repeated thrice There were significant negative changes in FVC and
with gap of 5 minute between each attempt subject FEV1 (p<0.001) among control group subjects after
encouraged to perform at their optimum level applying four weeks. However there was no significant change
maximal effort. The value of the best effort was then in FEV1/FVC in both the groups. In yoga group,the
considered for data analysis. percentage of changes were highly significant in FVC
and FEV1 (p<0.001).
QoL: Saint George Respiratory Questionnaire
(SGRQ) used for assessing COPD patients’ quality Changes in SGRQ showed significantly better
of life, as it is a disease-specific designed to measure improvement in all the QoL scores, namely symptoms
impact on overall health, daily life, and perceived well- score (p<0.001) and activity score (p<0.05), impacts
being in patients with obstructive airways disease.11 score (p<0.01) and quality score (p<0.001) among yoga
An excel-based scoring calculator was used for scoring group subjects after four weeks of yoga therapy. There
QoL variable symptoms score, activity score, impacts was no significant change in QoL score among control
score and QoL score. Changes in pulmonary function group subjects after four weeks.
parameters were recorded and correlated with QoL
(symptoms, activity, impacts and quality) scores of Intergroup comparisons (Table 3): There was highly
SGRQ. significant changes in both FVC and FEV1 (p<0.001)
in yoga group. FEV1/FVC showed no change between
Statistical Analysis: All data passed normality testing the groups. The % change showed highly significant
by Kolmogorov-Smirnov test. Hence intra-group change in both FVC and FEV1 (p<0.001) in yoga group.
comparisons of pre and post study data was done using
Student’s paired ‘t’ test while intergroup comparisons QoL score showed highly significant changes
between groups was done using Student’s unpaired ‘t’ (p<0.001) in all the scores of yoga group when compared
test. Relationships between baseline characteristics between groups. In yoga group, the % change was
Table 3: Pulmonary function and quality of life parameters in yoga and control groups before (pre) and after(post) four weeks study period.
FVC: forced vital capacity, FEV1: forced expiratory volume in first second.
Yoga group (n=32) Control group (n=36)

Parameters
Pre Post % change Pre Post % change
Pulmonary
function
FVC (L) 1.99 ± 0.64 2.21 ± 0.50 ***, a 17.80 ± 30.75 a 1.96 ± 0.50 1.80 ± 0.51 *** -8.45 ± 12.90
FEV1 (L) 1.35 ± 0.49 1.61 ± 0.53 ***, a 24.75 ± 33.93 a 1.30 ± 0.51 1.18 ± 0.43 *** -6.47 ± 14.31
FEV1/FVC 0.66 ± 0.10 0.68 ± 0.12 2.82 ± 9.91 0.65 ± 0.15 0.66 ± 0.14 3.64 ± 22.63
QoL scores of
SGRQ
Symptoms score 51.74 ± 9.04 29.72 ± 6.86 ***, a -41.27 ± 14.50 a 49.74 ± 8.72 46.92 ± 6.00 -3.14 ± 19.71
Activity score 26.92 ± 9.26 22.43 ± 6.85 *, a -6.67 ± 43.41 a 24.79 ± 8.90 26.90 ± 4.29 19.68 ± 38.30
Impacts score 25.44 ± 9.24 21.37 ± 5.61 **, a -8.53 ± 32.88 a 29.65 ± 9.58 31.44 ± 7.65 11.15 ± 27.09
Quality score 26.73 ± 4.18 21.12 ± 5.96 ***, a -19.05 ± 26.16 a 24.09 ± 8.74 26.13 ± 6.18 15.12 ± 29.35
Values are mean ± SD. ***p< 0.001, ** p< 0.01, * p<0.05 by Student’s paired ‘t’ test for intra group comparison and
a
p<0.001by Student’s unpaired ‘t’ test for intergroup comparison.
highly significant in all the QoL scores (p<0.001), trend in adjuvant yoga therapy. Such findings could
namely symptoms score, quality score, activity score, become more significant and marked if the therapy
impacts scoreand quality score. was continued for a longer duration.
Correlation of pulmonary function and QoL The improvement in lung function coupled with
(Table 4): Significant correlation was found between decreased need for regular and rescue medicinal usage
pulmonary function and QoL in yoga group. FVC has been established using yoga as an adjunct therapy
correlated with symptoms score (r= -0.418, p<0.001), inCOPD.14,15
activity score (r= -0.257, p<0.05), and quality score (r=
-0.304, p<0.01). FEV1 correlated with FVC (r=0.882, At baseline, both groups were comparable and
p<0.001), symptoms score (r= -0.442, p<0.001), after study period there was significant improvement
quality score (r= -0.326, p<0.01), weight (r= -0.367, in FVC and FEV1 in yoga group. Reduction in FEV1
p<0.01) and BMI (r= -0.308, p<0.05). is directly correlated with impaired lung function.16
FEV1 increased significantly in yoga group and can
DISCUSSION be attributed to the comprehensive yoga therapy
package administered to the participants that may have
In the present study there was a marginal reduction produced marked improvement.
in body weight and body mass index of yoga group,
with a marginal increase in control group. This may be In this study we found that FVC increased
attributed to the practices utilizing excess fat deposited significantly in yoga group but reduced in control
peripherally and is in line with other studies attributing group as found in previous reports.2 NICE guidelines
improved metabolic function.12 It is also well known state that an increase of FEV1>1.5 L and in FVC >2.0
that an increase in BMI is associated with decreased L is correlated with greater changes in arterial blood
pulmonary function and decline in FEV1.13 Hence gases.17 Improvement in FEV1 and FVC may be
the trend towards reduction of BMI shows a healthy correlated with decreased airway resistance and better
Table 4: Correlation of FVC with FEV1, symptoms, activity, impacts and quality scores of SGRQ in yoga (n=32) and control (n=36) groups
after four weeks study period.
Parameters FEV1 FVC SS AS IS QS Wt BMI
FVC 0.822 *** - -0.418 *** -0.257 * -0.133 -0.304 ** -0.167 -0.150
FEV1 - 0.822 *** -0.442 *** -0.151 -0.184 -0.326 ** -0.367 ** -0.308 *
Correlation is significant at *p<0.05, ** p<0.01, *** p< 0.001 level (2-tailed).

FVC – forced vital capacity; FEV1 – forced expiratory volume in first second; SS - symptoms score; AS - activity score; IS –
impact score; QS – quality score; Wt – weight.
lung compliance and such enhancing effects in yoga and improved exercise tolerance. Our results are
group may be attributed to the nonspecific broncho- consistent with other studies which reported related
protective or broncho-relaxing effect of yoga training as changes after yoga therapy in healthy volunteers as
postulated by Singh, along with the improved exercise well as in those suffering from different conditions.25,26
tolerance reported by Tandon following yoga therapy Our findings provide evidence for the scientific basis
in patients of COPD.18,19 This can also be correlated to of using yoga as an adjunct therapy in COPD with
the reports that well-performed slow yogic breathing significant improvement in pulmonary function and
maintains better blood oxygenation without increasing QoL indices.
ventilation, reduces sympathetic activation during
altitude-induced hypoxia and decreased chemoreflex We conclude that yoga has a positive and additive
sensitivity to hypoxia and hypercapnia.20,21 role as an adjuvant therapy along with standard medical
management of COPD. Results of this study reaffirm
Asthmatic patients showed a statistically significant that addition of such a complementary therapy improve
improvement in many lung parameters including FVC, physical condition by reducing weight and BMI while
FEV1 and QoL after 2 months of yoga practices and enhancing pulmonary function through parameters
Singh et al concluded that pranayama and yoga postures such as FVC and FEV1. It retarded the decline of
can be used to increase respiratory stamina, relax the pulmonary function that was seen in control group
chest muscles, expand the lungs, raise energy levels, only receiving medical management.
and calm the body.22
It is to be noted that adjuvant yoga therapy also
In the yoga group there was a significant significantly improved the qualitative aspects of the
improvement in activity score which implies that patient’s life through symptoms score, activity score,
patients were able to participate in more of the impacts score and total QoL score. As a form of therapy,
activities than earlier, which may be attributed to yoga is cost effective, relatively simple and carries
the improved vital capacity as well as enhanced minimal risk and we recommend that it can be advocated
self-confidence and self-reliance. Yogic counselling as an adjunct, complementary therapy in our search for
included dietary change and life style modification an integrated system of medicine capable of producing
which may improved significantly in impact score of health and well being in all. It is expected that the results
yoga group and the practice of pranayama resulted of this RCT will provide momentum for further in-depth
in overall improvement in QoL. Yoga group showed research in evaluating the efficacy of yoga in COPD
significant improvement in total quality score which patients. We recommend that yoga therapy can be safely
is similar to earlier reports that yogic breathing had advocated as an adjunct, complementary therapy in our
an overall positive effect on patients with moderate- search for an integrated system of medicine capable of
to-severe COPD.23,24 producing health and well being in all.
Pulmonary functions in COPD patients are The limitation of the study is that this has been done
compromised. Yoga therapy improved pulmonary on limited number of patients for only few weeks. More
function and quality of life by various mechanisms such studies with larger numbers of COPD patients
which include long time housework, carrying things and for a longer period of time may be done in future
upstairs, going out for entertainment and recreation to further validate such short term studies.
11. St Georges Respiratory Questionnaire Manual. 2009. Available from:

Acknowledgments: We acknowledge the support http://www.healthstatus.sgul.ac.uk/SGRQ_download/ SGRQ%20
of the management and administration of Sri Manual%20June% 202009.pdf. (accessed 6 June 2018).
Balaji Vidyapeeth who set up CYTER in 2010. 12. Divekar M, Bhat M, Mulla A. Effect of Yoga therapy in diabetes and
obesity. J Diab Assoc Ind 1978; 17: 75-8.
Heartfelt gratitude is offered to Dr. G. Ezhumalai, 13. Kamal R, Kesavachandran CN, Bihari V, Sathian B, Srivastava
Senior Statistician & Research Consultant, SBV for AK. Alterations in lung functions based on BMI and body fat %
professional advice. We thank Dayanidy G (Lecturer among obese Indian population at national capital region. Nepal J
CYTER), Mariangela.A (Yoga instructor CYS), Epidemiol. 2015 ;5:470–9.
14. Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a
Dhanushapnadeesh and Sarulatha G (Yoga Instructors controlled study. BMJ 1985; 291: 1077-9.
CYTER) and Ms. Gayathri (ANM of CYTER) for their 15. Vempati R, Bijlani RL, Deepak KK. The efficacy of a comprehensive
valuable assistance during the study. lifestyle modification programme based on yoga in the management
of bronchial asthma: a randomized controlled trial. BMC Pulm
Med 2009;9:37.
References: 16. Jung YJ, Ra SW, Lee S-D, Park CS, Oh Y-M. Clinical features of
subjects with an isolated FEV1 reduction. Int J Tuber Lung Dis
1. Viegi G, Pistelli F, Sherrill DL, Maio S, Baldacci S, Carrozzi L. 2012; 16: 262-7.
Definition, epidemiology and natural history of COPD. Eur Respir 17. Clinical Tutorials. Spirometry [Internet]. http://www.gp-therapy.
J 2007; 30: 993-1013. net/therapy/tutorials/clinical/respiratory/spirometry.htm. (accessed
2. Liu X-C, Pan L, Hu Q, Dong W-P, Yan J-H, Dong L. Effects of yoga on 6 June 2018)
training in patients with chronic obstructive pulmonary disease: a 18. Singh V. Effect of respiratory exercises on asthma. The Pink City
systematic review and meta-analysis. J Thorac Dis. 2014 ;6:795-802. lung exerciser. J Asthma 1987; 24: 355-9.
3. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto 19. Tandon M K. Adjunct treatment with Yoga in chronic severe airways
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chronic obstructive pulmonary disease: GOLD executive summary. 20. Bernardi L, Passino C, Vetal W. Breathing patterns and cardiovascular
Am J Respir Crit Care Med 2013;187: 347-65. autonomic modulation during hypoxia induced by simulated
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In: Cherniack NS, editor. Chronic Obstructive Pulmonary 21. Spicuzza L, Gabutti A, Porta C, Montano N, Bernardi L. Yoga and
Disease. Toronto, ON, Canada: W.B. Saunders; 1991. pp. 357–63. chemoreflex response to hypoxia and hypercapnia. Lancet 2000;
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Pondicherry, India: Dhivyananda Creations, 2013. p. 313-7. 22. Singh S, Soni R, Singh KP, Tandon OP. Effect of Yoga practices on
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6 June 2018) J Bras Pneumol. 2014; 40 : 128-33.
Pill reverses Type 2 diabetes

Researchers have engineered a material that temporarily coats the small intestine and reduces the amount of glucose
that enters the bloodstream during digestion. Scientists 'envision a pill' that 'mimics surgery' for people with
diabetes.
When they tested the material, which is called Luminal Coating of the Intestine (LuCI) on rats, they found that
it reduced "glucose response" by almost half. The research team developed the material because they want to find
a non-invasive treatment for reversing type 2 diabetes that is as effective as surgery. The intention is that once
swallowed, LuCI forms a temporary coating in the gut and then dissolves harmlessly a few hours later. The material
acted as a partial barrier to nutrient absorption, and prevented blood sugar "spikes" following a meal.
Source: Nature Materials. 2018 Jun 11:1
Original Article
Immediate effect of Sukha Pranayama: A slow and

deep breathing technique on maternal and fetal
cardiovascular parameters
Vasudevan Rajalakshmi Vasundhara1, Ananda Balayogi Bhavanani1, Meena Ramanathan1, Seetesh Ghose2,
Ganesan Dayanidy1
1
Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Puducherry, India, 2Department of Obstetrics and Gynecology,
MGMC and RI, Sri Balaji Vidyapeeth, Puducherry, India
Abstract Aim: This pilot study was done to evaluate the immediate effect of Sukha Pranayama, a slow and deep breathing
technique on maternal and fetal cardiovascular parameters.
Subjects and Methods: Single session pre-post comparison was done for 10 min of Sukha Pranayama in 12 pregnant
women in their 3rd trimester. The study participants were guided to breathe in and out in a slow and regular manner
for a count of 4 s each. Maternal cardiovascular parameters, namely mean heart rate (MHR), systolic pressure
(SP), and diastolic pressure (DP), were measured before and after the session and rate-pressure product (RPP)
derived with the formulae. Fetal heart rate (FHR) was derived from the nonstress test tracing.
Results: SP, MHR, FHR, and RPP reduced significantly after single session of Sukha Pranayama. The mothers
reported that they felt more relaxed and also sensed active fetal movement while performing the pranayama.
Discussion: Reduction in maternal cardiovascular parameters may be attributed to reduced sympathetic activity
coupled with enhanced vagal parasympathetic tone. Reduction in RPP signifies reduced myocardial oxygen
consumption and load on the heart as evidenced by previous studies. These changes in cardiac autonomic status
may enhance placental circulation, leading to healthier fetal development.
Conclusion: The present study reiterates the importance of yoga for the psychosomatic health of maternal-fetal
unit as an add-on relaxation technique. We plan to develop this pilot study into a full-fledged evaluation of maternal
and fetal wellbeing through yoga.
Key Words: Cardiovascular, fetal heart, maternal-fetal unit, pranayama

Dr. Ananda Balayogi Bhavanani, Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Puducherry - 607 403, India.
E-mail: yoga@mgmcri.ac.in
INTRODUCTION maternal condition on fetal heart rate (FHR), and this is notable
as FHR is a vital predictor of fetal outcome (Chapman, 1978;
Pregnancy is the phase in human life where two individuals are Leeuwen et al., 2009; Dietz et al., 2016). Previous studies have
physiologically interlinked, and hence, the prenatal condition reported that Sukha Pranayama at the rate of 6 breaths/min can
represents a unique opportunity to investigate the physiological reduce HR and blood pressure (BP) in hypertensive patients
interaction between mother and fetus. With respect to cardiac
interaction, there is evidence that indicates an influence of the This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work non-commercially, as long as
Access this article online appropriate credit is given and the new creations are licensed under the identical terms.
Quick Response Code:
Website:
For reprints contact: reprints@medknow.com
www.ym-kdham.in
How to cite this article: Vasundhara VR, Bhavanani AB, Ramanathan M,

DOI: Ghose S, Dayanidy G. Immediate effect of Sukha Pranayama: A slow and
10.4103/ym.ym_14_18 deep breathing technique on maternal and fetal cardiovascular parameters.
Yoga Mimamsa 2018;50:49-52.
© 2018 Yoga Mīmāṃsā | Published by Wolters Kluwer - Medknow 49

Vasundhara, et al.: Sukha Pranayama on maternal-fetal cardiovascular health
within 5 min of practice and attributed it to a normalization of those who couldn’t or were not willing to perform the pranayama
autonomic cardiovascular rhythms and improved baroreflex as well as those in whom FHR could not be assessed.
sensitivity (Bhavanani, 2013).
After obtaining informed consent, participants were recruited
The human fetus is capable of responding to a sound stimulus from obstetrics and gynecology in-patient ward of MGMC and
applied to the maternal abdomen, by increase in movement RI by convenient sampling till predetermined sample size of 12
of the fetal muscles. The response becomes more marked was reached.
as term approaches and the development of such a response
may furnish some index of development and maturity of fetus Single session pre-post comparison was done for 10 m of Sukha
(Sontag & Wallace, 1934). Maternal stress and anxiety during Pranayama as follows: Maternal cardiovascular parameters,
pregnancy affect the fetus developing brain morphology namely mean heart rate (MHR), systolic pressure (SP), and
and child development outcomes (Sandman, Davis, Buss, & diastolic pressure (DP), were measured using noninvasive semi-
Glynn, 2012). automatic BP Monitor while FHR was derived from the nonstress
test (NST) tracing done by qualified technicians. Rate-pressure
It is hypothesized that maternal stress affects the fetus by reducing product (RPP) was derived with the formula, RPP = (HR × SP)/100.
blood flow and oxygen to the uterus and increases activation
of the placental stress system, resulting in the circulation of Sukha Pranayama
corticotrophin-releasing hormone (Fink et al., 2011). Maternal This is a simple type of yogic breathing that is done by consciously
stress plays an important role in the etiology of fetal and maternal regulating the inspiration and expiration to an equal ratio with
disorder other than biomedical risks (Alder, Fink, Hoesli, Bitzer, internal awareness of the complete breathing process involving
& Holzgreve, 2007; Mulder et al., 2002). all sections of the lungs (Bhavanani, 2013). The participants were
taught to perform Sukha Pranayama as per the Gitananda tradition
Yoga practices may moderate stress responses at the physiological in an individual-based manner and were then guided to breathe
level and this can postively influence both maternal and fetal in and out in a slow and regular manner for a count of 4 s each
outcomes (Booth-Laforce, Taylor-Swanson, Nagarathna, while sitting in a comfortable semi-recumbent posture with legs
Chaku, 2016). Yoga may be understood as the re-integrator of stretched forward. Fingers were kept interlocked and participants
the multicomplex human systems that result in positive health were instructed to be aware of their own breathing and also of the
by inducing a state of dynamic well-being a state of health fetal movements. They were asked to keep their eyes closed to
(Bhavanani, 2011). facilitate the development of internal awareness. The pranayama
was done through both nostrils in a calm and regular manner with
With the above in mind, this pilot study was done to investigate a conscious effort to use the low, mid, and upper parts of the lungs
the immediate effect of Sukha Pranayama, a slow and deep in a sequential manner for both inspiration and expiration. This
breathing technique on maternal and fetal cardiovascular was continued for 10 min. Then, we once again recorded all the
parameters as such findings could pave way for the application parameters in the mother and FHR taken from a new NST tracing.
of yoga therapy in pregnant women and enable determination of
wellness and bonding between pregnant mothers and their fetus. Statistical analysis
Pre- and post-intervention data were assessed using GraphPad
SUBJECTS AND METHODS InStat version 3.06 for Windows 95 (GraphPad Software, San
Diego California USA, www.graphpad.com). As all data passed
We undertook the present study as an interdisciplinary collaborative normality testing by Kolmogorov–Smirnov Test, statistical
work between Centre for Yoga Therapy, Education and Research analysis was carried out using Student’s paired t-test and p < 0.05
(CYTER) of Sri Balaji Vidyapeeth, and the Department of was accepted as significant difference between pre and post
Obstetrics and Gynecology of Mahatma Gandhi Medical College comparisons [Table 1].
and Research Institute (MGMC and RI) in Puducherry. Approval
was obtained from the Institutional Human Ethics Committee of
Table 1: Resting maternal and fetal cardiovascular
Sri Balaji Vidyapeeth (Project No: PG Dissertation/2018/06/03
parameters before and after 10 min of Sukha
dated 06/06/2018), and the study was registered with the Clinical
Pranayama in 12 pregnant women
Trial Registry-India (CTRI: CTRI/2018/08/015163).
Before After p
SP (mm Hg) 107.12±6.32 105.11±4.12 0.184
This single session pre-post comparison study was conducted in
DP (mm Hg) 65.5±4.01 67.20±5.29 0.356
12 pregnant women who were in their 3rd trimester (from 28th week MHR (beats/min) 97.80±8.35 94.40±6.42 0.039
till term of gestation). Inclusion criteria were pregnant women FHR (beats/min) 139.70±6.17 135.20±7.33 <0.001
in whom baseline FHR can be assessed and who were willing RPP (units) 104.71±11.38 99.22±7.84 0.046
to participate and were above 18 years of age. Those having Values are given as mean±SD for 12 participants. p value obtained by Student’s
paired t‑test for intragroup comparisons. SD, Standard deviation; SP, Systolic
medical or surgical OG complications, elderly pregnant women pressure; DP, Diastolic pressure; MHR, Maternal heart rate; FHR, Fetal heart rate;
and high-risk pregnancy were excluded from the study as also RPP, Rate‑pressure product
50 Yoga Mīmāṃsā | Volume 50 | Issue 2 | July-December 2018

RESULTS CONCLUSION
The results are shown in Table 1. There was significant (p < 0.05) The present pilot study provides initial evidence of beneficial
fall in maternal HR and RPP with significant (p < 0.001) decrease effects of pranayama in the pregnant women. It reiterates the
in FHR after the single session of Sukha Pranayama. There was importance of yoga for psychosomatic health of maternal-fetal
also an insignificant reduction in SP and increase in DP. The unit as also its role as an add-on relaxation technique. We plan to
mothers also reported that they felt more relaxed and also sensed develop this pilot study into a full-fledged evaluation of maternal
active fetal movement while performing the pranayama. and fetal well-being through yoga.
DISCUSSION Acknowledgments
The authors would like to thank the management and authorities
Maternal and fetal cardiovascular parameter showed an overall of Sri Balaji Vidyapeeth for setting up the CYTER in MGMC and
reduction following a single session of 10 min of Sukha Pranayama. RI. The authors are grateful to nursing staffs of OBG department
This may be attributed to a healthier cardiac autonomic regulation of MGMC and RI as well as the CYTER yoga instructors
as a previous study has reported that slow deep breathing shifts the P. Danushapnadeesh, G. Sarulatha and ANM Gayathri B for their
autonomic balance from sympathetic dominant to parasympathetic valuable assistance during the sessions.
(Jerath, Edry, Barnes, & Jerath, 2006). An earlier study on
Sukha Pranayama in patients of hypertension reported that it Financial support and sponsorship
reduced HR and BP in such patients within 5 min of practice Sri Balaji Vidyapeeth funds the CYTER and all of its activities
and attributed such changes to a normalization of autonomic in yoga therapy, education, and research.
cardiovascular rhythms as a result of increased vagal modulation
and or decreased sympathetic activity and improved baroreflex Conflicts of interest
sensitivity (Bhavanani, Sanjay, & Madanmohan, 2011). There are no conflicts of interest.
Previous studies by Bhavanani et al. at JIPMER have reported REFERENCES

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52 Yoga Mīmāṃsā | Volume 50 | Issue 2 | July-December 2018

Selected
Published Articles
Ann. SBV, July - Dec, 2012 1(2)
Yoga in Health Care

Ananda Balayogi Bhavanani *
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.
*
* Yogacharya Dr.Ananda Balayogi Bhavanani ,
Hon Advisor CYTER, MGMCRI
Annals of SBV Page 15

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
Page 16 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
and Vincent (eCAM 2007; 4: 469-86) also postulated similar mechanisms to be operating in reducing risk for Type 2
Diabetes 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. 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.
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
siddhimaapnoti sarvayogeshvatandritah-Hathayoga Pradipika I:64). The World Health Organization (WHO) defines
health 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
sukham asanam- Yoga Darshan II:46). Patanjali also tells us that through the practice of asana we can attain a state that
is 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

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

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

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
search in Indian Medicine and Homeopathy. New Delhi. 1976.
3.Anantharaman TR. Ancient Yoga and Modern Science. Mushiram Manoharlal Publishers Pvt Ltd, New Delhi.
1996
4.Anantharaman TR. Yoga as Science. Souvenir: Seminar on Yoga, science and man. Central council for research
in Indian Medicine and Homeopathy. New Delhi. 1976.
5.Back issues of International Journal of Yoga Therapy. Journal of the International Association of Yoga Therapists,
USA. www.iayt.org
6.Back issues of Yoga Life, Monthly Journal of ICYER at Ananda Ashram, Pondicherry. www.icyer.com
7.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) on reaction time in mentally challenged adolescents. Indian J Physiol Pharmacol 2012; 56 : 174–180
10.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.Bhavanani AB. Yoga for health and healing. Dhivyananda Creations. 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
immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003 Jul-Aug; 65(4): 571-81.
20.Chidbhavananda Swami. The Bhagavad Gita. Ramakrishna Tapovanam, Trichy, 1984
21.Datey KK, Deshmukh SN, Dalvi CP, Vinekar SL. “Shavasana”: A yogic exercise in the management of
hypertension’. Angiology 1969 ; 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.Gitananda Giri Swami. Yoga the art and science of awareness. Souvenir 1996; 4thInternational Yoga Festival,
Govt of Pondicherry.
25.Gitananda Giri Swami. Yoga: Step-by-Step, Satya Press, Pondicherry, 1976.
26.Go VL and Champaneria MC. The new world of medicine: prospecting for health. Nippon Naika Gakkai
Zasshi. 2002 Sep 20; 91 Suppl: 159-63.
27.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.
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: 491-519
29.Khalsa SBS. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J
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.Sharma R, Gupta N, Bijlani RL. Effect of Yoga based lifestyle intervention on subjective well-being. Indian J Physiol Pharmacol 2008;
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. J Altern Complement Med 2007; 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
relaxation training. Indian J Physiol Pharmacol 2004; 48: 59-64
40.Yoga the Science of Holistic Living. Vivekananda Kendra Patrika. Vol. 17- 2. 1988.

Psychosomatic Mechanisms Of Yoga

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:
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.
*
* 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: yoga@mgmcri.ac.in and yognat@gmail.com

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, and
2. 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

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. 2007
7.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. 2007
9.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. 1996
11. 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.1961
16. Meena Ramanathan. Thiruvalluvar on Yogic Concepts. Aarogya Yogalayam, Venkateswara Nagar, Saram, Pondicherry-13.2007
17. Swami Satyananda Saraswathi. Four Chapters on Freedom. Bihar School of Yoga, Munger, India. 1999
18. 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.

Yoga Practices for Prevention and Management of Lifestyle Disorders

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
*
* 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: yoga@mgmcri.ac.in and yognat@gmail.com

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 Practices

Jattis 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 Namaskar
Rishikesh 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

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 Asanas
TALA 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 KRIYA

Stand 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 ASANA
Stand 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 ASANA
Sit 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 ASANA

Sit 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

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 PRANAYAMA

Take 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 MUDRA
To 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 ASANA

Lie 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 ASANA

From 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 ASANA

From 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 ASANA
Lie 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

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 PRANAYAMA

Lie 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 KRIYA
The 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 PRACTICES
PRANAVA PRANAYAMA
‘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.
NASARGA MUKHA BHASTRIKA

Nasarga 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

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.
CHANDRA PRANAYAMA
Sit 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.
BHRAMARI PRANAYAMA
Sit 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 PRACTICES
PRANA DHARANA -BREATH AWARENESS: 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.
MINDFULNESS BASED MEDITATION: 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.
OM JAPA: 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.
AJAPA JAPA: 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.

Clinical Roundup
Selected Treatment Options for Depression
CAM Therapies treatment, compared to fluoxetine, for acute treatment of pa-

tients with depression9; however, inconclusive results were
Estimates indicate that > 350 million people are affected obtained when comparing individualized homeopathic treat-
by depression worldwide.1 While conventional medicine dement with placebo.10
fines depression as a neurochemical disequilibrium disorder,
treating it with psychoactive drugs, such as neurotransmitter Polyunsaturated fatty acids (PUFAs)—A high proportion
reuptake inhibitors,2 complementary and alternative medicine of PUFAs are found in brain lipids. n-3 PUFAs may affect
(CAM) finds different causes for depression and, therefore, its serotoninergic and dopaminergic transmissions,11 which are
treatment. Approximately 10%–20% of patients’ conditions involved in depression. Observational data have shown an as-
respond poorly to conventional therapy or the conditions are sociation between lower levels of n-3 PUFAs and depression.3
nonresponsive.3 Thus, we report some CAM interventions Although the ideal dose is still debated, we have seen positive
with which we have seen good results in our clinical practice results with 2 g/day of flaxseed oil, a precursor of the n-6 and
by combining them in an individualized way according to each n-3 PUFAs.
patient’s needs.
References
Acupuncture—A significant beneficial effect of acupunc-
ture is that it can reduce the severity of depression. One meta-
1. World Health Organization: Depression. 2012. Online document at: www.
analysis showed that acupuncture and electroacupuncture as who.int/mediacentre/factsheets/fs369/en Accessed December 10, 2013.
monotherapies had similar effects, compared to usual medica- 2. Bondy B. Pathophysiology of depression and mechanisms of treatment.
tion,4 although when either of these therapies were combined Dialogues Clin Neurosci 2002;4:7–20.
with antidepressants, the results were no better than medica- 3. Ortega RM, Rodríguez-Rodríguez E, López-Sobaler AM. Effects of omega
tion alone.5 3 fatty acids supplementation in behavior and non-neurodegenerative neuro-
psychiatric disorders. Br J Nutr 2012;107(suppl2):261–270.
Vitamin D—Research shows that elderly people with vita- 4. Stub T, Alræk T, Liu J. Acupuncture treatment for depression—a systematic
min D deficiency have an increased risk of depression, with an review and meta-analysis. Eur J Integr Med 2011;3:e259–e270.
association between the severity of symptoms and decreased 5. Zhang ZJ, Chen HY, Yip KC, et al. The effectiveness and safety of acupunc-
serum 25OHD3 levels.6 A trial of 600 international units ture therapy in depressive disorders: Systematic review and meta-analysis. J
(IU)/day supplementation for 6 months produced significant Affect Disord 2010;124:9–21.
improvement in the well-being of subjects.7 Although the ideal 6. Eyles DW, Burne TH, McGrath JJ. Vitamin D, effects on brain develop-
ment, adult brain function and the links between low levels of vitamin D and
dose recommended has not been determined yet, higher doses
neuropsychiatric disease. Front Neuroendocrinol 2013;34:47–64.
seem to produce better results; thus, we usually recommend
7. Leedahl DD, Cunningham JL, Drake MT, et al. Hypovitaminosis D in psy-
600–800 IU/day. chiatric inpatients: Clinical correlation with depressive symptoms, cogni-
tive impairment, and prescribing practices. Psychosomatics 2013;54:257–
Homeopathy—“A rapid, gentle and permanent restoration 262.
of the health,”8 proposed by Hahnemann, may be achieved 8. Hahnemann S; O’Reilly WB, Decker S, transl. Organon of the Medical Art,
by using an individualized homeopathic medicine selected 6th ed. Redmond, WA: Birdcage Books, 1996.
according to the similitude to the patient’s symptoms. In 9. Adler UC, Paiva NM, Cesar AT, et al. Homeopathic individualized Q-Po-
one trial, homeopathy was not considered to be an inferior tencies versus fluoxetine for moderate to severe depression: Double-blind,
randomized non-inferiority trial. Evid Based Complement Alternat Med 2011;
2011:520182.
All comments, opinions, and recommendations in the Clinical Roundup 10. Adler UC, Krüger S, Teut M, et al. Homeopathy for depression: A ran-
are those of the authors and do not constitute those of the Journal, its Pub- domized, partially double-blind, placebo-controlled, four-armed study (DEP-
lisher, or its editorial staff. HOM). PLoS One 2013;8:e74537.
52 DOI: 10.1089/act.2014.20110 • MARY ANN LIEBERT, INC. • VOL. 20 NO. 1

FEBRUARY 2014
ALTERNATIVE AND COMPLEMENTARY THERAPIES
ALTERNATIVE AND COMPLEMENTARY THERAPIES • FEBRUARY 2014
11. Liperoti R, Landi F, Fusco O, et al. Omega-3 polyunsaturated fatty acids 3. Donohue JM, Pincus HA. Reducing the societal burden of depression: A
and depression: A review of the evidence. Curr Pharm Des 2009;15:4165– review of economic costs, quality of care and effects of treatment. Pharmaco-
4172. economics 2007;25:7–24.
4. Sobocki P, Jönsson B, Angst J, Rehnberg C. Cost of depression in Europe.
J Ment Health Policy Econ 2006;9:87–98.
Eugenia Aparecida Kalleian, MD1
and Jaqueline Kalleian Eserian, MS2 5. Kou MJ, Chen JX. Integrated traditional and Western medicine for treat-
1Universidade Federal de São Paulo, São Paulo, Brazil ment of depression based on syndrome differentiation: A meta-analysis of
2Instituto Adolfo Lutz, São Paulo, Brazil
randomized controlled trials based on the Hamilton depression scale. J Tradit
Chin Med 2012;32:1–5.
6. Stub T, Alraek T, Liu J. Acupuncture treatment for depression—a system-
atic review and meta-analysis. Eur J Int Med 2011;3:259–270.
7. Wen TS. Clinical experience. In: Hsing WT, ed. Therapeutic Manual of
Acupuncture Acupuncture [in Portuguese]. Barueri, Brazil: Manole, 2008:334–336.
8. MacPherson H, Richmond S, Bland M, et al. Acupuncture and counsel-
Depressive disorders are defined by the American Psychiatric ling for depression in primary care: A randomised controlled trial. PLoS Med
Association in the DSM–V as comprising a group of disorders 2013;10:e1001518.
that include major depression, dysthymic disorder, adjustment
disorder with depressed mood, and minor depression.1 Clinical Yolanda Maria Garcia, MD, PhD1
symptoms may be emotional (intense sadness and emotional and Mariana Rebêlo César Cavalcanti, MD2
distress, emotional numbness, anxiety, or irritability), ideational 1Ambulatory Geriatrics Division
(worthlessness or guilt, death or suicide), and neurovegetative Clinical Medicine Department
(loss of energy, changes in sleep and appetite), causing clinically 2Medical Residency Program of Acupuncture, Orthopedics
significant distress or psychosocial impairment.1 and Traumatology Department
Depression is commonly associated with other disorders São Paulo University Medical School
such as anxiety and alcohol and drug abuse.2 Depression is São Paulo, Brazil
highly prevalent, frequently underdiagnosed and undertreated,
and, at the same time, a major cause of functional disability,
mortality, and economic loss.2–4
Modern literature recognizes acupuncture and moxibus- Auriculotherapy
tion, two techniques from Traditional Chinese Medicine
(TCM), as useful resources for managing depressive disor- Depression is known to be associated with physical illness-
ders. These techniques are used in conjunction with drugs es, immune dysfunction, and mortality from suicide.1 Given
and psychotherapy.5,6 the pharmacologic therapy limitations for treating depression,
The description of depressive disorders in TCM is based on other noninvasive complementary methods integrated with
the same clinical features as in Western medicine, but they will mainstream medicine must be explored. Auriculotherapy, an
be classified according to the patient’s condition and symptoms. approach involving Traditional Chinese Medicine (TCM),
There are different pathogenic factors in TCM. Stagnation of is proposed as a therapy for patients who have depression,
Liver Qi and Spleen Deficiency is one of the most common syn- wherein specific points on the auricle are punctured or stimu-
dromes of depression.5 Heart Yin Deficiency, Disharmony of the lated to treat various disorders of the body.2 This therapy is a
Spleen and Stomach, and Kidney Deficiency may also exist, and specialized form of acupuncture that treats the ear as a micro-
their meridian points should be tonified.5,7 For each syndrome system of the body.3
there is a specific TCM prescription. Neurovegetative manifesta- In auricular acupuncture, eight auricular points that can
tions, such as insomnia and palpitations, may be treated with the be used to relieve depressive status are identified (Table 1).
Heart or Pericardium meridian acupoints, while chest tightness The Chinese Standard Ear-Acupoints Chart, which is rec-
and epigastric discomfort, memory loss, and excessive worry ognized by the World Health Organization, is used to locate
can be treated with the Spleen meridian acupoints.7 the points (Fig. 1). The selection of points was based on the
Acupuncture may be effective for reducing the severity of “organ” theory of Chinese medicine as well as perspectives
depression,6,8 and, used in conjunction with Western conven- in Western medicine.
tional care, may help lower doses of drugs and may improve Depression is associated with defects in the neurotransmit-
adherence to conventional treatments.3,8 ters (norepinephrine, dopamine, and serotonin) in the brain4;
thus, a number of selected auricular points correspond to the
References different parts of the brain. The treatment protocol includes
application of magnetic pellets starting on either the left ear or
1. American Psychiatric Association. Diagnostic and Statistical Manual of Men-
the right ear. Only one ear receives treatment at a time, with
tal Disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013. each ear treated alternately, for a total treatment of 4 weeks.
2. Pietrzak RH, Kinley J, Afifi TO, et al. Subsyndromal depression in the After the first application, the magnetic pellets are retained on
United States: Prevalence, course, and risk for incident psychiatric outcomes. the acupoints for 1 week, and then a new set of pellets is ap-
Psychol Med 2013;43:1401–1414. plied on the opposite ear in a similar fashion.
MARY ANN LIEBERT, INC. • VOL. 20 NO. 1

53
Hamilton Depression Rating Scale and the Subjective Happiness

Table 1. Eight Specific Auricular Points for Scale. Based on my and my colleagues’ clinical experiences au-
Treating Depression ricular acupuncture provides a holistic, convenient, nonpainful,
hygienic, and risk-free therapy to help patients with depression.
Auricular points Rationale
Shenmen Used to calm the mind
References
Liver Liver is associated with emo-
tion from the TCM perspective
Occiput Also known as the “Antidepres- 1. Tsang HWH, Cheung L, Lak DCC. Qigong as a psychosocial interven-
sant point”3 tion for depressed elderly with chronic physical illnesses. Int J Geriatr Psych
2002;17:1146–1154.
Subcortex Also known as the “Excitement
2. Suen LKP, Wong TKS, Leung AWN. Is there a place for auricular therapy in
point,” to relieve depression & is
the realm of nursing? Complement Ther Nurs Midwifery 2001;7:132–139.
used to calm the mind.3
3. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear
Anterior ear lobe Also known as “Master Cerebral”
Acupuncture, 3rd ed. Los Angeles: Health Care Alternatives, 2003.
(lower portion) & is near the “Be happy point,”
which is located on the back 4. Bao AM, Ruhe HG, Gao SF et al. Neurotransmitters and neuropeptides in
of the ear.3,a depression [review]. Handb Clin Neurol 2012;106:107–136.
Center of ear Also known as “Point zero,” for

achieving general homeostatic Lorna Suen, BN, MPH, DipClinAcup, PhD
balance3 School of Nursing
Brainstem Also known as the “Brain”3 The Hong Kong Polytechnic University
Lower tragus Also known as the “Pineal Gland”3 HungHom, Hong Kong
(lower portion)
aHuang LC. Auricular Treatment: Formulae and Prescriptions. Orlando: Auricular
Medicine International Research and Training Centre, 2001.

TCM, Traditional Chinese Medicine.
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

Figure 1. Location of auricular points for depression.
breath are synchronized particularly in the use of kriya or
To enhance the treatment effect, the pellets are applied to the structured movements, such as the sun salutation. We use
reactive region of each identified acupoint as detected by an acu- forceful breath patterns, such as bhastrika and kapalbhathi
point detector. The effect of the treatment is evaluated using the for activation.
54 MARY ANN LIEBERT, INC. • VOL. 20 NO. 1

on the blood circulation, thus elevating mood and psychologic

(2) Shifting from individuality to universality—Yogic coun- well-being.5
seling aims to help the participant understand the bigger A study of 28 young adults with depression, who were
picture and improve self-esteem. randomly divided into two groups (yoga and wait-list con-
(3) Holistic approach of yoga as a lifestyle—Use of early trol), showed that two classes of Iyengar yoga per week
morning sunlight for healing and rejuvenating activities, for 5 weeks led to a significant reduction in self-reported
use of water for internal and external cleansing, and care- symptoms of depression, negative mood, and fatigue.6 Yoga
ful attention to diet. Gentle stretching and strengthening postures emphasized in this study were backbends, stand-
static practices (āsanās) are introduced in a graded man- ing and inverted postures with brief periods of relaxation,
ner, depending on the physical ability of the patient.
and breathing exercises in between.6 In another study,
Shavāsana was examined as a therapeutic technique for de-
References
pression, which revealed this type of yoga’s effectiveness
for alleviating depression.7
1. Nespor K. Twelve years of experience with yoga in psychiatry. Int J Psy- In a randomized clinical trial, 45 untreated patients with
chosom 1993;40:105–107. depression were divided into three groups who received (1)
2. Bhavanani AB. Yoga Chikitsa: The application of yoga as a therapy. Pondi- antidepressant medication (i.e., imipramine), (2) electrocon-
cherry, India: Dhivyananda Creations, 2013.
vulsive therapy, or (3) Sudarshana Kriyā Yoga (SKY). Assess-
3. Lavey R, Sherman T, Mueser KT, et al. The effects of yoga on mood in
ments were made at baseline and performed every week for 4
psychiatric inpatients. Psychiatr Rehabil J 2005;28:399–402.
weeks. All three groups had reductions in depression scores
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 on the Beck Depression Inventory and the Hamilton
Based Complement Alternat Med 2007;4:493–502. Rating Scale for Depression). In the third week, the SKY
5. Streeter CC, Whitfield TH, Owen L, et al. Effects of yoga versus walking on group and the group taking imipramine had similar scores, but
mood, anxiety, and brain GABA levels: A randomized controlled MRS study. the SKY group had higher scores than the electroconvulsive
J Altern Complement Med 2010;16:1145–1152. therapy group.8
6. Sharma R, Gupta N, Bijlani RL. Effect of yoga based lifestyle intervention The practice of Sahaja Yoga meditation produced additional
on subjective well-being. Indian J Physiol Pharmacol 2008;52:123–131. improvement in executive functions. These included manipu-
7. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, et al. An- lation of information in verbal working memory and added
tidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: A ran- improvement in attention span and visual–motor speed of pa-
domized comparison with electroconvulsive therapy (ECT) and imipramine. J
Affect Disord 2000;57:255–259.
tients with depression.9
8. Waelde LC, Thompson L, Gallagher-Thompson D. A pilot study of a
The following yogic practices10 (60 minutes daily for 3
yoga and meditation intervention for dementia caregiver stress. J Clin Psy- months) may be useful for managing depressive disorders:
chol 2004;60:677–687.
(1) Loosening practices11—Shithilikarana vyāyāma for ~ 15
Ananda Balayogi Bhavanani, MBBS, ADY, FIAY, MD (AM) minutes:
Centre for Yoga Therapy, Education and Research (A) Standing practices are jogging, jumping, hip twist-
Mahatma Gandhi Medical College & Research Institute ing, forward and backward bending, alternate toe
Pillayarkuppam, Pondicherry, India touching, and side bending
(B) Sitting practices are Tiger stretch and Halāsana-
Paschimottānāsanā stretch
(C) Supine practices are straight leg raising, both legs
Yoga II raising, and cycling
(2) Breathing practices10—Prānāyāma for ~ 8 minutes in-
Depression, a significant contributor to the global burden of volves forceful exhalation (Kapālbhāti for 2 minutes),
disease, is estimated to affect 350 million people worldwide.1 right nostril breathing (Suryānuloma Viloma prānāyāma
The World Health Organization estimates that depression will for 2 minutes), Bellow breathing (Bhastrikā for 2 min-
be the number-one health concern in both developed and de- utes); or SKY and Oceanic breathing (Ujjayi for 2 min-
veloping nations by 2030.2 utes).
Yoga is cost-effective; easy to implement; and produces (3) Physical postures10—Āsanas for a total of ~ 12 minutes:
beneficial emotional, psychologic, and biologic effects. Thus, (A) Standing āsanas are Sun Salutation (Surya Nama-
it appears to be a promising intervention for depression.3 In a skāra for 5 minutes) and Half wheel pose
study, it was found that yogāsanās featuring backbends of long (Ardha Chakrāsana; 1 minute for each side)
duration, both passive and active, along with vigorous hand (B) Sitting āsanas are Camel pose (Ustrāsana for 1
balancing and, finally, restful supported backbending relax- minute), and Posterior Stretching Pose
ation, were beneficial in depression.4 Iyengar yoga also places (Paschimottānāsana for 1 minute)
a great deal of emphasis on postures that involve opening of (C) A prone āsana is the Cobra pose (Bhujangāsana for
the chest, such as backbends, as they may have direct effects 1 minute)

55
(D) Supine āsanas are Upside down Seal (Viparithkar- It is easy to teach my patients how to perform the meditation
ani āsana for 2 minutes) and Wind releasing pose at the end of their clinic visits. In addition, my patients often
(Pavanmukthāsana for 1 minute) do not have the time for more time-intensive interventions,
(4) Meditations—Pranava japa10 (OM Chanting) and Saha- and are always looking for something easy and quick to do
ja Yoga9 Meditation for 15 minutes that will improve their health.
(5) Guided relaxation—Corpse pose (Savāsana)11 for 10 min- As a result of my own personal improvements, I decided to
utes at the end of āsanas and prānāyama. study Kelee meditation in a clinical population at the Univer-
sity of California San Diego (UCSD) Medical Center. My col-
leagues and I were able to demonstrate statistically significant
References reductions in stress, anxiety, and depression in participants af-
ter 12 weeks across 6 different administered questionnaires.5
1. World Health Organization: Depression. 2012. Online document at: www. The real advantage of Kelee meditation, compared to other in-
who.int/mediacentre/factsheets/fs369/en Accessed December 23, 2013. terventions for improving mental health, is that Kelee meditation
2. World Health Organization. The Global Burden of Disease: 2004 Update. does not introduce a new medication into the body nor does it try
2008. Online document at: www.who.int/healthinfo/global_burden_disease/ to change a person’s thoughts to change how that person feels.
GBD_report_2004update_full.pdf Accessed June 16, 2012.
Kelee meditation is unique in making a distinction between brain
3. Kozasa EH, Santos RF, Rueda AD, et al. Evaluation of Siddha Samadhi function and mind function. Developing stillness of mind allows
Yoga for anxiety and depression symptoms: A preliminary study. Psychol Rep
2000;103:271–274.
each person to develop clearer perception of mind and to stop the
brain’s tendency to ruminate over what it does not understand.
4. Robin M. A Handbook for Yogasana Teachers: The Incorporation of Neu-
roscience, Physiology and Anatomy into the Practice, 1st ed. Tucson: Wheat- Of all of the potential interventions for depression, I have found
mark Press, 2009. this meditation to be the most effective way to help my patients
5. Shapiro D, Cline K. Mood changes associated with Iyengar yoga practices: learn how to troubleshoot their minds and help themselves.
A pilot study. Int J Yoga Ther 2004;14:35–44.
6. Woolery A, Myers H, Sternlieb B, et al. A yoga intervention for young adults
with elevated symptoms of depression. Altern Ther Health Med 2004;10:60–63. References
7. Khumar SS, Kaur P, Kaur S. Effectiveness of Shavasana on depression
among university students. Indian J Clin Psychol 1993;20:82–87. 1. Rathbun RW. The Kelee: An Understanding of the Psychology of Spiritual-
8. Naga Venkatesha Murthy PJ, Janakiramaiah N, Gangadhar BN, et al. P300 ity, 2nd ed. Oceanside, CA: Quiescence Publishing, 2007.
amplitude and antidepressant response to Sudarshan Kriya Yoga (SKY). J Af- 2. Rathbun RW. The Kelee Meditation Practice: The Basic Principles of the
fect Disord 1998;50:45–48. Kelee. Oceanside, CA: Quiescence Publishing, 2008.
9. Sharma VK, Das S, Mondal S, et al. Effect of Sahaj Yoga on neuro-cog- 3. Rathbun RW. Troubleshooting the Mind: Understanding the Basic Prin-
nitive functions in patients suffering from major depression. Indian J Physiol ciples of the Kelee. Oceanside, CA: Quiescence Publishing, 2010.
Pharmacol 2006;50:375–383.
4. Rathbun RW. Kelee Foundation.® Online document at: www.thekelee.org.
10. Naveen GH, Rao MG, Vishal V, et al. Development and feasibility of yoga Accessed November 25, 2013.
therapy module for out-patients with depression in India. Indian J Psychiatry
5. Lee D. The Kelee® Meditation Medical Study: Troubleshooting the mind
2013;55(suppl3):S350–S356.
through Kelee Meditation. A distinctive and effective therapeutic intervention for
11. Nagarathna R, Nagendra HR. Yoga module for anxiety. In: Nagendra HR, stress, anxiety, and depression. Oceanside, CA: The Kelee® Foundation, 2013.
ed. Yoga for Anxiety and Depression, 1st ed. Bangalore, India: Swami Vive-
kananda Yoga Prakashana, 2001:33–86.
Daniel Lee, MD
University of California San Diego (UCSD)
Hemant Bhargav, MBBS, MD (Y&R),
School of Medicine
Praerna Chowdhury, BAMS, MD (Y&R)
UCSD Medical Center–Owen Clinic
and Nagarathna Raghuram, MD, FRCP (UK)
San Diego, CA
S-VYASA University
K.G. Nagar, Bengaluru, India
Reflective Garden Walking

Kelee® Meditation
There is a long history of the therapeutic use of plants and
In my clinical practice, I try to teach my patients how to gardens in the care of patients with both physical and mental
perform Kelee® meditation to help relieve their stress, anxi- illnesses.1 Outdoor gardens have been suggested as a means of
ety, and depression. I have personally practiced Kelee medita- improving morale, self-confidence, cooperation, social interac-
tion for 8 years and have noticed the continual improvement tion, and physical functioning for older adults.2–4 In Japan an
in the quality of my own life with regard to these same three intervention, Shinrin-yoku (“forest bathing”), recommended by
problems. Kelee meditation is a specific form of meditation medical providers, is based on a leisurely stroll in a forest or gar-
focused on developing “stillness of mind,” which only takes den. Researchers have demonstrated that Shinrin-yoku has the
5–10 minutes twice daily to perform.1–4 ability to increase immunoglobulins and decrease depression.5

Based on this evidence, a walking guide and reflective

journal entitled Stroll for Well-Being: Garden Walks (Stroll) and/or unaddressed spiritual needs of a patient as (additional)
was written by the author and used at a local Japanese gar- causative factors. The description of anthroposophic health
den. The Stroll was structured so that participants would care (AH) that follows is the result of a consensus-seek-
complete 12 walks in the garden, stopping at 6 specified ing process with experienced anthroposophic doctors and
spots, and reading a descriptive paragraph. Participants therapists in The Netherlands and a review of the literature
would also reflect on the words provided and on the garden in this field.
surroundings, and express thoughts in the journal provided AH addresses all factors contributing to depressive disor-
in the Stroll. ders. As the factors are intertwined, AH is organized in an
For the research, the participants met in groups of ~ 20, to organic, multidisciplinary way,2 focusing on the restoration
review the Stroll guide’s journaling and stopping spots. Two ad- of the patient’s ability to heal first. Thus, first, financial
ditional meetings were held to discuss the experience of partici- and housekeeping problems, etc., are addressed by social
pation. We used the Geriatric Depression Scale (GDS), prior to workers. Second, physiologic issues such as exhaustion
and after the 12 walks, to study the effect of the Stroll on depres- are treated. In the latter phase, compresses, hydrotherapy,
sion in 40 older adults and noted a significant improvement in medicinal bath treatments, and rhythmic massages3 may be
mean scores pre-walk versus post-walk (t = 12.54, P = 0.001).6 prescribed. Dietary advice4 (to promote sleep and regular
After audiotaped and transcribed focus meetings, four and healthy food intake) is also given in this phase. Both of
themes emerged: (1) “being forced to spend time away from these phases may be combined with either conventional or
pressures of the day”; (2) “a sense of the beauty of nature”; anthroposophic medicines5 from plant, mineral, or animal
(3) “the guide helped us to begin our life reflection”; and (4) substances.3
“gratitude for the beauty of nature and the life I have led.” Furthermore, it is acknowledged that some patients ben-
Based on these results, we concluded that reflective garden efit from psychologic help, especially when biographic is-
walking using a journal has the ability to decrease depression sues and life events influence recovery. Psychologic help,
in older adults. however, is focused on admitting the importance of these
factors in the development of the depression rather than
truly addressing the reason that these factors have led to a
References depression.
A third phase starts as soon as the patient is able and will-
1. Pachana N, McWha JL, Arathoon M. Passive therapeutic gardens: A study ing to address causative factors that can be influenced by the
on an inpatient geriatric ward. J Gerontol Nurs 2003;29:4–10. patient only. Thus, mental cognition and biographic and spiri-
2. O’Connor PJ, Youngstedt SD. Sleep quality in older adults: Effects of ex- tual issues contributing to the depressive disorder are treated
ercise training and influences of sunlight exposures. JAMA 1997;277:1034– in this phase. Therapeutic goals are reached with the support of
1035.
anthroposophic medicines,3 art therapists, curative eurhythmic
3. Refinetti R. Circadian Physiology. Boca Raton, FL: CRC Press, 1999.
therapists6,7 and/or psychotherapists.
4. Hill CO, Relf PO. Gardening as an outdoor activity in geriatric institutions.
Activities Adapt Aging 1982;31:47–54.
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Health Prev Med 2010;15:9–17.
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research report. Holist Nurs Pract 2010;24:252–259. chiatric Approach. Bolks’s Companions for the Practice of Medicine, 2010.
Online document at: www.louisbolk.org/downloads/2391.pdf Accessed De-
cember 23, 2013.
Ruth McCaffrey, DNP, ARNP, FNP-BC, GNP-BC, FAAN 2. Ponstein A, Van Gerven M, Van der Bie G. Health Care Program for Depressive
Christine E. Lynn College of Nursing Disorders: An Anthroposophic Approach [in Dutch]. Leiden, The Netherlands:
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Boca Raton, FL aems/lectoraatAgEn/AHCPabstract.pdf. Accessed December 23, 2013.
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Health Care. Washington DC: American Psychiatric Publishing, 2007.
Depressive disorders evolve as the result of a combination
of several factors from biologic, physiologic, social, men- 5. Rissmann W. Therapy of depression—anthroposophical medicines [in Ger-
man]. Der Merkurstab 2006;5:407–413.
tal, biographic, and spiritual origins1 that are likely to influ-
6. Hamre HJ, Witt MC, Glockmann A, et al. Anthroposophic therapy for chron-
ence each other. Conventional pharmaceutical interventions
ic depression: A four-year prospective cohort study. BMC Psychiatry 2006;
(e.g., antidepressants, sleeping pills) and psychotherapy 6:57–70.
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57
Anne S. Ponstein, PhD,1 and Christof Zwart, MD2 4. Block G. Foods contributing to energy intake in the US: Data from
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Nutritional Psychology Amanda Hull, PhD, and Ephi Morphew-Lu, MS, CN

Nutritional psychology is the science of how nutrients af- Center for Nutritional Psychology
fect mood and behavior. This is a burgeoning field that ex- Santa Clara, CA
amines the biophysiologic mechanisms, influenced by our
nutrient intake, that underlie mood, behavior, and brain func-
tion. Increasing research supports the fact that diet plays an Body Psychotherapy
important role in mental health and well-being in Western-
ized societies.1–3 People often eat to relieve symptoms of In depression, patients frequently have physical complaints
depression and anxiety, without realizing that their dietary and body-image disturbances.1 Somatic symptoms are now re-
choices actually result in greater fatigue, stress, and mood garded as “common presenting features throughout the world.”2
imbalances.4 These dietary influences on mood and behav- These are also expressions of psychosomatic processes.
ior have an important impact on the diagnosis and treatment The therapeutic strategy in body psychotherapy (BPT) is
of mental health disorders, including mood disorders such experiential and relational.3 According to Heller, it includes
as depression.5,6 “body techniques to strengthen the developing dialogue be-
We have developed nutritional psychology tools and meth- tween patient and psychotherapist about what is experienced
odological approaches aimed at improving symptoms of de- and perceived. . . .the body is considered a means of communi-
pression and anxiety. A central concept is the blood sugar–ad- cation and exploration.”4 BPT focuses upon the link between
renal axis (BSAA). The BSAA is a physiologic hormone sys- motor systems and emotion regulation, as well as on disturbed
tem in the body, including cortisol and insulin that is activated emotional processing and affect regulation.
by an individual’s daily dietary pattern. This axis describes the Drawing upon findings from embodied cognitive sci-
physiologic link between poor dietary intake, fluctuating glu- ences5 and psychotherapy research6–8 BPT offers a range
of disorder-specific interventions, addressing the link be-
cose levels, and mood symptoms.
tween depressive symptoms and bodily experiences. The
The BSAA functional concept forms the cornerstone by
disorder-specific approach of BPT for depression has been
which the effects of macronutrients on mood are interpreted.
tested in single case studies, small case series, and, most re-
The 3-Day Food Journal for Mood (3-DFJM) is a tool designed
cently, in a randomized controlled trial, all of which showed
to help patients self-identify their macronutrient dietary intake
good efficacy.6–8
patterns, and accordingly, to identify dietary factors that can
BPT encompasses the following main components:
lead to states of depression, anxiety, and fatigue.
Based on the results of the 3-DFJM, a Macronutrient Mood
(1) Exploratory movements, exercises, and increased sen-
Therapy (MMT) program can be designed to help patients
sory awareness (to address lack of affect and reduced
improve their own moods from a dietary perspective. MMT
psychomotor activity—lack of drive/initiative)
involves selective removal of dietary factors associated with
(2) Techniques derived from neo-Reichian BPT, movement
mood disturbances (e.g., processed, sugary foods) and replaces
psychotherapy, and psychodrama; exploring, enacting,
these factors with increased intakes of dietary components as-
revitalizing, and transforming the mind, particularly sup-
sociated with improved moods. Currently, we are developing
pressed negative/aggressive impulses (especially those
a 12-week nutritional psychology group manual incorporating
featuring self-destructive/suicidal tendencies); and en-
the aforementioned tools. We plan to collect pilot data in a
hancing patients’ affective modulation, psychomotor ex-
veteran sample in January 2014.
pressiveness; and fostering healthy self-regulation
References (3) Interventions focusing on bodily strength, capabilities,
and other healthy resources, aimed at rebalancing patients’
negative self-evaluation and strengthening self-demar-
1. Jacka F, Pasco J, Mykletun A, et al. Association of Western and traditional
cation
diets with depression and anxiety in women. Am J Psychiatry 2010;167:305–
311. (4) Working against gravity (physically and metaphori-
2. Weng T, Hao J, Qian Q, et al. Is there any relationship between dietary pat-
cally) to counteract feelings of heaviness and the un-
terns and depression and anxiety in Chinese adolescents? Public Health Nutr bearable weight of emotional/mental pain
2012;15:673–682. (5) Body-oriented psychologic work directed toward bio-
3. Akbaraly T, Brunner E, Ferrie J, et al. Dietary pattern and depressive symp- graphic backgrounds with a specific focus toward
toms in middle age. Br J Psychiatry 2009;195:408–413. unmet physical/emotional needs, nourishment, and un-

resolved traumata (i.e. separation/loss), enabling pa- Frank Röhricht, MD, FRCPsych
1Centrefor Psychoanalytic Studies, University of Essex
tients to identify how self-destructive tendencies are
diverted from external objects to identify a range of more- East London National Health Service (NHS)
constructive responses and solutions. n Foundation Trust, London, UK
on behalf of/with co-authors*
of the Science & Research Committee,
References European Association for Body Psychotherapy
*Co-authors:
1. Röhricht F, Beyer W, Priebe S. Disturbances of body experiences in acute Sheila Butler, PhD,1 Siegmar Gerken, PhD,2
anxiety and depressive disorders—neuroticism or somatization? [in German]. Herbert Grassmann, PhD,3
Psychother Psychosom Med Psychol 2002;52:205–213. Joop Valstar, PhD,4
2. Bhugra D, Mastrogianni A. Globalisation and mental disorders: Overview and Courtenay Young, BSc(Econ), DipPsych 5
with relation to depression. Br J Psychiatry 2004;184:10–20. 1Kent and Medway NHS
3. European Association for Body Psychotherapy. Home Page. Online docu- and Social Care Partnership Trust, Maidstone, UK
ment at: www.eabp.org Accessed December 12, 2013. 2Core Evolution, Mendocino, CA
4. Heller MC. Body Psychotherapy: History, Concepts, Methods. New York & 3Institut for Core Therapy, Regensburg, Germany
London: W.W. Norton & Co., 2012. 4Wilhem Reich Foundation, Amsterdam, The Netherlands
5. Gallagher S. How the Body Shapes the Mind. Oxford, UK: Oxford Univer- 5UKCP, EABP & NHS Lothian, Edinburgh, Scotland
sity Press/Clarendon Press, 2005.
6. Röhricht F. Body oriented psychotherapy–the state of the art in empirical
research and evidence based practice: A clinical perspective. Body, Movement For this interactive feature column, Clinical Roundup, a
Dance Psychother 2009;4:135–156. new question is posed and then answered by experts in the
7. Röhricht F, Papadopoulos N, Priebe S. An exploratory randomized con- field. In the next issue, the Clinical Roundup will focus on
trolled trial of body psychotherapy for patients with chronic depression. J Af- how you treat cancer-related fatigue in your practice.
fect Disord 2013;151:85–91.
8. Papadopoulos N, Röhricht F. An investigation into the application and pro-
cesses of manualised body psychotherapy for depressive disorder in a clini-
cal trial. Body Movement Dance Psychother 2013;October 18:e-pub ahead To order reprints of this article, e-mail Karen Ballen at: Kballen@liebertpub.com
of print. or call (914) 740-2100.

59
Ann. SBV, Jan - Jun 2014;3(1)
YOGA AND MIND BODY THERAPIES IN HEALTH AND DISEASE: A BRIEF REVIEW
Ananda Balayogi Bhavanani *, Meena Ramanathan **, Madanmohan ***
Introduction represents the first yoga therapy. Yoga chikitsa

could be termed as man’s first attempt at unitive
“Oh, East is East, and West is West, and never
understanding of mind-emotions-physical distress
the twain shall meet,” said Rudyard Kipling. This
and is the oldest wholistic concept and therapy in
dichotomy however seems to have been overcome
the world.” 5
in recent times, as many eastern healing traditions
have slowly and steadily percolated the health care To achieve this yogic integration at all
system worldwide. This is especially true of mind– levels of our being, it is essential that we take
body therapies that focus on the health promotive into consideration the all encompassing multi
intrinsic connections that exist between the human dimensional aspects of yoga that include the
brain, mind, body, and individual behaviour. following: a healthy life-nourishing diet, a healthy
This includes techniques of meditation (mantra and natural environment, a wholistic lifestyle,
meditation, mindfulness meditation, and others), qi adequate bodywork through asana, mudra-bandha
gong, tai chi, and yoga.1 In the USA, reported use and kriya, invigorating breath work through
of deep breathing, meditation, and yoga increased pranayama and the cultivation of a healthy thought
between 2002 and 2007 with 12.7% of adults process through jnana yoga and raja yoga.
using deep-breathing exercises, 9.4% practicing
meditation, and 6.1% taking up yoga.2,3 Pain The International Association of Yoga
related issues were the top usage statistics while Therapists (IAYT), USA has taken this idea into
more than 40% of adults with neuropsychiatric account in defining Yoga therapy as follows6: “Yoga
symptoms were drawn to the usage of various therapy is the process of empowering individuals
mind–body therapies.4 to progress toward improved health and well-being
through the application of the philosophy and
Yoga As A Therapy practice of yoga.” This has been further elabourated
Yoga as a mode of therapy (yoga chikitsa) has by the IAYT in its “Recommended Educational
become extremely popular, and a great number Standards for the Training of Yoga Therapists”,
of studies and systematic reviews offer scientific published on 1 July, 2012.7 This is one of the best
evidence of its potential in treating a wide range of documents on standards in yoga therapy and is a
psychosomatic conditions. Yoga understands health path breaking effort covering comprehensively all
and well-being as a dynamic continuum of human aspects of yoga as a holistic therapy.
nature and not merely a ‘state’ to be reached and
maintained. Yoga helps the individual to establish The need of the hour is for a symbiotic
“sukha sthanam”, which may be defined as a dynamic relationship between yoga and modern science. To
sense of physical, mental, and spiritual well-being. satisfy this need, living, human bridges combining
Yogamaharishi Dr. Swami Gitananda Giri Guru the best of both worlds need to be cultivated. It
Maharaj, the visionary founder of Ananda Ashram is important that more dedicated scientists take
at the ICYER, Pondicherry (www.icyer.com) and up yoga and that more yogis study science, so that
one of the foremost authorities on Yoga in the past we can build a bridge between these two great
century exclaimed lucidly, “Yoga chikitsa is virtually evolutionary aspects of our civilization. The process
as old as yoga itself, indeed, the return of mind that as well as the goal of yoga is all about becoming
feels separated from the Universe in which it exists “one” with an integrated state of being.8
* Ananda Balayogi Bhavanani , Deputy Director, E mail: yognat@gmail.com

** Meena Ramanathan, Co-ordinator and Yoga therapist, E mail: saineema@yahoo.com
*** Madanmohan, Director, Prof & Head, Dept. of Physiology, E mail: drmadanmohan999@rediffmail.com
Centre for Yoga Therapy, Education and Research (CYTER)
Mahatma Gandhi Medical College and Research Institute, Puducherry 607402, India

Promotes Positive Health 4. Improvement in dexterity, strength, steadiness,

stamina, flexibility, endurance, and neuro-
Healthy life can be considered as a by-product
musculo-skeletal coordination 13, 21, 22, 23, 24, 25, 26
of practicing yogic techniques since it has been
observed that Yoga practitioners are physically and 5. Increase in alpha rhythm, inter-hemispheric
mentally healthier and have better coping skills to coherence and homogeneity in the brain 27, 28,
29, 30
stressors than the normal population. Knowledge
of inexpensive, effective and easily administrable 6. Improved sleep quality 31
yogic techniques by health professionals will go 7. Improved cognitive functions 9, 32, 33, 34, 35, 36, 37, 38
a long way in helping us achieve the goal of the 8. Alteration in brain blood flow and brain
World Health Organisation to provide “physical, metabolism 39, 40, 41, 42
mental, spiritual and social health” for all sections 9. Modulation of the neuro-endocrine axis 43, 44, 45,
of human society. 46, 47, 48
Some of the important documented health We can say that the eastern mind-body
promoting benefits of mind-body practices such as techniques affect every cell of the human
yoga and meditation include: body. They bring about better neuro-effector
1. Improvement in cardio-respiratory efficiency 9, communication, improve strength, and enhance
10, 11, 12 optimum functioning of all organ-systems while
2. Improvement in exercise tolerance 13, 14, 15, 16 increasing resistance against stress and diseases
3. Harmonious balance of autonomic function 17, with resultant tranquillity, balance, positive attitude
18, 19, 20 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 of yoga interventions in stress with an Agency for

Healthcare Research and Quality (AHRQ) report
It is well established that stress weakens our
stating that “Yoga helped reduce stress.”49 Reductions
immune system. Scientific research in recent times
in perceived stress following yoga are reported to be
has shown that the physiological, psychological and
as effective as therapies such as relaxation, cognitive
biochemical effects of yoga are of an anti-stress nature.
behavioural therapy and dance therapy.
A majority of studies have described beneficial effects

Mechanisms postulated include the restoration nerves, the main peripheral pathway of the
of autonomic balance as well as an improvement parasympathetic nervous system, and ii) reduce
in restorative, regenerative and rehabilitative allostatic load.
capacities of the individual. A healthy inner sense
of wellbeing produced by a life of yoga percolates According to the theory proposed by them,
down through the different levels of our existence decreased parasympathetic nervous system and
from the higher to the lower levels producing health GABAergic activity that underlies stress-related
and wellbeing of a holistic nature. Streeter et al disorders can be corrected by yoga practices
recently proposed a theory to explain the benefits resulting in amelioration of disease symptoms. A
of yoga practices in diverse, frequently co-morbid review by Bhavanani concluded that heart rate
medical conditions based on the concept that yoga variability (HRV) testing has a great role to play
practices reduce allostatic load in stress response in our understanding of the intrinsic mechanisms
systems so that optimal homeostasis is restored.50 behind such potential autonomic balancing effects
of yoga.51 Innes et al had earlier postulated two
They hypothesized that stress produces an: interconnected pathways by which yoga reduces
• I mbalance of the autonomic nervous the risk of cardiovascular diseases through the
system with decreased parasympathetic mechanisms of parasympathetic activation coupled
and increased sympathetic activity, with decreased reactivity of sympathoadrenal
system and HPA axis.52
• Under activity of the gamma amino-
butyric acid (GABA) system, the primary It is notable that one of the newer applications
inhibitory neurotransmitter system, and of yoga has been in managing the aftermaths of
• Increased allostatic load. natural disasters. Studies have shown that yoga
significantly reduces symptoms of posttraumatic
They further hypothesized that yoga- stress disorder (PTSD), self-rated symptoms of
based practices i) correct under activity of the stress (fear, anxiety, disturbed sleep, and sadness)
parasympathetic nervous system and GABA and respiration rate.53
systems in part through stimulation of the vagus
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 on their benefits for smoking cessation couldn’t be

drawn due to scarcity of papers, low quality of some
Yoga can enhance one’s spiritual life and
publications, and numerous limitations of these
perspective beyond the physical life regardless
studies like inadequate sample size, limitations of
of one’s particular religion.54 It enables people to
study design, lack of adherence monitoring, lack of
attain and maintain a balance between exertion
objective measures, inadequate or absent control
and relaxation, and this produces a healthy and
conditions and absence of blinding.
dynamic state of homeostatic equilibrium.5 Recent
studies have shown that yoga improves mood A large number of studies show that the
and reduces depression scores.55,56 These changes practice of yoga can produce significant decrease
have been attributed to an increased secretion in the basal anxiety scores in different populations.
of thalamic GABA with greater capacity for 60, 61, 62, 63, 64, 65
These reports have shown significant
emotional regulation.56,57 Even a 10 day yoga-based improvements in perceived stress, state and trait
lifestyle modification program has been reported to anxiety, subjective well-being, vigour and decrease
improve subjective wellbeing scores of patients.20 in salivary cortisol, fatigue and depression. Physical
well-being also increased, and those subjects
There has been extensive work done on
suffering from headache or back pain reported
Sudarshan Kriya Yoga and depression at the
marked pain relief. We can conclude that yoga and
National Institute of Mental Health and Neuro
other mind body therapies do have a potential role
Sciences (NIMHANS) in India. This technique
in management of depressive and anxiety disorders.
has been recommended as a potential alternative
to drugs for melancholia as a first-line treatment.58 In addition to its benefits for patients themselves,
yoga also has a great role for managing depression
A review by Carim-Todd et al on yoga and
manifesting in family caregivers of patients with
smoking cessation, reported positive benefits of
dementia.66 Researchers also support the promising
mind–body interventions.59 These interventions
role of yoga as an intervention for depression
produced changes in smoking behaviour/in
because it is cost-effective and easy to implement.61
predictors of smoking behaviour such as abstinence,
However a point to consider is that all the mind-body
decreased number of cigarettes smoked, lower
interventions do seem to be effective when compared
intensity of cravings and attitudinal changes
to passive controls but reports are less conclusive
regards smoking. However, definite conclusions
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 Büssing 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 with warm saline or muslin cloth) and netikriya

(warm saline nasal wash) remove excessive mucous
Many studies have tried to explore the
secretions, decrease inflammation and reduce
mechanisms by which yoga modifies coronary
bronchial hypersensitivity thereby increasing
artery disease risk factors. Manchanda et al68,
provocation threshold while kapalabhati through
Ornish et al69 and Yogendra et al70 have conducted
forceful exhalations improves the capacity to
prospective, randomized and controlled trials on
exhale against resistance.76 A nonspecific broncho
angiographically proven coronary artery disease
protective or broncho relaxing effect has been also
patients with yoga intervention and demonstrated
postulated77 while improved exercise tolerance has
that yoga based lifestyle modification helps in
been reported following yoga therapy in patients
regression of coronary lesions and improvement in
of chronic severe airways obstruction.78 It has
myocardial perfusion. The effect of yogic lifestyle on
been reported that well-performed slow yogic
some of the modifiable risk factors could probably
breathing maintains better blood oxygenation
explain the preventive and therapeutic beneficial
without increasing minute ventilation, reduces
effect observed in coronary artery disease.
sympathetic activation during altitude-induced
A review of 70 eligible studies investigating the hypoxia79 and decreased chemoreflex sensitivity
effects of yoga on risk indices associated with the to hypoxia and hypercapnia80. These help bring
insulin resistance syndrome, cardiovascular disease, about both objective and subjective improvements
and possible protection with yoga, reported that in the condition of patients with bronchitis. Yoga
most had a reduction of systolic and/or diastolic as a therapy is also cost effective, relatively simple
pressure. However, the reviewers also noted that and carries minimal risk and hence should be
there were several noted potential biases and advocated as an adjunct, complementary therapy
limitations that made it difficult to detect an effect in our search for an integrated system of medicine
specific to yoga.52 Another literature review reported capable of producing health and wellbeing for all.
significant improvements in overall cardiovascular
Metabolic/Endocrine Conditions
endurance of young subjects who were given
varying periods of yoga training.71 Physical fitness A few RCTs have suggested that yoga and
increased as compared to other forms of exercise meditation practices act on the hypothalamic–
and longer duration of yoga practice produced pituitary–adrenal axis (HPA) axis to reduce
better cardiopulmonary endurance. In fact a cortisol levels in plasma, 81, 82, 83, 84 as well as reduce
detailed review of yoga in cardiac health concluded sympathetic nervous system tone, increase vagal
that it can be beneficial in the primary and activity, 85,86 and elevate brain GABA levels62.
secondary prevention of cardiovascular disease and
that it can play a primary or a complementary role Major systematic reviews of the effects of yoga
in this regard.72 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
Respiratory Disorders
reported post-intervention improvement in various
Scientific basis of using yoga as an adjunct indices but with results varying by population and
therapy in chronic obstructive pulmonary diseases study design. Another systematic review addressed
is well established with significant improvements in the management of type 2 diabetes and concluded
lung function, quality of life indices and bronchial that the reviewed trials suggest favourable effects of
provocation responses coupled with decreased need yoga on short-term parameters related to diabetes
for regular and rescue medicinal usage.73,74 Behera but not necessarily for long-term outcome.88 The
reported perceptible improvement in dyspnea and AHRQ cites two studies comparing yoga versus
lung function in patients of bronchitis after 4 weeks medication which reported a large and significant
of yoga therapy that used a variety of postures and reduction of fasting glucose in individuals with type
breathing techniques.75 Yogic cleaning techniques 2 diabetes in one, and a smaller but still significant
such as dhautikriya (upper gastrointestinal cleaning 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 therapeutic exercises, relaxing yoga, touch and
menopausal symptoms reported small effects manipulation, or no intervention. Yoga was more
on psychological symptoms with no effects on effective for chronic back pain than the control
total menopausal symptoms, somatic symptoms, interventions such as usual care or conventional
vasomotor symptoms, or urogenital symptoms.89 therapeutic exercises though some studies
showed no between group differences.91 Recently
Musculoskeletal Conditions two well designed trials of yoga for back pain
A review by Posadzki et al90 found that 10 of 11 reported clinically meaningful benefits over usual
RCTs reported significantly greater effects in favor medical care but not over an intensive stretching
of Yoga when compared to standard care, self-care, 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 A systematic review and meta-analysis of RCTs

on the physical and psychosocial benefits of yoga in
According to the findings of a comprehensive
cancer patients and survivors by Buffart and colleagues
meta-analysis of role of yoga in cancer, improvements
concluded that yoga may be a feasible intervention as
in psychological health were seen in yoga groups when
beneficial effects on several physical and psychosocial
compared to waitlist or supportive therapy groups.94
symptoms were reported.97 They showed that it
With respect to overall quality of life, there was a
has strong beneficial effects on distress, anxiety and
trend towards improvement. To explain the positive
depression, moderate effects on fatigue, general
outcomes, Smith and Pukall suggested various
HRQoL, emotional function and social function, small
complex pathways which may involve relaxation,
effects on functional well-being, and no significant
coping strategies, acceptance, and self-efficacy.95
effects on physical function and sleep disturbances. It
Kochupillai et al reported increase in natural killer
was suggested that yoga can be an appropriate form
cells in cancer patients who had completed their
of exercise for cancer patients and survivors who are
standard therapy after practicing Sudarshan Kriya
unable or unwilling to participate in other traditional
Yoga and pranayam breathing techniques.96
aerobic or resistance exercise programs.

Pregnancy produced higher levels of maternal comfort during

labour and 2 hour post-labour with a decrease in
Preliminary evidence from various scientific studies
subject evaluated labour pain. They also reported
supports yoga’s potential efficacy, particularly if
shorter duration of the first stage of labour, as well
started early in the pregnancy. Women practicing
as total time of labour in subjects practicing yoga.
yoga in their second trimester reported significant
reductions in physical pain from baseline to post A study by Narendran et al reported a
intervention compared with women in the third lower trend in the occurrence of complications
trimester whose pain increased.98 Women in of pregnancy such as pregnancy-induced
their third trimester showed greater reductions in hypertension, intrauterine growth retardation and
perceived stress and trait anxiety. Another study pre-term delivery in subjects who practiced yoga.102
reported significantly fewer pregnancy discomforts They concluded that an integrated approach to yoga
at 38-40 weeks of gestation.99 Subjects who during pregnancy is safe and that it improved birth
participated in the yoga programme exhibited weight, decreased preterm labour, and reduced
higher outcome and self-efficacy expectancies IUGR either in isolation or associated with PIH,
during active and second stage of labour. Provision with no increased complications.
of booklets and videos on yoga during pregnancy
may contribute to a reduction in pregnancy A review by Field reported that alternative
discomforts and improved childbirth self-efficacy. therapies have been found effective for reducing
pregnancy-related back and leg pain and nausea
Satyapriya et al concluded that yoga reduces and for reducing depression and cortisol levels and
perceived stress and improves adaptive autonomic the associated prematurity rate.103 It also noted
response to stress in healthy pregnant women100 that alternative therapies reduce pain and thereby
while Chuntharapat et al101 concluded that yoga 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 Population are positive, due to methodological limitations,

Clinical applications of Yoga have been studied in evidence provided is still in its infancy.104 Yoga has
paediatric and young adult populations with focus been suggested as an option for children to increase
on physical fitness, cardio-respiratory effects, mental physical activity and fitness and that yoga may be
health, behaviour and development, irritable bowel a gateway for adopting a healthy active lifestyle in
syndrome, eating disorders, and prenatal effects on sedentary children who are intimidated by more
birth outcomes. Though a large majority of studies vigorous forms of exercise. They recommended

that further research is necessary to identify conditions are small

clinical applications of yoga for children and that 2. Poor-quality trials in general with multiple
such research needs to be conducted with rigorous instances for bias
methodology in RCTs with detailed description of 3. Substantial heterogeneity with regards to the
protocols and reporting of results. Methodological • populations studied,
issues specific to mind-body interventions should • yoga interventions,
be addressed including adequate description of the • duration and frequency of yoga practice,
intervention and control group, and single blinding • comparison groups, and
of the outcome assessor. • outcome measures.
4. Compliance was not routinely noted, thus
A review by Galantino et al concluded that “the preventing an understanding of the apt ‘dosage’
evidence shows physiological benefits of yoga for requirements with regard to the mind-body
the paediatric population that may benefit children interventions
through the rehabilitation process, but larger 5. Yoga requires active participation and
clinical trials, including specific measures of QOL motivation that requires active efforts from
are necessary to provide definitive evidence.”105 both the researcher as well as the participants.
They rightly suggested that the type and intensity 6. Changes in attitudes and behavior need to be
of yoga, the specific postures for the intended documented and understood better, especially
outcome, and the measurement of adherence in the lifestyle, stress induced psychosomatic
beyond the clinic have to be determined. Their conditions.
review showed that yoga may benefit children with 7. It is not clear which patients may benefit
mental challenges by improving their mental ability, from the mind-body interventions, and which
along with motor coordination and social skills and aspects of the interventions or which specific
that restoration of some degree of functional ability styles were more effective than others.
is possible in those having physical disabilities.
It was suggested that physical therapists might It has been suggested that yoga may help
apply these findings in the neuromuscular areas improve patient self-efficacy, self-competence,
of learning, motor control, and coordination. physical fitness, and group support, and may well
A notable point mentioned by them was that, be effective as a supportive adjunct to mitigate
“Regardless of the goal, yoga appears to be a medical conditions. Büssing et al concluded that
multitasking modality that simultaneously treats yoga may have potential to be implemented as a
both physical impairments as well as more global safe and beneficial supportive/adjunct treatment
issues such as stress, anxiety, or hyperactivity.” that is relatively cost-effective, may be practiced
at least in part as a self-care behavioral treatment,
In Conclusion provides a life-long behavioral skill, enhances self-
All of the above studies and reviews suggest a efficacy and self-confidence, and is often associated
number of areas where mind-body therapies such with additional positive side effects.106
as yoga may be beneficial, but more research is
required for virtually every one of them to establish It is important to develop objective measures of
their benefits conclusively. This is true in the various mind-body therapies and their techniques
process of introducing any new therapy into the while including them in intervention trials. It has
modern health care system and is not surprising also been suggested that the publication of specific
when we realize that the proper studies on yoga interventions used in future studies in manual
as a therapeutic modality are not older than a few form can allow reliable replication and future
decades. implementation. It is also important to develop tools
to monitor objectively the participants’ self-practice,
Some of the major issues highlighted by these compliance, and adherence to the interventions. Yoga
studies and reviews include: has preventive, promotive as well as curative potential
1. Individual studies on yoga for various and a yogic lifestyle confers many advantages to

the practitioner. Since lifestyle related diseases are of complementary and alternative medicine (CAM) and
frequency of visits to CAM practitioners: United States,
alarmingly on the rise in our modern society, yogic 2007. Natl Health Stat Report 2009; 18:1-14.
lifestyle should be given a special place in preventing 4. Purohit MP, Wells RE, Zafonte RD, Davis RB, Phillips RS.
and managing these diseases. Neuropsychiatric symptoms and the use of complementary
and alternative medicine. PM&R 2013; 5: 24–31.
As suggested by Bussing et al, “Yoga may well 5. Bhavanani AB. Yoga Chikitsa: The application of Yoga as a
be effective as a supportive adjunct to mitigate some therapy. Pondicherry, India: Dhivyananda Creations, 2013
medical conditions, but not yet a proven stand-alone, 6. Taylor MJ. What is Yoga Therapy? An IAYT definition. Yoga
curative treatment. Larger-scale and more rigorous Therapy in Practice 2007; 3: 3.
research with higher methodological quality and 7. Recommended Educational Standards for the Training of
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YOGIC PERSPECTIVES ON MENTAL HEALTH

Dr Ananda Balayogi Bhavanani *
Introduction: He explains the root cause of disease as follows.

“Yoga, a wholistic, unified concept of oneness,
Yoga is first and foremost a moksha shastra meant
is adwaitam or non-dual in nature. It suggests
to facilitate the individual to attain the final
happiness, harmony and ease. Dis-ease is created
freedom, liberation or emancipation. One of the
when duality or dwaitam arises in the human
important by-products of the Yogic way of living is
mind. This false concept of duality has produced all
attainment of health and well being. This is brought
conflicts of human mind and the vast list of human
about by right-use-ness of the body, emotions and
disorders. Duality (dis-ease) is the primary cause
mind with awareness and consciousness. This must
of man’s downfall. Yoga helps return man to his
be understood to be as healthy a dynamic state
pristine, whole nature.
that may be attained in spite of the individual’s
sabija karma that manifests as their genetic All diseases, maladies, tensions, are
predispositions and the environment into which manifestations of divisions of what should be man’s
they are born. Yoga also helps maintain and sustain complete nature, the atman or ‘Self ’. This ‘Self ’ is
this dynamic positive state of health after it has “ease”. A loss of “ease” creates “dis-ease”. Duality is
been attained through disciplined self effort. the first insanity, the first disease, the unreasonable
thought that “I am different from the whole…. I
The central theme of Yoga is the golden
am unique. I am me.” The ego is a manifestation
mean, finding the middle path, a constant search
of disease. Only a distorted ego could feel alone,
for moderation and a harmonious homoeostatic
suffer from “the lonely disease”, in a Universe, a
balance. Yoga is the “unitive impulse” of life, which
Cosmos totally filled with the ‘Self ’.
always seeks to unite diverse streams into a single
powerful force. Proper practice produces an inner Interestingly, he points out that one of the oldest
balance of mind that remains stable and serene words for man is “insan”. Man is “insane”. A return
even in the midst of chaos. This ancient science to sanity, “going sane,” is the subject of real Yoga
shows its adherents a clear path to the “eye of the Sadhana and Yoga Abhyasa. Yoga Chikitsa is one of
storm” and ensures a stability that endures within, the methods to help insane man back onto the path
even as the cyclone rages externally. of sanity. A healthy man or woman may be known by
the term-Yogi”. A very strongly worded yet very true
Causation of Psychosomatic Disorders: statement indeed from the Lion of Pondicherry!
Yogamaharishi Dr Swami Gitananda Giri, founder
of Ananda Ashram at Pondicherry (www.icyer. Yogic Perspective of Depression:
com) has written extensively about the relationship According to the Yoga Darshan codified by Maharishi
between health and disease. He says, “Yoga views Patanjali, depression or rather daurmanasya is
the vast proliferation of psychosomatic diseases as one of the four vikshepa sahabhuvah that are
a natural outcome of stress and strain created by the manifestations that accompany the obstacles
desire fostered by modern propaganda and abuse to yoga sadhana, the nava antaraya. The other
of the body condoned on all sides even by religion, sahabhuvah are duhkha or suffering, angamejayatva
science and philosophy. Add to this the synthetic or tremors and shvasaprasvasa or irregular respiration.
“junk food” diet of modern society and you have (duhkhadaurmanasya angamejayatva shvasaprasvasa
the possibility of endless disorders developing… vikshepasahabhuvah Yoga Darshan -1:31). When we
even the extinction of man by his own ignorance analyze this sutra deeply we find that they are very
and misdeeds”. true reflections of our inner state.
* Dr Ananda Balayogi Bhavanani, Deputy Director, CYTER, Mahatma Gandhi Medical College and Research
Institute, Puducherry 607402, India, Email: yognat@gmail.com

Duhkha or painful suffering at the physical, many aspirants get scared whether they are harming
emotional and mental level can drive us to despair. themselves and stop their Sadhana out of fear.
Suffering is an excellent trick our mind plays as
very few can overcome the ‘moment’ of suffering. Shvasaprasvasa refers to the irregularity in
Very few are capable of realizing what is really breathing patterns. One of the main physical
happening in the process of their evolutionary manifestations of mental and emotional upsets
journey. The moment ‘suffering’ is felt, most people is the haphazardness of respiration. Ancient
give up, and the lower mind survives to fight Yogis contemplated this deeply and found that
another day. mental disturbances cause irregularity and
instability of respiration. Though their jnana
Daurmanasya refers to dejection and despair. drishti (perspective of wisdom) they realised
We must remember that depression is not just in that by stabilizing the breath, we can conversely
the mind but has many physical aspects too. A produce a stability of emotions and mind. This
state of depression is another tool by which the knowledge is used even today in the practice
lower mind tries to halt the spiritual progress of a of pranayama, when it is used as a means of
sadhaka. However we must realise that the greatest altering the higher (mind) through the lower
teachings are often given at moments of great (body). This is one of the best examples of the
despair. The art and science of Yoga understands numerous somato-psychic applications found in
that this may be the best ‘teachable’ moment and the practices of hatha yoga, the physical science
hence we find the highest teachings of the Bhagavad of balancing equal and opposite energies.
Gita and Ramayana coming at this point.
Our Guru Swami Gitananda Giri Guru

Yogic Methods To Attain and Maintain
Maharaj used to say, “A nervous breakdown is
Health:
actually an opportunity for a spiritual breakthrough The science of Yoga has numerous practical
if we can realise the positive implications in our techniques as well as advice for proper life style in
moment of despair and dejection”. The teachings order to attain and maintain health and well being.
of the Yoga Vasishtha and the Bhagavad Gita Bahiranga practices such as yama, niyama, asana
which may be said to be the first and second and pranayama help produce physical health while
recorded ‘psychological counseling’ sessions in antaranga practices of dharana and dhyana work
human history were delivered when both Lord on producing mental health along with pratyahara.
Rama and Arjuna respectively were at the depths Yoga works towards restoration of normalcy in all
of their depression. If we realise that this is indeed systems of the human body with special emphasis
a window of opportunity for growth, success will on the psycho-neuro-immuno-endocrine axis.
come to us the soonest. But if we miss this golden
chance, then even the Divine will struggle to help In addition to its preventive and restorative
us out of our own deep pit of self pity. capabilities, Yoga also aims at promoting positive
health that will help us to tide over health challenges
Angamejayatva are the physical tremors of the that occur during our lifetime. Just as we save
body. The practice of asana helps us to attain to a money in a bank to tide over financial crises, so also
state of physical control over our body. This enables we can build up our positive health balance to help
us to go beyond the dwandwa, the pair of opposites us manage unforeseen health challenges with faster
that are the cause of these tremors. Tremors are an recovery and recuperation. This concept of positive
externalized manifestation of internal imbalances health is one of Yoga’s unique contributions to
of our emotions and mind. Imbalance at the higher modern healthcare as Yoga has both a preventive
level causes the imbalance in the neuro-chemical as well as promotive role in the healthcare of our
transmitters and psycho-physiological pathways of masses. It is also inexpensive and can be used in
the body, resulting in these physical tremors. When tandem with other systems of medicine in an
confronted with such a frightening manifestation, integrated manner to benefit patients.

Becoming One With The Breath: personal. The ego which is fixated only on its own
shallow self will soon run into the blank wall of
In the science of Yoga, body movement and
depression and despair, overwhelmed by its own
breath must be synchronized. The breath pattern
superficiality. That striving spirit which looks
is important. Particularly in the use of kriya or
within at the universal aspect of its own nature and
structured movements like Surya namaskar, the
sees the oneness of the whole of creation will find
body is normally lifted on an incoming breath and
an endless fountain of inspiration and joy. In short
lowered on an outgoing breath. Some of the breath
it may be safely said that the practice of Yoga as
patterns such as the bhastrika strengthen the whole
a unified whole helps the individual shift from an
solar plexus area as well as the diaphragm, building
‘I”-centric approach to a “we”-centric approach.
up stamina while producing internal cleansing
of organs and the blood stream. Kapalbhathi The Srimad Bhagavad Gita says, “yogaha karmasu
is another dynamic technique that enables us koushalam” meaning thereby that Yoga is skill in
to break out of the deep hole of depression by action (BG 2:50). The real Yogi, immensely conscious
creating a sense of activation. Surya nadi and ujjayi and aware at the physical, mental and emotional
pranayama can also help in activating those who levels gains great control through that consciousness
need the activation for healthy well being. The over all aspects of life thus developing a real skill in
bandha trayam as well as the aswini mudra are both living. Part of that skill springs from his cultivated
a God-send for those suffering from depression as detachment, his ability to work for “work’s sake,”
they revitalise the entire psycho-neuro-endocrine and not for the sake of the reward. He realizes that
system. The pranava and bhramari pranayama work his duty is to do his best but that the ultimate result
towards creating an inner harmony that results in is not in his hands. The Yogi performs the needed
the attainment of a state of mental calmness. action not for the sake of the fruits of that action, but
because it is good and necessary to do so.
According to Dr Swami Gitananda Giri, one
of the foremost exponents of Yoga in the 20th Such an attitude of mind produces consummate
century, the inherent message of Pranayama can be skill in whatever action the Yogi undertakes.
summarised as follows: Consummate concentration, consummate controls
are all offshoots of good Yoga Sadhana. This
• Th
ere is an absolute and direct correlation
belies the age-old belief that the competitive
between the way an organism breathes and
spirit produces the highest skill. To this the
its energy level.
Yogic answer is: detachment from the fruits of the
• There is an absolute and direct correlation action produces the greatest efficiency, for one is
between the way a man breathes and the then emotions connected with “goal-oriented”,
length of his life span. competitive thinking. The beauty of Yoga is that
• There is an absolute and direct correlation these abstract principles become concrete in the
between the way a man breathes and the daily practice of the techniques available in the
state of mind and clarity of thought, which Yoga system. Once the “seed of Yoga” finds fertile
he enjoys. soil, these concepts grow naturally, slowly but surely
• There is an absolute correlation between taking root in all aspects of life.
the way a man breathes and the quality of
emotions, which he experiences. Wholistic Approach of Yoga:
• There is an absolute and direct correlation The Yogic wholistic approach to life that ‘everything
between the way a man breathes and is important and everything has its effect’ could do
the subtlety of the thoughts, which pass much to improve the mind, body and emotional
through his mind. states of well being. These practical approaches to
health include:
Shifting From Individuality To Universality:
• Th
e use of early morning sunlight for
Yoga, which emphasizes the universal, is a perfect healing and rejuvenative activities
foil to those human activities, which glorify the

• Th
e use of water for internal and external mind-emotions-spirit continuum is intensified and
cleansing controlled through pranayama using breath control
• Careful attention to diet of a sattvic nature as a method to attain controlled expansion of the
• Realising the necessity for balance between vital cosmic energy. The externally oriented senses
exertion and relaxation as all tension must be are explored, refined, sharpened and made acute,
balanced using concept of spanda nishpanda until finally the individual can detach themselves
or “exertion-relaxation-exertion-relaxation” from sensory impressions at will through
in an alternating rhythm of activity, pratyahara.
• Learning how to “unwind” through the The restless mind is then purified, cleansed,
many relaxation techniques available in focused and strengthened through concentration
the Yoga science which can balance the (dharana). If these six steps are thoroughly
immense amount of stress and strain that understood and practiced then the seventh, dhyana
are part and parcel of day to day life or meditation (a state of union of the mind with
• Realising the need for clean air, water and the object of contemplation) is possible. Intense
food meditation produces samadhi, or the enstatic
• Becoming aware of the effect of modern feeling of Union, Oneness with the Universe. This
modes of entertainment and addictive is the perfect state of integration or harmonious
habits in general debilitation of the physical, health.
emotional and mental nature
Yogic Tools For Positive Mental Health:
• Providing a “working philosophy” which
will sustain one in triumph and defeat In order to create an environment conducive to the
• Learning to be sensitive to one’s own bio- development of positive mental health as also to
rhythms, one’s own physical, mental and prevent and manage the psychosomatic lifestyle
emotional cycles disorders that are threatening humankind, Yoga
offers us many practical ‘day-to-day’ methods of
• Being aware of the effects of the seasons action. Some of these tools for positive health are
and the various unnatural life styles to as follows.
which the modern man is exposed
1. Become aware of your body, emotions and
In short, all of these aspects of Yoga as a way mind: Without awareness there cannot be health or
of natural living can provide relief for many of healing. Awareness of body implies conscious body
the psychosomatic ailments affecting humankind work that needs to be synchronized with breath to
today. qualify as a psychosomatic technique of health and
Cultivation of Positive Health: healing. Psychosomatic disorders cannot be tackled
without awareness.
According to Yogacharini Meenakshi Devi
Bhavanani, Director ICYER at Ananda Ashram 2. Improve your dietary habits: Most disorders
in Pondicherry, Yoga has a step-by-step method are directly or indirectly linked to improper dietary
for producing and maintaining perfect health at all patterns that need to be addressed in order to find
levels of existence. She explains that social behaviour a permanent solution to health challenges. One of
is first optimized through an understanding and the most important lifestyle changes that needs
control of the lower animal nature (pancha yama) be implemented in management of any lifestyle
and development and enhancement of the higher disorder is diet.
humane nature (pancha niyama).
3. Relax your whole body: Relaxation is
The body is then strengthened, disciplined, most often all that most patients need in order
purified, sensitized, lightened, energized and to improve their physical condition. Stress is the
made obedient to the higher will through asana. major culprit and may be the causative, aggravating,
Universal pranic energy that flows through body- or precipitating factor in so many psychosomatic

disorders. Doctors are often found telling their other thorns continue falling or choose to wear
patients to relax, but never tell them how to do it! a pair of shoes and walk through the forest. The
The relaxation part of every Yoga session is most difference is in attitude. Choosing the right attitude
important for it is during it that benefit of practices can change everything and bring about a resolution
done in the session seep into each and every cell of the problem by healing the core. Stress is more
producing rest, rejuvenation, reinvigoration and about how you react to the stressor than about the
reintegration. nature of the stressor itself !
4. Slow down your breath making it quiet and 8. Increase your self reliance and self
deep: Rapid, uncontrolled, irregular breathing is confidence: Life is full of challenges that are there
a sign of ill health whereas slow, deep and regular only to make us stronger and better. The challenges
controlled breathing is a sign of health. Breath is should be understood as opportunities for change
the link between body and mind and is the agent and faced with confidence. We must understand we
of physical, physiological and mental unification. have the inner power to overcome each and every
When breath is slowed down, metabolic processes challenge that is thrown at us by life. The Divine is
are also slowed and anabolic activities begin the not a sadist to give us challenges that are beyond
process of healing and rebuilding. If breath is calm, our capacity!
mind is calm and life is long!
9. Facilitate natural emanation of wastes:
5. Calm down your mind and focus it Facilitate natural emanation of waste from the body
inwardly: The mind is as disturbed as a drunken by practicing shuddi kriyas like dhauti, basti and neti.
monkey bitten by a scorpion say our scriptures. To Accumulation and stagnation of waste materials
bring that wayward agitated mind under control, either in inner or outer environment always causes
and take it on a journey into our inner being is problems. Yogic cleaning practices help wash out
fundamental in finding a way out of the ‘disease impurities (mala shodhana) thus helping the process
maze’ in which we are entangled like a fly in the of regeneration and facilitating healing.
spider’s web. Breath work and sensory control
are the base on which mind training can occur; 10. Take responsibility for your own health:
hence much importance is given to pranayama and Remember that ultimately it is “YOU” who are
pratyahara. It is only after this that concentration responsible for your own health and well being and
practices leading to meditation can have any use. must take the initiative to develop positive health
Just sitting and thinking about something is not to tide you over challenging times of ill health.
meditation! Yoga fixes responsibility for our health squarely
upon our own shoulders. If we do healthy things
6. Improve the flow of healing ‘Pranic Life we are healthy and if we do unhealthy things we
Energy’: Improve the flow of healing ‘Pranic Life become sick. No use complaining that we are not
Energy’ to all parts of the body, especially to those well when we have been the cause of our problem.
diseased parts, thus relaxing, regenerating and As Swamiji Gitananda Giri would say, “You don’t
reinvigorating ourselves. Prana is life and without have problems-you are the problem!”
it there cannot be healing. The different prana and
upa prana vayu that are energies driving different 11. Health and happiness are your birthright:
physiological functions of the body need to be Health and happiness are your birthright, claim
understood and applied as per needs of the patient. them and develop them to your maximum potential.
This message of Swamiji is a firm reminder that the
7. Fortify yourself against omnipresent goal of human existence is not health and happiness
stressors: Decrease your stress level by fortifying but is moksha (liberation). Most people today are
yourself against the various omnipresent stressors so busy trying to find health and happiness that
in your life. When face to face with the innumerable they forget why they are here in the first place.
thorns in a forest, one may either choose to spend Yoga helps us regain our birthright and attain the
all their time picking them up one by one while goal of human life.

Conclusion: 2. Ancient Yoga and Modern Science. TR

Anantharaman. Mushiram Manoharlal Publishers Pvt Ltd,
The dedicated practice of Yoga as a way of life New Delhi. 1996
is no doubt a panacea for problems related to 3. Back issues of International Journal of Yoga Therapy.
psychosomatic, stress related physical, emotional Journal of the International Association of Yoga Therapists,
USA. www.iayt.org
and mental disorders and helps us regain our
4. Back issues of Yoga Life, Monthly Journal of
birthright of health and happiness. It is only when ICYER at Ananda Ashram, Pondicherry. www.icyer.com
we are healthy and happy that we can fulfil our 5. Four Chapters on Freedom. Commentary on Yoga
destiny. Sutras of Patanjali by Swami Satyananda Saraswathi, Bihar
School of Yoga, Munger, India. 1999
Recommended Reading: 6. Srimad Bhagavad Gita by Swami Swarupananda.
Advaita Ashrama, Kolkata. 2007
1. Yoga Chikitsa: The application of Yoga as a Therapy. 7. Yoga and Sport. Dr Swami Gitananda Giri and
Dr. Ananda Balayogi Bhavanani. Dhivyananda Creations, Meenakshi Devi Bhavanani. Satya Press. Pondicherry. 1991.
Iyyanar Nagar, Pondicherry. 2013. www.icyer.com

THE YOGA OF INTERPERSONAL RELATIONSHIPS

Dr Ananda Balayogi Bhavanani *
Introduction: gentleness (Maardavam), modesty (Hrir

Acaapalam), vigor (Tejah), forgiveness (Kshama),
All aspects of our human personality are cultured
fortitude (Dhritih), cleanliness of body and mind
through the process of Yoga helping us evolve
(Saucam), freedom from malice (Adroho), and
towards perfection until we are “One” with the
absence of pride (Naa Timaanita). One who is
Divine Self. Yoga helps destroy the Kleshas, the
blessed with these qualities is indeed a divine
psychological afflictions that warp our vision, as well
blessing to the social life of their immediate family,
as eradicates Karma Bandha that prevents us from
friends, relatives and their society itself.
realizing our potential Divinity. Our great Rishis
like Veda Vyasa and Maharishi Patanjali have given The Four Pronged Approach:
us a clear road map for this evolutionary journey
with vital clues towards understanding both the Our ancient Indian culture, a vibrant living culture
internal and external culturing processes of Yoga. till even today, has a lot to offer in every sphere
The cultural teachings of Yoga help us become “All of life. The elevated spiritual, psychological and
One” by losing our sense of individuality to gain an metaphysical concepts of our great Maharishis
unparalleled sense of universality. hold true even today and it is up to us to delve into
them and reap benefits of psycho-physiological
In our day-to-day personal and inter-personal health, happiness as well as intra-personal and
social life, Yoga has given us multitudes of tools, inter-personal social harmony. Our Rishis were
concepts,attitudes and techniques through which we visionary seers who codified innumerable concepts
can attain inner contentment leading to happiness that produce physically, emotionally and mentally
and spiritual realization while simultaneously healthy individuals who are valuable for betterment
creating harmony in all relationships. All psycho- of society.
social qualities essential for healthy inter-personal
relationships are cultivated when we live a life of Our ancients in their infinite wisdom realised
Yoga that is in tune with the eternal Dharma. These that we need to deal with different people differently.
humane qualities include loving understanding, Some people can be held close whereas with others
innate sensibility that sees other’s perspectives, an arm’s length or often a six feet pole’s length is
compassion, empathy, respect, gratitude, fidelity required. Sensitive, sensible people may respond
and responsibility. In fact the Srimad Bhagavad to a soft carrot approach while the arrogant who
Gita delineates very similar qualities of a spiritually are usually dull and inert may only respond to a
healthy person in Chapter XVI. These include: heavy and strong stick. The Rishis have codified a
fearlessness (Abhayam), purity of inner being four pronged approach to deal with different types
(Sattva Samshuddhih), steadfastness in the path of human personalities at different times and in
of knowledge ( Jnanayoga Vyavasthitih), charity different ways. Saint Thiyagaraja in his composition
(Danam), self control (Dama), spirit of sacrifice “sarasa sama dana bheda danda chatura” describes
(Yajna), self analysis (Svadhyaya), disciplined Lord Rama as the perfect example of a human
life (Tapa), uprightness (Arjavam), non violence possessing these qualities of Kingship and kinship.
(Ahimsa), truthfulness (Satyam), freedom from
anger (Akrodhah), spirit of renunciation (Tyagah), The first of these four methods is known as
tranquility (Shanti), aversion to defamation Sama and is the dealing with people using a sense
(Apaishunam), compassion to all living creatures of equanimity and treating them as equals in the
(Daya Bhutesv), non covetedness (Aloluptvam), search for truth. This can only be applied with the
noble ones and will be misused by others as seen in
* 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 between the “old” (reptilian - mammalian) and the
Dana, which implies the affording of concessions “new” (conscious, neo-cortex) parts of the human
towards those who are truly needy. This may be in brain. As the “old brain” developed over 60 to 375
the material, physical, mental or emotional form million years it is powerful and well-set in its ways.
and is the giving of a bit of leeway that can help Its habitual responses to environmental survival
those who are in trouble to come up to par with challenges are strong and automatic – “kill or be
others and then slowly develop into one who can killed”. On the other hand, the “New Brain” of
be treated at the Sama level. Bheda is the third human consciousness is only 40 to 100 thousand
method and is a separation from troublesome years old and hence the new boy on the block.
elements in order to reduce the extent of the The lack of communication between the old and
problem. When used in a proper and judicious new brains produces the “Five Quirks” that are the
manner this can help many situations to normalize major causes behind innumerable problems we face
and prevent them from going from “bad to worse”. in all interpersonal relationships. These quirks are:
When things get really bad or worse, then Danda
or minimal deterrent action through judicious 1. The Object Quirk – the animal brain sees
punishment can be of use when we considering the objects only in a very vague, hazy, general sense and
holistic picture. not in a specific sense. It views objects and classifies
them as to how they may fulfill its needs or in what
In modern times the “spare the rod” mentality way they may threaten its safety. Thus, it confuses
is prevalent and we do seem to end up spoiling different people and things. It sees everything
our children and youth by making them weaker generally as friend or foe, provider of food or as a
in all aspects. We take away their ability to be sexual possibility. It does not need to see any object
responsible citizens by teaching then indirectly with specific characteristics. For example, it does
that “anything that happens is not your fault- you not choose a mate on personal charm or elevated
are the victim”. I reiterate clearly that I am not a character but simply as a means to gratify sex drive.
supporter of any form of corporal punishment, but Other objects and other creatures are important
I do realize the need for a determent in order for only as means to satisfy basic needs.
the betterment of the whole. One rotten apple is all
that we need to spoil a barrel and the same can be 2. The Time Quirk – Keyes says the “Old
said of the repeated offenders. Such situations need Brain” has no time sense. It does not perceive past
to be nipped in the bud and the Danda method or future. It lives only in the present moment. It
has its uses too in such situations. Of course this “eats or is eaten.” There is no sense of tomorrow
requires a lot of Viveka on the part of the parent, or yesterday. Everything is immediate, now, urgent.
teacher or person in authority and also needs safety At that lower level of life, every experience is in the
precautions so that it is not misused by ignorant “Now” of survival.
egotistical persons who want to be the “star of the
show” at the cost of the others. The most basic 3. The Unsafe Stranger Quirk – The “Old
qualities required for a good parent, teacher and Brain” views all strangers with suspicion. The
leader in any field of endeavor are intelligence and “unknown stranger” is a possible threat to survival or
empathy. Yet how many of our people have these a competitor for resources. Any creature “different”
qualities today? from oneself and one’s species is a potential threat.
Evolutionary Quirks of the Human Brain: 4. The Unchanging Entity Quirk – To the
“Old Brain” incapable of perceiving subtleties,
Ammaji, Kalaimamani Meenakshi Devi Bhavanani everything remains the same – a tree is always a
often talks about the five quirks of the human tree. It does not perceive the various changes,
brain and quotes the Ken Keyes Jr who in his book which all things pass through. It sees all things
“Your Road Map to Lifelong Happiness” argues as “unchanging” as the perception of intricate
that there is an essential “lack of communication” subtleties of change is not necessary for survival.

5. Adaptable Memory Quirk – The animal The “Unchanging Entity Quirk” manifests
does not need memory. The only memory when people cannot see that those around them are
necessary is what enables it to survive. Hence, what constantly changing, that they are not what they
it remembers can be “adjusted” to whatever best were yesterday. A thief may have reformed himself,
helps it to survive. There is no objective truth. The but others may always perceive him as “a thief.” The
only “Truth” to the animal brain is “survival of the husband may have overcome his bad habit, but the
fittest.” wife cannot see him anew. This is carried further by
the “Adjustable Memory Quirk” that occurs when
The manner in which animals and reptiles people deliberately or unconsciously “re-arrange”
perceive the world is a much dimmer, less precise, their memories to support or justify their emotions
less clear, survival-oriented perception totally geared or desires. For example, a couple who wish to
to survival. This is much less than that available divorce may “adjust their memories’ to “remember”
to the conscious mind. The “Old Brain” is fuelled only the “bad times” or the “bad characteristics”
by emotional responses. The basic motivating of their partners. This is very common in most
emotion is fear. The other important drives-sex, relationships and cannot be overcome without
survival instinct, herd mentality, dominance, power awareness and consciousness that springs from
struggles, nurturing and being nurtured-are all tied introspectional self analysis of Swadyaya.
to the organism’s basic need to survive at all costs
and fear of death or extinction. Animals are prisoners of their genes. They are
incarnated into a conditioned, stimulus-response
For example, the “Object Quirk” manifests programming and they have no choice, but to
in human experience when a person in the past follow their instincts. Man, the new being, the first
was abused by a red-haired woman and hence, in “Conscious Organism” has the power of choice.
future, always has a dislike for red-haired women. He / she may now act, and choose to respond in
The “Old Brain” cannot see the possibility that all a dignified and adequate manner, rather than re-
red-haired women will not abuse it. Similarly the act in an uncontrolled and totally inappropriate
Time Quirk manifests itself in human behavior in manner. The human being has the power to think,
this manner: when one experiences unhappiness, to recall past situations and compare them to
one feels one is “always unhappy.” This may cause the present reality. Man has the power of reason
one to perceive another person as “always angry”, which frees him from the instinctive responses to
even though the person may only be angry at that challenge which is the mode of behavior of the
moment. Witness how many husband-wife or reptilian and mammalian kingdom. But the power
parent-child quarrels begin with the words… ‘You of the unconscious emotions and instincts rising
always do this…” from the “Old Brain” in a kind of “evolutionary lag”
sometimes overpowers the “Rational Brain” and
The “Unsafe Stranger Quirk” is evidenced in causes “The New Being” to react in an irrational
the suspicion that people feel when a foreigner manner. Man as a social, conscious being has lifted
enters their circle, or someone of a different religion himself from the jungle environment with its
a different race, a different culture etc comes into moment to moment dangers and constant life and
their social circle. There is an instinctual fear, even death challenges. He no longer faces challenges
though that person may be perfectly harmless. This to his very survival on a constant basis. His life
is highly visible in today’s society where everyone is relatively secure on the physical level (barring
wants “their” country, state, language, religion wars and other unusual circumstance). Yet, his
etc to be the “best”. Linguistic, religious and “Old Brain” is hard wired to react as though every
regional fanaticism springs forth from such “old” threat (physical or psychological) is a life and death
conditioned responses that are so deeply ingrained matter. Hence, even psychological challenges, or
in the animal brain that people lose all ‘sense’ and innocuous frictions trigger off “Old Brain” extreme
do things that they would never do in even their responses, especially on the emotional level.
wildest dreams.

We can witness in so many human relationships for they are the “sarvabhauma mahavratam” of
that the old, animal and reptilian autonomic Maharishi Patanjali. If we want to grow, to evolve
responses and reactions cloud the “human” or out of our reptilian – mammalian past into the
conscious perception. The “Old Brain” reacts out truly human, humane and divine nature, we must
of past conditioning. It is heavily “loaded” with restrain the primordial instincts through Yama and
emotions which are part of the mammalian complex, consciously reinforce our Divine nature through
and hence, “unconscious.” The animal-reptile the observances and practice of Niyama.
(Pashu) is not “free” to choose as it is bound by the
tight noose (Pasha) of its conditioned stimulus- The Pancha Yamas are Ahimsa (Non – violence),
response mechanism. If it is threatened, it will flee Satya (truthfulness), Asteya (non-stealing),
or fight. These are the only options open to it. We Brahmacharya (control of the creative impulse)
must remember that on the other hand, the “New and Aparigraha (non – covetedness). These are the
Brain” has the power to act after considering the “DO NOT’S” in a Yoga Sadhaka’s life. Do not kill,
reality of the present situation. We have the choice do not be untruthful, do not steal, do not waste
of using discernment, rationality and deliberation your god given creativity and do not covet that
to choose consciously our actions and responses which does not belong to you. These guide us to say
in any given circumstance. This power of choice a big “NO” to our lower self and the lower impulses
is concomitant to the event of consciousness. The of violence etc. When we apply these to our life
multiple million dolor question is however, “Are we we can definitely have better personal and social
ready and willing to be real human beings?” relationships as social beings.
Importance of Adhikara Yoga: The Pancha Niyamas are Soucha (cleanliness),

Santhosha (contentment), Tapa (discipline),
The Pancha Yama and Pancha Niyama are considered
Swadyaya (study of one’s-self ) and Ishwar
as Adhikara Yoga by Dr TR Anantharaman as they
Pranidhana (gratitude to the Divine). The Pancha
give us the self resplendent authority and inner
Niyamas guide us with “DO’S” - do be clean, do
resolve for spiritual realizations. They provide
be contented, do be disciplined, do self - study
a strong moral and ethical foundation for our
(introspection) and do be thankful to the divine
personal and social life. They guide our attitudes
for all of his blessings. They help us to say a big
with regard to the right and wrong in our life and
“YES” to our higher self and the higher impulses.
in relation to our self, our family unit and the entire
Definitely a person with such qualities is a God-
social system.
send to humanity.
The higher,conscious power to reflect,to perceive
We must remember that even if we are
the current situation freed of all past conditioning,
unable to live the Yama-Niyama completely, the
and then to consciously choose an appropriate
attempt by us to do so will bear fruit and make us
response is the essence of Yama-Niyama, the
a better person, of value to those around us and
moral and ethical system of Rishiculture Ashtanga
a valuable person within our family and society.
Yoga. Yama may be understood to be a conscious
These are values which need to be introduced to
restraint of primitive instincts and impulses rising
our children and youth, making them aware and
from the “Old Brain.” Yama is thus the control
conscious of these wonderful concepts of daily
of our unconsciousness tendencies, our Vasanas
living. These are indeed qualities that are to be
and the deeply ingrained habitual patterns of our
imbibed in a natural and Sahaja manner and not
Samskaras. Niyama may be on the other hand said
learnt under the threat of fear or compulsion.
to be a positive and conscious reinforcement of the
The parents and teachers can by example show
higher consciousness, those Divine characteristics
their children the importance of these qualities
that propel one’s evolution into more advanced
and when the children see the good examples of
states of being. Niyama is the cultivation of
their parents and teachers living there principles
consciousness. Pujya Swamiji, Gitananda Giri
they will surely follow suit sooner than later.
called the Yama and Niyama as “No-Option Yoga”

Other Important Yogic Concepts: Ramalinga Adigalar. Tirumoolar says that the most
important aspects of right living are the devoted
There are many important Yogic concepts that
loving offering to the Divine while in daily life
help guide us in shaping our personal lives as well
the feedings of other human beings and animals
as helping us to create harmonious interpersonal
with loving compassion. He also stresses the need
relationships that make up our daily social life.
of speaking good and kind words to others as the
Some examples of these spiritually uplifting
means to spiritual upliftment. Tiruvalluvar asks us
concepts that transform all aspects of our social life
the poignant question, “Of what use is intelligence
include:
if one cannot empathize with the pain of others
• Vasudeiva Kudumbakam: The whole and help them”
world is one family. This is an excellent concept
• Chatur Bhavana: The four attitudes that
which helps one to understand that division on
Patanjali advises us to cultivate are given in the
the basis of class, creed, religion and geographical
33rd Sutra of the Samadhi Pada. These attitudes
distribution are all ‘man made’ obstructions
that help us to control our mental processes are:
towards oneness. One can then look upon all as
friendliness towards those who are happy (Maitri
his own and can bond with everyone irrespective
– Sukha); compassion towards those who are
of any barrier. All the great Yogic saints such as
miserable (Karuna – Dukha); cheerfulness towards
Tirumoolar, Tiruvalluvar, Basava, Periyalvar and
the virtuous (Mudhita – Punya); and indifference
Tirunavukkarasar have reminded us again and
towards the wicked (Upekshanam – Apunya).
again in so many lovely verses of the singular
These help us create a Yogic attitude of Sama
teachings that there is only “One Humanity and
Bhava or equal mindedness in all situations. They
One God”.
also help us to overcome the Kleshas, and provide
• Chaturvidha Purusharthas: The four us with answers on how to live a Yogic life. They
legitimate goals of life tell us how we can set make us humane and help us to live within the
legitimate goals in this life and work towards social structure in a healthy and happy manner.
attaining them in the right way, following our
• Pratipaksha Bhavanam: The concept of
dharma to attain Artha (material prosperity), Kama
Pratipaksha Bhavanam is an amazing teaching
(emotional prosperity) and finally the attainment
and must be inculcated in our Sadhana of day-
to the real goal of our life, Moksha (spiritual
to-day living as we face it so many times each
prosperity). These four are termed as Aram, Porul,
day. Even if we cannot replace negative thoughts
Inbam and Veedu respectively in Nannool, an
with emotion-laden positive reinforcements, we
ancient Dravidian text and the great life enhancing
must at least make an attempt to stop them in
teachings in the Tirukkural of Tiruvalluvar deal
their troublesome track! I have personally found
directly with the first three and hints at the fourth.
that a strong ”STOP” statement works wonders
• Pancha Klesha: Avidya (ignorance), Asmita in helping block out the negative thoughts that
(ego), Raaga (attraction), Dwesha (repulsion) and otherwise lead us into the quicksand-like cesspool
Abinivesha (urge to live at any cost) are the five of deeper and greater trouble. Tiruvalluvar advises
Kleshas or mental afflictions with which we are us to repay negative actions done to us by others
born into this human life. Through Yoga we can with positive selfless actions towards them.
understand how these control our life and see their
• Karma Yoga: Selfless action and the
effects on our behavior. These ‘Kleshas’ hinder
performance of our duty without any motive are
our personal and social life and must be destroyed
qualities extolled by the Bhagavad Gita which
through the practice of Patanjali’s Kriya Yoga
is one of the main Yogic texts. Performing one’s
which is Tapa, Swadyaya and Ishwar Pranidhana.
duty for the sake of the duty itself and not with
• Jiva Karunya: Empathic compassion any other motive helps us to develop detachment
towards all living beings is extolled in the (Vairagya) which is a quality vital for a good
teachings of Tirumoolar, Tiruvalluvar and Vallalar life. Karma Yoga includes important concepts of

action-reaction and teaches us the importance of personal. The ego which is fixated only on its own
right action. This includes the concepts of selfless shallow self will soon run into the blank wall of
action (Nishkama Karma) as well as skill in action depression and despair, overwhelmed by its own
(Karmasu Koushalam). Selfless action and the superficiality. That striving spirit which looks
performance of our duty without any motive are within at the universal aspect of its own nature and
qualities extolled by the Bhagavad Gita which is sees the oneness of the whole of creation will find
one of the main yogic texts. Performing one’s duty an endless fountain of inspiration and joy. In short
for the sake of the duty itself and not with any other it may be safely said that the practice of Yoga as
motive helps us to develop detachment (Vairagya) a unified whole helps the individual shift from an
which is a quality vital for a good life. Yoga is skill ‘I”-centric approach to a “we”-centric approach.
in action according to Yogeshwar Krishna in the Tirumoolar stresses the importance of cutting the
Bhagavad Gita. ‘To do our best and leave the rest’ is ego sense (Anava Mala) in countless verses of the
how Pujya Swamiji Gitananda Giri Guru Maharaj 3000 versed classic Tirumandiram.
used to describe the best way of life. Even if we
don’t practice the other aspects of Yoga, we can be Yoga not only considers the importance of
‘living’ Yoga, by performing all our duties skill fully attaining a dynamic state physical health but
and to the best of our ability. A great teacher can also more importantly mental health. Qualities
be a true Yogi by performing doing their duty to of a mentally healthy person (Stitha Prajna) are
perfection and without care for the rewards of the enumerated in the Bhagavad Gita as follows:
action, even if they do not practice any Asanas or
Pranayama. • B
eyond passion, fear and anger (veeta raga
bhaya krodhah- II.56)
• Samatvam: ‘Yoga is equanimity’ says • Devoid of possessiveness and egoism
the Bhagavad Gita. Development of a complete (nirmamo nirahamkarah- II.7)
personality who is neither affected by praise • Firm in understanding and un bewildered
nor blame through development of Vairagya (sthira buddhir asammudhah- V.20)
(detachment) leads to the state of “Stitha Prajna”
• Engaged in doing good to all creatures
or “Sama Bhava”. This is a state of mind which is
(sarva bhutahiteratah- V.25)
equally predisposed to all that happens, be it good
or bad. Such a human is a boon to society and a • Friendly and compassionate to all ( maitrah
pleasure to live and work with. karuna eva ca- XII.13)
• Pure hearted and skilful without expectation
• Bhakti Yoga: The self effacing, loving path (anapekshah sucir daksah- XII.16)
of Bhakti enables us to realize the greatness of the
Divine and understand our puniness as compared Maharishi Patanjali tells us that we can gain
to the power of the Divine or nature. We realize unexcelled happiness, mental comfort, joy and
that we are but ‘puppets on a string’ following his satisfaction by practicing and attaining a state of
commands on the stage of the world and then inner contentment (santoshat anuttamah sukha
perform our activities with the intention of them labhah- PYS II: 42). This link is quite apparent once
being an offering to the Divine and gratefully we think about it, but not too many associate the
receive HIS blessings. “It is only with the blessings need for contentment in their greed for anything
of the Divine, that we can even worship his holy and everything in this material world. The Srimad
feet (avanarulal avan thal vanangi)” says the Shiva Bhagavad Gita says, “yogaha karmasu koushalam”
Puranam, a Shaivite Dravidian classic. meaning thereby that Yoga is skill in action (II.50).
The real Yogi, immensely conscious and aware at
Shifting From Individuality To the physical, mental and emotional levels gains
Universality: great control through that consciousness over
Yoga, which emphasizes the universal, is a perfect all aspects of life thus developing a real skill in
foil to those human activities, which glorify the 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 one’s inner environment in order to focus inward.
his duty is to do his best but that the ultimate result Yoga is isometric, pitting one part of the body
is not in his hands. The Yogi performs the needed against the other and the Yogi strives to be “more
action not for the sake of the fruits of that action, perfect today, than he/she was yesterday”. It is
but because it is good and necessary to do so. Such practically impossible for classical Yoga Sports,
an attitude of mind produces consummate skill in Pranayamas and other Yoga practices to harm the
whatever action the Yogi undertakes. Consummate practitioner when they are performed in the proper
concentration, consummate controls are all manner.
offshoots of good Yoga Sadhana. This belies the
age-old belief that the competitive spirit produces Yoga is not just performing some contortionist
the highest skill. To this the Yogic answer is: poses or huffing and puffing some Pranayama or
detachment from the fruits of the action produces sleeping our way through any so-called meditation.
the greatest efficiency, for one is then emotions It is an integrated way of life in which awareness
connected with “goal-oriented”, competitive and consciousness play a great part in guiding
thinking. The beauty of Yoga is that these abstract our spiritual evolution through life in the social
principles become concrete in the daily practice of system itself and not in some remote cave in the
the techniques available in the Yoga system. Once mountains or hut in the forest. Yoga can be rightly
the “Seed of Yoga” finds fertile soil, these concepts said to be the science and art of right-useness of
grow naturally, slowly but surely taking root in all body, emotions and mind.
aspects of life.
Tiruvalluvar says, “The loving ones live for
Regaining Our Health And Happiness the sake of others while the unloving live only
Through Yoga: for themselves”. Yogis have immense love and
compassion for all beings and wish peace and
“Health and happiness are your birthrights,
happiness not only for themselves, but for all
Moksha is your goal. Reclaim your birthrights
living beings. They are not “individualists” seeking
and attain your goal though Yoga” roared the
salvation for themselves but on the contrary are
Lion of Modern Yoga, Yogamaharishi Dr Swami
“universalists” seeking to live life in the proper
Gitananda Giri. Living a happy and healthy
evolutionary manner to the best of their ability
life on all planes is possible through the unified
and with care and concern for their fellow human
practice of Hatha Yoga Asanas and Pranayamas,
brethren and those beings living at all planes of
Dharana, Dhyana and Bhakti Yoga especially
existence. This is well exemplified by Yogic prayers
when performed consciously and with awareness.
such as, “Om, loka samasta sukhino bhavanthu
Asanas help to develop strength, flexibility, will
sarve janaha sukhino bhavanthu Om shanti, shanti,
power, good health, and stability and thus when
shanti Om”.
practiced as a whole give a person a “stable and
unified strong personality”. Pranayama helps us to May we all become true Yogis as extolled by
control our emotions which are linked to breathing Yogeshwar Sri Krishna when he says, “tasmad yogi
and the Pranamaya Kosha (the vital energy sheath bhavarjuna –become thou a Yogi, Oh Arjuna”. Hari
or body). Slow, deep and rhythmic breathing helps Om Tat Sat- May that be the reality!
to control stress and overcome emotional hang-
ups. Dharana and Dhyana help us to focus our Suggested Reading:
mid and dwell in it and thus help us to channel
our creative energy in a wholistic manner towards 1. A Primer of Yoga Theory. Dr. Ananda Balayogi
Bhavanani. Dhivyananda Creations, Iyyanar Nagar,
the right type of evolutionary activities. They help Pondicherry. 2008.
us to understand our self better and in the process
become better humans in this social world. 2. A Yogic Approach to Stress. Dr Ananda Balayogi
Bhavanani.. Dhivyananda Creations, Iyyanar Nagar,
The true Yogic life involves a sustained struggle Pondicherry. (2nd edition) 2008.
against past conditioning, an attempt to control 3. Ancient Yoga and Modern Science. Dr. TR

Anantharaman. Mushiram Manoharlal Publishers Pvt Ltd, Ramanathan, Aarogya Yogalayam, Venkateswara Nagar,
New Delhi. 1996 Saram, Pondicherry-13.2007
4. Ashtanga Yoga of Patanjali. Dr Swami Gitananda 10. Tirumandiram: A Tamil Scriptural Classic.
Giri. Edited by Meenakshi Devi Bhavanani. Satya Press, Translated by Dr. B. Natarajan, Sri Ramakrishna Math,
Pondicherry.1995 Chennai. 2006
5. Culturing one’s self though Yoga. Ananda Balayogi 11. Understanding the Yoga Darshan. An Exploration
Bhavanani. Yoga Mimamsa 2011; 43 (1): 84-94. of the Yoga Sutras of Maharishi Patanjali by Ananda Balayogi
Bhavanani. Dhivyananda Creations, Pondicherry. 2011
6. Evolutionary quirks, yama – niyama & the human
brain. Meenakshi Devi Bhavanani. Yoga Vijnana 2009; 2 (3 12. Yoga for Health and Healing. Dr Ananda Balayogi
&4): 1-8. Bhavanani. Dhivyananda Creations, Iyyanar Nagar,
Pondicherry. 2007
7. Frankly speaking. Dr Swami Gitananda Giri. Edited
by Meenakshi Devi Bhavanani. Satya Press, Pondicherry.1995 13. Yoga Therapy Notes. Dr Ananda Balayogi Bhavanani.
Dhivyananda Creations, Iyyanar Nagar, Pondicherry. 2007
8. Srimad Bhagavad Gita. Swami Swarupananda.
Advaita Ashrama, Kolkata. 2007 14. Yoga: Step by Step. Dr Swami Gitananda Giri.
Satya Press, Pondicherry. 1975
9. Thiruvalluvar on Yogic Concepts. Meena

Review Article
Diverse dimensions of Yoga

Centre for Yoga Therapy, Education and Research (CYTER), Mahatma Gandhi Medical College and Research Institute (MGMCRI),
Pillayarkuppam, Pondicherry, India
Abstract Yoga is a word very commonly used in the world today and carries various connotations depending on its usage.
It has been defined in various manners as an art and science, as well as the process of conscious evolution. All human
beings can gain a lot from the bountiful dimensions of Yoga, which enables them to manifest their inherent divinity, the
universal potentiality that lies dormant unless channelized. “All souls are potentially divine,” said Swami Vivekananda
and, indeed, they are. This article aims to elucidate the diverse dimensions of Yoga that include the dimensions
related to Indian culture as well as those associated with health, therapy, society, education, and research. Various
physical, mental, emotional, and spiritual benefits attainable through Yoga are explained in detail, highlighting the
multiple sub‑dimensions of these major fields. Yoga, which emphasizes the universal, is a perfect foil to those human
activities which glorify the personal. 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 beauty of Yoga is that these abstract
principles become concrete by the daily practice of the techniques available in the integrated system. Once the “seed
of Yoga” finds fertile soil, these concepts grow naturally, slowly but surely taking root in all aspects of life.
Key Words: Dimensions, health, Yoga, youth
WHAT IS YOGA? DIMENSIONS OF YOGA
Yoga is a word very commonly used in the world today and The multi-pronged approach of Yoga has a lot to offer
carries various connotations depending on its usage. It has humanity as we all can gain a lot from the bountiful
been defined in various manners as an art and science, as dimensions of Yoga [Figure 1], enabling us to manifest our
well as the process of conscious evolution. Swami Gitananda inherent divinity, the universal potentiality that lies dormant
Giri (Giri, 1976) has defined Yoga as fivefold awareness that unless channelized. “All souls are potentially divine,” said
includes the initial awareness of how unaware we are, Swami Vivekananda (Nagarathna & Nagendra, 2001) and,
which is followed by a step‑by‑step development of the indeed, they are.
awareness of one’s body, emotions, and mind, with the final
step being an ultimate awareness of awareness itself. Yoga However, most of us never wake up to this inherent
may be understood as being both the tool and the actual greatness that lies within each and every one of us, and
process of unification or holistic integration resulting in the this is where Yoga offers us a light into our own selves. It
union–reunion–communion of our individuality with our dispels our confusions, and as Arjuna said to Yogeshwar
universality. In modern times, the best way to understand Krishna (Chidbhavananda, 1984), “I see, I see; the scales have
this great way of life is as a conscious performance of skillful lifted from my eyes.”
action without expectation.
The diverse dimensions of Yoga [Figure 2] that we will be
Access this article online focusing on include those related to Indian culture, health,
Quick Response Code: therapy, society, education, and research.
Website:
www.ym-kdham.in
CULTURAL DIMENSION
DOI: Yoga is the cultural heritageof India and the great Rishis
10.4103/0044-0507.137846 are the ancestors of all those who live a life of Yoga, in
more ways than one. Spirituality is in the very genes of

Dr. Ananda Balayogi Bhavanani, Deputy Director, Centre for Yoga Therapy, Education and Research (CYTER), Mahatma Gandhi
Medical College and Research Institute (MGMCRI), Pillayarkuppam, Pondicherry ‑ 607 402, India. E‑mail: yognat@gmail.com

Bhavanani: Diverse dimensions of yoga
humans, and this physical and spiritual genetic potential the suffering of those who are balanced in diet, relaxation,
enables us to experience the transcendental concepts effort, sleep, and wakefulness (Chidbhavananda, 1984).
of Yoga in their fullness. However, we are hindered by
the widely prevalent ignorance of the treasures we have HEALTH DIMENSION
inherited. We have forgotten that we are the safe keepers
of these treasures. These encompass the vast literature Yoga understands health and well‑being as a dynamic
of Vedas, Upanishads, and the classical texts such as the continuum of human nature and not as a mere “state” to be
Yoga Sutras, Hatha Yoga texts, Tirumandiram, Tirukkural, attained and maintained. The lowest point on the continuum
etc., (Anantharaman, 1996). All of the fine arts like music, with the lowest speed of vibration is that of death, whereas the
dance, drama, pottery, painting, handicrafts, as well as the highest point with the highest vibration is that of immortality.
vibrant folk arts have a deep element of the spirituality In between these two extremes lie the states of disease and
of Yoga running through them. This is also visible in our normal health. Yoga improves all aspects of our health,
day‑to‑day life as Yogic concepts deal with how we eat, including the physical, mental, emotional, social, and spiritual
sleep, get up, interact with others, etc. (yuktāhāravihārasya components. At the physical level, it induces equilibrium of
yuktaceshtasya karmasu, yuktasvapnāvabodhasya yogo bhavati the autonomic nervous system, with a tendency toward
duhkhahā BG‑VI: 17). As this verse tells us, Yoga destroys parasympathetic dominance rather than stress‑induced
sympathetic dominance (Innes, Bourguignon, & Taylor,
2005; Innes & Vincent, 2007; Streeter et al., 2007) Heart rate
and blood pressure decrease implying better relaxation,
reducing the load on the heart. Respiratory rate decreases
and respiratory efficiency improves along with all the
pulmonary parameters like tidal volume, vital capacity, and
breath‑holding time. Cardiovascular efficiency increases,
while gastrointestinal function and endocrine function
maintain their normal balance. Musculoskeletal flexibility
and joints’ range of motion increase, posture improves, while
the strength, resilience, endurance, and energy level increase.
Weight normalizes, sleep improves, immunity increases, and
pain decreases (Khalsa, 2004; Bhavanani, 2014)
The psychological health benefits of Yoga include better

somatic and kinesthetic awareness with improvement
Figure 1: Dimensions of Yoga of mood and subjective well‑being. Improvement is
Figure 2: Dimensions and sub-dimensions of Yoga

also seen in self‑acceptance, self‑actualization, and Modern medical advancements provide the rationale for
social adjustment, with a decrease observed in anxiety, the integration of various traditional healing techniques
depression, and hostility (Sharma, Gupta & Bijlani, 2008). including Yoga to promote healing, health, and longevity.
There is improvement of various cognitive functions While modern medicine has a lot to offer humankind in its
such as attention, concentration, memory, and learning treatment and management of acute illnesses, accidents,
efficiency. Psychomotor functions such as grip strength, and communicable diseases, Yoga has a lot to offer in terms
balance, dexterity and fine motor skills, eye–hand of preventive, promotive, and rehabilitative methods in
coordination and reaction time, steadiness and depth addition to many management methods to tackle modern
perception, and the integrated functioning of body parts illnesses. While modern science looks outward for the
improve (Bhavanani, 2013, 2014). cause of all ills, the Yogi searches the depth of his own
self. This two‑way search can lead us to many answers
Yogi Swatmarama in the Hathayoga Pradipika, one for the troubles that plague modern man.
of the classical Yoga texts, gives us the assurance,
“One who tirelessly practises Yoga attains success There are numerous therapeutic modalities used in the
irrespective of whether they are young, old, decrepit, application of Yoga as a therapy (Bhavanani, 2013). Given
diseased or weak” (Bhatt, 2004). He assures us that below are some of the commonly used modalities:
Yoga improves the health of all alike and wards off • Physical therapies: Asanas (static postures),
disease, provided we properly abide by the rules and kriyas (systematic and rational movements), mudras
regulations (yuvāvrddho'tivriddho vā vyādhito durbalo'pi (seals of neuromuscular energy), and bandhas (locks for
va, abhyāsātsiddhimāpnoti sarvayogesvatandritah - Hathayoga neuromuscular energy) gently stretch and strengthen
Pradipika I: 64). the musculoskeletal system in a healthy manner. They
improve the mobility and flexibility of different joints
Yoga works toward restoration of normalcy in all and groups of muscles. There is also concomitant
systems of the human body with special emphasis on improvement in the systemic functions such as
the psycho‑neuro‑immuno‑endocrine axes. In addition respiration, circulation, digestion, and elimination.
to its preventive and restorative capabilities, Yoga also A general sense of health and well‑being is also
aims at promoting positive health that will help us to promoted by these aspects of Yoga that help release
tide over health challenges that occur during our lifetime. feel‑good hormones like endorphins and enkephalins.
This concept of positive health is one of Yoga’s unique • Emotional therapies: Swadhyaya (introspectional
contributions to modern healthcare, as Yoga has both self‑analysis), pranayama (techniques of vital energy
preventive and promotive role in the healthcare of the control), pratyahara (sensory withdrawal), dharana (intense
masses. It is also inexpensive and can be used along with concentration), dhyana (meditational oneness), and
other systems of medicine in an integrated manner to bhajana (devotional music) stabilize emotional turmoil
benefit patients. and relieve stress and mental fatigue. They bring about an
excellent sense of emotional balance that is vital for good
THERAPEUTIC DIMENSION health. Individual and group work is important to achieve
proper emotional balance that is essential for good health.
Modern medical advancements provide the rationale • Development of healthy psychological attitudes: Yoga
for the integration of various traditional healing encourages us to step back and take an objective view of our
techniques including Yoga to promote healing, health, habitual patterns of behavior and thoughts. This enables
and longevity (Madanmohan, 2013). It is imperative that us to cope better with situations that normally put our
advances in medicine include the holistic approach of bodies and minds under strain. Patanjali emphasized the
Yoga to face the current challenges in health care. The need to develop the following qualities in order to become
antiquity of Yoga must be united with the innovations of mentally balanced human beings: Vairagya (detached,
modern medicine to improve the quality of life throughout dispassionate attitude), chittaprasadanam (acceptance of
the world. No wonder that Dr. Dean Ornish, the eminent the Divine will), maitri (friendliness toward those who
American doctor who has shown that Yogic lifestyle can are at peace with themselves), karuna (compassion for
reverse heart disease, says, “Yoga is a system of perfect the suffering), mudita (cheerfulness toward the virtuous),
tools for achieving union as well as healing” (Bhavanani, upeksha (indifference and avoidance of the evil), etc.
2012). • Mental therapies: There are a great many Jnana and
RajaYoga techniques of relaxation and visualization that
Today we are faced with numerous debilitating chronic are useful. Other practices such as trataka (concentrated
illnesses related to aging, environment, and hedonistic gaze), pranayama, pratyahara, dharana, as well as dhyana
lifestyle, such as cancer, diabetes, osteoporosis, and may also be utilized. Relaxation is a central element in
cardiovascular diseases, as well as many incurable diseases Yoga as it is the body’s own way of recharging its cells and
such as AIDS (Acquired immuno deficiency syndrome). helps to ease physical, emotional, and mental tensions.

• Spiritual therapies: Swadhyaya, satsangha (spiritual • Vasudhaivakutumbakam (yadhumooreyyavarumkelir in the

gathering seeking knowledge of the reality), bhajana Tamil language): This means the whole world is one
sessions, and Yogic counselling are important aspects family, in Sanskrit. This is an excellent concept which
of Yogic therapy that are often neglected in favor of helps one to understand that divisions on the basis of
physical therapies alone. They help patients understand class, creed, religion, and geographic distribution are all
their inner spiritual nature and that “Oneness” is health “manmade” obstructions toward oneness. One can then
whereas “Duality” is disease. We cannot remain lonely, look upon all as his own and can bond with everyone
depressed, and diseased if we realize that we are part irrespective of any barrier. All the great Yogic saints such
of this wonderful, happy, and healthy universe. as Tirumoolar, Tiruvalluvar, Basava, Periyalvar, and
• Preventive and rehabilitative therapies: Yoga has Tirunavukkarasar have reminded us again and again
numerous preventive benefits, especially when it is in so many verses of the singular teachings that there
started early in childhood. It helps in prevention of is only “ondreykulamoruvaneytheivam”–which in Tamil
accidents by increasing awareness as well as agility. means “One Humanity and One God” (Ramanathan,
Improved immunity helps in preventing infectious and 2007).
contagious diseases. The added benefit of starting early • Jiva Karunya: Empathic compassion toward all living
is that the person knows the technique so that he/she beings is extolled in the teachings of Tirumoolar,
can do it if needed at a later stage in life. Psychosomatic, Tiruvalluvar, and Vallalar Ramalinga Adigalar.
stress‑related, and lifestyle disorders may be effectively Tirumoolar says that the most important aspects
prevented by adoption of a Yogic way of life. Yoga also of right living consist of the both a devoted loving
offers rehabilitative therapies for most musculoskeletal offering to the Divine in daily life as well as the
conditions as well as for recovery from debilitating feeding of other human beings and animals with
illnesses. The practice of Yoga also goes a long way love and compassion. He also stresses the need of
toward prevention of disability and improving the using virtuous words while talking to others as the
quality of life in numerous chronic conditions. means to spiritual upliftment. Tiruvalluvar asks us
• Pain relief therapies: Yoga is a useful addition to the the poignant question in Tamil, “arivinaanaaguvathu
pain relief therapies as it improves pain tolerance and undo pirithinnoaithannoypolpoatraakkadai‑ of what use is
provides an improved quality of life. It can be safely intelligence if one cannot empathize with the pain of
said that Yoga helps us endure conditions that cannot others and help them?”(Ramanathan, 2007).
be cured. This is vital in terminal ailments where it • Pratipaksha Bhavanam: The cultivation of a strong
is important that the patient has a sense of improved contrary attitude toward negativities must be induced
quality of life during their end days. Yoga can also in our day‑to‑day living as we face our own demons
benefit caretakers of patients with chronic or terminal so many times each day. Even if we cannot replace
illnesses, who are under great stress themselves. the negative thoughts with emotion‑laden positive
reinforcements, we must at least make an attempt to
SOCIAL DIMENSION stop them on their track. I have personally found that
a strong “STOP” statement works wonders in helping
In our day‑to‑day personal and interpersonal social life, block out the negative thoughts that otherwise lead us
Yoga provides us with a multitude of tools, concepts, into the quicksand‑like cesspool of deeper and greater
attitudes, and techniques through which we can attain trouble. Tiruvalluvar advises us to repay negative
inner contentment leading to happiness and spiritual actions done to us by others with positive selfless
realization while simultaneously creating harmony in actions toward them (Ramanathan, 2007).
all relationships. All psycho‑social qualities essential for • Karma Yoga: Selfless action and the performance of
healthy interpersonal relationships are cultivated when our duty without any expectations in return are
we live a life of Yoga. These humane qualities include the qualities extolled by Yogeshwar Krishna in the
loving, understanding, innate sensibility that sees other’s Bhagavad Gita (Chidbhavananda, 1984). This helps
perspectives, compassion, empathy, respect, gratitude, us to develop into an autotelic personality where we
fidelity, and responsibility. One who is blessed with perform acts because they are intrinsically rewarding,
these qualities is indeed a divine blessing to the social rather than to achieve external goals. This is an
life of their immediate family, friends, relatives, and their important aspect of developing a state of “flow”–a
society itself. state of complete absorption with the activity at hand
giving one the greatest sense of bliss. Such people
There are many important Yogic concepts that help guide us are more autonomous and independent because
in shaping our personal lives as well as create harmonious they cannot be as easily manipulated with threats
interpersonal relationships that make up our daily social or rewards from outside. At the same time, they are
life. Some examples of these spiritually uplifting concepts more involved with everything around them because
that transform all aspects of our social life include: they are fully immersed in the current of life. To

me this represents the cream of humanity, the truly therapy course in a medical college at its Mahatma
self‑realized and self‑actualized true human beings. Gandhi Medical College in Pondicherry that is being
As Yogeshwar Krishna tells us in the Srimad Bhagavad conducted by the Centre for Yoga Therapy, Education
Gita (Chidbhavananda, 1984), karmanyevādhikāraste and Research (CYTER).
mā phaleshu kadāchana, mā karmaphalaheturbhurmā
tey sango'stvakarmani (II: 47)–“You have the right to RESEARCH DIMENSION
perform the action, but not to the fruits of the action.
Never consider yourself the cause of the resultant Numerous studies have been done in the past few
fruits, and don’t let this make you cling to non‑action decades on the psycho‑physiological and biochemical
either.” Basically the key message is “Do your best and changes occurring following the practice of Yoga. The
leave the rest.” Choice of the right beatitude is the only main fields of research in Yoga are the Scientific–Medical–
way one can grow and evolve in consciousness. Clinical aspect that deals with both fundamental and
applied research in various medical conditions, and
The true Yogic life involves a sustained struggle against past the Philosophico‑Literary side that tries to develop an
conditioning, an attempt to control one’s inner environment understanding of the context and traditional basis of Yoga.
in order to focus inward. The Yogi strives to be “more perfect Traditional Knowledge Digital Library (TKDL) has been
today than he/she was yesterday.” set up by the Indian Government to try and systematize
the abundant traditional knowledge in Yoga and Indian
EDUCATIONAL DIMENSION systems of medicine (www.tkdl.res.in). A great amount of
published research on Yoga and its diverse applications in
For those interested in taking up academic studies in Yoga, various fields of human endeavor is available from www.
there are many short and long‑term self‑development ncbi.nlm.nih.gov/pubmed.
courses being run by both traditional and modern
centers worldwide. There are courses on personality CONCLUSION
development, efficiency enhancement, and stress
management. If one is interested in becoming a Yoga The Srimad Bhagavad Gita says, “yogaha karmasu koushalam,”
professional, then such training is offered by numerous which means that Yoga is skill in action (Chidbhavananda,
institutes and universities through certification courses 1984). The real Yogi, immensely conscious and aware at
for Yoga instructors, teachers, and therapists, as well as the physical, mental, and emotional levels, gains great
diploma and PG diploma courses. Masters, M.Phil, and control over all aspects of life by using that consciousness,
PhD programs are also being run by many universities. and thus develops a real skill in living. Part of that skill
To maintain the standard of Yoga education worldwide, springs from his cultivated detachment, his ability to
a dozen eminent institutions have come together to form work for “work’s sake” and not for the sake of the reward.
the Council for Yoga Accreditation International (CYAI), He realizes that his duty is to do his best but that the
a peer accreditation association of Yoga certification ultimate result is not in his hands. The Yogi performs the
and degree granting institutions (www.cyai.org). The needed action not for the sake of the fruits of that action,
International Association of Yoga Therapists in the but because it is good and necessary to do so. Such an
USA (www.iayt.org) is doing a lot of work to make Yoga attitude of mind produces consummate skill in whatever
acceptable to the medical community worldwide. action the Yogi undertakes. Consummate concentration
and consummate control are all offshoots of good Yoga
Yoga in India as a subject is governed by the Department Sadhana. This belies the age‑old belief that the competitive
of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, spirit produces the highest skill. To this the Yogic answer
Siddha and Homoeopathy) in the Ministry of Health is: Detachment from the fruits of the action produces the
and Family Welfare. This department runs the National greatest efficiency, for one is then emotionally detached
Institute of Yoga (Morarji Desai National Institute of Yoga) with goal‑oriented, competitive thinking. The beauty of
in New Delhi (www.yogamdniy.nic.in), while it’s Central Yoga is that these abstract principles become concrete
Council for Research in Yoga and Naturopathy (CCRYN) during the daily practice of the techniques available in the
wing funds and supports various research projects and Yoga system. Once the “seed of Yoga” finds fertile soil,
Bachelor of Naturopathy and Yogic Sciences (BNYS) these concepts grow naturally, slowly but surely taking
courses in India (www.ccryn.org).Yoga therapists root in all aspects of life.
have been appointed under the National Rural Health
Mission (NRHM) programs in government hospitals Yoga, which emphasizes the universal, is a perfect foil to
all over the country and most major private medical those human activities which glorify the personal. The ego
hospitals are running Yoga and healthy living centers. that is fixated only on its own shallow self is likely to soon
Sri Balaji Vidyapeeth University (www.sbvu.ac.in) is a run into depression and despair, overwhelmed by its own
pioneer in having started the first PG Diploma in Yoga superficiality. That striving spirit which looks within at

the universal aspect of its own nature and sees the oneness NisargopacharVarta, 6,(5) 13‑15.
of the whole of creation will find an endless fountain of Chidbhavananda, S. (1984). The Bhagavad Gita. Trichy, Tamil Nadu:
inspiration and joy. In short, it may be safely said that the Ramakrishna Tapovanam Publishers.
practice of Yoga as a unified whole helps the individual shift Giri, G. S. (1976). Yoga: Step‑by‑Step. Pondicherry: Satya Press.
from an “I”‑centric approach to a “we”‑centric approach. Innes, K. E., Bourguignon, C., & Taylor, A. G. (2005). Risk indices
associated with the insulin resistance syndrome, cardiovascular
“Tasmad yogi bhavarjuna–be thou a Yogi,”says Lord Krishna
disease, and possible protection with yoga: A systematic review.
in the Gita (Chidbhavananda, 1984). May we all grow and Journal of the American Board of Family Practice, 18(6), 491‑519.
glow in consciousness until we reach that highest state of Innes, K. E., & Vincent, H. K. (2007). The Influence of Yoga‑based
consciousness, the state of Yoga! programs on risk profiles in adults with type 2 diabetes mellitus:
A systematic review. Evidence‑Based Complementary and Alternative
Medicine, 4(4), 469‑486. doi: 10.1093/ecam/nel103.
ACKNOWLEDGMENTS
Khalsa, S. B. (2004). Yoga as a therapeutic intervention: A bibliometric
analysis of published research studies. Indian Journal of Physiology
The author thanks the management of Sri Balaji Vidyapeeth and Pharmacology, 48(3), 269‑285.
University for setting up the Centre for Yoga Therapy, Education
Madanmohan, T. (2013). Yoga for healthy lifestyle. Annals of SBV,
and Research (CYTER) in Mahatma Gandhi Medical College 2(2), 20‑23.
and Research Institute (MGMCRI). The author is grateful to
Nagarathna, R., & Nagendra, H. R. (2001). Integrated approach of Yoga therapy
Yogacharini Meenakshi Devi Bhavanani, Director ICYER at for positive health. Bangalore: Swami Vivekananda Yoga Prakashan.
Ananda Ashram, Pondicherry, and Prof Madanmohan, Director
Ramanathan, M. (2007). Thiruvalluvar on Yogic Concepts. Pondicherry:
CYTER, MGMCRI, Pondicherry, for their constant motivation Aarogya Yogalayam.
and supportive guidance.
Sharma, R., Gupta, N., & Bijlani, R. L. (2008). Effect of yoga based
lifestyle intervention on subjective well‑being. Indian Journal of
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Anantharaman, T. R. (1996). Ancient Yoga and Modern Science. Terhune, D. B,… Renshaw, P. F. (2007). Yoga asana sessions increase
New Delhi: Munshiram Manoharlal Publishers. brain GABA levels: A pilot study. Journal of Alternative and
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of Hathayoga‑pradīpikā, Gheranda‑samhitā and Śiva‑samhitā (P.
Singh, R. Bahadur, and S. C. Vasu, Trans.). New Delhi: Motilal
Banarsidass Publishers. How to cite this article: Bhavanani AB. Diverse dimensions of
Bhavanani, A. B. (2012). Yoga in health care. Annals of SBV, 1(2), Yoga. Yoga Mīmāṃsā 2014;46:3-8.
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Bhavanani, A. B. (2014). Yoga: A novel integrative therapy. Conflict of interest: None declared.

30 | Department of Physiology & CYTER, MGMCRI - Puducherry
MEDITATION: THE INNER YOGA

Yogacharya Dr. Ananda Balayogi Bhavanani &Yoga Chemmal Meena Ramanathan
Introduction
Maharishi Patanjali is the codifier of the Yoga Darshana, the yogic view of life. Meditation is
preceded by dharana, or one-pointed concentration that helps us to flow into meditation. Patanjali defines
dharana or concentration as desha bandhah chittasya dharana, meaning that concentration is the process
of binding the consciousness to a point, place, region or object. This implies a duality between the seer and
the seen. He further defines dhyana, or meditation, as tatra pratyaya ekatanata dhyanam, meaning thereby
that meditation is a state in which there is a steady and continuous flow of attention and concentration
on a point, place, region or object. There ceases to be a duality between the seer and the seen. The final
step in the three, free-flowing higher states of consciousness is samadhi or union with the divine nature
in the ultimate, universal unification.
The one-pointedness of concentration, of dharana raises the yogi into the higher stages of the
ideating mind, where buddhi, or intellect, is available as an instrument of the Cosmic Mind. When free–
flowing concentration is achieved, it is known as dhyana, or meditation. Meditation is not “thinking,”
as so many today mistake it to be. Meditation is a transcendental state, where if there is awareness, it is
awareness of awareness itself, a state beyond the mind.
Meditation is the fruit of long and arduous effort. The mind is so trained in its focus that it naturally
flows into the object of contemplation. A deep, vibrant quietness is the characteristic of meditation,
which infuses one’s entire lifestyle with calmness and control. Meditation becomes a quality of mind that
manifests in all aspects of our daily life. The mind develops the capacity to delve into every experience,
thought, emotion and situation that arises, and this focused awareness produces yogic skill in living.
Mudras for Meditation
Various hastha mudras, or hand gestures, are used to enhance the concentration and deepen the
experience of meditation. At the end of your meditation, when ready, slowly release each of these mudras
and bring your hands back to the thighs.
Jnana Mudra: This “Gesture of Wisdom” is performed by joining the thumb and forefinger together
in a perfect circle. The other three fingers are outstretched in a rigid fashion. Jnana Mudra is placed over
the knees and held with the palm facing upwards. This mudra helps focus the restless mind and enables
us to attain a state of jnana, or discriminatory wisdom. It is an excellent mudra for meditation and
contemplation and can be used at times of study and introspection.
Chin Mudra: This gesture of consciousness helps us to go within and attain a state of elevated
consciousness. From a straight-back sitting position such as Vajrasana, bring both hands up to the chest
level with palms facing forward. Join the tips of your thumbs and index fingers to form a perfect circle.
Keep the other three fingers straight and with their sides joined together in parallel. Place the Chin
Mudra on your thighs with the palm facing down. Contemplate the mudra as it stimulates the mind into
higher states of consciousness.
CME on Sleep, consciousness and meditation: Neurophysiological correlates 2014

Department of Physiology & CYTER, MGMCRI - Puducherry | 31
Namaskar Mudra: Sit in any meditative posture. Bring both your hands up to your chest and join
your palms together. Keep your elbows in a lifted position. This mudra is commonly used in many eastern
cultures as a gesture of greeting and peace as it helps us to recognize that the Divine manifests through
all beings.
Anjali Mudra: Sit in any meditative posture. To perform this gesture of salutation, slowly lift both
arms up from the side of your body. At the peak of the stretch bring both your palms together with your
arms high over your head. Hold the mudra with sensitivity and awareness. Contemplate the subtle energies
of the six higher chakras that are located in the higher region of the subtle body.
Kailash Mudra: Sit in any meditative posture. Slowly lift both your hands and perform the Anjali
Mudra. Gently bring the Anjali Mudra down to your head so that your wrists are touching the top of
your head. Make sure that your elbows are kept in line with your shoulders. This mudra forms a beautiful
triangular frame for your face. Try to visualize Mount Kailash in its wonderful snow-coated splendor.
This mudra helps energize the sahasrara chakra, the crown center of psychic energy and is a useful mudra
for contemplation.
Bhairava Mudra: Sit in any meditative posture. Bring your left hand onto your lap with the palm
facing up and then place the right hand on it with the right palm facing upwards also. Sit quietly and
contemplate the mudra. The right hand represents the masculine energy of Shiva and in this mudra that
energy is kept dominant.
Bhairavi Mudra: Sit in any meditative posture. Bring your right hand onto your lap with its palm
facing up and then place your left hand on it with the left palm facing upwards too. Sit quietly and
contemplate the mudra. The left hand represents the feminine energy, and this mudra indicates the
dominance of our creative and artistic energy of Shakti over the masculine energy of Shiva.
Yoga Mudra: Sit in any meditative posture. Entwine the fingers of both hands with the fingers of the
right over the left. The right thumb should be at the top of the piled up heap of fingers. Place the Yoga
Mudra on your lap in a relaxed manner and enjoy the calm arising within yourself. Perform deep breathing
and become aware of how this mudra brings about a steady and harmonious balance between the right
and left flows of energy in your subtle body.
Bhumi Sparsha Mudra: Sit in any meditative posture and perform the Jnana Mudra. Place the hands
over the knees and then extend the fingers forward until the tips are touching the ground. This earth
witnessing or earth touching gesture is a gesture of reverence for our planet, the earth that sustains our
race. Ancient yogis were true environmentalists and through the development of reverence for nature,
they upheld the highest ethical principles of conservation.
Mahabhinishkramana Mudra: From a sitting position, bring your left hand close to your navel with
the palm facing upwards. Make your right hand into a clenched fist with your thumb directed straight
upwards and place your right hand on the upturned left palm in front of your navel. This hand gesture
represents the symbol of Lord Shiva, the Lord of evolutionary change. This mudra’s name means, the
“mighty gesture of renunciation.” After you have held the mudra for a comfortable period of time, relax
your hands back to your thighs and sit quietly to absorb the higher energies of evolutionary change and
renunciation that will start to flow through your system.
Trataka: Yogic gazes
Concentration upon a sin¬gle point or object for a prolonged period helps to shut out the outer world
and also produces a state of alert awareness. With prolonged practice of one-pointed, concentrative gaze,
all irrelevant sensory feedback can be eliminated from consciousness, leading to the experience of a state
of meditation. Various types of concentrative points may be chosen for the practice of yogic gaze. Here
are a few of them:
Jyoti Trataka: The term jyoti means a “luminous light,” and so this trataka is the concentrated gaze at
the tip of the flame of a lamp kept in front and at eye level 3 to 4 feet away. Sit in any of the meditative
postures and gaze steadily at the tip of the flame without blinking the eyes. Don’t allow any distracting
thoughts to enter your mind, and if they do, then clean them out at once. Try to maintain the gaze and
control the blinking of the eyes as much as possible. Do not strain the eyes. Repeat the practice at least 3
to 9 times at each sitting to obtain maximum benefit. To relieve any tension that may have accumulated
in your eyes, rub your palms together to generate healthy, warm, pranic energy. Place your cupped palms
over the respective eye blocking out any external light and relax for some time.
Bhrumadhya Drishti Trataka: Bhrumadhya Bindu refers to the midpoint between the eyebrows and is
one of the most important concentration points in Yoga. Perform Siddhasana and do a few rounds of deep
breathing. Open your eyes wide and gaze upward. Focus your gaze on the Bhrumadhya Bindu. Concentrate
on this point without blinking your eyes as long as possible and then relax your gaze. Close your eyes and
hold this point inwardly for 15 to 20 seconds. To relieve any tension that may have accumulated in your
eyes, rub your palms together to generate healthy, warm, pranic energy. Place your cupped palms over the
respective eye blocking out any external light and relax for some time. Repeat the practice 3 times at each
sitting until a sense of inner concentration is achieved.
Nasagra Drishti Trataka: In this practice, we gaze open-eyed upon the tip of the nose, an important
concentration point used in the inner practices of Yoga. Sit in Padmasana and do a few rounds of deep
breathing. Open your eyes wide and focus your gaze upon the tip of your nose. Your left eye must catch
the tip of the nose with the same balance and lack of tension as does your right eye. If there is tension,
close your eyes and imagine that you are still gazing at the tip of your nose. Hold this concentration for
15 to 20 seconds and then open your eyes to see if the tip of your nose is actually still in the drishti of
your eyes. Repeat 3 to 9 times at each session until a sense of relaxation is achieved. One should gradually
increase this practice without putting too much strain on the eyes. To relieve any tension practice the eye
cupping technique previously outlined.
If a headache develops, stop the practice session and rest your eyes with palming. It is advisable to
washout your eyes with lukewarm saline solution after the practice if any tension is still felt in the eyes.
Anthara Dharana
Anthara Dharana refers to the various techniques of inner concentration that can be done from
Dharmika Asana (the devotional asana, or Child’s Pose):
Kshitijan Kriya: Kshiti means “horizon” in Sanskrit, but the horizon used for this inner concentration
is the inner-mind horizon. After performing the Dharmika Asana, mentally think of the point where
your head is touch¬ing the floor. Directly inside the head be¬tween the hemispheric folds of the brain is
a nerve center called Bindu Nadi. Withdraw your concentration into this Bindu and imagine that you are

Department of Physiology & CYTER, MGMCRI - Puducherry | 33
looking into the Eastern sky, just be¬fore dawn. Your inner screen or mental hori¬zon is one of velvety,
warm darkness. Then, imagine a full sun rise, with all its colors. Relax in this pleasant inner view, letting
the experience flood through your entire nervous system.
Eka Varna Kriya: This practice elicits inner light experiences. Concentrate at the same Bindu point,
thinking only about your favorite color. Choose the color that you like best from the entire color spectrum.
Imagine that you are completely engulfed in this liquid color, as though you have fallen into an ocean of
colored liquid. Sometimes a swirling sensa¬tion of color will develop, and you will be literally sucked into
a point of light in which you may also experience some inner sounds. Do not let these sounds interrupt
your concentration, but become completely lost in the color and sound. This is very healing to the body
and the mind.
Jyotir Darshana: This is the blessing of a view of the inner light. Begin by concentration in Bindu
Nadi, at that point where the head touches the floor in Dharmika Asana. Imagine you are sitting out of
doors in bright sunlight or watching a bright sunrise. Concentrate fully on this idea. If you do so, a pinhole
of light will appear from within the mind’s eye, the third eye, the Ajna Chakra. Hold this light gently in
your inner gaze. Do not concentrate too hard, or it will go away. Learn to gaze passively, without a desire
to grasp, possess or hold what your mind experiences. Keep the concentration until the light fades or you
feel sufficiently relaxed to discontinue the practice.
Pranava Dhyana
This practice is a one pointed concentration on the form and nada, or sound, of the sacred Pranava
AUM, known as the mantra of all mantras. This can be done from any of the sitting postures but make
sure that your back is erect. It is best to do this after performing a few rounds of conscious deep breathing
so that the mind is in a calm state. Pranava Dhyana harmonizes the body, emotions and mind. In this
practice emphasis is first placed on making the sounds AAA, UUU and MMM separately and then in
combination.
This is followed by the performance of the practice mentally without the audible sound. Sit in Vajrasana
and place the Chin Mudra on your thighs. Breathe in deeply into your lower chest area 2-3-4-5-6. Breathe
out with the sound, Aaaaa, Breathe in 2-3-4-5-6. Breathe out with the sound, Aaaaa. Breathe in 2-3-4-
5-6. Breathe out with the sound, Aaaaa. Now concentrate on the sound, Aaaaa mentally and perform the
same practice 3 times without the audible sound.
Curl your fingers inward to form the Chin Mudra and place it on your thighs. Breathe deeply into your
mid chest region 2-3-4-5-6. Breathe out with the sound Ooooo. Breathe in 2-3-4-5-6. Breathe out with
the sound, Ooooo. Breathe in 2-3-4-5-6. Breathe out with the sound, Ooooo. Now concentrate on the
sound, Ooooo, mentally and perform the same practice 3 times without the audible sound. Perform the
Adhi Mudra by clenching your fists with your thumbs in the center and place the mudra on your thighs.
Breathe deeply into your upper chest and clavicle regions 2-3-4-5-6. Now, exhale with the sound,
Mmmm. Breathe in 2-3-4-5-6. Breathe out with the sound, Mmmm. Breathe in 2-3-4-5-6. Breathe
out with the sound, Mmmm. Now concentrate on the sound mentally and perform the same practice 3
times without the audible sound.
To perform the 4th part of the practice that unites the 3 earlier parts, perform Adhi Mudra and then
place it with the knuckles of both 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 Aaaaa—Ooo—Mmmm. Breathe in 2-3-4-5-6. Breathe out Aaaaa—Ooo—Mmmm. Breathe
in 2-3-4-5-6. Breathe out Aaaaa—Ooo—Mmmm. Now concentrate on the sound Aaaaa—Ooooo—
Mmmm and perform the same practice 3 times without the audible sound.
A practice of 3 to 9 rounds of the Pranava Dharana, when done daily, helps to relax the body-mind-
emotion complex and provides complete healing through the production of healing vibrations at all levels
of our existence. This is the cornerstone of yogic breath therapy and can produce health and wellbeing for
all. When the concentrative aspect of the practice is taken to its peak, a state of meditation, or Pranava
Dhyana, can ensue.
Chakra Meditation
This meditative sitting is best done facing North or East. The practice of a few rounds of deep and
conscious breathing in Savasana prior to this meditative sitting can serve to enhance its effect dramatically.
Kneel in Vajrasana, or any sitting posture in which you are absolutely certain that the spine is yogically
erect so that the energy can move upward in an effortless and smooth manner.
Do some pranayama focusing on the chakras. As you come up through the chakras, starting from
the base of the spine and through to beyond the top of the head, try to become aware of each of these
centers. With practice and inner growth these centers will start to become conscious centers filling with
light, sound and color.
When the breath is completely filled in and you are in the Sahasrara Chakra, beyond the top of the
head, hold your breath in a Prana Kumbhaka, a held-in breath, for a lengthy period of time. Slowly let the
breath out and keep your concentration in that Thousand-Petal Lotus Chakra. Let the breath take on any
form that it wishes and simply hold the idea that you are sitting in the midst of a beautiful thousand-petal
pink lotus. Hold that idea as long as you can, repeating the visualization over and over until there occurs
a pleasing sensation of being suspended.

Journal of Symptoms and Signs 2014; Volume 3, Number 5
Expert Opinion
Role of yoga in health and disease
Centre for Yoga Therapy, Education and Research (CYTER), Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pillayarkuppam,
Pondicherry, India.
Abstract
Yoga as a mode of therapy 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. Healthy 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.
This review paper details some of the health promoting benefits of yoga as well as discusses the important cardiovascular, respiratory, musculoskele-
tal and metabolic conditions in which it may have preventive, supportive, curative and rehabilitative potential. Role of yoga in stress, mental health,
cancer, pregnancy and childhood are also detailed. Mechanisms for such beneficial physiological, biochemical and psychological effects are dis-
cussed. Psycho-neuro-endocrine changes including correction of GABAergic activity, and parasympathetic activation coupled with decreased reactivity
of sympathoadrenal system and HPA axis are highlighted. Changes in the various evaluated parameters for different conditions are detailed and
discussed with ample references. Though most studies and reviews suggest a number of areas where yoga may be beneficial, 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 consider that the proper studies on yoga as a therapeutic modality are not older than a
few decades. It is important to develop objective measures of various mind-body therapies and their techniques while including them in intervention
trials. An overview is given of the lacunae present in the reviewed studies and suggestions given for improvements in future studies. In conclusion,
we can say that yoga has preventive, promotive as well as curative potential and that a yogic lifestyle confers many advantages to the practitioner.
Since lifestyle related diseases are alarmingly on the rise in our modern society, yogic lifestyle that is cost effective and relatively safe, should be
given a special place in preventing and managing these diseases.
Keywords: health; disease; stress; yoga therapy.
Received: February 25, 2014; Accepted: May 29, 2014; Published: December 16, 2014
Corresponding Author: Ananda Balayogi Bhavanani, Deputy Director, Centre for Yoga Therapy, Education and Research (CYTER), Mahatma Gandhi
Medical College and Research Institute (MGMCRI), Pillayarkuppam, Pondicherry, India.
E-mail: yognat@gmail.com.
http://www.intermedcentral.hk/ 399
Yoga in health and disease
Introduction Educational Standards for the Training of Yoga Thera-

pists”, published on 1 July, 2012 [3]. This is one of the
“Oh, East is East, and West is West, and never the
best documents on standards in yoga therapy and is a
twain shall meet,” said Rudyard Kipling. This dichoto-
path breaking effort covering comprehensively all as-
my however seems to have been overcome in recent
pects of yoga as a holistic therapy.
times, as many eastern healing traditions have slowly
The need of the hour is for a symbiotic relationship
and steadily percolated the health care system world-
between yoga and modern science. To satisfy this need,
wide. This is especially true of mind-body therapies
living, human bridges combining the best of both
that focus on the health promotive intrinsic connections
worlds need to be cultivated. It is important that more
that exist between the human brain, mind, body, and
dedicated scientists take up yoga and that more yogis
individual behaviour.
study science, so that we can build a bridge between
Yoga as a mode of therapy (yoga chikitsa) has be-
these two great evolutionary aspects of our civilization.
come extremely popular, and a great number of studies
The process as well as the goal of yoga is all about be-
and systematic reviews offer scientific evidence of its
coming "one" with an integrated state of being [4].
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 Promotes Positive Health
‘state’ to be reached and maintained. Yoga helps the Healthy life can be considered as a by-product of prac-
individual to establish “sukha sthanam”, which may be ticing yogic techniques since it has been observed that
defined as a dynamic sense of physical, mental, and Yoga practitioners are physically and mentally healthier
spiritual well-being. Yogamaharishi Dr. Swami and have better coping skills to stressors than the nor-
Gitananda Giri Guru Maharaj, the visionary founder of mal population. Knowledge of inexpensive, effective
Ananda Ashram at the ICYER, Pondicherry and easily administrable yogic techniques by health
(www.icyer.com) and one of the foremost authorities professionals will go a long way in helping us achieve
on Yoga in the past century exclaimed lucidly, “Yoga the goal of the World Health Organisation to provide
chikitsa is virtually as old as yoga itself, indeed, the “physical, mental, spiritual and social health” for all
‘return of mind that feels separated from the Universe sections of human society.
in which it exists’ represents the first yoga therapy. We can say that the eastern mind-body techniques
Yoga chikitsa could be termed as “man’s first attempt affect every cell of the human body. They bring about
at unitive understanding of mind-emotions-physical better neuro-effector communication, improve strength,
distress and is the oldest wholistic concept and therapy and enhance optimum functioning of all organ-systems
in the world” [1]. while increasing resistance against stress and diseases
To achieve this yogic integration at all levels of our with resultant tranquillity, balance, positive attitude and
being, it is essential that we take into consideration the equanimity.
all encompassing multi-dimensional aspects of yoga Some of the important documented health promot-
that include the following: a healthy life nourishing diet, ing benefits of mind-body practices such as yoga and
a healthy and natural environment, a wholistic lifestyle, meditation include:
adequate bodywork through asana, mudra, bandha and 1. Improvement in cardio-respiratory efficiency [5−8]
kriya, invigorating breath work through pranayama and 2. Improvement in exercise tolerance [9−12]
the cultivation of a healthy thought process through 3. Harmonious balance of autonomic function [13−16]
jnana yoga and raja yoga. 4. Improvement in dexterity, strength, steadiness, stamina,
The International Association of Yoga Therapists flexibility, endurance, and neuro-musculo-skeletal [9,
(IAYT), USA has taken this idea into account in defin- 17−22]
ing Yoga therapy as follows [2]: “Yoga therapy is the 5. Increase in alpha rhythm, inter-hemispheric coherence
process of empowering individuals to progress toward and homogeneity in the brain [23−26]
improved health and well-being through the application 6. Improved sleep quality [27]
of the philosophy and practice of yoga.” This has been 7. Improved cognitive functions [5, 28−34]
further elabourated by the IAYT in its “Recommended
400 http://www.intermedcentral.hk/

8. Alteration in brain blood flow and brain metabolism rected by yoga practices resulting in amelioration of
[35−38] disease symptoms. A review by Bhavanani concluded
9. Modulation of the neuro-endocrine axis [39−44] that heart rate variability (HRV) testing has a great role
to play in our understanding the intrinsic mechanisms
behind such potential autonomic balancing effects of
Managing Stress
yoga [47]. Innes, et al. had earlier also postulated two
It is well established that stress weakens our immune
interconnected pathways by which yoga reduces the
system. Scientific research in recent times has showed
risk of cardiovascular diseases through the mechanisms
that the physiological, psychological and biochemical
of parasympathetic activation coupled with decreased
effects of yoga are of an anti-stress nature. A majority
reactivity of sympathoadrenal system and HPA axis[48].
of studies have described beneficial effects of yoga
interventions in stress with an Agency for Healthcare
Cardiovascular Conditions
Research and Quality (AHRQ) report stating that “Yo-
ga helped reduce stress.”[45] Reductions in perceived A review of 70 eligible studies investigating the effects
stress following yoga are reported to be as effective as of yoga on risk indices associated with the insulin re-
therapies such as relaxation, cognitive behavioral ther- sistance syndrome, cardiovascular disease, and possible
apy and dance therapy. protection with yoga, reported that most had a reduction
Mechanisms postulated included the restoration of of systolic and/or diastolic pressure. However, the re-
autonomic balance as well as an improvement in restor- viewers also noted that there were several noted poten-
ative, regenerative and rehabilitative capacities of the tial biases and limitations that made it difficult to detect
individual. A healthy inner sense of wellbeing produced an effect specific to yoga [48]. Another literature re-
by a life of yoga percolates down through the different view reported significant improvements in overall car-
levels of our existence from the higher to the lower diovascular endurance of young subjects who were
producing health and wellbeing of a holistic nature. given varying periods of yoga training [49]. Physical
Streeter, et al. recently proposed a theory to explain the fitness increased as compared to other forms of exercise
benefits of yoga practices in diverse, frequently co- and longer duration of yoga practice produced better
morbid medical conditions based on the concept cardiopulmonary endurance. In fact a detailed review
that yoga practices reduce allostatic load in stress re- of yoga in cardiac health concluded that it can be bene-
sponse systems such that optimal homeostasis is re- ficial in the primary and secondary prevention of cardi-
stored [46]. ovascular disease and that it can play a primary or a
They hypothesized that stress induces an: complementary role in this regard [50].
• Imbalance of the autonomic nervous system with
decreased parasympathetic and increased sympa- Mental Health
thetic activity; Yoga can enhance one’s spiritual life and perspective
• Under activity of the gamma amino-butyric acid beyond the physical life regardless of one’s particular
(GABA) system, the primary inhibitory neuro- religion [51]. It enables people to attain and maintain a
transmitter system, and balance between exertion and relaxation, and this pro-
• Increased allostatic load. duces a healthy and dynamic state of homeostatic equi-
They further hypothesized that yoga-based practices i) librium [1]. Recent studies have shown that yoga im-
correct under activity of the parasympathetic nervous proves mood and reduces depression scores [52, 53].
system and GABA systems in part through stimulation These changes have been attributed to an increased
of the vagus nerves, the main peripheral pathway of the secretion of thalamic GABA with greater capacity for
parasympathetic nervous system, and ii) reduce allo- emotional regulation [53, 54]. Even a 10-day yoga-
static load. based lifestyle modification program has been reported
According to the theory proposed by them, decreased to improve subjective wellbeing scores of patients [16].
parasympathetic nervous system and GABAergic activ- A review by Carim-Todd, et al. on yoga and smoking
ity that underlies stress-related disorders can be cor- cessation, reported positive benefits of mind–body in-

terventions [55]. These interventions produced changes ventilation, reduces sympathetic activation during alti-
in smoking behaviour/in predictors of smoking behav- tude-induced hypoxia [64] and decreased chemoreflex
iour such as abstinence, decreased number of cigarettes sensitivity to hypoxia and hypercapnia [65]. These help
smoked, lower intensity of cravings and attitudinal bring about both objective and subjective improve-
changes regards smoking. However, definite conclu- ments in the condition of patients with bronchitis. Yoga
sions on their benefits for smoking cessation couldn’t as a therapy is also cost effective, relatively simple and
be drawn due to the scarcity of papers, low quality of carries minimal risk and hence should be advocated as
some publications, and the numerous limitations of the an adjunct, complementary therapy in our search for an
studies such as reduced sample size, limitations of integrated system of medicine capable of producing
study design, lack of adherence monitoring, lack of health and wellbeing for all.
objective measures, inadequate or absent control condi-
tions and absence of blinding. Metabolic/Endocrine Conditions
In addition to its benefits for patients themselves, A few RCTs have suggested that yoga and meditation
yoga also has a great role for managing depression practices act on the hypothalamic–pituitary–adrenal
manifesting in family caregivers of patients with de- axis (HPA) axis to reduce cortisol levels in plasma [66-
mentia [56]. Researchers also support the promising 69], as well as reduce sympathetic nervous system tone,
role of yoga as an intervention for depression because it increase vagal activity [70, 71], and elevate brain
the intervention is cost-effective and easy to implement GABA levels [54]. Major systematic reviews of the
[61]. However a point to consider is that all the mind- effects of yoga on risk indices associated with insulin
body interventions do seem to be effective when com- resistance syndrome and risk profiles in adults with
pared to passive controls but reports are less conclusive type 2 diabetes have been done in recent times [48, 72].
when compared with active controls [57]. They reported post-intervention improvement in vari-
ous indices but with results varying by population and
Respiratory Disorders study design. Another systematic review addressed the
Scientific basis of using yoga as an adjunct therapy in management of type 2 diabetes and concluded that the
chronic obstructive pulmonary diseases is well estab- reviewed trials suggest favorable effects of yoga on
lished with significant improvements in lung function, short-term parameters related to diabetes but not neces-
quality of life indices and bronchial provocation re- sarily for long-term outcome [73]. The AHRQ cites two
sponses coupled with decreased need for regular and studies comparing yoga versus medication which re-
rescue medicinal usage [58, 59]. Behera reported per- ported a large and significant reduction of fasting glu-
ceptible improvement in dyspnoea and lung function in cose in individuals with type 2 diabetes in one, and a
patients of bronchitis after 4 weeks of yoga therapy that smaller but still significant improvement in the other
used a variety of postures and breathing techniques [60]. [45].
Yogic cleaning techniques such as dhautikriya (upper
gastrointestinal cleaning with warm saline or muslin Musculoskeletal Conditions
cloth) and netikriya (warm saline nasal wash) remove A review by Posadzki, et al.[ 74] found that 10 of 11
excessive mucous secretions, decrease inflammation RCTs reported significantly greater effects in favor of
and reduce bronchial hypersensitivity thereby increas- Yoga when compared to standard care, self-care, thera-
ing provocation threshold while kapalabhati through peutic exercises, relaxing yoga, touch and manipulation,
forceful exhalations improves the capacity to exhale or no intervention. Yoga was more effective for chronic
against resistance [61]. A nonspecific broncho protec- back pain than the control interventions such as usual
tive or broncho relaxing effect has been also postulated care or conventional therapeutic exercises though some
[62] while improved exercise tolerance has been re- studies showed no between group differences [75]. Re-
ported following yoga therapy in patients of chronic cently two well-designed trials of yoga for back pain
severe airways obstruction [63]. It has been reported reported clinically meaningful benefits over usual med-
that well-performed slow yogic breathing maintains
better blood oxygenation without increasing minute

ical care but not over an intensive stretching interven- and videos on yoga during pregnancy may contribute to
tion [76, 77]. a reduction in pregnancy discomforts and improved
childbirth self-efficacy. Satyapriya, et al. concluded
Cancer that yoga reduces perceived stress and improves adap-
According to the findings of a comprehensive meta- tive autonomic response to stress in healthy pregnant
analysis of yoga in cancer, yoga groups showed im- women [84] while Chuntharapat, et al. [85] concluded
provements in psychological health when compared to that yoga produced higher levels of maternal comfort
waitlist or supportive therapy groups [78]. With respect during labour and 2 hour post-labour with a decrease in
to overall quality of life, there was a trend towards im- subject evaluated labour pain. They also reported short-
provement. To explain the positive outcomes, Smith er duration of the first stage of labour, as well as total
and Pukall suggested various complex pathways which time of labour in subjects practicing yoga. A study by
may involve relaxation, coping strategies, acceptance, Narendran, et al. reported a lower trend in the occur-
and self-efficacy [79]. Kochupillai, et al. reported in- rence of complications of pregnancy such as pregnan-
crease in natural killer cells in cancer patients who had cy-induced hypertension, intrauterine growth retarda-
completed their standard therapy after practicing Sudar- tion and pre-term delivery in subjects who practiced
shan Kriya Yoga and pranayam breathing techniques yoga [86]. They concluded that an integrated approach
[80]. A systematic review and meta-analysis of RCTs to yoga during pregnancy is safe and that it improved
on the physical and psychosocial benefits of yoga in birth weight, decreased preterm labour, and reduced
cancer patients and survivors by Buffart and colleagues IUGR either in isolation or associated with PIH, with
concluded that yoga may be a feasible intervention as no increased complications.
beneficial effects on several physical and psychosocial
symptoms were reported [81]. They showed that it has Paediatric Population
strong beneficial effects on distress, anxiety and de- Clinical applications of Yoga have been studied in pae-
pression, moderate effects on fatigue, general HRQoL, diatric and young adult populations with focus on phys-
emotional function and social function, small effects on ical fitness, cardio-respiratory effects, mental health,
functional well-being, and no significant effects on behaviour and development, irritable bowel syndrome,
physical function and sleep disturbances. It was sug- eating disorders, and prenatal effects on birth outcomes.
gested that yoga can be an appropriate form of exercise Though a large majority of studies are positive, due to
for cancer patients and survivors who are unable or methodological limitations, evidence provided is still in
unwilling to participate in other traditional aerobic or its infancy [87]. Yoga has been suggested as an option
resistance exercise programs. for children to increase physical activity and fitness and
that yoga may be a gateway for adopting a healthy ac-
Pregnancy tive lifestyle in sedentary children who are intimidated
Preliminary evidence from various scientific studies by more vigorous forms of exercise. They recommend-
supports yoga's potential efficacy, particularly if started ed that further research is necessary to identify clinical
early in the pregnancy. Women practicing yoga in their applications of yoga for children and that such research
second trimester reported significant reductions in needs to be conducted with rigorous methodology in
physical pain from baseline to post intervention com- RCTs with detailed description of protocols and report-
pared with women in the third trimester whose pain ing of results. Methodological issues specific to mind-
increased [82]. Women in their third trimester showed body interventions should be addressed including ade-
greater reductions in perceived stress and trait anxiety. quate description of the intervention and control group,
Another study reported significantly fewer pregnancy and single blinding of the outcome assessor. A review
discomforts at 38‒40 weeks of gestation [83]. Subjects by Galantino, et al. concluded that “the evidence shows
who participated in the yoga programme exhibited physiological benefits of yoga for the paediatric popu-
higher outcome and self-efficacy expectancies during lation that may benefit children through the rehabilita-
active and second stage of labour. Provision of booklets tion process, but larger clinical trials, including specific
measures of QOL are necessary to provide definitive

evidence” [88]. They rightly suggested that the type 7. It is not clear which patients may benefit from the mind-
and intensity of yoga, the specific postures for the in- body interventions, and which aspects of the interven-
tended outcome, and the measurement of adherence tions or which specific styles were more effective than
others.
beyond the clinic have to be determined. Their review It has been suggested that yoga may help improve
showed that yoga may benefit children with mental patient self-efficacy, self-competence, physical fitness,
challenges by improving their mental ability, along and group support, and may well be effective as a sup-
with motor coordination and social skills and that resto- portive adjunct to mitigate medical conditions. Büssing,
ration of some degree of functional ability is possible in et al. concluded that yoga may have potential to be im-
those having physical disabilities. It was suggested that plemented as a safe and beneficial supportive/adjunct
physical therapists might apply these findings in the treatment that is relatively cost-effective, may be prac-
neuromuscular areas of learning, motor control, and ticed at least in part as a self-care behavioral treatment,
coordination. A notable point mentioned by them was provides a life-long behavioral skill, enhances self-
that, “Regardless of the goal, yoga appears to be a mul- efficacy and self-confidence, and is often associated
titasking modality that simultaneously treats both phys- with additional positive side effects [89].
ical impairments as well as more global issues such as It is important to develop objective measures of vari-
stress, anxiety, or hyperactivity.” ous mind-body therapies and their techniques while
including them in intervention trials. It has also been
Conclusion suggested that the publication of specific interventions
All of the above studies and reviews suggest a number used in future studies in manual form can allow reliable
of areas where mind-body therapies such as yoga may replication and future implementation. It is also im-
be beneficial, but more research is required for virtually portant to develop tools to monitor objectively the par-
every one of them to establish their benefits conclusive- ticipants’ self-practice, compliance, and adherence to
ly. This is true in the process of introducing any new the interventions. Yoga has preventive, promotive as
therapy into the modern health care system and is not well as curative potential and a yogic lifestyle confers
surprising when we realize that the proper studies on many advantages to the practitioner. Since lifestyle
yoga as a therapeutic modality are not older than a few related diseases are alarmingly on the rise in our mod-
decades. ern society, yogic lifestyle should be given a special
place in preventing and managing these diseases.
Some of the major issues highlighted by these studies
and reviews include:
1. Individual studies on yoga for various conditions are Disclosure
small There are no conflicts of interest.
2. Poor-quality trials in general with multiple instances for
bias
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lf~.~~<WT
~~~-~O~~ National Yoga Week-2015
Yoga for Middle Aged
ROLE OF YOGA IN NON-COMMUNICABLE DISEASES: A BRIEF REVIEW.

Yogacharya Dr Ananda Balayogi Bhavanani
Director, leYER, Puduchery
INTRODUCTION a path breaking effort covering comprehensively all

aspects of yoga as a holistic therapy.
Yoga as a mode of therapy (yoga chikitsa) has become
extremely popular, and a great number of studies and The need of the hour is for a symbiotic relationship
systematic reviews offer scientific evidence of its between yoga and modern science. To satisfy this need,
potential in treating a wide range of psychosomatic living, human bridges combining the best of both worlds
conditions. Yoga understands health and well-being as a need to be cultivated. It is important that more dedicated
dynamic continuum of human nature and not merely a scientists take up yoga and that more yogis study
'state' to be reached and maintained. Yoga helps the science, so that we can build a bridge between these two
individual to establish "sukha sthanam", which may be great evolutionary aspects of our civilization. The
defined as a dynamic sense of physical, mental, and process as well as the goal of yoga is all about becoming
spiritual well-being. Yogamaharishi Dr. Swami "one" with an integrated state of being. (4)
Gitananda Giri Guru Maharaj, the visionary founder of
PROMOTES POSITIVE HEALTH
Ananda Ashram at the leYER, Pondicherry
(www.icyer.com) and one of the foremost authorities on Healthy life can be considered as a by-product of
Yoga in the past century exclaimed lucidly, "Yoga chikitsa practicing yogic techniques since it has been observed
is virtually as old as yoga itself, indeed, the return of mind that Yoga practitioners are physically and mentally
that feels separated from the Universe in which it exists healthier and have better coping skills to stressors than
represents the first yoga therapy. Yoga chikitsa could be the normal population. Knowledge of inexpensive,
termed as man's first attempt at unitive understanding of effective and easily administrable yogic techniques by
mind-emotions-physical distress and is the .oldest health professionals will go a long way in helping us
wholistic concept and therapy in the world." (1) achieve the goal of the World Health Organisation to
provide "physical, mental, spiritual and social health" for
To achieve this yogic integration at all levels of our being,
all sections of human society.
it is essential that we take into consideration the all
- encompassing multi dimensional aspects of yoga that Some of the important documented health
include the followi~g: a healthy life-nourishing diet, a promoting benefits of mind-body practices such as
healthy and natural environment, a wholistic lifestyle, yoga and meditation include:
adequate bodywork through asana, mudra-bandha and 1. Improvement in cardio-respirato_ry efficiency (5-8)
kriya, invigorating breath work through pranayama and

2. Improvement in exercise tolerance (iJ-12)
the cultivation of a healthy thought process through

3. Harmonious balance of autonomic function (13-16)
jnana yoga and raja yoga.
4. Improvement in dexterity, strength, steadiness,
The International Association of Yoga Therapists (IAYT), stamina, flexibility, endurance, and neuro-musculo-
USA has taken this idea into account in defining Yoga skeletal coordination (9,17-22)
therapy as follows'": "Yoga therapy is the process of 5. Increase in alpha rhythm, inter-hemispheric
empowering individuals to progress toward improved coherence and homogeneity in the brain (23-26)
health and well-being through the application of the
6, Improved sleep quality (27)
philosophy and practice of yoga." This has been further
7. Improved cognitive functions (5,28-34)
elabourated by the IAYT in its "Recommended
"Educational Standards for the Training of Yoga 8. Alteration in brain blood flow and brain
metabolism (35-38)
Therapists", published on 1 July, 2012. (3) This is one of
the best documents on standards in yoga therapy and is 9. Modulation ofthe neuro-endocrine axis (39-44)
~ Morarji Desai National Institute of Yoga 21st June -International Day of Yoga 53
\"-~-
National Yoga Week-2015
ll~ • cfi ~ t:iPr ~ '4rr ~-~o'!(
Fig1. POSSIBLE FACTORS RESPONSIBLE FOR PHYSICAL PERFORMANCE IMPROVEMENT BY YOGA
/1__ -
CIU'dJo.r·'.Utarol1l'tsfn·,.
LocaJIDQ.lC'Ubo' A4lap~h
t pb,.a.J~(aI fallc1ioD.f
l
»:
Ray US, Pathak A, Tomer as. Hatha Yoga Practices: Energy Expenditure, Respiratory Changes and
Intensity of Exercise. Evid Based Complement Alternat Med. 2011; 2011: 241294.
We can say that the Yoga affects every cell of the human produced by a life of yoga percolates down through the
body bringing about better neuro-effector different levels of our existence from the higher to the
communication, improve strength, and enhance lower levels producing health and wellbeing of a holistic
optimum functioning of all organ-systems while nature. Streeter et al recently proposed a theory to
»:
increasing resistance against stress and diseases with explain the benefits of yoga practices in diverse,
resultant tranquillity, balance, positive attitude and frequently co-morbid medical conditions based on the
equanimity. concept that yoga practices reduce allostatic load in
stress response systems so that optimal homeostasis is
MANAGING STRESS
restored. (46)
It is well established that stress weakens our immune
They hypothesized that stress produces an:
system. Scientific research in recent times has shown
that the physiological, psychological and biochemical Imbalance of the autonomic nervous system with
effects of yoga are of an anti-stress nature. A majority of decreased parasympathetic and increased
studies have described beneficial effects of yoga sympathetic activity,
interventions in stress with an Agency for Healthcare
Under activity of the gamma amino-butyric acid
Research and Quality (AHRQ) report stating that "Yoga
(GABA) system, the primary inhibitory
helped reduce stress."?" Reductions in perceived stress
neurotransmitter system, and
following yoga are reported to be as effective as
therapies such as relaxation, cognitive behavioural Increased allostatic load.
therapy and dance therapy. They further hypothesized that yoga-based practices i)
Mechanisms postulated include the restoration of correct under activity of the parasympathetic nervous
autonomic balance as well as an improvement in system and GABA systems in part through stimulation of
restorative, regenerative and rehabilitative capacities of the vagus nerves, the main peripheral pathway of the
the individual. A healthy inner sense of wellbeing parasympathetic nervous system, and ii) reduce
allostatic load.
54 218t June -InternatlonalDay otYoga Morarji Desai National Institute of Yoga ~

--
+fur ~ cf? ~ ~
~~~-~oC)~ National Yoga Week-2015
According to the theory proposed by them, decreased yoga in cardiac health concluded that it can be beneficial
parasympathetic nervous system and GABAergic in the primary and secondary prevention of
activity that underlies stress-related disorders can be cardiovascular disease and that it can playa primary or a
corrected by yoga practices resulting in amelioration of complementary role in this regard. (54)
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
RESPIRATORY DISORDERS
Scientific basis of using yoga as an adjunct therapy in

behind such potential autonomic balancing effects of chronic obstructive pulmonary diseases is well
yoga. (47) Innes et al had earlier postulated two established with Significant improvements in lung
interconnected pathways by which yoga reduces the risk function, quality of life indices and bronchial provocation
of cardiovascular diseases through the mechanisms of responses coupled with decreased need for regular and
parasympathetic activation coupled with decreased rescue medicinal usage. (55.56) Behera reported perceptible
reactivity of sympathoadrenal system and HPAaxis. (48) improvement in dyspnea and lung function in patients of
bronchitis after 4 weeks of yoga therapy that used a
It is notable that one of the newer applications of yoga
variety of postures and breathing techniques. (57)Yogic
has been in managing the aftermaths of natural
cleaning techniques such as dhautikriya (upper
disasters. Studies have shown that yoga significantly
gastrointestinal cleaning with warm saline or muslin
reduces symptoms of posttraumatic stress disorder
cloth) and netikriya (warm saline nasal wash) remove
(PTSD), self-rated symptoms of stress (fear, anxiety,
excessive mucous secretions, decrease inflammation
.",- disturbed sleep, and sadness) and respiration rate. (49)
and reduce bronchial hypersensitivity thereby increasing
CARDIOVASCULAR CONDITIONS provocation threshold while kapalabhati through forceful
exhalations improves the capacity to exhale against
Many studies have tried to explore the mechanisms by
resistance.?" A nonspecific broncho protective or
which yoga modifies coronary artery disease risk factors.
broncho relaxing effect has been also postulated?" while
--- Manchanda et al (SO), Ornish et al (51)and Yogendra et al (52)

have conducted prospective, randomized and controlled
trials on angiographically proven coronary artery disease
improved exercise tolerance has been reported following
yoga therapy in patients of chronic severe airways
obstruction. (60)It has been reported that well-performed
patients with yoga intervention and demonstrated that
yoga based lifestyle modification helps in regression of slow yogic breathing maintains better blood oxygenation
coronary lesions and improvement in myocardial without increasing minute ventilation, reduces
perfusion. The effect of yogic lifestyle on some of the sympathetic activation during altitude-induced hypoxia
modifiable risk factors could probably explain the (61)and decreased chemoreflex sensitivity to hypoxia and
preventive and .therapeutic beneficial effect observed in hypercapnia (62).These help bring about both objective
- coronary artery disease.
A review of 70 eligible studies investigating the effects of

and subjective improvem~nts in the condition of patients
with bronchitis. Yoga as a therapy is also cost effective,
relatively simple and carries minimal risk and hence
yoga on risk indices associated with the insulin
should be advocated as an adjunct, complementary
resistance syndrome, cardiovascular disease, and
therapy in our search for an integrated system of
possible protection with yoga, reported that most had a
medicine capable of producing health and wellbeing for
reduction of systolic and/or diastolic pressure. However, all.
the reviewers also noted that there were several noted
potential biases and limitations that made it difficult to METABOLIC/ENDOCRINE CONDITIONS
detect an effect specific to yoga. (48)Another literature A few RCTs have suggested that yoga and meditation
review reported significant improvements in overall practices act on the hypothalamic-pituitary-adrenal axis
cardiovascular endurance of young subjects who were (HPA) axis to reduce cortisol levels in plasma, (63-66)as
well
given varying periods of yoga training. (53)
Physical fitness as reduce sympathetic nervous system tone, increase
increased as compared to other forms of exercise and vagal activity, (67.68)
and elevate brain GABAlevels. (69)
longer duration of yoga practice produced better
Major systematic reviews of the effects of yoga on risk
cardiopulmonary endurance. In fact a detailed review of
indices associated with insulin resistance syndrome and
~ Morarji Desai National Institute of Yoga 21st June - International Day of Yoga 55
National Yoga Week-2015
l1Uf.~~~
~ "4rT ~-~o,~
Fig. 2. POSTULATED MECHANISMS BY WHICH YOGA CAN HELP REDUCE RISK FOR
TYPE 2 DIABETES MELLITUS AND ITS COMPLICATIONS
Vagal
stimulation
Yoga Interveunon:
Pathway 2 ---+ ~
-.
Parasympathenc
-,
Yoga tntervennou:
«
activation
Pathway 1
• .j. Perceived stress

.l. Activatioufrfilcti"itv ~ ~ J, Inflammatory cytokines
of sympathondrenal .!. Heal t I ate. blood prl'Ssnrf'
"~~
I
Eniumced metatrottc
psychological profile
t Insulin sensitivity
i Glucolle tolerance
Improved Upid pr oflie
an«
u
Improved coagulation
f fibrinolytic profile
.!. Oxidative stress
-----
J, Visceral adiposity i Endothelial function
Improved mood
)) ()
Reduced rtsk for:
Type 2 diabetes and compllcatious of
'!YIlt 2 Diabetes
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.
risk profiles in adults with type 2 diabetes have been MUSCULOSKELETAL CONDITIONS
done in recent times. (48:0)
They reported post-intervention
A review by Posadzki et al (73)found that 10 of 11 RCTs
improvement in various indices but with results varying
reported significantly greater effects in favor of Yoga
by population and study design. Another systematic
when compared to standard care, self-care, therapeutic
review addressed the management of type 2 diabetes
exercises, relaxing yoga, touch and manipulation, or no
and concluded that the reviewed trials suggest
intervention. Yoga was more effective for chronic back,
favourable effects of yoga on short-term parameters
pain than the control interventions such as usual care or
related to diabetes but not necessarily for long-term
conventional therapeutic exercises though some studies
outcome.?" The AHRQ cites two studies comparing yoga
showed no between group differences.'?" Recently two
versus medication which reported a large and significant
well-designed trials of yoga for back pain reported
reduction of fasting glucose in individuals with type 2
clinically meaningful benefits over usual medical care but
diabetes in one, and a smaller but still significant
not over an intensive stretching intervention. (75,76)
improvement in the other. (45)
CANCER
A recent systematic review of yoga on menopausal
-. symptoms reported small effects on psychological According to the findings of a comprehensive meta-
analysis of role of yoga in cancer, improvements in
symptoms with no effects on total menopausal
symptoms, somatic symptoms, vasomotor symptoms, or psychological health were seen in yoga groups when
urogenital symptoms. (72) compared to waitlist or supportive therapy groups,(77)With
56 . 21st June -International Day of Yoga Morarji Desai National Institute of Yoga ~
l1Uf. ~ fWz ~
\$~~-~oC)~ National Yoga Week-2015
respect to overall quality of life, there was a trend towards that requires active efforts from both the researcher
improvement. To explain the positive outcomes, Smith as well as the participants.
and Pukall suggested various complex pathways which 6. Changes in attitudes and behavior need to be
may involve relaxation, coping strategies, acceptance, documented and understood better, especially in
and self-efficacy. (78) Kochupillai et al reported increase in the lifestyle, stress induced psychosomatic
natural killer cells in cancer patients who had completed conditions.
their standard therapy after practicing Sudarshan Kriya
7. It is not clear which patients may benefit from the
Yoga and pranayam breathing techniques. (79)
Yogic interventions, and which aspects' of the
A systematic review and meta-analysis of RCTs on the interventions or which specific styles were more
physical and psychosocial benefits of yoga in cancer effective than others.
patients and survivors by Buffart and colleagues It has been suggested that yoga may help improve
concluded that yoga may be a feasible intervention as patient self-efficacy, self-competence, physical fitness,
beneficial effects on several physical and psychosocial and group support, and may well be effective as a
symptoms were reported. (80) They showed that it has supportive adjunct to mitigate medical conditions.
strong beneficial effects on distress, anxiety and Bussing et al concluded that yoga may have potential to
depression, moderate effects on fatigue, general be implemented as a safe and beneficial
-- HRQoL, emotional function and social function, small

effects on functional well-being, and no significant effects
on physical function and sleep disturbances. It was
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
suggested that yoga can be an appropriate form of skill, enhances self-efficacy and self-confidence, and is
exercise for cancer patients and survivors who are often associated with additional positive side effects. (81)
unable or unwilling to participate in other traditional
aerobic or resistance exercise programs. It is important to develop objective measures of various
mind-body therapies and their techniques while including
IN CONCLUSION them in intervention trials. It has also been suggested
All of the above studies and reviews suggest a number of that the publication of specific interventions used in
areas where mind-body therapies such as yoga may be future studies in manual form can allow reliable
beneficial, but more research is required for virtually replication and future implementation. It is also important
every one of them to establish their benefits conclusively. to develop tools to monitor objectively the participants'
This is true in the process of introducing any new therapy self-practice, compliance, and adherence to the
into the modern health care system and is not surprising interventions. Yoga has preventive, promotive as well as
when we realize that the proper studies on yoga as a curative potential and a yogic lifestyle confers many
therapeutic modality are not older than a few decades. advantages to the practitioner. Since lifestyle related
diseases are alarmingly 011 the rise in our modern
....-- Some of the major issues highlighted by these studies
and reviews include:
society, yogic lifestyle should be given a special place in
preventing and managing these diseases.
1. Individual studies on yoga for various conditions are
As suggested by Bussing et ai, ."Yoga may well be
small
effective as a supportive adjunct to mitigate some
2. Poor-quality trials in general with multiple instances medical conditions, but not yet a proven stand-alone,
for bias curative treatment. Larger-scale and more rigorous
3. Substantial heterogeneity with regards to the research with higher methodological quality and
populations studied, yoga interventions, duration adequate control interventions is highly encouraged
and frequency of yoga practice, comparison groups, because yoga may have potential to be implemented as
and outcome measures. a beneficial supportive/adjunct treatment that is relatively
4. Compliance was not routinely noted, thus cost-effective, may be practiced at least in part as a self-
preventing an understanding of the apt 'dosage' care behavioural treatment, provides a life-long
requirements with regard to the mind-body behavioural skill, enhances self-efficacy and self-
interventions confidence and is often associated with additional
positive side effects"?"
5. Yoga requires active participation and motivation
~ Morarji Desai National Institute of Yoga 21st June -International Day of Yoga 57
National Yoga Week-2015 ~~~-~o,~
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~ -Morarji Desai National Institute of Yoga 21'~tJune -Jfiternatlonal Day"'of'Yoga I 59

, -
11~ ~ cfi ~ $I
National Yoga Week-2015 ~~~-~o~!c
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-
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---
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60· 21st June -International Day of Yoga Morarji Desai National Institute of Yoga ~
80 | Yoga for Harmony & Peace
POTENTIAL OF YOGA AS A THERAPY
Yogacharya Dr Ananda Balayogi Bhavanani,

MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY, MD(Alt.Med)
Deputy Director, CYTER, MGMCRI and Chairman ICYER, Puducherry
yoga@mgmcri.ac.in www.icyer.com
Introduction
In modern times when the terms Yoga and Yoga therapy have become synonymous, this paper is but a
small attempt to put into perspective what Yoga therapy can offer us as an integrative system of wholistic
well being.
According to Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj, the founder of Ananda Ashram
at ICYER, Pondicherry and one of the foremost authorities on Yoga in the past century,
“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 “man’s first attempt at Unitive understanding of mind-emotions-physical distress and is
the oldest wholistic concept and therapy in the world.”
Some Principles Of Yoga Therapy
• Become aware of your body, emotions and mind

• Improve your dietary habits
• Relax your whole body from toes to head
• Slow down your breath by making it quiet and deep
• Calm down your mind and focus it inwardly
• Improve the flow of Healing Pranic Life Energy to all parts of your body, especially to those
diseased parts, thus relaxing, regenerating and reinvigorating yourself
• Decrease your stress level by fortifying yourself against the various omnipresent stressors in your life
• Increase your self reliance and self confidence
• Facilitate the natural emanation of waste from your body by the practice of Yoga Shuddi Kriyas
such as Dhauti, Basti and Neti.
• Remember that ultimately it is “YOU” who are responsible for your health and well being and
must take the initiative to develop positive health to tide you over challenging times of ill health.
• Health and happiness are your birthright, claim them and develop them to your maximum
potential.
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. These include the psychosomatic and
stress disorders such as bronchial asthma, diabetes mellitus, hypertension, irritable bowel syndrome,
gastro intestinal ulcer diseases, atherosclerosis, seizure disorder (epilepsy) and headache. It also includes
INTERNATIONAL DAY OF YOGA CELEBRATIONS 2015

Yoga for Harmony & Peace | 81
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, obesity and the modern metabolic syndrome.
Therapeutic Modalities of Yoga Therapy
1. Physical therapies: Asanas, Kriyas, Mudras and Bandhas gently stretch and strengthen muscles, improve
mobility, flexibility, respiration, circulation, digestion and elimination, and promote a general sense of health
and well being.
2. Emotional therapies: Swadhyaya, Pranayama, Pratyahara, Dharana, Dhyana and Bhajana can calm and centre
the mind, helping to relieve stress and mental fatigue and bring about emotional balance.
3. Development of proper psychological attitudes: By encouraging us to step back and look objectively at our
habitual patterns of behaviour and thoughts, Yoga can help us to cope better with situations that put our
bodies and minds under strain. Development of the following qualities are also emphasized in order to
become mentally balanced humane beings: Vairagya (detached, dispassionate attitude), Chitta Prasadann
(acceptance of the Divine Will), Maitri (friendliness towards the happy), Karuna (compassion for the
suffering), Mudita (cheerfulness towards the virtuous) and Upekshanam (indifference and avoidance of
the evil) etc.
4. Mental therapies: Relaxation and visualization practices, Trataka, Pranayama, Pratyahara, Dharana as well
as Dhyana. Relaxation is a central element in Yoga therapy as relaxation is the body’s way of recharging its
cells and helps to ease physical, emotional and mental tensions.
5. Spiritual therapies: Swadhyaya, Satsangha, Bhajana sessions and Yogic counseling are important aspects of
Yogic therapy that are often neglected in favour of the physical therapies alone.
6. Preventive therapies: Yoga has numerous preventive benefits especially when it is started early in childhood.
It helps in the prevention of accidents by increasing awareness as well as agility. Improved immunity helps
I preventing infectious and contagious diseases. The added benefit of starting early is that the person knows
the technique so that they can do it if needed at a later stage in life. Yoga also offers rehabilitative therapies
for most musculoskeletal conditions as well as in recovery for debilitating illnesses. The practice of Yoga also
goes a long way towards prevention of disability and improving quality of life in numerous chronic conditions.
7. Pain relief therapies: Yoga is a useful addition to the pain relief therapies as it increases pain tolerance and
provides an improved quality of life. It can be safely said that Yoga helps us endure conditions that it may
not be able to cure.
Integrated Approach of Yoga Therapy
In Yoga therapy it is vital that we take into consideration all of the following aspects that are part of an
integrated approach to the problem. These include 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 and Raja Yoga.
The application of Yoga therapy can be correlated with the Pancha Koshas and various Yoga practices
may be used as therapeutic interventions at different levels in this respect.
• Annamaya Kosha (anatomical level): Jattis (simple units of movements), Mudras (gestures
for energy generation and conservation), Kriyas (structured movements), Asanas (steady and
comfortable postures) along with the dietary modifications and control.
• Pranamaya Kosha (physiological level): Shat Karmas (cleansing actions), various Pranayamas,
development of breath awareness, working on breath-movement coordination and the energizing
and balancing of the Pranic energy.
• Manomaya Kosha (psychological level): Trataka (concentrated gaze), Dharana (concentration),

Dhyana (meditation), Japa and Japa-Ajapa practices are useful. Various aspects of concentration
such as the Mandala Dharana and other Yoga Drishti techniques are available for this purpose.
• Vijnanamaya Kosha (intellectual level): Swadhyaya (self analysis), Satsangha (lectures and
spiritually uplifting exchange) along with the wonderful Jnana Yoga and Raja Yoga relaxation
and concentration practices of Yoga.
• Anandamaya Kosha (universal level): Learning to implement the principles of Karma Yoga
(Yoga as skilled action performed without expectation) and following the principle of action in
relaxation help us to bring about joy in all our activities. A realization that we live in a blissful
universe and that all life is joy is to be brought about in this intervention through use of Bhakti
Yoga, Karma Yoga and other aspects like Bhajana, Yogic counselling and Satsangha.
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 life style 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 then 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
Yoga helps us regain the ease we had lost through dis-ease (as implied by sthira sukham asanam). It
also produces mental equanimity (samatvam Yoga uchyate) where the opposites cease to affect (tato
dwandwa anabhigatha). 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.
Recommended Reading
• Yoga: Step by step by Dr Swami Gitananda Giri

• The science of Yoga by IK Taimni
• Asana, Pranayama, Mudra, Bandha by Swami Satyananada
• Yoga its basis and applications by Dr HR Nagendra
• Yoga for health by Dr HR Nagendra and Dr H Nagarathna
• Yoga chikitsa by Dr Ananda Balayogi Bhavanani
• Yoga for health and healing by Dr Ananda Balayogi Bhavanani
• A primer of Yoga theory by Dr Ananda Balayogi Bhavanani
• www.icyer.com
• www.iayt.org
YOGA PRACTICES FOR PREVENTION AND MANAGEMENT OF PSYCHOSOMATIC

STRESS DISORDERS
Yogachemmal Dr.Meena Ramanathan1 & Yogacharya Dr. Ananda Balayogi Bhavanani2
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.
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 corporate companies 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 deep breaths and you will immediately feel the difference.
1 MA, MSc, PhD., Cordinator-cum-Yoga Therapist, CYTER, MGMCRI and Yoganjali Natyalayam,
Pondicherry. http://sbvu.ac.in/cyter-center-for-yoga-therapy-education-and-research
2 Deputy Director, CYTER, MGMCRI and Chairman ICYER at Ananda Ashram, Pondicherry.
www.icyer.com and www.rishiculture.org

6. Attitude: It is important to “Let things lie” for some time 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 Practices
Jattis 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.
Rishikesh Surya Namaskar
Rishikesh 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 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
Tala 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 Kriya
Stand 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 Asana
Stand 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 Asana
Sit 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 Asana
Sit 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 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 Pranayama
Take 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 Mudra
To 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 Asana
Lie 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 Asana
From 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 Asana
From 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 Asana
Lie 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 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 Pranayama
Lie 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 Kriya
The 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 PRACTICES
Nasarga Mukha Bhastrika
Nasarga 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 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. 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.
Pranava Pranayama
‘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.
Chandra Pranayama
Sit 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.
Bhramari Pranayama
Sit 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 PRACTICES
Prana Dharana -Breath Awareness: 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.
Mindfulness Based Meditation: 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.
Om Japa: 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.
National Conference on Chronobiology and Health
Nasal cycle and its therapeutic applications: a yogic perspective
Yogacharya Dr Ananda Balayogi Bhavanani. MBBS, MD (AM).

Deputy Director,
Sri Balaji Vidyapeeth University,
MGMC&RI Campus, Pondicherry.
YogachemmalDr Meena Ramanathan. PhD (Yoga).

Coordinator-cum-Yoga therapist,
Sri Balaji Vidyapeeth University,
MGMC&RI Campus, Pondicherry.
Introduction: The nasal cycle is an ultradian rhythm of nasal congestion and

decongestion with a quasi-periodicity of 60 to 240 minutes.(1) Keyser made the first
formal description and the use of the term nasal cycle in 1895.(2) However the concept
of the nasal cycle and an understanding of its role in our life had existed for long in
Indian thought. The Vedic science of understanding the function of the nasal cycle
was known as SwarodayaVigjnan (swara = sonorous sound produced by the airflow
through the nostrils in the nasal cycle, udaya = functioning state, and vigjnan =
knowledge).(3) The Shivaswarodaya, an ancient treatise in Sanskrit literature advises
the Yogi to undertake quieter, passive activities (soumyakarya) when the left nostril
flow is dominant (ida / chandraswara), to engage in challenging and exertional
activities (roudrakarya) when right nostril is dominant (pingala / suryaswara) and to
relax or meditate when the bilateral nasal flow is operational (sushumnaswara) as it
was considered to be unsuitable for performance of worldly activities. Ida swara (left
nostril dominance) was described as feminine, Shakti and moon-like (chandra) while
the pingalaswara (right nostril dominance) was described as masculine, Shiva and
sun-like (surya). Traditional Indian description of Ardhanarishwara consists
of Shakti (the female element) being depicted on the left and Shiva (the male element)
on the right side of the body. Such a notion of left-right, female-male duality was
common in oriental traditional medicine as also in western alchemy. (1)
Postulated mechanisms: Various mechanisms were postulated for the occurrence of

the nasal cycle and a great amount of research work has been done in this field. It has
been seen that the use of Yoga Danda (T-shaped wooden implement used by
the Yogis to regulate differential breathing patterns), pressure of a crutch in the axilla,
26
pressure on the thorax while sitting and also the act of lying down on the side, can
affect pattern of nasal dominance. (4-7)The nasal cycle is dependent upon the tonic
activity of the limbic autonomic nervous system, the levels of circulating
catecholamines and other neuro-hormones. Nasal congestion correlates with low
sympathetic-high parasympathetic activity whereas decongestion is directly related
to high sympathetic-low parasympathetic activity mode.(8) Compression of the hemi
thorax from any surface lateral, anterior, posterior or superior leads to congestion of
the ipsilateral nostril with simultaneous decongestion of the opposite nostril. (9) Eccles
proposed that the hypothalamus was the centre for the sympathetic effects on the
nasal mucosa and the nasal cycle.(10)
Therapeutic applications: A group of pranayama, namely chandra and suryanadi

(CN and SN, respectively) and chandrabhedana and suryabhedana (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 nadishuddhi (NS), a specific technique involving
alternate use of both nostrils in a specific pattern. 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.
(11)
These yogic UNB and ANB techniques have captured the imagination of researchers
worldwide and recent studies have reported their differential physiological and
psychological effects including effects on O2 consumption, metabolism and body
weight,(12) blood glucose,(11)involuntary blink rates(11) and intraocular pressure, (13) heart
rate (HR), stroke volume and end diastolic volume(14)as well as skin resistance, digit
pulse volume, and blood pressure (BP).(15)ANB (as done in NS pattern) has been
reported to rapidly alter cardiopulmonary responses and improve simple problem
solving. (16)Yogic breathing through right, left, or through both nostrils alternately
produce distinct autonomic changes: right UNB increased systolic pressure (SP) and
diastolic pressure (DP), whereas left UNB resulted in significant reduction in SP and
mean pressure (MP).(17)
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. (11) 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. (18)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.
27
Research studies at CYTER: Our studies at CYTER have demonstrated that right and
left yogic UNB and ANB techniques have differential physiological effects.(19-21) 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 pingalaswara) is
activatory in nature, whereas the flow through left nostril (chandranadi and idaswara)
is relaxatory. 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.
References:
1. Bhavanani AB. Swarodayavigjnan. A scientific study of the nasal cycle. Yoga Mimamsa.2007; 39: 32–38.
2. Kayser R. Die exakteMessung der Luftdurchgängigkeit der Nase. Arch. Laryng. Rhinol (Berl.) 1895; 3: 101-210.
3. Giri R, Shankar G. Swara Yoga - an introduction and its applications. NisargopacharVarta 2001; 1: 18-20.
4. Rao S, Potdar A. Nasal airflow with body in various positions. J Appl Physiol 1970; 28:162-65.
5. Block RA, Arnott DP, Quigley B, Lynch WC. Unilateral nostril breathing influences lateralised cognitive
performance. Brain Cognit 1989; 9:181-90.
6. Davies AM, Eccles R. Reciprocal changes in nasal resistance to air flow caused by pressure applied to the axilla.
ActaOtolaryngol (Stockh) 1985; 99:154-59.
7. Mitti Mohan S. Reflex reversal of nostril dominance by application of pressure to the axilla by a crutch. Indian J of
8. Deshmukh VD. Limbic autonomic arousal: its physiological classification and review of the literature. Clinical
Electroencephalography 1991; 22: 46-60.
9. Singh V. Thoracic pressure and nasal patency. J Appl Physiol 1987; 62: 91-94.
10. Eccles R. The Central Rhythm of the Nasal Cycle. ActaOto-Laryngologica 1978; 86: 464-68.
11. 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.
12. Telles S, Nagarathna R, Nagendra HR. Breathing through a particular nostril can alter metabolism and autonomic
activities. Indian J Physiol Pharmacol 1994; 38: 133–37.
13. Mohan SM, Reddy SC, Wei LY. Modulation of intraocular pressure by unilateral and forced unilateral nostril
breathing in young healthy human subjects. IntOphthalmol 2001;24: 305–11.
14. Shannahoff-Khalsa DS, Kennedy B. The effects of unilateral forced nostril breathing on the heart. Int J Neurosci
1993; 73: 47–60.
15. Telles S, Nagarathna R, Nagendra HR. Physiological measures of right nostril breathing. J Altern Complement Med
1996; 2: 479–84.
16. 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–
16.
17. Raghuraj P, Telles S. Immediate effect of specific nostril manipulating yoga breathing practices on autonomic and
respiratory variables. ApplPsychophysiol Biofeedback 2008; 33: 65–75.
18. Kennedy B, Ziegler MG, Shannahoff-Khalsa DS. Alternating lateralization of plasma catecholamines and nasal
patency in humans. Life Sci 1986; 38: 1203–14.
19. 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.
20. Bhavanani AB, Ramanathan M, Madanmohan. Immediate effect of alternate nostril breathing on cardiovascular
parameters and reaction time. Online International Interdisciplinary Research Journal 2014; 4: 297-302.
21. Ramanathan M and Bhavanani AB. Immediate effect of chandra and suryanadipranayamas on cardiovascular
parameters and reaction time in a geriatric population. International Journal of Physiology 2014; 2: 59-63.
28
SMGr up Research Article
SM Journal of Yoga and Cardiovascular Health:

Cardiovascular Exploring Possible Benefits and
Disorders Postulated Mechanisms
Ananda Balayogi Bhavanani1*
Deputy Director, Centre for Yoga Therapy, Education and Research (CYTER), Mahatma Gandhi Medical
1
College and Research Institute (MGMCRI), India
Article Information Abstract
Received date: Apr 21, 2016 Background: Yoga as a mode of therapy has become extremely popular, and a great number of studies and
Accepted date: May 26, 2016 systematic reviews offer scientific evidence of its potential in treating a wide range of psychosomatic conditions.
Healthy life can be considered as a by-product of practicing yogic techniques since it has been observed that
Published date: Jun 05, 2016 yoga practitioners are physically and mentally healthier and have better coping skills to stressors than the normal
population.
Aims and objective: This review paper details some of the health promoting benefits of yoga with
Ananda Balayogi Bhavanani, Deputy regard to cardiovascular health and discusses mechanisms for such beneficial physiological, biochemical and
Director, Centre for Yoga Therapy, psychological effects. Psycho-neuro-endocrine changes including correction of Gamma Amino-Butyric Acid
(GABA) activity, and parasympathetic activation coupled with decreased reactivity of sympathoadrenal system
Education and Research (CYTER), and Hypothalamo-Pituitary-Adrenal (HPA) axis are highlighted.
Mahatma Gandhi Medical College and
Conclusion: Though most studies and reviews suggest a number of areas where yoga may be beneficial
Research Institute (MGMCRI), India; for cardiovascular health, more research is required to establish these benefits conclusively. It is important
Email: yognat@gmail.com to develop objective measures of various mind-body therapies and their techniques while including them in
intervention trials. In conclusion, we can say that yoga has preventive, promotive as well as curative potential as
Distributed under Creative Commons an adjunct therapy and that a yogic lifestyle confers many advantages to the practitioner.
CC-BY 4.0
Keywords Cardiovascular health; Introduction

Disease; Stress; Yoga Therapy
The popularity of yoga and its application as a therapy are increasing day by day all over the
world. Yoga maharishi Dr. Swami Gitananda Giri Guru Maharaj, the visionary founder of Ananda
Ashram at the International Centre for Yoga Education and Research (ICYER), Pondicherry, India
(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.” [1] Healthy 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 Organization to provide “physical,
mental, spiritual and social health” for all sections of human society.
When we recognize that cardiovascular disease is basically a lifestyle disorder, we realize
that the holistic science of yoga considered by many as the best life style has a definite role in its
prevention and management as well as rehabilitation [2]. Both modern medicine and yoga have
sound scientific basis and are, therefore, natural allies. The addition of yoga as an adjunct therapy
through integrative medicine enhances preventive, curative as well as rehabilitative potential of
both systems. The holistic action of yoga can be explained on the basis of its ability to modulate
autonomic functions, relieve stress, improve physiological functions including cardio-respiratory
fitness and improve quality of life
Research Findings
Many studies have tried to explore the mechanisms by which yoga modifies coronary artery
disease risk factors. Ornish et al [2], Manchanda et al [3] and Yogendra et al [4] 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.
How to cite this article Bhavanani AB. Yoga and Cardiovascular Health: Exploring
OPEN ACCESS Possible Benefits and Postulated Mechanisms. Sm J Cardiovasc Dis. 2016; 1(1):1003.
Manchanda et al reported that a yoga lifestyle retards progression Mechanisms postulated include the restoration of autonomic
/ increases regression of coronary atherosclerosis in severe coronary balance as well as an improvement in restorative, regenerative and
artery disease. [3] They also found that it improves symptomatic rehabilitative capacities of the individual. A healthy inner sense of
status, functional class and risk factor profile. Another study by wellbeing produced by a life of yoga percolates down through the
Bijlani et al concluded that even a short lifestyle modification and different levels of our existence from the higher to the lower levels
stress management education program could lead to favorable producing health and wellbeing of a holistic nature. Streeter et al
metabolic effects and reduces risk factors for cardiovascular disease recently proposed a theory to explain the benefits of yoga practices
and diabetes mellitus [5]. in diverse, frequently co-morbid medical conditions based on the
concept that yoga practices reduce allostatic load in stress response
Comprehensive reviews by Innes et al have suggested that yoga
systems so that optimal homeostasis is restored [12]
reduces the cardiovascular risk profile by decreasing activation
of sympatho-adrenal system and hypothalamic-pituitary-adrenal They hypothesized that stress produces an:
axis and also by promoting a feeling of wellbeing along with direct
• Imbalance of the autonomic nervous system with decreased
enhancement of parasympathetic activity [6-7]. They also suggested
parasympathetic and increased sympathetic activity,
that yoga provides a positive source of social support that may also
be one of the factors reducing risk for cardiovascular diseases. In • Under activity of the Gamma Amino-Butyric Acid (GABA)
fact all the studies reviewed by them suggested that yoga improves system, the primary inhibitory neurotransmitter system, and
lipid profile, and as this is an important risk factor for heart disease,
• Increased allostatic load.
such a possibility needs further exploration in greater detail. Their
2005 review covered 70 eligible studies investigating the effects of They further hypothesized that yoga-based practices i) correct
yoga on risk indices associated with the insulin resistance syndrome, under activity of the parasympathetic nervous system and GABA
cardiovascular disease, and possible protection with yoga, and they systems in part through stimulation of the vagus nerves, the main
reported that most had a reduction of systolic and/or diastolic peripheral pathway of the parasympathetic nervous system, and ii)
pressure [6]. They however also noted that there were several noted reduce allostatic load.
potential biases and limitations that made it difficult to detect an
According to the theory proposed by them, decreased
effect specific to yoga.
parasympathetic nervous system and GABA ergic activity that
The cardiovascular health promoting benefits of yoga have been underlies stress-related disorders can be corrected by yoga practices
studied in a literature review that reported significant improvements resulting in amelioration of disease symptoms. A review by Bhavanani
in overall cardiovascular endurance of young subjects who were concluded that Heart Rate Variability (HRV) testing has a great role
given varying periods of yoga training [8]. Physical fitness increased to play in our understanding of the intrinsic mechanisms behind
as compared to other forms of exercise and longer duration of yoga such potential autonomic balancing effects of yoga [13] Innes et al
practice produced better cardiopulmonary endurance. Another had earlier postulated two interconnected pathways by which yoga
detailed review of yoga in cardiac health concluded that yoga is reduces the risk of cardiovascular diseases through the mechanisms
beneficial in the primary and secondary prevention of cardiovascular of parasympathetic activation coupled with decreased reactivity
disease and that it can play a primary or a complementary role in this of sympathoadrenal system and Hypothalomo-Pituitary-Adrenal
regard [9]. (HPA) axis [6].
A recent retrospective review of clinical data to determine Possible Mechanisms
cardiovascular effects of a single yoga session in 1896 normal subjects
The BP lowering ability of yoga training has been documented by
as well as patients of different medical conditions at the Centre for
Patel and North, Datey et al., Sundar et al. and Vijayalakshmi et al.
Yoga Therapy, Education and Research (CYTER), in the Sri Balaji
[14-17]. Yoga training blunts exercise-induced increase in HR and
Vidyapeeth at Pondicherry, India showed healthy reductions in Heart
BP [18]. while shavasan in particular has been found to reduce load
Rate (HR), Blood Pressure (BP) and derived cardiovascular indices
on the heart by blunting sympathetic response [19]. Shavasan and
following a single yoga session. The magnitude of this reduction
pranayama have also been found to be beneficial in patients having
depended on the pre-existing medical condition as well as the yoga
premature ventricular complexes and palpitations [20]. Udupa et al.,
therapy protocol adopted. These changes were attributed to enhanced
[21]. Reported that pranayama training decreased basal sympathetic
harmony of cardiac autonomic function as a result of coordinated
tone, increased basal parasympathetic activity and decreased load on
breath-body work and mind-body relaxation due to yoga [10].
the heart and such breathing exercises and relaxation training have
Managing Stress been documented to have beneficial effects in patients with previous
myocardial infarction [22].
It is well established that stress weakens our immune system.
Scientific research in recent times has shown that the physiological, Mechanisms for these changes have been suggested to be via
psychological and biochemical effects of yoga are of an anti-stress improvement of baroreflex sensitivity and attenuation of sympathetic
nature. A majority of studies have described beneficial effects of yoga and rennin angiotensin activity following yoga training [23] Decreased
interventions in stress with an Agency for Healthcare Research and BP, drug score and risk factors such as blood glucose, cholesterol
Quality (AHRQ) report stating that “Yoga helped reduce stress” [11]. and triglycerides as well as overall improvement in subjective well
Reductions in perceived stress following yoga are reported to be as being and quality of life with reduced sympathetic activity and
effective as therapies such as relaxation, cognitive behavioral therapy oxidant stress are some of the mechanism suggested for positive
and dance therapy. health promoting changes. It has been reported that Yoga improves

Page 2/4
Conclusion
The majority of studies on yoga and cardiovascular health show
positive trends and this augurs well for the future of healthcare in
general and the use of yoga as part of integrative health care system
in particular. The major benefits of yoga may occur due to its lifestyle
components (healthy diet, activity, relaxation and positive attitude)
as well as the psychosomatic harmonizing effects of pranayama and
yogic relaxation. According to tradition, yoga implies both the process
as well as the attainment of a state of psychosomatic, harmony and
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 all short term and long term
studies.
Figure 1: A Summary of the Effects of Different Pranayamas in Hypertensives.
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5: 10-15.

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National Seminar & CME at SBV, Pondicherry 2016
INTEGRATING YOGA AND MODERN MEDICAL SCIENCE

Yogacharya Dr. Ananda Balayogi Bhavanani
MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY, MD (AM)
Introduction: 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.
At first glance, modern 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 endeavour as a student of both these life giving, life changing and
lifesaving 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 behaviour 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 World 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 leading to the
optimum wellbeing of the individual. Yoga also aims at the attainment of mental and
physical wellbeing 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 Shiva Samhita lists the
characters of a fully qualified disciple (shishya) as follows. “Endowed with great
Chairman ICYER and Deputy Director, CYTER, SBV, Puducherry.

www.sbvu.ac.in Email: yognat@gmail.com
48
Introducing Yoga in Health Professions Education
energy and enthusiasm, intelligent, heroic, learned in the scriptures, free from
delusion…” Doesn’t a modern medical scientist require the same qualities?
Anatomy and physiology: The study of anatomy and physiology is a great meeting
point for modern medicine and yoga. Yoga therapists and practitioners can benefit
from the intricate and detailed ‘break-down study’ of modern medicine where the
body is broken down into many systems, then into many organs, many tissues and
finally into billions of cells. On the other hand the yogic “ wholistic” view of the
pancha kosha (the five sheathed existence) can help modern doctors realise that we
are not just, ‘one-body’ organisms but have four more bodies that are equally if not
more important. We are a manifestation of the divine and have, not only the physical
body but also an energy body, a mental body, a body of wisdom and a body of eternal
bliss. An understanding of the psychic anatomy and physiology of nadis, chakras and
bindus when coupled with the practical understanding of the details of the physical
body can inspire real knowledge of the self in all health care personnel. Maharishi
Mahesh Yogi has tried to correlate 37 areas of human physiology with 37 areas of
intelligence or consciousness as available in Vedic literature. Some of the examples are
the correlation between Nyaya and the thalamus as well as Samkhya and the types of
neuronal activity.
In his excellent book, ‘The Shambala Guide to Yoga’, Dr. Georg Feuerstein says,
“Long before physicists discovered that matter is energy vibrating at a certain rate, the
yogis of India had treated this body-mind as a playful manifestation of the ultimate
power (shakti), the dynamic aspect of Reality. They realized that to discover the true
self, one has to harness attention because the energy of the body-mind follows
attention. A crude example of this process is the measurable increase of blood flow to
our fingers and toes that occurs when we concentrate on them. Yogis are very careful
about where they place their attention, for the mind creates patterns of energy,
causing habits of thought and behavior that can be detrimental to the pursuit of
genuine happiness”. Professor Dr SV Rao, an eminent medical doctor and yoga
scientist says, “Yoga is a science because it is verifiable. Yoga as a science of living is
also an art. Yoga, therefore, may be defined as the science and art of optimum living.
Yoga has the capacity to move, either side by side with medical science or
independently. This is because yoga has a sound system of etiology, diagnosis and
pathogenesis of disease. Thus we have a complete system by itself in yoga.”
Prevention of disease: Modern medicine has come to realise the importance of
prevention only in recent times but the role of preventive medicine is still very
limited. The yogic lifestyle that includes the yama and niyama can help prevent a
great many of the modern diseases like Hepatitis B and AIDS. Cleanliness that is
taught through shoucha can help prevent and limit spread of contagious and
infectious diseases. Mental peace and right attitudes of yoga such as pratipaksha
bhavanam (taking the opposite view), samatvam (equanimity of mind) and vairagya
(dispassionate detachment) can help prevent many psychosomatic ailments running
wild in the modern world. If these yogic values as well as practices such as asana,
pranayama, kriya and dhyana are inculcated in the modern human race, we can
prevent virtually all diseases that abound today. Communicable diseases as well as
degenerative disorders of the body can be well prevented in a true manifestation of
the adage, “A stitch in time saves nine”. However the ‘will’ to do so is also of
49
paramount importance as there is no money or fame in prevention and we don’t

know what we have prevented because we have prevented it from happening!
To quote the eminent neurosurgeon Padma Bhushan Dr B Ramamurthi, “The revival
of the science of yoga bodes well for mankind. All technological advances in the third
millennium will not lead to happiness of mankind as man has a severe aggressive
tendency and is likely to destroy himself because of this aggression. The only way out
of this mess is through the science of yoga, which transcends all religions and cults. It
is a science of the mind and the body and needs to be practised by all human beings to
ensure their own future”.
Promotive 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 sympathetic and parasympathetic
wings of autonomic nervous system leads to a dynamic state of health. According to
Dr B Ramamurthy, Yoga re-orients functional hierarchy of the entire nervous system.
He has noted that yoga not only benefits the nervous system but also cardiovascular,
respiratory, digestive, endocrine and immune systems in addition to bringing about
biochemical changes in yoga practitioners. He has also said that the science of yoga
has been India’s greatest contribution to mankind.
Management of diseases and disorders: Yoga doesn’t negate 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 to benefit the patient. Ayurveda is definitely more in tune with yogic views
of healing in this regard. Modern antibiotic treatment of infectious diseases and
modern emergency medical and trauma management techniques are life-savers in
times of dire 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 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
psychosomatic stress related disorders such as diabetes, asthma, irritable bowel
syndrome, epilepsy, hypertension, back pain as well as 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-honoured 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 and 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."
50
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
patients stop medical treatment thinking that it is 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
patients 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, “The treatment of the part shouldn’t
be attempted without a treatment of the entirety,” meaning that treatment of body
without treating mind and soul is 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. Mentally challenged individuals can
benefit by an improvement in their IQ as well as by learning to relate better with
themselves and others. As their physiological functions improve with yoga, a
combination of yoga and physical therapies can benefit such patients as well as those
with learning disabilities. Musculoskeletal problems can be treated by a combination
to improve function as well as range of movement, strength and endurance abilities.
Balance and dexterity can also be improved by such 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”. 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 proper wholistic values of a good diet. Modern research shows
us benefits of ‘break-down’ study of foods on the basis of their physical and chemical
properties. This is important for knowing how much of each constituent of food is
required and the proper quantity. Yoga can help a person learn the right attitude
towards food as well as understand concepts based on 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, types of food as well as importance of timings
and moderation in diet. A combination of modern aspects of diet with a dose of yogic
thought can help us not only eat the right things but also eat them in the right way, at
the right time thus ensuing our good health and longevity.
Relaxation: Most medical doctors understand that relaxation is important in order to
get better. However, though doctors tell patients to relax, they don’t tell them how to
do so. Maybe they don’t know the answer themselves in the first place. Hatha yoga
and jnana yoga relaxation practices help relax body, emotions and mind. Relaxation is
a key element of any yoga therapy regimen and must not be forgotten at any cost.
51
Shavasana has been reported to benefit hypertensive patients while practices such as
savitri pranayama, chandra nadi pranayama, kaya kriya, yoga nidra, anuloma viloma
prakriyas and marmanasthanam kriyas are also available to attain a state of complete
relaxation. It is important to remember that relaxation on its own is less effective than
relaxation following activity.
Coping Skills: Yoga has a lot to offer those unable to cope with death and dying as
well as those suffering from incurable diseases. Yoga philosophy sees death as an
inevitable aspect of life that cannot be wished away. Swami Gitananda Giri used to
say that the whole of life is but a preparation for the moment of death, so that we can
leave our body in the best possible manner. Those who are taking care of the dying as
well as those taking care of patients of incurable diseases and major disabilities are
under extreme stress and yoga practice as well as its philosophy helps them gain
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 drug dosage in patients suffering
from 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 side 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 one to endure”.
Expenditure: Modern medicine is often criticized for its exorbitant costs. Yoga offers
an inexpensive method of health care that can be added to medical armoury 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, but they are awfully off the mark. Reduction in drug
dosage and avoidance of unnecessary surgeries in many cases can also help reduce
spiralling cost of medicare.
Aging: Aging is inevitable and yoga can help us age gracefully. Modern medicine
tries to retard aging and help people look better by costly surgical methods that are
only an external covering over 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, Alzheimer’s and other dementias. Physical accidents and falls can be
minimised and many an artificial hip, knee or shoulder replacement surgery avoided.
Swami Gitananda Giri, Yogashri Krishnamacharya, Sri Kannaiah Yogi, Yogeshwarji,
Yogendraji, Sri Pattabi Jois and Padma Bhushan BKS Iyengar 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
archetypes that abound in collective unconscious. Yoga helps psychotherapists in
52
training self-awareness, and in self-regulation of body, diet, breath, emotions, habit

patterns, values, will, unconscious pressures and drives. It also helps in relating to
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
swadyaya, pranayama, pratyahara, dharana, dhyana and bhajans. Development of
proper psychological attitudes is inculcated via concepts of vairagya, chitta
prasadanam as well as Patanjali’s advise on adopting attitudes of maitri, karuna,
mudita and upekshanam respectively 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 swadyaya, satsanga, bhajans and yogic counselling. It is also interesting to
note that both yoga and psychoanalysis share common ground in understanding that
symptoms of disease are often willed by patients. While all psychoanalysists 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 superconscious.
Lifestyle changes: Yoga helps patients take their health in their own hands. They
learn to make an effort and change their lifestyle for the better so that their health can
improve. Lifestyle 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. Dr Dean Ornish, an
eminent American medical doctor who has shown that yogic lifestyle can reverse
heart disease says, “Yoga is a system of perfect tools for achieving union as well as
healing.
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 health status of women. Puberty and menopause become easier
transitions with yoga and many eminent yoginis have said that they were not even
aware of a single menopausal symptom as they went through this normally difficult
period. Similarly our young girls can vouch for the fact that their pubertal changes
and menarche have been relatively smoother than their counterparts who don’t
practice yoga. Once conception occurs, yoga helps the young mother to prepare
herself physically and mentally for the upcoming childbirth. Yoga helps open the
joints of the pelvis and hip as well as strengthen abdominal muscles aiding childbirth.
Simple pranayama and relaxation techniques help the new mother relax and enjoy the
new experience of her life. Postpartum 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 drug dosage in medical problems often complicating
pregnancy such as diabetes, asthma and hypertension.
Research: Positive benefits of yoga research are of vital significance. An
understanding of how various practices work in different conditions and in normal
situations is of great value for both yoga and for the world of medicine. Yoga
therapists can benefit through scientific understanding of yogic techniques bringing
about a rational approach to yoga therapy. Institutions such as AIIMS, BHU,
53
NIMHANS, DIPAS, JIPMER, sVYASA, Kaivalyadhama, Bihar School of Yoga and

ICYER have done significant work in bringing forth the scientific methods of yoga
vidya. Universities such as BHU, Sagar, Himachal, Mangalore, Venkateshwara,
Gujarat Ayurvedic, Annamalai, Andhra and Sri Balaji Vidyapeeth University have
created Centres for Yoga Education and Research and are doing great service. The
Central Government has created the Central Council for Research in Yoga and
Naturopathy (CCRYN) that is the governing body for research in yoga and
naturopathy under the Ministry of AYUSH and through Morarji Desai National
Institute of Yoga (MDNIY) advanced centres for Yoga were set up in JIPMER,
NIMHANS, AIIMS, Gujarat Ayurved University and DIPAS to promote yoga in these
premier medical institutions of our country. 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 centres. Various conditions such as diabetes,
hypertension, arthritis, mental depression, bronchial asthma etc have been found to be
relieved by yoga therapy and centres such as sVYASA, Kaivalyadhama, National
institute of Naturopathy, Manipal Institute and the Morarji Desai National institute
are doing a great deal of work in this field.
A lot of yoga research is being done nowadays but it is important to remember Swami
Gitananda Giri’s words, “We must research yoga and not the lack of yoga”. Many
studies are badly constructed and many-a-time we find that yoga practices performed
by patients have no real relation to yoga at all. The higher aspects of yoga are still not
in the ‘researchable’ realm of modern science. Dr VSSM Rao writes that, “The
tradition of yoga is so perfect that we have to seek ways of expounding it in modern
scientific terminology instead of simply evaluating it in terms of current concepts of
science, which is expanding so rapidly that a time may come when man would like to
live by his intuition rather than by scientific planning, bristling with conflicts and
balancing a number of variables not completely understood.”
In conclusion: Many medical doctors have tried to bridge the gap between modern
medicine and Yoga and one of the best is Dr Steven F Brena who in his work, “Yoga
and Medicine” puts into perspective similarities between yoga and medicine and
discusses their relationship with different aspects of human phenomena. He says,
“Besides more or less close similarities, is there a realistic ground upon which both
contemporary science and yoga philosophy are going to meet and possibly to
cooperate? The actual field of convergence between them lies in the recognition that
physical laws of matter are binding only to a certain point; beyond them, man can
find inner freedom, using his will power and proper techniques to select his habits
and to gain control of his visceral and emotional functioning, according to the
principles of learning. Psychology tells us that our biological functions are bound to
the rhythmicity of earthly phenomena, but it also has demonstrated that our
performances can be controlled by instrumental training, which is not influenced by
circadian rhythms. It looks as though scientific investigations from one side are
showing man bound to the earth, like any other living creature, while from another
side they seem to prove that the human potentials are greater than the forces binding
us – which is exactly what the Vedas have been teaching for thousands of years. The
concept of “dysponesis” is much more than a new theory in medicine. It is almost a
new philosophy, bringing into perspective the value of energy-spending in problems
54
of health and disease. Because of our habitual lack of control over our visceral
systems, we are often too prodigal in spending our energy capital. In any given
situation we are not only prone to “overshoot”, but also to learn the “overshooting” as
a model of habitual interrelation with our environment. We are always tense and
aggressive in whatever task we perform, always in competition with somebody or
with ourselves, wasting our energies in confused actions and maladjusted reactions.
We often do not cope with some given situation following a rational and intelligent
evaluation, but with emotional outbursts, burning a lot of fuel. The experiences
gained from the various rehabilitation centres around the world, dealing with a
variety of disabilities, confirm that our potentialities are greater than we assume,
provided that we adequately train our energy-spending and effort-making.
Yoga has been teaching for centuries that the secret of fulfilment in life and spiritual
evolution lies in the ability to concentrate vital energy instead of dissipating it. The
“Royal Way of Yoga” takes man as he is, with all his handicaps, and brings him above
the boundaries of material forces to cosmic consciousness, teaching him how to
expand his energy capital and how to use it wisely. Along the way, while he is
seeking spiritual realization, man can also discover the key to health, joy and inner
freedom. In this field of thinking and teaching, the age-old yoga discipline and the
more advanced investigations in health sciences have actually met and do agree”.
It is apt to conclude with a favourite statement of my Guru, Pujya Swamiji Gitananda
Giri Guru Maharaj, who said, “Health and happiness are your birthright. Do not
forsake your golden culture for the plastic playthings of the western world. Learn and
live yoga, for then you will know true health and happiness”.
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 research in Indian Medicine and Homeopathy. New Delhi. 1976.
3. Anantharaman TR. Yoga as Science. Souvenir: Seminar on Yoga, science and man. Central council
for research in Indian Medicine and Homeopathy. New Delhi. 1976.
4. Anantharaman TR. Yoga Vidya and Yoga Vidhi. The Yoga Review 1983: III: 3, 119-137.
5. Bhavanani Ananda Balayogi. A primer of Yoga theory.Dhivyananda Creations. Puducherry-13.
6. Bhavanani AB. Yoga for health and healing. Dhivyananda Creations. Puducherry-13. (2008)
7. Brena Steven F. Yoga and medicine. Penguin Books Inc. USA. 1972.
8. Chidbhavananda Swami. The Bhagavad Gita. Ramakrishna Tapovanam, Trichy, 1984.
9. Feuerstein Georg. The Shambala Guide to Yoga. Shambala Publications Inc, Boston, Massachusetts,
USA.1996.
10. Gitananda Giri Swami. Frankly Speaking. Satya Press, Pondicherry, 1997.
11. Gitananda Giri Swami. Yoga the art and science of awareness. Souvenir 1996; 4th International Yoga
Festival, Govt of Pondicherry.
12. Gitananda Giri Swami. Yoga: Step-by-Step, Satya Press, Pondicherry, 1976.
13. 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. 1991.
14. Healthy mind, healthy body. Sri Ramakrishna Math, Chennai, India.1997.
15. Mahesh Yogi Maharishi. Natural law for doctors. Maharishi institute of management. New
Delhi.1996.
16. Nagarathna R and Nagendra HR. Integrated approach of Yoga therapy for positive health. Swami
Vivekananda Yoga Prakashana, Bangalore, India. 2001.
17. Taimni IK. The Science of Yoga. The Theosophical Publishing House, Adyar, Chennai.1961.
18. Yoga the Science of Holistic Living. Vivekananda Kendra Patrika. Vol. 17- 2. Aug 1988.
55
Journal of
Yoga & Physiotherapy
Perspective J Yoga & Physio

Volume 1 Issue 1 - September 2016 Copyright © All rights are reserved by Bhavanani AB
Understanding Yoga as a Therapy

Bhavanani AB*
Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, India
Submission: August 03,2016; Published: September 09, 2016
*Corresponding author: Ananda Balayogi Bhavanani, Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Pondicherry,
India.
Perspective
the disease. This is known as the adhi vyadhi or adhija vyadhi,
Yoga may be said to be as ancient as the universe itself, since it
where the mind brings about the production of disease in the
is said to have been originated by Hiranyagarba, the causal germ
physical body. In modern language, this is called psychosomatic
plasm itself. This timeless art and science of humanity sprouted
illness [11]. Virtually every health problem that we face today
from the fertile soil of Sanathana Dharma, the traditional pan-
either has its origin in psychosomatics or is worsened by the
Indian culture that continues to flourish into modern times
psychosomatic aspect of the disease. The mind and the body
[1-4]. Today, Yoga has become popular as a therapy, and most
seem to be continuously fighting each other. What the mind
people come to it seeking to alleviate their physical, mental and
wants, the body won’t do, and what the body wants, the mind
emotional imbalances. We must understand, however, that the
won’t do. This creates a dichotomy, a disharmony, in other words,
use of Yoga as a therapy is a much more recent happening in the
a disease. Yoga helps restore balance and equilibrium by virtue
wonderful long history of Yoga which has historically served to
of the internal process of unifying mind, body and emotions. The
promote spiritual evolution. Yoga helps unify all aspects of our
psychosomatic stress disorders that are so prevalent in today’s
very being: the physical body, in which we live our daily life; the
world can be prevented, controlled and possibly even cured via
energy body, without which we will not have the capacity to do
the sincere and dedicated application of Yoga as a therapy.
what we do; the mind body, which enables us to do our tasks
with mindfulness; the higher intellect, which gives us clarity; and Psychosomatic disorders go through four major phases. The
finally, the universal body, which gives us limitless bliss [5,6]. first is the psychic phase, in which the stress is located essentially
in the mind. There is jitteriness, a sense of unnatural tension, a
All aspects of our life physical, energetic, mental, intellectual
sense of not being ‘at ease’. If the stress continues, the psychic
and universal are unified through the practice of Yoga, which
stage then evolves into the psychosomatic stage. At this point, the
may also be described as the science of right-use-ness, that is, of
mind and body are troubling each other and fluctuations, such
using our body, emotions, and mind responsibly and in the most
as a dramatic rise in blood pressure, blood sugar or heart rate,
appropriate manner. One of the best definitions of Yoga given by
begin to manifest intermittently. If this is allowed to continue,
Swami Gitananda Giri is that it is a ‘way of life’ [7,8]. It is not
one reaches the somatic stage, where the disease settles down in
something you do for 5 minutes a day or 20 minutes a day. It is
the body and manifests permanently. At this stage, it has become
indeed a 24x7x365 lifestyle.
a condition that requires treatment and therapy. In the fourth,
Illness, disease and disorders are so common in this world, organic stage, the disease settles permanently into the target
and people everywhere are desperately seeking relief from organs. This represents the end stage of the disease.
their suffering. Yoga helps us to think better and to live better;
Yoga as a therapy works very well at both the psychic and
indeed, it helps us improve ourselves in everything we do. Hence
psychosomatic stages. Once the disease enters the somatic stage,
it holds out the promise of health, well-being and harmony.
Yoga therapy as an adjunct to other therapies may improve the
According to the Bhagavad Gita, an ancient text which can
condition. In the organic stage, Yoga therapy’s role is more of
be said to be a Yoga Shastra (seminal textual source of Yoga),
a palliative, pain relieving and rehabilitative nature. Of course
Lord Krishna the Master of Yoga(Yogeshwar) defines Yoga as
the major role of Yoga is as a preventive therapy, preventing
“dukkhasamyogaviyogam yoga samjnitham” meaning thereby
that which is to come. Maharishi Patanjali tells us in his Yoga
that Yoga is the disassociation from the union with suffering.
Darshan, “heyamdukkhamanagatham”-prevent those miseries
Pain, suffering, disease -Yoga offers a way out of all of these
that are yet to come [1,11].
[5,6,9,10].
If the practice of Yoga is taken up during childhood, we can
One of the foremost concepts of Yoga therapy is that the mind,
prevent so many conditions from occurring later on in life. This is
which is called adhi, influences the body, thus creating vyadhi,
J Yoga & Physio 1(1): JYP.MS.ID.555551 (2016) 001

Journal of Yoga and Physiotherapy
primary prevention. Once the condition occurs, once the disease of our lower, sub-human nature, into our elevated human and
has set in, we have secondary prevention, which is more in the humane nature. Ultimately, this life giving, life enhancing and
nature of controlling the condition to whatever extent we can. life sustaining science of humanity allows us to achieve in full
Tertiary prevention is done once the condition has occurred, as measure the Divinity that resides within each of us.
we try to prevent the complications, those that affect the quality,
I wish you a happy, healthy and fruitful Sadhana in Yoga. May
and even the quantity, of a patient’s life [9].
your potential manifest in a wholesome, harmonious manner.
I would like to conclude this perspective with a word of
References
caution. Yoga therapy is not a magic therapy! It is not a ‘one pill
1. Feuerstein G (2001) The Yoga Tradition: Its history, literature,
for all ills’. There should be no false claims or unsubstantiated philosophy, and practice. Prescott Ariz: Hohm Press, USA.
tall claims made in this field. Yoga therapy is also a science
2. Bhatt (2004) The Forceful Yoga: Being the Translation of Hatha Yoga-
and must therefore be approached in a scientific, step-by-step pradipika, Gheranda-samhita and Siva-samhita. (P. Singh, R. Bahadur, &
manner. It should be administered primarily as a ‘one on one’ S. C. Vasu, Trans.) Motilal Banarsidass Publishers, India.
therapy that allows the therapist to modify the practices to meet 3. Bhavanani (2010) The history of yoga from ancient to modern times.
the needs of the individual. It is not a “one size fits all” or “one Satya Press, India.
therapy fits all” approach 4. Sovik R, Bhavanani AB (2016) History, Philosophy, and Practice of
Yoga. In: Khalsa SB, et al. (Eds.), The Principles and Practice of Yoga in
When we use Yoga as a therapy, we need to consider both Health Care. East Lothian, UK: Handspring pp. 17-29.
the nature of the person-his or her age, gender and physical
5. Feuerstein G (2003) The Deeper Dimension of Yoga Theory and
condition and the nature and stage of the disorder. A step-by- Practice. Boston Massachusetts: Shambala Publications Inc, USA.
step approach must include a detailed look at all aspects of
6. Bhavanani AB (2013) Yoga Chikitsa: Application of Yoga as a therapy.
diet, necessary lifestyle modifications, attitude reconditioning
Pondicherry, India: Dhivyananda Creations.
through Yogic counseling, as well as the appropriate practices.
7. Giri GS (1976) Yoga: Step-by-step. Satya Press, India.
All of these are integral components of holistic, or rather,
wholesome Yoga therapy. When such an approach is adopted, 8. Giri GS (1999) Ashtanga Yoga of Patanjali. Satya Press, India.
tremendous changes will manifest in the lives of the patients 9. Ramanathan M (2007) Applied Yoga-Application of Yoga in Various
and their families. The quality of life improves drastically and, in Fields of human Activity. Puducherry: Aarogya Yogalayam.
many cases, so does the quantity. 10. Bhavanani AB (2014) A primer of yoga theory (4th ed). Dhivyananda
Creations, India.
As human beings, we fulfill ourselves best when we help
11. Bhavanani AB (2011) Understanding the yoga darshan. Dhivyananda
others. Yoga is the best way for us to consciously evolve out
Creations, India.
002 How to cite this article: Bhavanani AB. Understanding Yoga as a Therapy. J Yoga & Physio. 2016; 1(1) : 555551.
OPEN ACCESS
Jacobs Journal of Yoga and Natural Medicine

Review Article
Mental Health and Wellbeing through Yoga

Yogacharya Ananda Balayogi Bhavanani1*
Sri Balaji Vidyapeeth, Pondicherry, India
1
*Corresponding author: Dr. Yogacharya Ananda Balayogi Bhavanani Chairman ICYER at Ananda Ashram and Deputy Director CYTER
at Sri Balaji Vidyapeeth, Pondicherry, Email: yognat@gmail.com
Received: 09-01-2016
Accepted: 09-15-2016
Published: 10-04-2016
Copyright: © 2016 Balayogi Bhavanani
Introduction ta- Yoga Darshan II: 48). We can even gain unexcelled happi-
ness, mental comfort, joy and satisfaction by practicing con-
Yoga, an ancient cultural heritage of India, understands health tentment, (santoshat anuttamah sukha labhah- Yoga Darshan
and well being as a dynamic continuum of human nature and II: 42) one of the five ethical observances or niyama-s [9]. This
not a mere ‘state’ to be attained and maintained[1]. Yogi Swat- inherent link is quite apparent once we think about it, but not
marama, author of the Hathayoga Pradipika, one of the classi- too many associate the need for contentment in their greed for
cal Hatha Yoga texts gives us the assurance, “One who tireless- anything and everything in this material world.
ly practises Yoga attains success irrespective of whether they
are young, old decrepit, diseased or weak”[2].
Yoga conceptualises the human being as a multi layered, con-

scious being, possessing three bodies or sharira (sthula-gross,
sukshma -subtle and kaarana -causal) and having a five layered
existence (pancha kosha) consisting of our anatomical, phys-
iological, psychological, intellectual and universal existential
layers[3,4]. Yoga as a way of conscious living, enables the in-
dividual 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 (II: 48) defines Yoga
as samatvam meaning thereby that Yoga is a harmonious and
balanced state of equanimity or equipoise at all levels[5]. This
may be also understood as a perfect state of dynamic wellbeing
wherein physical homeostasis, emotional balance and mental
equanimity manifest in harmony.
Figure 1. Pancha kosha, the five existential layers[1,3].
This qualitative aspect of health is something that Yoga and
traditional Indian systems of medicine have considered im- Qualities of a mentally healthy person
portant for thousands of years[6,7]. Even Maharishi Patanjali’s
definition of asana (sthira sukham asanam- Yoga Darshan II:46) The central theme of Yoga is the golden mean ( yukta ), find-
implies this dynamic state of steady well being at all levels of ing the middle path, a constant search for moderation and a
existence [9]. He also goes on to say that through the practice harmonious homoeostatic balance [6,7]. Yoga is the “unitive
of asana we can attain a state that is beyond dualities leading impulse” of life, which always seeks to unite diverse streams
to harmonious and serene calmness (tato dvandva anabhigha- into a single powerful force[3, 8]. Proper practice and living of
Cite this article: Balayogi Bhavanani.Mental Health and Wellbeing through Yoga. J J Yoga Nat Med. 2016, 1(1): 004.
Jacobs Publishers 2
the Yogic principles produces an inner balance that gives sta- those who are at peace with themselves), karuna (compassion
bility and calm even in the midst of chaos. This ancient science for the suffering), mudita (cheerfulness towards the virtuous)
shows its adherents a clear path to the “eye of the storm” and and upekshanam (indifference and avoidance of the evil)[4,9].
ensures a stability that endures within, even as the cyclone
may rage on externally.
Some of the prerequisite qualities of a mentally healthy person

(stitha prajna) are enumerated in the Bhagavad Gita as follows:
Beyond passion, fear and anger (veeta raga bhaya krodhah-BG
II.56), devoid of possessiveness and egoism (nirmamo nira-
hamkarah- BG -II.7), firm in understanding and unbewildered
(sthira buddhir asammudhah-BG - V.20), engaged in doing good
to all creatures (sarva bhutahiteratah- BG V.25), friendly and
compassionate to all (maitrah karuna eva ca- BG XII.13); and
pure hearted and skilful without expectation (anapekshah su-
cir daksah- BG XII.16)[5].
Some Yogic tools for mental health and well being
• Tools to induce psycho-physical harmony: Asana-s (stat-

ic postures), kriya-s (systematic and rationale movements),
mudra-s (seals of neuromuscular energy) and bandha-s (locks
for neuromuscular energy) gently stretch and strengthen the
musculoskeletal system in a healthy manner. They improve mo-
bility and flexibility of the different joints and groups of mus-
cles. There is also concomitant improvement in the systemic Figure 2. Mechanisms of Yoga [1,3].
function such as respiration, circulation, metabolism, diges-
tion and elimination. A general sense of health and well being • Contemplation, relaxation and meditation: There are a
is also promoted by these aspects of Yoga that help release feel great many Jnana Yoga and Raja Yoga techniques of relaxation
good hormones like endorphins and encephalins[1,4]. Tools and visualization that are useful[3,4]. Other practices such as
to balance emotional volatility: Swadhyaya (introspection- trataka (concentrated gaze), pranayama, pratyahara, dharana
al self analysis), pranayama (breathing techniques for control as well as dhyana may also be utilized. Relaxation is a central
of vital energy), pratyahara (sensory withdrawal), dharana element in Yoga as it is the body’s own way of recharging its
(intense concentration), dhyana (meditational oneness) and cells and helps to ease physical, emotional and mental ten-
bhajana (devotional music) stabilize emotional turmoil and re- sions. We can facilitate our own healing when we are relaxed.
lieve stress and mental fatigue. They bring about an excellent In fact, we often unintentionally retard our inherent healing
sense of emotional balance that is vital for good health. Group mechanisms when we are tense and uptight. Choice is ours to
work also enables achievement of emotional balance essential make!
for good health.
• Enhancing spiritual awareness: Yoga is the best way for
• Development of appropriate psychological attitudes: us to consciously evolve out of our lower, sub-human nature,
Yoga encourages us to step back and take an meta-cognitive, into our elevated human and humane nature[8]. Ultimately,
objective view of our habitual patterns of behaviour and this life giving, life enhancing and life sustaining science of hu-
thoughts. This enables us to cope better with situations that manity allows us to achieve in full measure the Divinity that
normally put our bodies and minds under strain. Patanjali em- resides within each of us. Swadhyaya, satsanga (spiritual gath-
phasizes the need to develop following qualities in order to ering), bhajana sessions and Yogic counselling are important
become mentally balanced humane beings[9]. He emphasises aspects of Yogic living We need to realise that “Oneness” is
abhyasa (relentless positive self effort) and vairagya (dispas- health whereas “Duality” is disease. We cannot remain lonely,
sionate attitude) along with ishwara pranidhana (acceptance depressed and diseased if we realize that we are part of a won-
and humility of the universal plan). He provides an antidote derful, joyful and harmonious Universe. Spirituality is the per-
to the stress pandemic by suggesting change in our inner personal connection we feel with our own inner being. This can
spective through pratipaksha bhavanam (adoption of the con- be strengthened greatly through conscious introspection and
trary attitudes in the face of negativities). He advises us to de- self inquiry. When we begin to understand the oneness man-
velop clarity of mind (chitta prasadanam) through adoption of ifest through all forms of life, we manifest gratitude, respect
four conscious attitudes: namely maitri (friendliness towards and love. Our life becomes one of selfless service (nishkama
Jacobs Publishers 3
seva) for humanity. At that point, we start to radiate joy, love “Health and happiness are your birthright, claim them and de-
and wellbeing (tejasvi). velop them to your maximum potential”[8]. This message of
Swamiji Gitananda Giri Guru Maharaj is a firm reminder that
• Relieving suffering and pain: In the Bhagavad Gita (VI:23), the goal of human existence is not health and happiness but is
Yoga is also defined as “dukkhasamyogaviyogam yoga sam- moksha (liberation). Most people today are so busy trying to
jnitham”, the conscious disassociation from union with suffer- find health and happiness that they forget why they are here in
ing [5,1]. Yoga improves pain tolerance and provides an im- the first place. Yoga is the best way for us to regain our birth-
proved quality of life. It can be safely said that Yoga helps us rights and attain the goal of our human existence.
endure conditions that it may not be able to cure. This is vital
in end life situations where it is important that the patient has References:
a sense of improved quality of life during their final days and
moments on earth. Yoga can also benefit caretakers of such 1. Bhavanani AB. Yoga Chikitsa: The application of Yoga as a
terminal patients who are under great stress themselves as it therapy. Pondicherry, India: Dhivyananda Creations, 2013.
enables them to realise that we fulfil ourselves best as human
beings when we help others. 2. Bhatt GP. The Forceful Yoga: Being the Translation of Hatha-
Yoga-pradipika, Gheranda-samhita and Siva-samhita (P. Singh,
Conclusion R. Bahadur, & S. C. Vasu, Trans.). New Delhi, India: Motilal Ba-
narsidass Publishers. 2004
Yoga is the original mind body medicine and is one of the great-
est treasures of the unique Indian cultural heritage. As both an 3. Gitananda Giri Yoga: Step-by-step Swami.. Pondicherry, In-
art and science it has a lot to offer humankind in terms of an dia: Satya Press. 1976
understanding of both the human mind as well as all aspects
of our multilayered existence. Yogic lifestyle, Yogic diet, Yogic 4. Bhavanani AB. A Yogic Approach to Stress. Pondicherry, In-
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normalizing the perception of stress, optimizing the reaction Ramakrishna Tapovanam, 1984
to it and by releasing it effectively through various practices.
Yoga is truly a wholesome and integral science of life that deals 6. Feuerstein Georg. The Deeper Dimension of Yoga Theory
with multidimensional aspects of health in both the individual and Practice. Boston Massachusetts, USA: Shambala Publica-
and society. tions Inc. 2003
Yoga helps us to take the appropriate attitude towards our 7. Bhavanani MD. The history of yoga from ancient to modern
challenges and thus tackle them effectively and efficiently. “To times. Pondicherry, India: Satya Press, 2010
have the will (iccha shakti) to change (kriya shakti) that which
can be changed, the strength to accept that which cannot he 8. Gitananda Giri Swami (Meenakshi Devi Bhavanani. Ed).
changed, and the wisdom (jnana shakti) to know the differ- Frankly speaking. Pondicherry, India: Satya Press,1995
ence” is the attitude that needs to the cultivated. An attitude
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standing of our mental process helps to create a harmony in ry, India: Dhivyananda Creations, 2011.
our body, and mind whose disharmony is the main cause of
‘aadi – vyadhi’ or psychosomatic disorders.
YOGA THERAPY: AN OVERVIEW
Yogacharya Dr Ananda Balayogi Bhavanani, Deputy Director, CYTER,
Centre for Yoga Therapy, Education and Research
Sri Balaji Vidyapeeth - Mahatma Gandhi Medical College and Research Institute Campus
Pillaiyarkuppam, Puducherry - 607403, India
“Yoga Chikitsa is virtually as old as Yoga itself, indeed, the emotions, and mind responsibly and in the most
‘return of mind that feels separated from the Universe in which appropriate manner. One of the best definitions of Yoga
it exists’ represents the first Yoga therapy. Yoga Chikitsa could given by Swami Gitananda Giri is that it is a ‘way of
be termed as “man’s first attempt at unitive understanding life’.7,8 It is not something you do for 5 minutes a day or
of mind-emotions-physical distress and is the oldest wholistic 20 minutes a day. It is indeed a 24 × 7 × 365. lifestyle.
concept and therapy in the world.”
Illness, disease and disorders are so common in this
- Yogamaharishi Dr. Swami Gitananda Giri, ICYER at world,and people everywhere are desperately seeking
Ananda Ashram, Pondicherry. relief from their suffering. Yoga helps us to think better
and to live better; indeed, it helps us improve ourselves
Yoga may be said to be as ancient as the universe itself, in everything we do. Hence it holds out the promise
since it is said to have been originated by Hiranyagarba, of health, well-being and harmony. According to the
the causal germ plasm itself. This timeless art and Bhagavad Gita, an ancient text which can be said to be
science of humanity sprouted from the fertile soil of a Yoga Shastra (seminal textual source of Yoga), Lord
Sanathana Dharma, the traditional pan-Indian culture Krishna the Master of Yoga (Yogeshwar) defines Yoga
that continues to flourish into modern times. 1,2,3,4 as “dukkhasamyogaviyogam yoga samjnitham” meaning
thereby that Yoga is the disassociation from the union
Today, Yoga has become popular as a therapy, with suffering. Pain, suffering, disease - Yoga offers a
and most people come to it seeking to alleviate their way out of all of these. 5,6,9,10
physical, mental and emotional imbalances. We must
understand, however, that the use of Yoga as a therapy One of the foremost concepts of Yoga therapy
is a much more recent happening in the wonderful is that the mind, which is called adhi, influences
long history of Yoga–which has historically served to the body, thus creating vyadhi, the disease. (Fig 1)
promote spiritual evolution. Yoga helps unify all aspects This is known as the adhi vyadhi or adhija vyadhi,
of our very being: the physical body, in which we live where the mind brings about the production of
our daily life; the energy body, without which we will disease in the physical body. In modern language,
not have the capacity to do what we do; the mind body, this is called psychosomatic illness. 6 Virtually
which enables us to do our tasks with mindfulness; the every health problem that we face today either has
higher intellect, which gives us clarity; and, finally, the its origin in psychosomatics or is worsened by the
universal body, which gives us limitless bliss. 5,6 psychosomatic aspect of the disease. The mind and
the body seem to be continuously fighting each other.
All aspects of our life--physical, energetic, mental, What the mind wants, the body won’t do, and what
intellectual and universal--are unified through the the body wants, the mind won’t do. This creates a
practice of Yoga, which may also be described as the dichotomy, a disharmony, in other words, a disease.
science of right-use-ness, that is, of using our body, Yoga helps restore balance and equilibriumby virtue
Page 28 Ann. SBV, July-Dec 2016;5(2)

Yoga Therapy: An Overview
MODALITIES OF YOGA AS A THERAPY(6)

ADHI
PHYSICAL THERAPIES
∙ Asanas, Kriyas, Mudras and Bandhas
MENTAL EMOTIONAL THERAPIES

AGITATIONS ∙ Swadhyaya, Pranayama, Pratyahara, Dharana, Dhyana
and Bhajans
∙ Development of +ve attitudes
HAPAZARD FLOW UNSTABLE – Vairagya
OR PRANA NADIS – Chitta Prasadan
– Maitri, Karuna, Mudita, Upekshanam
MENTAL THERAPIES
AJIRANATVAM ATIJIRANATVAM KUJIRANATVAM ∙ Relaxation & visualization, Trataka, Pranayama,
(under digestion) (over-digestion) (wrong digestion) Pratyahara, Dharana & Dhyana
SPIRITUAL THERAPIES
∙ Swadhyaya, Satsangha, Bhajans and Yogic counseling
PHYSICAL AILMENTS
(VYADHI) PREVENTIVE THERAPIES
∙ Start early in childhood
Fig 1. Causation of disease, the Yogic perspective ∙ Prevention of accidents
∙ Improved immunity
of the internal process of unifying mind, body and ∙ Knows the technique so that can do it if needed
emotions. The psychosomatic stress disorders that
are so prevalent in today’s world can be prevented, REHABILITATIVE THERAPIES
controlled and possibly even cured via the sincere and ∙ Prevention of disability & improving QOL
dedicated application of Yoga as a therapy. PAIN RELIEF THERAPIES
∙ Increases pain tolerance - improved quality of life
Psychosomatic disorders go through four major
phases. The first is the psychic phase, in which the stress
is located essentially in the mind. There is jitteriness, a his Yoga Darshan, “heyamdukkhamanagatham”-prevent
sense of unnatural tension, a sense of not being ‘at ease’. those miseries that are yet to come”. 1,11
If the stress continues, the psychic stage then evolves
into the psychosomatic stage. At this point,the mind If the practice of Yoga is taken up during childhood,
and body are troubling each other and fluctuations, we can prevent so many conditions from occurring
such as a dramatic rise in blood pressure, blood sugar later on in life. This is primary prevention. Once the
or heart rate, begin to manifest intermittently. If condition occurs, once the disease has set in, we have
this is allowed to continue, one reaches the somatic secondary prevention, which is more in the nature
stage, where the disease settles down in the body and of controlling the condition to whatever extent we
manifests permanently. At this stage, it has become a can. Tertiary prevention is done once the condition
condition that requires treatment and therapy. In the has occurred, as we try to prevent the complications,
fourth, organic stage, the disease settles permanently those that affect the quality, and even the quantity, of
into the target organs. This represents the end stage a patient’s life. 7
of the disease.
When we use Yoga as a therapy, we need to consider
Yoga as a therapy works very well at both the psychic both the nature of the person–his or her age, gender
and psychosomatic stages. Once the disease enters the and physical condition–and the nature and stage of
somatic stage, Yoga therapy as an adjunct to other the disorder. A step-by-step approach must include a
therapies may improve the condition. In the organic detailed look at all aspects of diet, necessary lifestyle
stage, Yoga therapy’s role is more of a palliative, pain modifications, attitude reconditioning through Yogic
relieving and rehabilitative nature. Of course the major counseling, as well as the appropriate practices. All
role of Yoga is as a preventive therapy, preventing of these are integral components of holistic, or rather,
that which is to come. Maharishi Patanjali tells us in wholesome Yoga therapy. When such an approach is
Ann. SBV, July-Dec 2016;5(2) Page 29

Annals of SBV
adopted, tremendous changes will manifest in the lives I would like to conclude this overview of Yoga
of the patients and their families. The quality of life therapy with a word of caution. Yoga therapy is not a
improves drastically and, in many cases, so does th magic therapy! It is not a ‘one pill for all ills’. There
quantity. should be no false claims or unsubstantiated tall claims
made in this field. Yoga therapy is also a science and
As human beings, we fulfill ourselves best when we must therefore be approached in a scientific, step-by-
help others. Yoga is the best way for us to consciously step manner. It should be administered primarily as a
evolve out of our lower, sub-human nature, into our ‘one on one’ therapy that allows the therapist to modify
elevated human and humane nature. Ultimately, this the practices to meet the needs of the individual. It is
life giving, life enhancing and life sustaining science not a “one size fits all” or “one therapy fits all” approach!
of humanity allows us to achieve in full measure the
Divinity that resides within each of us.
REFERENCES
1. Feuerstein G. The Yoga Tradition : Its history, literature, philosophy, and practice. 3rd ed. Prescott, Ariz: Hohm Press; 2001.
2. Bhatt GP. The Forceful Yoga: Being the Translation of HathaYoga-pradipika, Gheranda-samhita and Siva-samhita. 2nd ed. New Delhi, India: Motilal Banarsidass Publishers;
2016.
3. Bhavanani MD. The history of yoga from ancient to modern times. 1st ed. Pondicherry, India: Satya Press; 2010.
4. Sovik R, Bhavanani AB. History, Philosophy, and Practice of Yoga. In: Khalsa SB, Cohen L, McCall T, Telles S, editors. The Principles and Practice of Yoga in Health Care.
1st ed. East Lothian, UK: Handspring, 2016.
5. Feuerstein G. The Deeper Dimension of Yoga Theory and Practice. 1st ed. Boston Massachusetts, USA: Shambala Publications Inc; 2003.
6. Bhavanani AB. Yoga Chikitsa: Application of Yoga as a therapy. 1st ed. Pondicherry, India: Dhivyananda Creations; 2013.
7. Giri G S. Yoga: Step-by-step. 1st ed. Pondicherry, India: Satya Press; 1976.
8. Giri G S. Ashtanga Yoga of Patanjali. 1st ed. Pondicherry, India: Satya Press; 1999.
9. Ramanathan M. Applied Yoga-Application of Yoga in Various Fields of human Activity. 1st ed. Puducherry, India: Aarogya Yogalayam; 2007.
10. Bhavanani AB. A primer of yoga theory. 4th ed. Pondicherry, India: Dhivyananda Creations;2014.
11. Bhavanani AB. Understanding the yoga darshan. 1st ed. Pondicherry, India: Dhivyananda Creations;2011.
Page 30 Ann. SBV, July-Dec 2016;5(2)

ejpmr, 2017,4(1), 256-262 SJIF Impact Factor 3.628
Review Article
Bhavanani et al. EUROPEAN JOURNAL OF PHARMACEUTICAL
European Journal of Pharmaceutical and Medical Research
AND MEDICAL RESEARCH ISSN 2394-3211
www.ejpmr.com EJPMR
UNDERSTANDING HOW YOGA WORKS: A SHORT REVIEW OF FINDINGS FROM

CYTER, PONDICHERRY, INDIA.
Meena Ramanathan1 and Ananda Balayogi Bhavanani2*

1
Coordinator, Yoga Therapist, CYTER, SBV, Puducherry.
2
*Corresponding Author: Dr. Ananda Balayogi Bhavanani

Article Received on 03/11/2016 Article Revised on 24/11/2016 Article Accepted on 14/12/2016
ABSTRACT
The Centre for Yoga Therapy Education and Research (CYTER) has been functioning at Mahatma Gandhi Medical
College and Research Institute (MGMCR & RI) under the auspices of the Faculty of Allied Health Sciences of Sri
Balaji Vidyapeeth, Puducherry, for the past six years (2010-2016). More than 30,000 patients have benefited from
Yoga therapy consultations and have attended individual and group therapy sessions at CYTER. Numerous
research projects are being conducted as collaborative efforts between CYTER and various departments of
MGMCRI, as well as KGNC and CIDRF. This review summarizes some of the important findings from 14
research works done at CYTER and published between 2010 and 2016. These studies provide preliminary evidence
of the therapeutic potential of Yoga and induce further studies exploring physiological, psychological and
biochemical mechanisms as well as beneficial clinical effects.
KEYWORDS: CYTER, MGMCRI, KGNC and CIDRF.
INTRODUCTION relatively low-risk, high-yield approach to improving

Integrative medicine is gaining in popularity and yoga overall health and wellbeing.[4, 5, 6]
has the potential to make a significant contribution. The
art and science of yoga has been practised for thousands The Centre for Yoga Therapy Education and Research
of years. Yoga is a popular means of relieving stress and (CYTER) has been functioning at Mahatma Gandhi
improving fitness as it decreases stress and anxiety and Medical College and Research Institute (MGMCR & RI)
improves health status. The application of Yoga as a under the auspices of the Faculty of Allied Health
therapy is simple and inexpensive and can be easily Sciences of Sri Balaji Vidyapeeth, Puducherry, for the
adopted in most patients without any complications.[1] past six years (2010-2016). More than 30,000 patients
Yoga is qualitatively different from other modes of have benefited from Yoga therapy consultations and
physical activity as it has a unique combination of have attended individual and group therapy sessions at
isometric muscular contractions, stretching exercises, CYTER. Numerous research projects are being
relaxation techniques, and breathing exercises. It must be conducted as collaborative efforts between CYTER and
emphasized that Yoga therapy or more correctly Yoga the Departments of Physiology, Medicine, Neurology,
Chikitsa, encompasses the use of asana, pranayama and Nephrology, Ophthalmology, Psychiatry, Anaesthesia
relaxation techniques along with dietary advice and and Biochemistry as well as KGNC and CIDRF. This
Yogic counseling that address the root cause of the paper summarizes some of the important findings from
problem rather than merely providing symptomatic 14 research works done at CYTER and published
relief[2] Yoga may be considered the original mind-body between 2010 and 2016. These studies provide
medicine; its philosophy and practice are highly effective preliminary evidence of the therapeutic potential of Yoga
in producing psycho-somatic and somato-psychic re- and induce further studies exploring physiological,
integration. Yoga improves mood and reduces stress by psychological and biochemical mechanisms as well as
emphasizing every-moment body awareness involving beneficial clinical effects.
attentional focus on one‟s breathing, emotions, thoughts
or specific parts of the body.[3] The practice of yoga has REVIEW OF SELECTED STUDIES
been shown to have preventive, curative as well as Study 1: Immediate effects of suryanamaskar on
rehabilitative potential that can be explained on the basis reaction time and heart rate in female volunteers[7]
of modulation of autonomic functions, stress reduction, Suryanamaskar (SN), a yogic technique is composed of
improvement in physiological functions and enhanced dynamic muscular movements synchronised with deep
quality of life. It has become quite apparent that yoga is a rhythmic breathing. As it may have influence on CNS,
www.ejpmr.com 256
this study planned to investigate immediate effects of SN attributed to enhanced harmony of cardiac autonomic
on reaction time (RT) and heart rate (HR). 21 female function as a result of coordinated breath-body work and
volunteers attending yoga classes were recruited for mind-body relaxation due to yoga.
study group and 19 female volunteers not participating in
yoga were recruited as external-controls. HR, auditory Study 3: Hematological, biochemical and
reaction time (ART) and visual reaction time (VRT) psychological effects of a yoga training programme in
were recorded before and after three rounds of SN in nursing students.[9]
study group as well as 5 minutes of quiet sitting in both We were granted the opportunity to impart a 6 month
groups. Performance of SN produced immediate comprehensive course of yoga training for nursing
decrease in both VRT and ART (P<0.001). This was students. The aim of this study was to analyse the effects
significant when compared to self-control period of the training on the participants´ health and quality of
(P<0.001) and compared to external control group, it life (QoL). 60 healthy nursing students (12 M, 48 F)
decreased significantly in ART (p=0.02). This was aged 18.60 ± 0.67 (SD) y were recruited, and 60 min of
pronounced when Δ% was compared between groups yoga training was given twice weekly, for 6 months.
(P<0.001). HR increased significantly following SN Selected biochemical and hematological parameters were
compared with both self-control (p=0.025) and external- recorded along with Ferrans and Powers QoL index
control group (p=0.032). Faster reactivity may be due to before and after the training period. QoL was also tested
intermediate level of arousal by conscious at mid term. Because we were not able to establish a
synchronisation of dynamic movements with breathing. separate control group, we correlated changes with the
Rise in HR is attributed to sympathetic arousal and subjects´ frequency of attendance. Post-intervention
muscular exertion. We suggest that SN may be used as statistical analysis (repeated measures of ANOVA)
an effective training means to improve neuro-muscular revealed highly significant and beneficial changes in
abilities. most hematological and biochemical parameters. Major
findings are enhanced bone marrow function, reduced
Study 2: Immediate cardiovascular effects of a single allergic tendency, alkalization of urine, metabolic
yoga session in different conditions.[8] reconditioning (with special emphasis on liver function)
This retrospective review of clinical data was done to and improvement in all QoL indices. These changes
determine cardiovascular effects of a single yoga session correlated positively with the subjects´ frequency of
in normal subjects as well as patients of different medical attendance, as evidenced by Pearson‟s linear correlation
conditions. Data of 1896 patients (1229 female, 633 male testing. There were also significant improvements in
and 34 transgender) with mean age of 36.28 ± 12.64 y QoL index and its subscales, both at mid training and
who attended yoga therapy sessions at CYTER between post training. These improvements also correlated
November 2010 and September 2012 was used for positively with attendance. The present study provides
analysis. Heart rate (HR), systolic (SP) and diastolic evidence of the beneficial psychological and physical
pressure (DP) had been recorded using non-invasive effects of yoga training amongst graduate nursing course
blood pressure (NIBP) apparatus before and after 60 students. We suggest that yoga be made an integral part
minute yoga sessions at CYTER and indices like pulse of medical and paramedical collegiate education.
pressure (PP), mean pressure (MP), rate-pressure product
(RPP) and double product (DoP) were derived from Study 4: Differential effects of uninostril and
recorded parameters. Participants were undergoing alternate nostril pranayamas on cardiovascular
appropriate yoga therapy protocols as per their individual parameters and reaction time.[10]
condition while normal subjects had a general schedule Recent studies have reported the differential
of practice. Typical yoga sessions included simple warm physiological and psychological effects of yogic
ups (jathis and suryanamaskar), breath body movement uninostril breathing (UNB) and alternate nostril
coordination practices (kriyas), static stretching postures breathing (ANB) techniques. This study aims to
(asana), breathing techniques (pranayama), relaxation determine differential effects of these techniques on
and chanting. There were statistically significant reaction time (RT), heart rate (HR), and blood pressure
(p<0.001) reductions in all the studied cardiovascular (BP). Twenty yoga‑trained subjects came to the lab on
parameters following the yoga session. The magnitude of six different days and RT, HR, and BP were recorded
reductions differed in the groups, it being more randomly before and after nine rounds of right UNB
significant in those having hypertension (n=505) and less (surya nadi [SN]), left UNB (chandra nadi [CN]), right
significant in those having endocrine/skin (n=230) and initiated ANB (surya bhedana [SB]), left initiated ANB
musculoskeletal (n=120) conditions. It was moderately (chandra bhedana [CB]), nadi shuddhi (NS), and normal
significant in the normal subjects (n=582) as well as breathing (NB). Overall comparison of Δ % changes
patients having psychiatric (n=302) and respiratory showed statistically significant differences between
(n=157) conditions. There is a healthy reduction in HR, groups for all parameters. There was an overall reduction
BP and derived cardiovascular indices following a single in HR‑ and BP‑based parameters following CB, CN,
yoga session. The magnitude of this reduction depends and NS with concurrent increases following SB and SN.
on the pre-existing medical condition as well as the yoga The differential effects of right nostril initiated (SB and
therapy protocol adopted. These changes may be SN) and left nostril initiated (CB, CN, and NS) UNB and
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ANB techniques were clearly evidenced. Changes Study 6: Immediate effect of chandra and suryanadi
following NB were insignificant in all respects. The pranayamas on cardiovascular parameters and
overall comparison of Δ % changes for RT showed reaction time in a geriatric population.[12]
statistically significant differences between groups that Previous studies have reported differential physiological
were significantly lowered following both SB and SN. and psychological effects of exclusive right and left
Our study provides evidence of sympathomimetic effects nostril breathing. Though potential health benefits have
of right nostril initiated pranayamas with been postulated, further clinical research is required to
sympatholytic/parasympathomimetic effect following prove immediate and sustained efficacy of these
left nostril initiated pranayamas. We suggest that the techniques. This study evaluated immediate effects of
main effect of UNB and ANB techniques is determined exclusive right (SNP) and left (CNP) nostril breathing on
by the nostril used for inspiration rather than that used cardiovascular (CV) parameters and reaction time (RT)
for expiration. We conclude that right and left yogic in a geriatric population. 26 subjects attending regular
UNB and ANB techniques have differential yoga sessions at a senior citizen hospice were recruited
physiological effects that are in tune with the traditional for this self-controlled study. They were instructed to sit
swara yoga concept that air flow through right nostril in any comfortable posture and relax for 5 min before
(SN and pingala swara) is activatory in nature, whereas taking the pre-intervention recordings of Heart rate (HR),
the flow through left nostril (CN and ida swara) is blood pressure (BP), auditory and visual RT (ART and
relaxatory. VRT respectively). They then performed the selected
technique and parameters were recorded immediately
Study 5: Immediate effect of alternate nostril after performance of 9 rounds of either SNP or CNP. The
breathing on cardiovascular parameters and reaction entire sequence of recordings was randomised to avoid
time.[11] any bias. Intra and inter group statistical analysis was
This study evaluated immediate effects of 27 rounds of carried out using Student's paired t test for data that
left nostril initiated alternate nostril breathing (ANB) passed normality testing and Wilcoxon matched-pairs
technique of nadi shuddi (NS) and right nostril initiated signed-ranks test applied for the others. Overall intra-
ANB of aloma viloma (AV) pranayama on group comparison of pre-post data and inter-group Δ %
cardiovascular (CV) parameters and reaction time (RT) comparisons showed statistically significant (p < 0.05)
in a trained population. 16 subjects attending regular differences for all parameters. There was an overall
yoga sessions were recruited and each subject performed reduction in HR and BP based parameters following both
27 rounds of either technique, selected randomly on SNP and CNP. However, inter-group Δ % comparisons
different days. Heart rate (HR), systolic pressure (SP), revealed a significantly greater reduction after CNP for
diastolic pressure (DP), auditory and visual reaction time all parameters. Inter-group comparisons revealed highly
(ART and VRT) were recorded before and after significant decreases (p < 0.001) in VRT and ART after
pranayamas. NS was done by breathing in through left SNP. In conclusion, our study sheds new light on the
nostril and out through right followed by breathing in physiological changes occurring after SNP and CNP in a
through right and out through left. AV was done by geriatric population. While both techniques reduce HR
breathing in through right nostril and out through left and BP, CNP does it more significantly. There is
followed by breathing in through left and out through shortening of RT following SNP and this may be
right. All data passed normality testing and statistical attributed to enhance sensory motor function that is of
analysis was carried out using Student‟s paired t test. great significance in the elderly. We suggest that Yoga
HR, SP and DP reduced significantly (p < 0.05 to 0.001) should be part of the heath care facilities for the elderly
after NS while they increased after AV. Post intervention as it can enhance their quality of life and improve their
differences as well as Δ% between groups was overall health status.
significant (p < 0.05 to 0.001) for HR, SP and DP. ART
and VRT were significantly (p < 0.05 to 0.001) shortened Study 7: Comparative immediate effect of different
after AV and significantly prolonged after NS. Post yoga asanas on heart rate and blood pressure in
intervention differences as well as Δ% between groups healthy young volunteers.[13]
was very significant (p < 0.001) for both ART and VRT. This study planned to compare immediate cardiovascular
Significant reductions of HR, SP and DP after NS and effects of different yoga asanas in healthy young
their increase after AV may be attributed to modulation volunteers. Heart rate (HR), systolic pressure (SP), and
of autonomic tone. Right nostril initiated ANB technique diastolic pressure (DP), blood pressure (BP), were
produces autonomic arousal, whereas left nostril initiated recorded using the non invasive blood pressure ( NIBP)
ANB technique induces relaxation/balance. These can be apparatus in 22 healthy young subjects, before and after
selectively applied in various therapeutic settings. the performance of Dhanurasana (DA), Vakrasana (VA)
Further studies in various clinical conditions and settings (both sides), Janusirasasana (JSA) (both sides),
can enable us to understand their therapeutic applications Matsyasana and Shavasana for 30 s. HR and BP were
better. further recorded during supine recovery at 2, 4, 6, 8, and
10 min. A repeated measure of ANOVA was used for
statistical analysis. There were significant changes in HR
and BP both immediately after the Asanas as well as
www.ejpmr.com 258
during the recovery period. Overall comparisons of Δ% indicating significant differences for pre-post
changes immediately after the performance of the Asanas comparisons. All parameters witnessed a reduction
revealed significant differences with regard to HR that following the single session. This was statistically more
increased significantly after DA. In the recovery phase, significant (P < 0. 0001) in HR, RPP and DoP while it
there were significant intergroup differences from 2 min was also significant (P < 0.01 and P < 0.05) in SP and
onward in both SP and DP. The decrease of SP after VA PP, respectively. The decrease in MP just missed
(right side) (VA‑R) was significantly greater than significance (P = 0.054) while it was not significant in
Shavasana (4th, 6th, and 8th min) and JSA (left side) DP. There is a healthy reduction in HR, BP and derived
(JSA‑L) at 6th and 8th min. DP decreased significantly cardiovascular indices following a single yoga session in
after performing JSA‑L compared to VA‑R at the 6th geriatric subjects. These changes may be attributed to
and 8th min. The cardiovascular changes immediately enhanced harmony of cardiac autonomic function as a
after the Asanas and during the recovery phase reveal result of coordinated breath-body work and mind-body
inherent differences between the selected postures. The relaxation due to an integrated “Silver Yoga” program.
rise of HR in DA may be attributed to increased
sympathetic response due to the relative difficulty of the Study 9: Effects of a single session of yogic relaxation
posture as well as abdominal compression occurring in it. on cardiovascular parameters in a transgender
The effect of supine relaxation is more pronounced after population[15]
the performance of the Asanas as compared to mere This pilot study was done to determine effects of a single
relaxation in Shavasana. This may be attributed to a session of yogic relaxation on cardiovascular parameters
normalization and resultant homeostatic effect occurring in a transgender population. Heart rate (HR) and blood
pressure (BP) measurements were recorded in 106
due to a greater, healthier de‑activation of the autonomic
transgender participants (mean age of 23.86 ± 7.87 y) a�
nervous system occurring towing to the presence of prior
ending a yogic relaxation program at CYTER,
activation. There were also subtle differences between
MGMCRI. Participants practised a series of techniques
the right sided and left sided performance of VA and
consisting of quiet sitting, om chanting, mukha bhastrika,
JSA that may be occurring due to the different internal
nadi shuddhi, brahma mudra, pranava pranayama in
structures being either compressed or relaxed on either
sitting posture and savitri pranayama in shavasana. HR,
side. Our study provides initial evidence of differential
systolic (SP) and diastolic pressure (DP) were recorded
cardiovascular effects of Asanas and subtle differences
before and after the 60 minute session using non-
between right and left sided performance. Further,
invasive blood pressure (NIBP) apparatus. Pulse pressure
cardiovascular recovery is greater after the performance
(PP), mean pressure (MP), rate-pressure product (RPP)
of the Asanas as compared to shavasan; thus, implying a
and double product (DoP) indices were derived from
better response when effort precedes relaxation.
recorded parameters. Student‟s paired t test was used to
compare data that passed normality testing and Wilcoxon
Study 8: Single session of integrated ‘silver yoga’
matched pairs signed-ranks test for others. P values less
program improves cardiovascular parameters in
than 0.05 were accepted as indicating significant
senior citizens.[14]
differences for pre-post comparisons. All recorded
This pilot study was carried out to determine
cardiovascular parameters witnessed a reduction
cardiovascular effects of a single session of an integrated
following the session. This was statistically more
“silver yoga” program in senior citizens of Serene
significant (p < 0. 0001) in HR, MP, RPP and DoP and
Pelican Township, Pondicherry. Heart rate (HR) and
significant (p = 0.002) in SP. There is a healthy reduction
blood pressure (BP) measurements were recorded in 124
in HR, BP and derived cardiovascular indices following
senior citizens (75 female, 49 male) with mean age of
a single yogic relaxation session in a transgender
67.19 ± 10.61 year who attended an integrated “Silver
population. These changes may be attributed to enhanced
Yoga” program at Centre for Yoga Therapy, Education
harmony of cardiac autonomic function as a result of
and Research from August to October 2014. Participants
mind-body relaxation program. It is suggested that an
practiced the protocol that was specially designed for
open and non-hostile environment is conducive for
senior citizens, keeping in mind their health status and
obtaining such a state of psychosomatic relaxation and
physical limitations. This included simple warm-ups
that such opportunities for transgender participants
(jathis), breath body movement coordination practices
should be created in all healthcare facilities.
(kriyas), static stretching postures (asanas), breathing
techniques (pranayamas), relaxation and simple chanting.
Study 10: Health status of elderly women residing in
Non-invasive BP apparatus was used to record the HR,
a hospice in Pondicherry.[16]
systolic (SP) and diastolic pressure (DP) before and after
With advancing age, the body tends to slow down and
the 60 min sessions. Pulse pressure (PP), mean pressure
becomes less efficient and elderly people are prone to a
(MP), rate-pressure product (RPP) and double product
few age-related health issues. The present study was
(DoP) indices were derived from the recorded
undertaken to assess psycho- physical health status of
parameters. Student‟s paired t-test was used to compare
data that passed normality testing by Kolmogorov–
After an introductory orientation program, thirty women
Smirnov Test and Wilcoxon matched-pairs signed-ranks
with mean age 68.67 ± 7.83 yrs, agreed to be subjects
test for those that did not. P < 0.05 were accepted as
www.ejpmr.com 259
and after obtaining informed consent, various parameters Study 12: A brief qualitative survey on the utilization
was recorded. Selected cardiovascular variables such as of Yoga research resources by Yoga teachers.[18]
heart rate (HR), systolic pressure (SP) and diastolic Yoga has become popular worldwide with increasing
pressure (DP) and respiratory rate (RR) were measured. research done on its therapeutic potential. However, it
Pulmonary function tests (PFT) were done using remains to be determined whether such findings actually
spirometer and reaction time (RT) measured using RT percolate down into teaching and practice of Yoga
apparatus. Select psychological variables including teachers/therapists. The aim of this survey was to
depression, anxiety and self-esteem were assessed using document awareness of Yoga research findings in the
Hamilton Depression Rating Scale, Hamilton Anxiety Yoga community and find out how these were utilized. It
Rating Scale and Rosenberg Self- Esteem scale was undertaken with a select group of 34 international
respectively. We found HR, SP, DP values were as Yoga teachers and therapists utilizing email and social
expected for age and gender and our subjects performed media between August and December 2015. Majority of
better on PFT and RT as compared to earlier studies in responders had well-established reputation in Yoga and
similar groups. However our subjects had lower were from diverse lineages with 30 of them having more
psychological health status with increased depression, than 5 years of experience in the field. A set of eight
anxiety and lower self-esteem. This may be due to being questions were sent to them related to essentiality of
in hospice away from family who either do not want Yoga research, how they updated themselves on research
them or are not there at all. Though physical health status findings and whether such studies influenced their
seems satisfactory for age, this finding of inadequate teaching and practice. Responses were compiled and
psychological health function may be first evidence of appropriate statistics determined for quantitative aspects
worsening physical health in future. We suggest that while feedback, comments and suggestions were noted in
older people must be acknowledged as integral members detail. About 89% agreed that it was essential to be up-
of society and provided opportunities to enjoy good to-date on Yoga research but only 70% updated
quality of life and easy access to health services. There is themselves regularly with average papers read fully per
great scope for incorporation of traditional health year being <10. Most accessed information through
practices such as Yoga and other CAM modalities. general news reports, emails from contacts, and articles
on internet sites whereas only 7% were through PubMed.
Study 11: Effect of different pranayamas on About 60% felt these studies helped them in general
respiratory sinus arrhythmia.[17] teaching whereas 20% said that such studies had not
Respiratory Sinus Arrhythmia (RSA) is the differential really influenced it in any way. This survey provides a
change of Heart Rate (HR) in response to inspiration and basic picture of a general lack of awareness of Yoga
expiration. This is a non-invasive sensitive index of research amongst practicing Yoga teachers and
parasympathetic cardiac control. To evaluate changes in therapists. Though a majority agree research is
RSA by utilizing a simple and cost-effective analysis of important, few seriously update themselves on this
electrocardiographic (ECG) tracings obtained during through scientific channels. With regard to future studies,
performance of four pranayama techniques. Fifty two most wanted “proof” that could be used to convince
trained volunteers performed the following pranayamas potential clients and felt that more qualitative methods
with different ratios for inspiration and expiration: sukha should be applied.
(1:1), traditional (1:2), pranava (1:3) and savitri (2:1:2:1)
and ECG was recorded while performing the techniques Study 13: Comparative study on the effect of yogic
with rest period of 5 minutes in-between. HR was relaxing asanas and pranayamas on cardiovascular
calculated and maximum HR during inspiration (Imax), response in healthy young volunteers.[19]
minimum HR during expiration (Emin), differences Cardiovascular morbidity is increasing recently in India.
between Imax and Emin (Δ), percentage differences Stress and autonomic dysfunction are associated with
between Imax and Emin (Δ%) and expiration: cardiovascular morbidity. Yoga is the best lifestyle ever
inspiration ratio (E:I) calculated by respective formulae. designed. Based on limited scientific research, yoga
Statistical analysis was carried out using repeated (meditation, asanas, and pranayamas including
measures of ANOVA with Tukey-Kramer multiple relaxation) therapy is known to improve cardiovascular
comparisons test. There were significant differences autonomic functions. To study and compare the effect of
between groups in all five aspects namely: p= 0.0093 for 6 months of training in relaxing asanas and pranayamas
mean Imax, p = 0.0009 for mean Emin, and p < 0.0001 on blood pressure (BP), pulse pressure (PP), heart rate
for Δ HR (I-E), Δ% HR (I-E) and E:I ratio. Pranava (HR), and rate-pressure product (RPP) in young healthy
pranayama produced the greatest changes in all five volunteers. A total of 109 healthy volunteers aged 20-25
comparisons. We suggest that further short and long term years were divided into 3 groups consisting of asan (n =
studies be undertaken with pranava pranayama in 38), pranayam (n = 38), and control group (n = 33). The
patients to further qualitatively and quantitatively Yoga training was given 25 min/day for 6 days/week for
evaluate inherent mechanisms of this simple technique. 6 months. Pranayam group received relaxing pranayam
Addition of these cost-effective techniques to the (pranav, savitri, nadi shuddhi and chandra nadi), asan
medical armoury will help patients of rhythm disorders group received relaxing asan (pawanmuktasana, balasan,
and other cardiovascular conditions. dharmicasan, and shavasan) and waiting list were kept as
www.ejpmr.com 260
a control group. The results were statistically compared physiological, psychological and biochemical
between groups by analysis of variance and intra-group mechanisms behind such beneficial effects. The strength
pre-post comparisons by paired t-test. Post training of our work is the excellent compliance of our patients in
analysis showed significant decreases in systolic BP and addition to the fact that these studies were been done in
diastolic BP as well as PP, mean arterial pressure and actual patient populations as well as in normal subjects
RPP in both asan and pranayam group as compared with and other sectors of people such as the transgender and
control. There was, however, no significant difference the geriatric populations too. We also suggest that yoga
between asan and pranayam group. Practising either be made an integral part of medical and paramedical
relaxing asan or pranayam enhances parasympathetic collegiate education as there is great scope for
activity and decreases sympathetic activity. incorporation of yoga and other CAM modalities.
Study 14: Effect of a 12 Week Yoga Therapy ACKNOWLEDGEMENTS

Program on Mental Health Status in Elderly Women The authors thank the benevolent management and
Inmates of a Hospice[20] visionary administrators of Sri Balaji Vidyapeeth
This study was undertaken to evaluate the effectiveness University for setting up the Centre for Yoga Therapy,
of yoga on the mental health status of elderly women Education and Research (CYTER) in Mahatma Gandhi
inmates residing in a hospice in Puducherry. Forty Medical College and Research Institute (MGMCRI). We
elderly women were randomly divided into yoga and thank our Chairman, Chancellor, Vice-chancellor, Dean
wait-listed control group. A yoga therapy program of 60 of Research & Allied Health Sciences and Registrar SBV
min was given twice a week for 12 weeks. This protocol for their constant support encouragement at every step.
was specially designed for senior citizens, keeping in We are grateful to Prof Madanmohan, Director CYTER
mind their health status and physical limitations that and Ammaji Yogacharini Meenakshi Devi Bhavanani,
included simple warm-up and breath-body movement Director ICYER for their constant motivation and
coordination practices (jathis and kriyas), static supportive guidance. The authors thank Prof AR
stretching postures (asanas), breathing techniques Srinivasan (Registrar SBV and Prof, Dept of
(pranayamas), and relaxation. Hamilton anxiety scale for Biochemistry), Dr K Jaiganesh (Prof, Dept of
measuring anxiety, Hamilton rating scale for depression, Physiology), Dr M Hanifah (Prof, General Medicine), Dr
and Rosenberg self-esteem scale to measure self-esteem Jenith Berlin Raj (Associate Professor, Dept of
were administered to both groups before and after the 12- Physiology), Sri S Vasanthan (Tutor, Dept of
week study period. Data were assessed for normality, Physiology), Dr R Balaji and Mrs D Pushpa of CYTER,
and appropriate parametric and nonparametric statistical Sri S Thirusangu (MSc student of KGNC) for their active
methods were applied for intra- and inter-group involvement in planning, conducting and reporting on
comparisons. Overall, intra- and inter-group comparison various studies. Thanks are due to the Lecturer of
of prepost data showed statistically significant (P < CYTER Sri G Dayanidy, Yoga instructors Mrs. M
0.001) differences for all three parameters. There was an Sangeetha, Mrs G Sarulatha, Mrs M Latha and Mr.
overall improvement in the scores indicating decreased Dhanushapnadeesh and ANM Ms Kavitha for
levels of depression and anxiety coupled with an increase conducting the therapy sessions and for their valuable
in the level of self-esteem after the yoga therapy assistance during recording sessions and data entry.
program. The influence of yoga in the reduction of
depression and anxiety scores and improvement in self- REFERENCES
esteem scores in elderly women subjects is evident from 1. Vijayalakshmi P, Madanmohan, Bhavanani AB,
this study. As reported in earlier studies, this may be Patil A, Babu K, Modulation of stress induced by
attributed to changes in central neurotransmitters such as isometric handgrip test in hypertensive patients
gamma-aminobutyric-acid coupled with increased following Yogic relaxation training. Indian J Physiol
parasympathetic tone and decreased sympatho-adrenal Pharmacol., 2004; 48: 59-64.
activity. It is recommended that yoga should be a part of 2. Bhavanani AB. Are we practicing Yoga therapy or
health-care facilities for elderly as it can enhance the Yogopathy? Yoga Therapy Today., 2011; 7(2): 26-
quality of life by improving their overall mental health 28
status. It could provide a healthy and positive alternative 3. Oken BS, Zajdel D, Kishiyama S, Flegal K, Dehen
from depressing negative thoughts, and give them a C, Haas M et al. Randomized controlled six-month
sense of purpose and hope. trial of yoga in healthy seniors: effects on cognition
and quality of life. Altern Ther Health
CONCLUSION Med., 2006; 12: 40–47
The selected research studies discussed above provide 4. Madanmohan, Udupa K, Bhavanani AB,
preliminary evidence of the therapeutic potential of Yoga Vijayalakshmi P, Surendiran A. Effect of slow and
in students, geriatric people, transgender population, fast pranayams on reaction time and cardio
healthy young volunteers as well as patients with various respiratory variables. Indian J Physiol
disorders like hypertension, musculoskeletal, endocrine, Pharmacol., 2005; 49: 313-18.
skin, psychiatric, respiratory conditions. These may 5. Innes KE, Bourguignon C, Taylor AG.
provide the basis for further studies that can explore the Risk indices associated with the insulin resistance
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syndrome, cardiovascular disease, and possible 19. Vasanthan S, Madanmohan T, Bhavanani A B,

protection with yoga: a systematic review. J Am Hanifah M, and Jaiganesh K. Comparative study on
Board Fam Pract., 2005; 18: 491-519. the effect of yogic relaxing asanas and pranayamas
6. Sengupta P. Health Impacts of Yoga and on cardiovascular response in healthy young
Pranayama: An art-of-the-state review. Int J Prev volunteers. National Journal of Physiology,
Med., 2012; 3: 444-58. Pharmacy and Pharmacology Online First: 25 Aug,
7. Bhavanani AB, Ramanathan M, Balaji R and Pushpa 2016. Web. 25 Aug
D. Immediate effect of suryanamaskar on reaction 2016 doi:10.5455/njppp.2017.7.0824018082016
time and heart rate in female volunteers. Indian J 20. Ramanathan M, Bhavanani AB, Trakroo M. Effect
Physiol Pharmacol., 2013; 57(2): 199–204. of a 12-week yoga therapy program on mental health
8. Bhavanani AB, Ramanathan M, Madanmohan. status in elderly women inmates of a hospice. Ahead
Immediate cardiovascular effects of a single yoga of print., 1 Aug, 2016. DOI:10.4103/0973-
session in different conditions. Altern Integ Med., 6131.186156.
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9. Bhavanani AB, Ramanathan M, Madanmohan,
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in nursing students. Int Res J Pharm App Sci., 2013;
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pranayamas on cardiovascular parameters and
reaction time. Int J Yoga., 2014; 7: 60-65.
11. Bhavanani AB, Ramanathan M, Madanmohan.
Immediate effect of alternate nostril breathing on
cardiovascular parameters and reaction time. Online
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12. 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.
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.
14. Bhavanani AB, Ramanathan M, Trakroo M. Single
session of integrated „silver yoga‟ program improves
cardiovascular parameters in senior citizens.. J
Intercult Ethnopharmacol., 2015; 4(2): 134-37.
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Thirusangu S. Effects of a single session of yogic
relaxation on cardiovascular parameters in a
transgender population. International Journal of
Physiology., 2016; 4(1): 27-31.
16. Ramanathan M, Bhavanani AB. Health status of
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17. Bhavanani AB, Raj JB, Ramanathan M, Trakroo M.
Effect of different pranayamas on respiratory sinus
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18. Bhavanani AB. A brief qualitative survey on the
utilization of Yoga research resources by Yoga
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www.ejpmr.com 262
“Role of Yoga in Prevention, Management and Rehabilitation of Chronic Diseases”
RESEARCH STUDIES ON THE ROLE OF YOGA IN CHRONIC DISEASES

Dr. Meena Ramanathan17and Dr. Ananda Balayogi Bhavanani228
Introduction
Yoga is an ancient art/science and philosophy which originated in India centuries
ago. It harmonises mind and body as well as aids in achieving enlightenment. Yoga
is multi-dimensional in nature consisting of many components. The popularity of
yoga has grown tremendously in recent years. Data from the National Centre for
Complementary and Alternative Medicine (NCCAM) show that the usage of
complementary and alternative medicine (CAM) treatments for all conditions is on
the rise. (1) Yoga is one of the commonest forms of complementary and alternative
medicine therapies, which is increasingly being practiced worldwide. (2)
A disease that lasts for a long time, generally three months or more or for a lifetime
is considered to be a chronic disease (3). These generally which cannot be prevented
by vaccines or cured by medication, nor do they just disappear. Health damaging
behaviours - particularly tobacco use, lack of physical activity, and poor eating
habits - are major contributors leading to chronic diseases.(4) The misguiding factor
is that people with these disorders think that they are free from the disease when
there are no symptoms.
Yoga is not an alternative to traditional treatments but is a useful complimentary
therapy and a potential tool to regain overall health and wellbeing. Regular practice
of yoga has been shown to increase endorphin release, resulting in improved pain
control and stress reduction. Reduced levels of stress have been noted in those
practicing yoga which alters their perception of stress resulting in an increased
sense of well-being, accomplishment and control over chronic pain, which, until
they began practicing yoga was absent. Improved musculoskeletal function has
also been linked to the practice of yoga providing a legitimate exercise format to
regain or keep muscle strength and aerobic capacity. (5)
However Yoga is being misunderstood as primarily “stretching” in the postures
which comprises just one of eight components of a broader discipline of
comprehensive physical, mental, and spiritual health and balanced state of mind.
Various techniques in Yoga can be tailored to suit the needs of individuals with
various physical or psychological limitations and can range from gentle to
strenuous workout, some providing cardiovascular rehabilitation whereas others
focus on relaxation and calming the mind.
Major Studies on Yoga and Chronic Diseases:

Recently, chronic diseases, such as chronic obstructive pulmonary disease (COPD),
cancer, cardiovascular diseases (CVD), obesity and diabetes mellitus, have emerged
as serious problems worldwide. Yoga has been reported to have positive effects on
1 Deputy Director, CYTER, Sri Balaji Vidyapeeth, Puducherry. saineema@yahoo.com

2 Director, CYTER, SBV, Puducherry. yognat@gmail.com
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IDY National Seminar-cum-Workshop at SBV, Pondicherry 2017
distress and functional performance in patients with chronic diseases. Eda et al

reviewed recent studies that have examined the effects of yoga on chronic diseases,
especially COPD and cancer, and immune functions including those mediated by
human β-defensin 2 (HBD-2), natural killer (NK) cells, and proinflammatory
cytokines and suggested that yoga might benefit patients with chronic diseases,
decreasing distress thereby improving functional performance. The positive effects
of yoga on several indicators have been reported and thus yoga could be effectively
used to prevent many diseases. Yoga has potential utility as a complementary and
alternative therapy for chronic diseases and can help maintain health and wellbeing
in all.(6)
Barnes demonstrated improvements in cardiovascular reactivity with a
transcendental meditation program where a significant reduction in resting systolic
blood pressure (BP) in adolescents with high normal BP was observed. A reduction
in reactivity of BP, heart rate, and cardiac output to simulated stressors reflects the
beneficial effects of yoga at rest and during stressful states. (7) The calming effect of
yoga on cardiovascular and respiratory parameters has been linked to a reduction
in the autonomic arousal.(8) Autonomic effects such as decreased heart rate and
blood pressure, with an elevation of mean skin temperature, were observed after
three months of daily yoga training.(9) Changes in the dopamine-beta-hydroxylase
activity, monoamine oxidase, and adrenal steroids further demonstrate a shift
towards parasympatho-dominance with yoga. This is further supported by a
randomized control study by Infante et al, in which no differences were recorded
between morning and evening epinephrine and dopamine levels in individuals
practicing yogic meditation, showing a tighter control in the daily hormonal
rhythm. (10)
Similar effects were also observed by Bhargava et al who recorded autonomic
responses in BP and heart rate, while holding breath at different phases of
respiration. The recordings showed a decrease of both BP and heart rate.
Pranayama, the yogic breathing technique, appears to alter autonomic responses to
breath-holding by increasing vagal tone and decreasing sympathetic discharges.(11)
The practice of yoga is also associated with some profound biochemical changes
which was demonstrated in a one year trial of yoga training amongst military
personnel that reported significant reductions in perceived exertion. These
individuals became more efficient in dealing with oxidative stress by increasing the
metabolism of glutathione, increasing the production of antioxidant enzymes, and
eliminating per-oxidation products more efficiently. The ability to achieve higher
work rates with reduced oxygen consumption was exhibited too.(12)
Yoga training improves the breathing pattern of the patients into a slower and
deeper rhythm helping them to tolerate higher workloads. Udupa and Singh (1972)
suggested that yoga has beneficial effect on respiratory function of normal persons
as after training in "Hatha Yoga", an increase in vital capacity, lowered respiratory
rate, and increased tolerance to physical stress was shown.(13) Symptomatic
improvement among patients undergoing training in yoga further suggests that it
is beneficial to patients with chronic severe airways obstruction. Significantly
greater number of patients reported that they could control an attack of severe
48
shortness of breath without having to seek medical help, due to regular practice of
yogic breathing exercises. (14)
Chronic urologic disorders are difficult to diagnose because their presentation
mimic other medical conditions are often a diagnosis of exclusion. Treatment is also
frustrating because the more traditional treatments are often unsuccessful in
managing chronic disorders. Health care practitioners are often forced to look for
other modalities to provide pain relief and improve quality of life. Hatha Yoga is
one of the modalities which has been extremely useful to many patients in reducing
the suffering seen with chronic urologic conditions. (5)
There are many studies claiming yoga can be an effective treatment for improving
a wide variety of conditions such as musculoskeletal problems, cardiopulmonary
function, lipid and carbohydrate metabolism, HIV, irritable bowel syndrome,
chronic low back pain, sleep problems, stress, anxiety and depression. Multiple
studies have documented the beneficial effects of yoga suggesting numerous
mechanisms of its action. The asanas are the aerobic component and may stimulate
the central nervous system release of endorphins, monoamines, and brain-derived
neurotrophic factor (BDNF) in the hippocampus. Pranayama and dhyana may
regulate the emotional responses by reducing the sympathetic and increasing the
parasympathetic tone and improve the cognitive functioning by increasing the EEG
synchrony and coherence. An increase in melatonin and decrease in cortisol have
been associated with the meditative component of yoga. A rise in melatonin
promotes sleep, stimulates immune system and reduces blood pressure. Numerous
studies have found a positive correlation between levels of cortisol, negative effects,
and depression. Different forms of yoga have shown effectiveness in treatment of
many chronic diseases such as cancer, asthma, diabetes, arthritis, fibromyalgia,
cardiac problems etc., where stress is considered to play an important role. (15)
Meditation is positively associated with mental health. Length of lifetime yoga
practice was significantly associated with better physical health, suggesting yoga
has a potential cumulative benefit over time. Different locations and methods of
practice may be associated with varying effects on health outcomes. (16) Most of the
studies indicate that yoga is rarely harmful, and is well received by participants
with a wide variety of health problems. The psychological benefits of yoga are as
well established as the physical benefits.
Groessl et al concluded that yoga interventions impact multiple outcomes that are
important to health and well-being of people afflicted with chronic low back pain.
Recent, high quality evidence suggests that yoga provides comparable effects to,
and is more appealing than, formal stretching and strengthening programs led by
physical therapists. The recent data suggested that it would be a boon for health
care organizations and the members they serve, to have yoga as an available health
service option at little or no cost. (1)
Chronic low back pain (CLBP) affects millions of people worldwide. In addition to
chronic pain, CLBP is associated with increased disability and psychological
symptoms, and reduced health-related quality of life. Yoga reduces pain and
disability, can be practiced safely, and is well received by participants and use of
pain medication is reduced considerably. (17)
49
IDY National Seminar-cum-Workshop at SBV, Pondicherry 2017
Chronic psychological stress affects the severity of metabolic syndrome (MetS) and
quality of life. The chief psychological components of yoga include maintaining
attention and relaxation which is of great significance and value where MetS is
considered. Sohl et al summarised the results of an exploratory study suggesting
that yoga combined with health education may lead to improvements in quality of
life outcomes among adults at risk for MetS. Although not statistically significant,
reductions in perceived stress and mood disturbance in the group that practiced
yoga was evident. Few studies have also concluded that yoga improves
cardiometabolic health, energy levels, general health perceptions, physical
component of quality of life, and social functioning. These results are important
because chronic psychological stress and quality of life increase the overall MetS
disease burden. Yoga, a form of physical activity that incorporates psychological
components is a promising intervention for improving the burden of MetS. (18)
Multiple sclerosis (MS) is a debilitating and demyelinating disease that damages
the myelin sheath surrounding the spinal cord. A RCT found yoga therapy to be
more effective in improving balance, walking endurance, fatigue, depression and
anxiety in MS as compared to controls but did not differ from treadmill training.
Pranayama, Hatha and Raja Yoga was shown in a RCT to improve physical pain
and quality of life of women with MS. An exploratory study reported improvement
in functional strength, balance, and peak expiratory flow in patients with MS
receiving yoga. The study also showed a trend towards improving quality of life in
such patients. A prospective case series reported integrated yoga to improve
neurogenic bladder dysfunction in MS (2)
Yoga has also been used to provide relief from stressful psychological states.
Raghavendra et al demonstrated significant reductions in anxiety, depression,
perceived stress, and cortisol levels in 88 breast cancer subjects practicing Yogic
meditation compared to controls. (19) Sudarshan Kriya (Yogic Breathing exercise)
has shown to enhance mood in people with melancholic depression, comparable to
the use of imipramine, a tricyclic anti-depressant. (20)
Conclusion:
Yoga has been used as a therapeutic modality in traditional Indian medicine for
centuries and as a complementary modality more recently. The most powerful
aspect of every chronic disorder is the negative impact they have on mind and
spirit. Every person suffering with a chronic disorder can develop a clear and
undeniable sense of wellbeing through proper practice of healing and restorative
yoga. This positive state of being, in turn, allows the body to heal itself physically
to its maximum capability with surprising and unimaginable results.
Attitude can be the difference between living a productive, happy life, or living one
of regret and sadness that potentially worsens the illness. Mind transforms
perceptions with its tremendous power. Yoga helps focus on the now, through
mediation, body awareness, and guided breathing exercises the mind is taught to
tune out external stresses and focus on the present.
50
Dedicated practice of Yoga will make life better for those with chronic
illnesses. Along with nutrition and medication, a regular Yoga practice is the best
thing for all. Learning to listen to the body and push beyond its comfort zone, just
a little bit more, can have tremendous positive results in the long run. It not only
helps to deal with chronic pain and the other physical issues, but also helps to
combat depression, anxiety, and the emotional issues as well.
References:
1. Groessl EJ, Chang D, Sklar M. Yoga as a Treatment for Low Back Pain: A Review of the Literature..
INTECH; 2012 [cited 2017 May 29]. Available from: http://cdn.intechopen.com/pdfs/36707/InTech-
Yoga_as_a_treatment_for_low_back_pain_a_review_of_the_literature_.pdf
2. Anand KS, Verma R. Yoga in Neuro-Psychiatry. J Yoga Phys Ther 2014;05(01).
3. Mosby. Mosby’s Medical Dictionary, 9th edition. St. Louis: Elsevier; 2013.
4. Medical Definition of Chronic disease - MedicineNet. www.medicinenet.com
5. Ripoll E, Mahowald D. Hatha Yoga therapy management of urologic disorders. World J Urol
2002;20(5):306–309.
6. Eda N. Yoga has Beneficial Effects on Patients with Chronic Diseases and Improves Immune Functions. J
Clin Res Bioeth [Internet] 2014 [cited 2017 May 29];05(05). Available from:
https://www.omicsonline.org/open-access/yoga-has-beneficial-effects-on-patients-with-chronic-
diseases-and-improves-immune-functions-2155-9627.1000197.php?aid=32688
7. Barnes VA, Treiber FA, Davis H. Impact of Transcendental Meditation on cardiovascular function at rest
& during acute stress in adolescents with high normal blood pressure. J Psychosom Res 2001;51:597–605.
8. Patel CH. Yoga and bio-feedback in the management of hypertension. Lancet Lond Engl
1973;2(7837):1053–5.
9. Joseph S, Sridharan K, Patil SK, Kumaria ML, Selvamurthy W, Joseph NT, et al. Study of some
physiological and biochemical parameters in subjects undergoing yogic training. Indian J Med Res
1981;74:120–4.
10. Infante JR, Torres-Avisbal M, Pinel P, Vallejo JA, Peran F, Gonzalez F, et al. Catecholamine levels in
practitioners of the transcendental meditation technique. Physiol Behav 2001;72(1–2):141–6.
11. Bhargava R, Gogate MG, Mascarenhas JF. Autonomic responses to breath holding and its variations
following pranayama. Indian J Physiol Pharmacol 1988;32(4):257–64.
12. Mishra K, Singh P, Bunch SJ, Zhang R. The therapeutic value of yoga in neurological disorders. Ann Indian
Acad Neurol 2012;15(4):247-54
13. Udupa KN, Singh RH. The scientific basis of yoga. JAMA 1972;220(10):1365.
14. Tandon MK. Adjunct treatment with yoga in chronic severe airways obstruction. Thorax 1978;33(4):514–
517.
15. Meyer HB, Katsman A, Sones AC, Auerbach DE, Ames D, Rubin RT. Yoga as an ancillary treatment for
neurological and psychiatric disorders: a review. J Neuropsychiatry Clin Neurosci 2012;24(2):152–64.
16. Birdee GS, Ayala SG, Wallston KA. Cross-sectional analysis of health-related quality of life and elements
of yoga practice. BMC Complement Altern Med 2017;17(1):83.
17. Galantino ML, Bzdewka TM, Eissler-Russo JL, Holbrook ML, Mogck EP, Geigle P, et al. The impact of
modified Hatha yoga on chronic low back pain: a pilot study. Altern Ther Health Med 2004;10(2):56–9.
18. Sohl SJ, Wallston KA, Watkins K, Birdee GS. Yoga for Risk Reduction of Metabolic Syndrome: Patient-
Reported Outcomes from a Randomized Controlled Pilot Study. Evid-Based Complement Altern Med
ECAM 2016;2016:3094589.
19. Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, Vanitha N, et al. Effects of a yoga
program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant
radiotherapy: a randomized controlled trial. Integr Cancer Ther 2009;8(1):37–46.
20. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK,
Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized
comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord 2000;57(1–3):255–9.
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Review Article DOI: 10.18231/2393-8005.2017.0012
Integrating yoga in health professional education: The SBV experience

Director, Centre for Yoga Therapy, Education & Research, Sri Balaji Vidyapeeth, Pondicherry
Email: yognat@gmail.com
Introduction to this purpose organized a National Workshop on

Medicine has been regarded as a noble profession Introducing Yoga in Medical Curriculum at JIPMER,
since time immemorial and its practitioners equated Pondicherry in March 2009.(5,6)
with the divine by ill and needy.(1) Divine qualities
expected in a medical practitioner include wisdom, National Seminar on “Integrating Yoga in
competence, humility, magnanimity, empathy, selfless Health Professions Education”
service and care. A compassionate heart, a listening ear A National Seminar was organized by CYTER and
coupled with a warm caring hand is known to make all Department of Physiology on “Integrating Yoga in
the difference between a successful or not so successful Health Professions Education” at MGMC & RI on 21
return to health for many. June 2016.(7) National experts in medical, dental and
In recent times however this image of the medical nursing education as well as Yoga and allied experts
profession has suffered badly through many scandals participated in the deliberations that unanimously
and news reports highlighting the lack of humanistic adopted the following recommendations:(8)
values in medical professionals. Modern medicine has 1. There was a consensus that Yoga deserves a
moved from being an art (with a heart) to a science prominent place in the curriculum ofall health
(with a brain) and now sadly to being a mere business professionals education, though further
with neither. It is bemoaned commonly that instead of deliberations may be needed towork out the
treating the individual who has the disease we have modalities of how, when and by whom it should be
moved on to treating the disease and now to even only taught and assessed.
treating the medical reports.(2) 2. From the point of view of not burdening the
The Government of India though the Ministry of existing curriculum which is already top-heavy,
AYUSH is strongly propagating the integration of attempts may be made to integrate the teaching of
Yogain the health professional educationand Sri Balaji Yoga at appropriateplaces in the curriculum such
Vidyapeeth (SBV), a deemed-to-be university in South as foundation courses, basic sciences
India has been in the forefront of this integration of particularlyphysiology, community medicine and
ancienthealing wisdom with modern scientific clinical disciplines such as physiotherapywhere
medicine.(3) SBV was awarded the coveted “A”Grade therapeutic benefits can be integrated.
by NAAC in 2015 and found place in the top 100 3. Integration of Yoga studies requires much effort
universities of India in the NIRF 2016 and 2017 from the faculty across variousdisciplines which
ranking. rest on training and preparation of faculty in the
form ofFaculty Development Programs. The
About CYTER existing mechanisms of faculty developmentshould
The Centre for Yoga Therapy, Education and address and incorporate this issue before
Research (CYTER) has been functioning at implementing Yoga training in astructured manner.
MGMC&RI since 2010 and more than 36000 4. The efforts to implement Yoga require a concerted
participants have benefited from the Yoga and and coordinated effort in theform of inter-
Yogatherapy sessions held in its premises.(4) All Master professional education. This requires effective
Health Checkups of the Corporate Health Services wing leadership and teamworkfrom the faculty across
have Yogaconsultation and Yoga therapy is often various disciplines, backed by curricular changes
offered for in-patients in many of the wards themselves. supportedby the respective councils (MCI, DCI,
More than a dozen research projects have been NCI).
completed with another dozen ongoing with a high 5. The Seminar laid special emphasis on the fact that
impact academic publication of 61 papers, five Yoga is a holistic approach. Assuch, it should
compilations and 21 abstracts published till date. This encompass the whole gamut of lifelong education,
‘one-of-its-kind’ centre functions under the auspices of starting fromearly school stage extended up to
the Deanery of Allied Health Sciences and is guided by higher education and workplaces to embracethe
its dean, Prof N Ananthakrishnan and its founding entire life span.
director Prof Madanmohan who is one of the first 6. The existing Centers of Yoga, especially CYTER
medical professionals to attempt the symbiotic with help from other Centers inIndia should take
integration of Yoga in the medical curriculum and had lead in initiating the process of Training of
Journal of Education Technology in Health Sciences, May-August, 2017;4(2): 42-46 42
Ananda Balayogi Bhavanani Integrating yoga in health professional education: The SBV experience
Trainers (ToT) in organizing Faculty Development of Physiology organized national level CMEs, seminars
Programs with support from Government and and workshops in the past four years. These include the
NGOs, to speed up the process of implementation. ones on “Yoga and Lifestyle Disorders” in 2013,
7. It was recommended and concluded that CYTER “Sleep, Consciousness and Meditation: Neurological
be made a “nodal centre” to leadin activities Correlates” in 2014,(12) “Therapeutic Potential of Yoga”
pertaining to Health Professions Education and in 2015(13) as well as an
necessary steps betaken by the concerned International symposium on Yoga and Wellbeing in
authorities. 2016. As a result of these initiatives two MD
dissertations have been taken up on Yoga as adjuvant
Yoga in MBBS curriculum therapy in General Medicine and Psychiatry.
For the past two years (2015 and 2016) all 1st International Day of Yoga was celebrated in a
MBBS students have received exposure to Yoga during grand manner in 2015 and 2016 at SBV with
their 10 day orientation program at the Mahatma multifaceted events involving faculty, staff and students
Gandhi Medical College and Research Institute. During of SBV as well as the general public. As per directives
these daily sessions, they received lectures detailing the of the UGC, the SBV Yoga Fest 2016 was organized by
foundations of the philosophy and psychology of Yoga CYTER in May 2016 with poster, essay, quiz and
as well as science behind the effects of Yoga. They also cultural events to enhance awareness of Yoga.(4,14)
received practical training in various techniques aimed Demonstrations of the Common Yoga Protocol devised
at stress management including Jathis, Kriyas, Asanas, by the Ministry of AYUSH as well as lecture-
Pranayamas and contemplative relaxation practices. demonstrations by experts were organized to give a
These lectures and practice sessions were also holistic perspective of the Yoga to all students. This
conducted for the 1st MBBS students of Sri Satya Sai was further facilitated by enthusiastic support of Dean
Medical College and Research Institute through an and Vice Principals of MGMC&RI. Speaking on the
intensive one day programme. Feedback from both occasion, Prof KR Sethuraman, Vice Chancellor of
years showed excellent response to the Yoga lectures SBV expressed the need for health professionals to look
and practical sessions with more than 80% rating it as towards salutogenesis, an understanding of the internal
excellent and another 18% as very good. Students and external factors that induce health rather than
reported that the Yoga sessions had helped them adjust mechanically focusing on pathogenesis of disease. (14,15)
to the college life better and also that the stress "Human beings are flawed as they are always
management techniques enhanced theirability to do susceptible to disease. Yet, some stay healthy even in
well in curricular and extracurricular activities. They the worst of conditions. This is because they have a
requested for more such sessions on a regular weekly or sense of coherence within themselves, find meaning in
biweekly basis. As a result, MBBS students are their lives and hence are more at ease with their lives"
currently receiving Yoga classes for one hour twice a said he. All the events were geared towards giving the
month on alternate Saturdays. Many of them are students a view of Yoga as an ancient system that
attending the regular practical sessions conducted in the enables one to create a positive environment both
evenings at CYTER for the faculty, staff and students within oneself as well as in the external environment.
of SBV. More than 4000 participants have benefited Such harmonious and dynamic balance between both
from these free sessions conducted twice daily from 6- worlds educes the manifestation of health and
7am and 4.30 to 5.30pm since September 2015. (9) wellbeing.
From 2014 onwards 1st MBBS students were also
given a series of lectures on the Yogic aspects of Yoga in BDS curriculum
lifestyle as well as physiological aspects of Since 2015 all 1st BDS students have received
Yogapractices such as Asana, Pranayama and exposure to Yoga during their orientation program at
therapeutic potential of Yoga.(10,11) These lectures and the Indira Gandhi Institute of Dental Sciences (IGIDS).
lecture-demonstrations took place during physiology They were given lectures on the philosophy and
hours of the timetable under guidance of Prof psychology of Yoga as well as science behind the
Madanmohan. A CME was also organized at effects of Yoga. They also received practical training in
SSMC&RI with departments of physiology, anatomy stress management techniques such as Jathis, Kriyas,
and biochemistry collaborating so that all these topics Asanas, Pranayamas and contemplative relaxation
were covered for the students by the CYTER team in a practices. Feedback from both years showed excellent
single day. Three of the students have also taken up response to the Yoga lectures and practical sessions. As
ICMR student research projects on Yoga in the past a result, BDS students are receiving two hours of Yoga
year. training at CYTER twice a month on alternate
In order to facilitate a general awareness about Thursdays. Many of them have also continued to attend
Yoga and its role in health and disease amongst the regular practical sessions conducted in the evenings
students and health professionals of SBV and other at CYTER. Thanks to the support of the Principal and
institutions, CYTER in collaboration with Department Vice Principal as well as faculty members, students of
IGIDS also participated enthusiastically in the SBV Based on positive changes experienced and
Yoga Fest 2016 as well as International Day of Yoga expressed by students, teachers and administrators, it
celebrations thus giving them an opportunity to was proposed to include Yogaofficially as a part of the
experience the wholesome nature of Yoga.(8,14) The nursing curriculum and the first meeting of the duly
interest generated at IGIDS and the support from the constituted Board of Studieswas held on 20 July 2016.
faculty have also resulted in an MDS dissertation being The board approved inclusion of Yoga in nursing
taken up on Yoga in autism spectrum disorder and oral curriculum through a specialized course namely
hygiene. “Foundation in Yoga Therapy”. It was decided that
lectures and training would be given during hours of
Yoga in BSc Nursing curriculum co-curricular activities for 1st year BSc (N) while it
The authorities of Kasturba Gandhi Nursing would be under Medical Surgical Nursing I & II subject
College were amongst the first to understand the value hours during 2nd and 3rd year BSc (N). A total of 45
of Yoga and started giving Yoga training to students of hours were earmarked for the 1st year, 30 hours for the
their college right from 2012. Initially it was given as 2nd year and 15 hours during the 3rd year thus making
an optional extracurricular activity and later became a up a total of 90 hours during the entire BSc (N) course.
co-curricular activity. A study done with 60 students The training commenced in August 2016 and the first
who receivedYoga training twice weekly for 6 months 45 hours have been completed. 2nd year students are
showed significant beneficial changes in quality of life regularly posted to CYTER for a full week on rotational
indices as well as hematological and biochemical basis and this has enabled them to receive
parameters and these changes correlated positively with comprehensive training and get hands-on experience in
attendance.(16) On the basis of this study it was how Yoga therapy is imparted for the patients through
recommendedthat Yoga be made an integral part of CYTER.
medical and paramedical collegiate education.(17) All To further enhance this integrative process, the
nursing students took part enthusiastically in the first theme chosen for 6th Foundation Day celebrations
and second International Day of Yogacelebrations in of CYTER on 2 November 2016 was "Introducing
2015 and 2016 and also bagged majority of prizes in the Yoga in Nursing Education".(18) Dr K Renuka, Dean
events held during the SBV Yoga Fest 2016.(8,14) Nursing Faculty and Principal KGNC gave the thematic
The avant-apres (pre-post) comparison elicited address highlighting innovations in nursing curriculum
from the students by our Vice-Chancellor after their at Sri Balaji Vidyapeeth that for the first time anywhere
training in January to March 2015 showed how Yoga included Yoga Therapy as a subject in the BSc Nursing
has transformed their personalities as well their sense of curriculum. Presiding over the event, Prof KR
wellness. Initial feelings expressed as heavy, inability, Sethuraman, VC of SBV reminded nursing students of
breathlessness, anxious, hesitant and scattered their vital role in healthcare as the primary caregivers
transformed through Yoga into feelings of being for patients and stressed the importance of Yoga in their
capable, respected, contentment, confident, composed, personal and professional life.
happy and peaceful.

Conclusion conducting the practical sessions in an admirable

Modern medical advancements provide the manner.
rationale for integration of various traditional healing
techniques like Yoga, Naturopathy, Ayurveda, Siddha References
and Music to promote health, healing and 1. Aggarwal KK. Medical Profession – A noble profession.
longevity.(19,20) Government of India is currently http://drkkaggarwal.blogspot.in/2013/07/medical-
profession-noble-profession.html.
promoting indigenous systems of health in an active
2. Bhavanani AB, Madanmohan. Restoring human values in
manner through Ministry of AYUSH. The limitations of medicine: Role of Yoga.National Conference on
modern medicine in managing stress induced Changing Trends in Health Professions Education (NC-
psychosomatic, chronic illnesses is the strength of these CTHPE 2016). SBV, Pondicherry. 18-21 Aug 2016.
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integration of both systems enables best quality of 3. Now, Yoga, sports part of MBBS curriculum. (21 may
2012)
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include the holistic approach of Yoga to face the Now-Yoga-sports-part-of-MBBS-
current challenges in health care. The antiquity curriculum/articleshow/13323559.cms.
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world. No wonder that Dr. Dean Ornish, the eminent in-harnessing-healing-touch-of-
Yoga/article14434854.ece.
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March, 2009.
all medical, dental and nursing students of a medical
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sri-balaji-vidyapeeth-pondicherry.
We can proudly state that it is only in the 8. Report on SBV's International Day of Yoga 2016
supportive and innovative milieu of Sri Balaji celebrations.
Vidyapeeth, Pondicherry, India that the holistic art and www.slideshare.net/anandabhavanani/report-on-sbvs-
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optimally, effectively and holistically. 2015). www.thehindu.com/news/cities/puducherry/Yoga-
programme-for-medicos-launched/article7688031.ece0.
10. Yoga therapy enters medical curriculum. (30 April 2015)
Acknowledgements www.thehindu.com/news/cities/puducherry/Yoga-
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University who setup the CYTER in 2010 is gratefully 2015). www.thehindu.com/news/national/tamil-
nadu/introducing-medicos-to-therapeutic-use-of-
acknowledged. Heartfelt gratitude is offered to our Yoga/article7246603.ece.
Hon’ble Chairman & Chancellor, Vice-chancellor, 12. An in-depth examination of sleep, consciousness and
Dean of Research & Allied Health Sciences and meditation (28 November 2014).
Registrar SBV for their constant support and www.thehindu.com/news/cities/puducherry/an-indepth-
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Prof. Madanmohan, Founder Director CYTER and meditation/article6642728.ece.
13. Going beyond the Yoga postures (29 June 2015).
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science.Souvenir of the National Seminar and CME on
Introducing Yoga in Health Professions Education.
SBVU, Puducherry. 19-21 June 2016. Pp. 48-55.

invited Review
Yoga for Dental Professional : Scope and Simplified Practices
Ananda Balayogi Bhavanani1
Introduction: occupational hazard prevalent among dentists, over

50% of the 390 respondents surveyed didn’t seek any
Yoga is an ancient cultural heritage of India spreading
measure to treat these occupational hazards and only
rapidly worldwide and being practiced by millions
10% of them practiced yoga as the alternative therapy.
across the globe. It offers a broader perspective of life (6)
The authors suggested that a healthy awareness of the
and refines the personality thus enabling practitioners
potential benefits of Yoga for the dental professionals
to attain their inherent potential in a holistic manner.
should be created through continuing dental education
(1,2)
It is not merely a system of exercise but is a way of
programs thus giving them tools with which they could
life that gives importance to social and personal values
effectively manage such occupational hazards.
through the Yama (restraints of subhuman tendencies
such as violence, stealing and greed etc) and the Mechanisms of Yoga:
Niyama (humane observances including cleanliness,
Extensive research on Yoga being done all over the
contentment, self-introspection and dispassionate
world has shown promise with regard to various
discipline). Inculcation of these universal values in
disorders and diseases that seem to be amiable to Yoga
health professionals as well as the practice of various
therapy (www.iayt.org, www.icyer.com, www.svyasa.
practical techniques by them will enable attainment
org ). These include psychosomatic, stress disorders
of optimal health while at the same time help them be
as well as physical disorders and psychiatric disorders.
more humane in their life and profession.
Musculoskeletal disorders can be tackled effectively
One of the major health issues faced by dental with Yogic techniques that place great importance of
professionals is risk for various musculoskeletal healthy spinal alignment, conscious deep breathing
disorders with prevalence of general musculoskeletal and breath-body coordination movements resulting in
pain documented to be between 64% and 93% with a relaxed sense of ease (Sukham).
major issues being back pain (36.3-60.1%) and neck
Healthy life can be considered as a by-product of
pain (19.8-85%).(3) Risk factors identified for these
practicing Yogic techniques since it has been observed
occupational predispositions include the static and
that Yoga practitioners are physically and mentally
awkward posture of clinical practice as well as other
healthier and have better coping skills to stressors than
non-ergonomic work practices. It has recently been
the normal population. (7) Knowledge of inexpensive,
suggested that Yoga may be a good way for dentists
effective and easily administrable Yogic techniques to
to relieve stress and reduce the risk for repetitive strain
health professionals will go a long way in helping us
injury and dysfunctional posture (4) and a recent survey
achieve the goal of the World Health Organisation to
amongst 220 dentist found statistically significant
provide “physical, mental, spiritual and social health”
difference in prevalence of musculoskeletal pain
for all sections of human society. We can say that the
among those practicing Yoga compared to those with
eastern mind-body techniques affect every cell of the
no regular activity over a period of 12 months. (5)
human body as they bring about better neuro-effector
However there is still ignorance and resistance to communication, improve strength, and enhance
Yoga amongst many health professionals and a recent optimum functioning of all organ-systems while
cross–sectional survey in Chennai reported that despite increasing resistance against stress and diseases with
musculoskeletal pain and stress being the most common resultant tranquillity, balance, positive attitude and
Journal of Scientific Dentistry, 7(1), 2017 1

Yoga for Dental Professional : Scope and Simplified Practices Ananda Balayogi Bhavanani
equanimity. (7,8) Yoga is not merely a set of exercises but is mindfulness

based, conscious way of life that inculcates simple
Some of the important documented health promoting
living and high thinking. Important principles of this
benefits of mind-body practices such as Yoga and
unique system of healthy living are: (1,2,7,8,14,15,16)
meditation include: (8, 9,10)
Become aware of your body, emotions and mind:
• Improvement in cardio-respiratory efficiency
Awareness of body implies conscious body work that
• Improvement in exercise tolerance needs to be synchronized with breath to qualify as a
psychosomatic technique of health and healing.
• Harmonious balance of autonomic function
Improve your dietary habits: Adoption of a Yogic
• Improvement in dexterity, strength, steadiness, lifestyle with proper nourishing diet, creates positive
stamina, flexibility, endurance, and neuro-musculo- antioxidant enhancement thus neutralizing free radicals
skeletal functioning while enabling a rejuvenative storehouse of nutrients
• Increase in alpha rhythm, inter-hemispheric packed with life energy to work on anabolic, reparative
coherence and homogeneity in the brain and healing processes. A freshly prepared balanced and
hygienic meal with adequate hydration, eaten with a
• Improved sleep quality and improved cognitive positive sense of sharing induces vitality.
functions
Relax your body-mind complex: Stress is the major
• Alteration in brain blood flow and brain metabolism culprit and may be the causative, aggravating, or
as well as precipitating factor in so many psychosomatic
disorders. The relaxation part of every Yoga session
• Modulation of the neuro-endocrine axis.
is most important for it is during it that benefits of
An extensive review by Innes et al postulated that practices done in the session seep into each and every
Yoga acts through two interconnected pathways to cell producing rest, rejuvenation, reinvigoration and
reduce risk of various lifestyle disorders through reintegration.
parasympathetic activation coupled with decreased
Slow down your breath making it quiet and deep:
reactivity of sympathoadrenal system and HPA axis.
Breath is the link between body and mind and is the
(11)
Streeter et al also proposed a theory to explain
agent of physical, physiological and mental unification.
the benefits of Yoga practices in diverse, frequently
Deep conscious breathing improves autonomic
comorbid medical conditions based on the concept
respiratory mechanisms that generate energy and
that Yoga practices reduce allostatic load in stress
enhance emotional stability. The mind and emotions
response systems such that optimal homeostasis is
are related to our breathing pattern and rate and hence
restored.(12) They hypothesized that stress induces
the slowing down of the breathing process influences
autonomic imbalance with decreased parasympathetic
autonomic functioning, metabolic processes as well as
and increased sympathetic activity coupled with under
emotional responses.
activity of the GABA system, and increased allostatic
load. They further hypothesized that Yoga-based Calm down your mind and focus it inwardly: The
practices correct underactivity of the parasympathetic mind is as disturbed as a drunken monkey bitten by
nervous system and GABA systems in part through a scorpion say our scriptures. Breath work is the base
stimulation of the vagus nerves, while reducing allostatic on which this mind training can occur and hence
load. Yoga seems to have a multidimensional action much importance needs to be given to Pranayama
and a review by Galantino et al mentioned, “Regardless (vital energy management) and Pratyahara (sensory
of the goal, Yoga appears to be a multitasking modality withdrawal) in Yoga. When the mind is focussed
that simultaneously treats both physical impairments as positively on activities being done, this enhances
well as more global issues such as stress, anxiety, or energy flow and healthy circulation to the different
hyperactivity.” (13) body parts and internal organs. Where the mind goes,
there the Prana flows!
Yogic living for health professionals:
2 Journal of Scientific Dentistry, 7(1), 2017

Improve the flow of healing ‘Pranic life energy’: Moksha (liberation). Most people today are so busy
Improve the flow of Healing ‘Pranic Life Energy’ to all trying to find health and happiness that they forget why
parts of your body, especially to those diseased parts, they are here in the first place. Yoga helps us regain our
thus relaxing, regenerating and reinvigorating yourself. birthrights and attain the goal of human life.
Prana is life and without it there cannot be healing.
SOME BASIC YOGA PRACTICES FOR
Fortify yourself against omnipresent stressors: Decrease DENTAL PROFESSIONALS: (7,8,14,17)
your stress level by fortifying yourself against the
Get ready for a “Yoga Break” in your busy office
various omnipresent stressors in your life: when face to
schedule by taking up a straight back sitting position
face with the innumerable thorns in a forest, you may
on your chair. Bring your whole back, neck and head
either choose to spend all your time picking them up
into one straight line. Place the palms of both hands on
one by one while others continue falling or choose to
your thighs. Close your eyes gently and begin to focus
wear a pair of shoes and walk through the forest. The
on your breathing. Breathe in and out in a calm and
difference is in attitude. Choosing the right attitude can
regular manner for a few minutes. Make sure you are
change everything and bring about a resolution of the
breathing into all sections of your lungs in a healthy
problem by healing the core. Stress is more about how
manner. Breathe in to the low, mid and upper sections
we react to the stressor than about the stressor itself!
of your lungs and then breathe out from the low, mid
Increase self reliance and self confidence: Life is full and upper sections. Perform this practice for a few
of challenges that are there only to make us stronger minutes and feel a sense of lightness as the energy of
and better. The challenges should be understood as your breath lifts your mood and readies you for the
opportunities for change and faced with confidence. We practices of Yoga.
must understand we have the inner power to overcome
each and every challenge that is thrown at us by life.
Energizing and loosening Jathis:
• Sit erect with your palms on your thighs. Lift
Facilitate natural emanation of wastes: Facilitate the
your right hand and start to shake it slowly with
natural emanation of waste from your body by the
awareness of the movements at your wrist joint.
practice of various Shuddi Kriyas(cleansing techniques)
Increase the speed of the movement a bit and then
such as Dhauti (gastric cleanser), Basti (colonic
after some time start to shake your hand as fast
cleanser) and Neti (nasal irrigation). Accumulation
as you can. Continue this fast shaking for a few
and stagnation of waste materials either in inner or
minutes. After a few minutes, stop shaking your
outer environment always causes problems. Yogic
hand, and bring it back to your thigh. Breathe
cleaning practices held to wash out the impurities
deeply and enjoy the fresh flow of blood rushing
(Mala Shodhana) helping the process of regeneration
into your hand as a result of this vigorous shaking.
and facilitating healing.
• Lift your left hand and start to shake it slowly. Be
Taking responsibility for our own health: Yoga fixes
aware of the movements of the wrist joint. Slowly
responsibility for our health squarely upon our own
increase the speed of the movement while keeping
shoulders. If we do healthy things we are healthy and
your hand as lax as possible. After some time start
if we do unhealthy things we become sick. No use
to shake your hand as fast as you can for a few
complaining that we are not well when we have been
minutes. When you feel ready, stop shaking your
the cause of our own problems. As Swamiji Gitananda
hand and bring it back to your thigh. Enjoy the
Giri would say, “You don’t have problems-you are the
fresh flow of blood rushing into your hand as a
problem!”
result of this vigorous shaking.
Health and happiness are your birthright: Health and
• Lift both your hands and start to shake them slowly.
happiness are your birthright, claim them and develop
Be aware of the movements at your wrist joints.
them to your maximum potential. This message of
Let your elbows be relaxed so that this shaking
Swamiji Gitananda Giri is a firm reminder that the goal
is transmitted throughout your forearms. Increase
of human existence is not health and happiness but is
the speed of the shaking movement bit-by-bit until

Nasarga Mukha Bhastrika. Start to shake your

hands as vigorously as possible to loosen up
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 all the tensions loosened
up, take in a deep breath and clench your fist as if
catching hold of all your tensions. With a powerful
blast through your mouth “whoosh” away all your
tensions as forcibly as possible. Relax for a short
time in the resting position
Again shake your hands fast as possible. Breathe in and

catch hold of the tensions in your fists. Throw them
all away with a powerful blast. Make sure that you are
using your diaphragmatic muscle vigorously while
blasting out the breath. After performing 3 to 9 rounds
of this practice, relax in a comfortable position with
deep breathing. Enjoy the feeling of calm and relief
sweeping through your whole body.
Dynamic Kriyas for psychosomatic harmony:

• Tala Kriya: Stand in a comfortable position.
Breathe in and lift both arms up over your head until
they are parallel to each other. Go up onto your toes
and stretch up as high as possible. Hold the breath and
feel a 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 for maximum
benefit. The term, “Tala” refers to a Palm tree and you
should try to stretch yourself as tall as a tree while
you are shaking your hands as fast as possible. performing this practice. With practice the posture can
Continue this for a few minutes. When ready, stop
shaking your hands and bring them back to your
thighs. Breathe deeply and enjoy the fresh flow
of blood coupled with revitalizing Pranic energy
rushing into your hands. This Jathi washes away all
accumulated toxins and negative stressful radicals
from your joints and releases pent up tensions from
the musculoskeletal system.
• Walk around your office space, kicking your

legs one after the other. Make sure this is done
consciously and with awareness. This will “kick
out” tensions from your feet and alleviate sluggish
blood circulation in the lower limb.
• To wind up this section of practices lets perform

Kailash Mudra that energizes Sahasrara Chakra.

Focus your mind on this area related to the
prefrontal region of the brain. It is important for
the development of an integrated personality
When the hands are brought down from Kailash

Mudra and placed in front of the forehead we
can energize our Ajna Chakra or centre of inner
intuition. This energizes our Pituitary Gland
which is the master conductor of our endocrine
orchestra and helps us to obtain excellent
glandular health.
be held for a longer time and normal breathing done
while holding the posture for 30 to 45 seconds. After As we bring the Namaskar Mudra to the front of
completing a few rounds of the practice stand still and the neck we stimulate energetic vibrations that
relax with deep breathing. recharge Vishudda Chakra and normalize our
thyroid function. Concentrate on this vital region
A modification of the Tala Kriya can be done from a
sitting position. Sit erect and lift both arms over your
head while breathing in. Interlock your fingers and turn
the joined palms outward and upward. Give yourself
a good stretch while holding the breath. When ready,
release the fingers and bring your arms back down while
breathing out. While stretching up, you can also turn
your head from right to left to help open up the upper
back and shoulder region thus dissolving tensions from
this area. When ready release the fingers and bring your
arms back to the thighs while breathing out.
Energizing Mudras
• Hastha Mudra sequence: Slowly stretch your
arms upwards and join your palms together
in Anjali Mudra. The whole back is given an
excellent stretch in this gesture of aspiration. All
the higher Chakras are energized by this Mudra.
Hold it for a short while and contemplate the
higher consciousness centered in this region.
that works at the level of our energy body.
Bring your hands down to your head with your
wrists touching the top of your head. This When the Namaskar Mudra is brought down to
beautiful, triangular frame for your face is the chest region we can feel the healing energies
flood through our Anahata or heart Chakra. Let
the qualities of compassion and empathy flow
through this centre to help us become a better and
more humane being with a universal outlook.
• Brahma Mudra: Brahma Mudra is a gesture of

the head and neck and is an excellent practice
for one and all. Take up any comfortable sitting
position such as Vajra Asana with your spine as

erect as possible. Rest your hands on your lap

while performing the Yoga Mudra.
Close your eyes and concentrate on this valuable

practice that combines the use of physical
movement synchronized with deep breathing
and the usage of Nada or vibrational sounds
involving utterance of the Bija sounds of AAA,
UUU, EEE and MMM.
Breathe in for a count of six and turn your head

towards the right. Breathe out while bringing
your head back to the central position and make
the guttural sound AAA.
Slowly turn your head to the left while breathing

in for six counts. Breathe out and bring your head
back to the central position making the labial
sound UUU.
Slowly lift your chin up as if attempting to look at the prevent as well as relieve disorders of the cervical spine
sky and breathe in for six counts. Breathe out and make that are so common in this modern day and age. It is
the palatal sound EEE while bringing your head back to important to concentrate on the area of the neck to be
the central position. Finally lower your head bringing relieved, repaired, or rejuvenated while sounding the
chin to chest while breathing in for six counts. Breathe Bija Mantras. This produces excellent psychosomatic
out and make the labial sound MMM while bringing relaxation. It also gives us the psychological benefit of
the head back to the central position. understanding the perspectives of others by seeing the
‘different viewpoints’.
Perform a minimum of 3 to 9 rounds of this practice at
each sitting. Brahma Mudra is an excellent practice to • Gomukha Mudra: Lift your right arm and bring it
behind your right shoulder as if trying to touch the
spine. Reach behind your back with your left arm
and catch hold of the fingers of the right. Once you
have got a good grip, tighten it and then turn your
head to the right and look up with your gaze focused
on the tip of your right elbow. This Mudra supplies
a great stretch to the musculature of the back and
rejuvenates the joints of the upper limb. It is also an
excellent eye exercise. Slowly release your hands
and bring them back to the thighs. Relax for a few
seconds with deep breathing. Enjoy the renewed
circulation of fresh blood into the upper part of the
body especially around the shoulders and neck.
Repeat the Mudra on the opposite side with the left
hand dominant to equalize the benefit on both sides
of the body. The development of a healthy spine
is assured and numerous musculoskeletal problems
that affect modern office goers are corrected by the
regular practice of this Mudra. When ready, release

your hands and bring them back to the thighs. from the ‘Kaki Mudra’ to the ‘Hasya Mudra’ for a
Shake your hands to release any tension that may few rounds. Alternating with the ‘Kaki Mudra’ and
have accumulated and then sit quietly performing the ‘Hasya Mudra’ is a good practice to stimulate
some deep breathing. nerves of the mouth and tone up the facial area.
Relax with some deep breathing and enjoy the
• Garuda Mudra: To perform the Eagle Gesture, lift
emotional release and uplifted mood that are a
both arms and extend them in front of your chest.
result of this practice
Bring your right hand over the left and cross your
hands at the wrist bringing your palms together. Pranayamas to overcome emotional and
Bring the clasped hand position inward and then mental stress:
twist it upward so that the twisted hand position
is in front of your chest and throat. Look straight • Vyagraha Pranayama: The tiger breath is
ahead. Garuda Mudra forces nerve currents to pass an important practice to relieve numerous
from one side of the body to the other thus bringing musculoskeletal problems that are the bane of
about healthy polarity. When ready relax your modern life.
position and bring your hands back to your thighs. Take up the Chatus Pada Asana with your weight
Enjoy the rejuvenated circulation of fresh blood evenly distributed between your hands and knees.
rushing into your upper limbs. Repeat the Garuda
Mudra again but this time exercise the other side
with the left hand crossing over the right in order to
develop both sides of the body in an equal manner.
It is an excellent tonic for the musculoskeletal
system and useful for those suffering from pain and
discomfort in muscles and joints of the upper body.
When ready relax your position and bring your
hands back to your thighs. Shake your hands to
release any tension that may have accumulated and
then sit quietly performing some deep breathing
Start breathing in and out for an equal count of six.
while enjoying the energetic circulation rushing
While breathing in slowly lift your head and arch your
through your upper limbs.
back downwards. Then breathe out slowly and lower
• Kaki and Hasya Mudras: To do the ‘Kaki Mudra’ your head while arching your back upwards. Breathe
or the Crow Gesture, pucker or pout the lips, as in while lifting your head and arch your back down.
if you were going to whistle, tensing the entire Breathe out while lowering your head and arching your
mouth and jaw region. Then releasing this Mudra, back up
come into a beautiful ‘Hasya Mudra’ or the Smile
Repeat this excellent practice at least nine times at
Gesture, relaxing all the facial muscles. Alternate

each session. Vyagraha Pranayama helps us to utilize breathe out with the sound AAA for a duration that is
all sections of our lungs in a balanced and controlled twice or thrice that of the inhalation. Repeat the practice
manner thus energizing the whole body with healing two more times for a total of three rounds.
Pranic energy. This is also very good for those
suffering from musculoskeletal disorders of the joints.
It is a simple and yet effective practice to prevent and
manage the numerous gynaecological disorders and is
a boon for pregnant women as it takes the load off the
spine and helps in post delivery period as an important
component of rejuvenation and rehabilitation. When
ready slowly relax back to Vajrasana for quiet
contemplation.
• Pranava Pranayama: This contemplative

energising breathing technique uses the sound of
the Omkara and has immense healing potential
To perform Adham Pranayama, the lower chest

breathing, bring your thumb and index finger together
and perform Chin Mudra. The other three fingers are
held straight together. Place the Mudra on your thighs
and breathe in deeply into your lower chest area. Then
To perform mid-chest breathing, Madhyam Pranayama,

curl your fingers inward from Chin Mudra to form
Chinmaya Mudra and place it on your thighs. Breathe
in deeply into your mid chest region and then breathe
out with the sound OOO for a duration that is twice or
thrice that of the inhalation. Repeat the practice two
more times for a total of three rounds

Adhyam Pranayama is upper chest breathing and the practice. Chandra Nadi Pranayama produces
utilizes Adhi Mudra. Clench your fists with your mental and emotional serenity and should be done
thumb in the centre. Keep the Mudra on your thighs for a minimum of 9 rounds at each sitting. Patients
and breathe deeply into your upper chest and clavicular of anxiety, hypertension, diabetes, insomnia and
regions. Now, exhale with sound MMM for a duration other stressful conditions can benefit by practising
that is twice or thrice that of the inhalation. Repeat the this Pranayama 27 times before breakfast, lunch,
practice two more times for a total of three rounds dinner and before going to bed at night
Joining the earlier three parts of this practice in a Relaxing your body and mind:
Complete Yogic breath is the fourth stage, known as
• Spandha – Nishpandakriya: Sit in a comfortable
Mahat Yoga Pranayama. Bring the Adhi Mudra in front
position. After a few rounds of deep rhythmic
of your navel with both knuckles touching. This is now
breathing and relaxation in this position, start
known as Brahma Mudra. Take a deep breath into low,
to tense your entire body part-by-part from your
mid and upper chest regions. Now let the breath out
toes up to the top of your head until every part of
with the sounds of AAA…OOO…MMM for a duration your body is as tense as possible
that is twice or thrice that of the inhalation. Repeat the
Hold this 100% tension state of Spandha for a few
practice two more times for a total of three rounds.
seconds. Let all muscles of your entire body be as
A performance of three to nine rounds of this Pranayama tense as possible. At the peak of the tension, just
done daily helps to relax the Body-Emotion-Mind ‘let go’ and immediately relax your entire body
complex and provides complete healing through the 100%. This is the state of Nishpandha. Enjoy
production of healing vibrations at all levels of our this relaxed state and with conscious awareness
existence. It is an integral part of the Rishiculture continue to watch your breath as it comes in and
Ashtanga Yoga tradition as taught by Yogamaharishi goes out of your nose
Dr Swami Gitananda Giri.
Repeat this practice at least three times and
• Chandra Nadi Pranayama: Sit straight in a then enjoy the complete relaxation that ensures.
comfortable manner. Perform Nasarga Mudra Be aware of how all your muscles relax in this
with your right hand by bending the 2nd and 3rd practice because the relaxation is deepened when
fingers into the palm. Close your right nostril it is contrasted with tension
with your thumb. Begin to inhale slowly through
• Marmanasthanamkriya: The twenty-two
your left nostril for a count of six. Follow this by
sensitive parts of the body are known by the
exhaling through the left nostril again for a count
collective term Marmanasthanam. Concentrating
of six. Keep your right nostril closed throughout
upon these body parts in a particular order,
commanding them to relax, produces a very deep
relaxation. Sit in a relaxed position and begin to
concentrate upon your toes and command them

to relax. Do the same with your feet and lower the “Now”. Do not let your thoughts waver or wander.
legs up to your knees. Let the relaxation spread Be aware of each thought or emotion as it arises. Curb
into your upper legs, hips and then go into your distracting thoughts or emotions by keeping your mind
buttocks and base of your spine. Relax the whole steady upon one thought at a time. Use the sound of
pelvic area. Then relax your lower and upper “Shanti”, the Sanskrit word for “Peace” and repeat
abdomen “Shanti” in your mind’s eye as a Japa or positive
repetition. Continue in this state as long as possible and
Let the relaxation spread into your low, mid and upper
try to let it filter into every aspect of your daily life.
chest and finally relax your shoulders. Now, take your
Yoga is a way of life and is a process of “conscious
concentration down to your fingers, and command
evolution”. Be an example of that in your own life.
them to relax. Move the relaxation into your hands,
spreading up the lower arms into your elbows and In conclusion:
then into your upper arms and shoulders. Begin to
Recent developments showcased through social media
focus on relaxing your throat and neck region and then
highlight a lack of human values in modern health
professionals. Compassion, empathy and a sincere
desire to relieve suffering are found lacking and this
seemingly becomes even rarer as qualifications increase.
Exploitation of trust with kidney rackets, unnecessary
surgeries, lab referral commissions and inflated bills
are commonly bemoaned and even recently medical
move the relaxation impulse to your chin and mouth. students in Chennai threw a poor dog off their rooftop
Slowly move up to your nose, cheeks and then your with glee while others at Vellore mercilessly killed a
eyes. Take the relaxation sideward to your ears and poor monkey.
then go to the back of your head and finally come over
the top of your head. Bring your mind to the middle Introduction of Yoga as a holistic way of life with
of your forehead while mentally repeating the subtle stress on its Asthanga (eight components) in the health
command of “relaxation.” Perform Jyoti Dharana and education curriculum will inculcate a compassionate
Jyoti Dhyana (a concentration and meditation on the sense of selfless service (Karuna and Seva) towards
Divine light) at the BrumadhyaBindu (the mid-point our human brethren. We need to understand that illness
between your eyebrows). Visualize the Divine Jyoti as becomes wellness when we consciously move from
having a brilliance equal to 1000 suns but without any the limited sense of “I” to a broader inclusive “WE”.
of the associated painful glare. Absorb yourself into Such an understanding will motivate young health
this Divine Jyoti professionals to be vehicles of change thus restoring
once again the much extolled nobility of our medical
Developing an inner quietness profession.
Meditative sitting: Take up a comfortable sitting Numerous physical and mental techniques of Yoga such
position with your back, neck and head in a straight as Asana, Pranayama, Dharana and Dhyana enable the
line. Perform Jnana Mudra with the tip of your index attainment of physical, mental and emotional fitness.
fingers joining the tips of your thumbs in a circle. The This facilitates a skilful and efficient management
other three fingers are kept together and straight. Place of omnipresent stressors. Inculcation of a broader
the Jnana Mudra on your thighs with palms facing up. ‘worldview’ leads to the performance of one’s duty in a
Close your eyes and consciously repeat in your mind the spirit of Nishkama Karma (non-attachment to results of
command to “relax”. Establish a regular breath rhythm. actions) thus preventing unhealthy “Me first”, “Make
Breathing in to a count of 6 and breathing out to a count the most money”, “Who cares as long as I am safe”
of 6 is a good rhythm to start with. Keep your entire type of attitudes. Healthier connection with one’s inner
awareness on your breath. Follow the movement of the being creates a cheerful, strong and compassionate
breath when you breathe in and follow its movement countenance with empathy towards the suffering.
when you breathe out. Keep your mind concentrated in

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Address of Correspondence Authors:

Yogacharya Dr Ananda Balayogi Bhavanani Deputy Director Centre for Yoga Therapy, Education and
1
MBBS, ADY, DPC, DSM, PGDFH, PGDY, Research (CYTER), Sri Balaji Vidyapeeth, Pondicherry
FIAY, MD (Alt.Med), C-IAYT.
Deputy Director Centre for Yoga Therapy,
Education and Research (CYTER),
Sri Balaji Vidyapeeth, Pondicherry.
How to cite this article :
Ananda Balayogi Bhavanani. Yoga for Dental Professional : Scope and Simplified Practices. Journal of Scientific Dentistry,
2017;7(1):1-11
Source of Support : Nil, Conflicts of Interest : None declared

Open Access
Annals of Yoga and Physical Therapy
Opinion
Somato-Psychic Aspects of Asana (Yogic Postures)

Bhavanani AB* hold phase) and concentric contractions (the contract phase) used
Centre for Yoga Therapy, Education and Research immediately before the passive stretch (the relax phase) can help to
(CYTER), Sri Balaji Vidyapeeth University, India facilitate autogenic inhibition that is reflex relaxation occurring in the
*Corresponding author: Bhavanani AB, C-IAYT, same muscle where GTO is stimulated [1,3].
Centre for Yoga Therapy, Education and Research
(CYTER), Sri Balaji Vidyapeeth University, Pondicherry, Reciprocal inhibition in asana
India Another important aspect is that concentric contraction of the
Received: February 19, 2018; Accepted: February 23, muscle group opposing that which is being stretched, helps achieve
2018; Published: March 02, 2018 reciprocal inhibition that is a reflex muscular relaxation occurring in
muscles antagonist to the agonist muscle where the GTO is stimulated.
Introduction Reciprocal inhibition is an example of the Yogic concept of dwandwa
In modern yoga teaching and practice, stretching is the main or pairs of opposites well exemplified by agonist-antagonist coupling.
focus of asana more often than not. This makes it imperative that When the agonist contracts the antagonist relaxes and vice versa.
we understand the anatomical and neuro-physiological aspects This knowledge can be used to enhance the experience of asana
of stretching. Proprioceptive Neuromuscular Facilitation (PNF) by contracting the agonist to relax the antagonist and deepen the
stretching techniques have become popular and are extensively cited posture. For example in paschimottanasana, the quadriceps would be
as the most effective techniques facilitating a greater experience of contracted to relax the hamstrings through the primitive spinal cord
the stretch itself. PNF utilizes the shortening contraction of opposing reflex inducing reciprocal inhibition. This can be termed the modern
muscles to place the target muscle on stretch followed by static equivalent to the yogic concept of spanda-nishpanda, activation-
contraction of the target muscle. This leads to enhanced Range of relaxation coupling.
Movement (ROM), both active and passive [1-5]. A recent study has used biomechanical methods to quantify the
Stretching in asana lower extremity joint angles, joint moments of force, and muscle
activities of 21 Hathayoga postures [6]. (Salem, 2013) The study
Stretching in asana involve isometric contraction of various
demonstrated that Hathayoga postures engendered a range of
muscles groups and the agonist-antagonist activity. Muscle spindle
appreciable joint angles, joint moments of force, and muscle activities
stretch receptors are modified muscle cells that act as sensory receptors
about the ankle, knee, and hip, and that demands associated with
and are located within the belly of muscles. They detect changes in
some postures and posture modifications were not always intuitive.
length and tonus of the active muscle and convey this information to
They also demonstrated that all postures elicited appreciable rectus
the Central Nervous System (CNS) via sensory neurons. These spinal
abdominis activity, which was up to 70% of that induced during
cord reflex arcs regulate contraction of muscles, by activating motor
walking.
neurons via the stretch reflex that signal active muscles to contract
and resist such excessive muscle stretch thus providing an instinctive Another study by Wang and colleagues suggested that
protection against over-stretching or tearing. This has practical musculoskeletal demand varies significantly across the different
application in asana practice as it is important one doesn’t try and poses and suggested that their findings be used to guide the design
force oneself into the asana. of evidence-based yoga interventions to address individual-specific
training and rehabilitation goals in seniors [7]. The Crescent, Chair,
If this were to be attempted, the muscles spindle activity would
Warrior II, and One-legged Balance poses generated the greatest
be intensified and the resultant “block” would prevent us from going
average support moments while Side Stretch generated the greatest
further. When we learn to work with the spinal cord reflex arcs, we
average hip extensor and knee flexor Joint Moments Of Force
can on the contrary help “dissolve” such “blocks” and enter a deeper
(JMOFs). Crescent placed the highest demands on the hip flexors
state of asana itself. It has been suggested that this can be done by
and knee extensors. All of the poses produced ankle plantar-flexor
either holding the stretch for 30-60 seconds thus causing muscle
JMOFs. In the frontal plane, the Tree generated the greatest average
spindles to decrease firing or to back out of the posture part-way thus
inducing relaxation of the muscle allowing for a deeper stretch into hip and knee abductor JMOFs; whereas Warrior II generated the
the asana. For example one could go into any of the forward bending greatest average hip and knee adductor JMOFs. Warrior II and One-
postures such as padahasthasana or paschimottanasana and then legged Balance induced the largest average ankle evertor and invertor
back out part-way, so that after a few deep breaths one can go into the JMOFs, respectively. The electromyographic findings were consistent
asana and attain a deeper and more relaxed “feel” of the asana. with the JMOF results.
On the other hand, the Golgi Tendon Organ (GTO) located in Asanas and neuroplasticity
the Musculo-Tendon Junction (MTJ) relaxes a muscle immediately It is well known that voluntary physical activity and exercise
if there has been a sustained contraction lasting longer than 6 training can influence neuroplasticity in a favorable manner by
seconds. Thus it has been suggested that isometric contractions (the facilitating natural neuro-generative, neuro-adaptive and neuro-
Ann Yoga Phys Ther - Volume 3 Issue 1 - 2018 Citation: Bhavanani AB. Somato-Psychic Aspects of Asana (Yogic Postures). Ann Yoga Phys Ther. 2018; 3(1):
ISSN: 2573-8585 | www.austinpublishinggroup.com 1038.
Bhavanani. © All rights are reserved
Bhavanani AB Austin Publishing Group
protective processes. Dishman and others have suggested that these Conclusion
intrinsic and natural regenerative and rehabilitative processes may be
modulated by neurotropic factors [8]. They suggested that metabolic The somato-psychic effects of the asana also include the release
and neurochemical pathways among skeletal muscle, the spinal cord of endorphins that induce a sense of relaxation, ease and wellbeing
and the brain offer plausible and testable mechanisms that might in the practitioner. These are triggered by stretching of the muscles
explain effects of physical activity and exercise on the CNS. in the asana-s and may be responsible for the positive feelings of self-
empowerment and self-regulation often quoted by practitioners.
Regular exercise and conscious motor skill training occurring
through asana practice may enhance executive functions of cognition Consciousness is the key to control and Hathayoga fosters
and motor learning in the spinal cord. Such improvements would be consciousness. One becomes deeply aware of old reptilian and
especially beneficial to those having cognitive decline associated with animal instincts lurking in the primordial sub-conscious. The
aging, trauma and neurological disorders including dementia and various practices purify and exorcise these old animal / reptilian
stroke [8]. conditionings. Swami Gitananda often explained this by saying, “All
of the evolutionary history of life on this earth planet is contained in
Asanas as simulators of life experiences your brain. You have a reptilian brain and a mammalian brain, in
Asana-s is an excellent system through which one can work common with those lower life forms and all their primordial instincts
towards the restoration of psychosomatic harmony and balance. for survival: sexual drive, dominance, territoriality etc. are also active
Regular, repeated and rhythmic practice of asana-s facilitate the there. Then, you have the cerebral cortex, the human brain, which is
restoration of the millieu interior as they gather attention to a no longer bound by instinct, but can make conscious choices. The
particular muscle/organ/area enabling regeneration by developing a problem facing man today is the lack of communication between this
positive mental state [9,10] However it is often not understood that “old, unconscious brain” and the “new conscious brain”. Hathayoga
the actual efforts being made in asana are soma to-psychic in nature is the superb technology which enables man to bridge that gap [10].”
while the benefits that accrue are of a psychosomatic nature. The
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our very perspective of the world in which we live. Interpersonal 8. Dishman RK, Berthoud HR, Booth FW, Cotman CW, Edgerton VR, Fleshner
relationships take on new meaning and we begin to understand what MR, et al. Neurobiology of exercise. Obesity. 2006; 14: 345-356.
it really takes to be ‘human’. Vrikshsana gives us a taste of the tree- 9. Giri GS. Yoga: Step-by-step. Pondicherry, India: Satya Press. 1976.
like experience while vajrasana makes us feel more humane as only
10. Bhavanani AB. Hatha Yoga Practices of Rishiculture Ashtanga (Gitananda)
humans can sit in it. The veera/veerabadrasana series enables courage
Yoga Tradition. Pondicherry, India: Dhivyananda Creations. 2009.
and strength to develop while asanas named after great rishi-s such
as vashistasana, matsyendrasana and bharatwajasana enable us to
develop our higher nature. We can take this even further through the
hanumanasana, trivikramanasana and natarajasana that simulate the
divine experiences.
Ann Yoga Phys Ther - Volume 3 Issue 1 - 2018 Citation: Bhavanani AB. Somato-Psychic Aspects of Asana (Yogic Postures). Ann Yoga Phys Ther. 2018; 3(1):
ISSN: 2573-8585 | www.austinpublishinggroup.com 1038.
Bhavanani. © All rights are reserved
Submit your Manuscript | www.austinpublishinggroup.com Ann Yoga Phys Ther 3(1): id1038 (2018) - Page - 02
THE YOGA OF
RESPONSIBILITY
Yogacharya Dr. ANANDA BALAYOGI BHAVANANI
MBBS, ADY, DPC, DSM, PGDFH, PGDY, MD (AM), FIAY, C-IAYT
Deputy Director CYTER, MGMCRI, SBVU (www.sbvu.ac.in) and
Chairman, ICYER at Ananda Ashram, Pondicherry (www.icyer.com).
We reap only by first sowing and constructive and conscious effort is required
every moment as nothing in life is obtained without effort. We must remember
to lay the foundations well and “leave no stone unturned” if we truly wish to
fulfill our ambitions. Nature goes through phases of seeding, nurturing much
before the fruition occurs. We must never forget ancient wisdom that says,
“As you sow so shall you reap” (Galatians 6:7).
CHATUR ASHRAMA: wherein the spiritual consciousness of the person

Indian culture has for millennia stressed the may manifest in totality. It is important to note
importance of responsibility or the fulfillment of that this final stage of Sanyasa is to be entered
one’s Dharma as the bedrock of life. One of the after completing one’s duties in the three earlier
many ways in which this is instilled is through phases. Many take Sanyasa as an escape from the
the division of the four stages of human life as world and this is not to be. It is the culmination
described in the Yogic science of Yantra.These of a life well lived and never an escape from
Chatur Ashrama are Brahmacharya, Grahasta, responsibility. As Pujya Swamiji used to say, “Many
Vanaprasta and Sanyasa and each of these has want to renounce, but they don’t have anything
specific responsibilities and duties that enable us to renounce in the first place!”
CHATURVIDHA
to grow fully as a human being. Brahmacharya
is the period of life from birth to 27 years of age.
This is the period of one’s life that is devoted PURUSHARTHA:
exclusively towards attaining knowledge. It is the Indian culture accepts the Chaturvidha
period of study at the feet of a realised master Purushartha, that there are the four legitimate
(Guru). The second phase of one’s life is the aims of life, namely Dharma, Artha, Kama and
Grahasta Ashrama or the householder phase. It Moksha. Tiruvalluvar deals with the first three
is said to be from 27 to 54 years of age. This is in his great Tamil scripture Tirukkural under the
the period of responsibility and obligations. It is headings of Aram, Porul and Inbam. Dharma
the productive period of life in family, financial or Aram is the living of a righteous life with
as well as personal pursuits. The world can be fulfillment of all duties in the spirit of Nishkama
said to turn because of the population in this Karma (selfless service) and Karmasu Koushalam
Ashrama as they have the responsibility to take (perfection in action). Artha or Porul is the
care of all the other three groups. The third stage fulfillment of all legitimate material needs in the
of life is the Vanaprasta that runs from 54 to 81 proper manner. We must realise that in many
years of age. This is the retirement time when instances our needs are legitimate, but our wants
one can sit back and relax in a quiet, reflective, may not be correct as they only mirror our greed.
meditative state. Inner unfoldment may be given Man needs a house for shelter, but his greed
paramount place without undue concern for makes him want ten houses. There are examples
worldly matters. Sanyasa Ashram is the fourth of even ‘spiritual leaders’ (?) who have trillions in
stage of life where total renouncement occurs. It banks, hundreds of cars and numerous houses!
is the period of one’s life beyond 81 years of age As the great soul Mahatma Gandhi once said,
AUTUMN 2018 MARCH - MAY 15

“There is enough for everyone’s need but not when least expected and can cause havoc with
for every man’s greed”. Kama or Inbam is the a peaceful productive life. According to Patanjali,
fulfillment of desires especially of the sexual Karmic fructification determines the class into
nature in the proper, legitimate, socially accepted which one is born (Jati), the life span (Ayu) as well
manner. Family life is an important learning as enjoyment (Bhoga) of pleasure and pain.
experience and is the stepping stone to further
Human embodiment is a rare opportunity for
experiences. It is important that the sexual
the soul as self-effort (Purushartha) is possible. A
potencies are utilised for the right purpose in the
human being can modify the fructifications of the
right way. When the first three goals are achieved
past by their present efforts, reduce the negative
in a legitimate manner, then we are ready for
Karmas of the past and enrich the positive ones.
attainment of the ‘goal of all goals’, Moksha or the
They are also in a unique position that they can
final liberation.
bring about the very eradication of the roots of
UNDERSTANDING THE the Karmic tree through a sincere Yoga Sadhana.
MATRIX OF KARMA: KARMA YOGA:

Karma is the universal law of action-reaction. As
long as the Kleshas exist, the Jiva is bound to
THE PATH OF
the fructification of the Karmas. The three main RESPONSIBILITY
sources of Karma are Adhyatmika, Adhibauthika Karma Yoga is one of the central teachings of
and Adhidaivika. Adhyatmika is that which is due the Bhagavad Gita and aims at the attainment
to the self. This is due to our thoughts, words and of Kaivalya or eternal freedom. The Karma Yoga
deeds. They may be due to our acts of omission Marga enables us to achieve this exalted ‘state of
as well as commission. Not doing the right thing being’ by performing with responsibility our day-
is sometimes Karmically as bad as doing the to-day duties. Lord Krishna tells Arjuna, “Therefore,
wrong thing. Adhibauthika is that which is due without attachment, constantly perform action
to the worldly side of creation. It may manifest which is duty, for, by performing action without
through animals or forces of nature. Adhidaivika attachment, man verily reaches the Supreme”.
is that which is due to the great clockwork of the
The other extreme is when some people translate
universe at the time of our birth. Astrology and
Sanyasa as the total renouncement and try to
numerology deal with this, but the Yogic science
escape from their responsibility through this
of Yantra gives us a complete understanding as
‘spiritual loophole’. It is important to remember
well as a master plan of this manifestation.
the real meaning of renouncement for Lord
The three major types of Karma are Prarabdha Krishna says, “Renouncing all actions in Me, with
Karma, Kriyamana (Agami) Karma and Sanchita or the mind centred in the Self free from hope and
Sabija Karma. Prarabdha Karma is the fructifying egoism and from mental fever, do thou fight”, and
Karma and is the load of Karma with which we who sit quiet, renouncing their own duty, will not
are born to work out in this lifetime. Kriyamana derive any benefit by such renunciation.
(Agami) or Vartamana is the one that we are
The whole teachings of the Bhagavad Gita
generating in the present. These actions that
reiterate the need for self-responsibility and in
are generated day by day may either join the
so many ways Lord Krishna tries to persuade
Prarabdha and become operative in this very
Arjuna to do his Dharma. In VI.5, Krishna preaches
life or join the Sanchita and become operative
about ‘right’ exertion: “Let a man lift himself by
in future lives. Sanchita Karma or Sabija Karma is
his own Self alone, let him not lower himself; for
the one that has most negative connotations. It is
this self is the friend of oneself and this self alone
the accumulated store of Karmas from many past
is the enemy of oneself”. The Lord tells Arjuna
embodiments that is stored in our sub conscious
that each one should do his duty according to
and manifests if we create an atmosphere
his nature, and that doing duty that is suited to
conducive for it to come to fruition. It strikes
one’s nature in the right spirit of detachment will
16 International Light
lead to perfection. He says, “Do thou perform thy hallmarks of what he called “self-actualizing”
bounden duty, for action is superior to inaction individuals. Maslow studied what he
and even the maintenance of the body would called exemplary people such as Albert
not be possible for thee by inaction”. Einstein, Jane Addams, Eleanor Roosevelt,
and Frederick Douglass rather than mentally
Another modern tendency is to ‘feel’ that one can
ill or neurotic people, writing that “the study
do somebody else’s job better than them but not
of crippled, stunted, immature, and unhealthy
one’s own job! This is a major ego-based survival
specimens can yield only a cripple psychology
technique, an escapist tendency that must be
and a cripple philosophy.”
watched carefully. So many people go around
saying, “I would be the best Prime Minister of this He basically concluded that “There are no
country or I would run this company better than perfect human beings”! Persons can be found
this guy” etc but look at them and you find that who are good, very good indeed, in fact, great.
they are totally incompetent messes! Arrogance There do in fact exist creators, seers, sages, saints,
and ignorance are a very dangerous combination shakers, and movers...even if they are uncommon
and so many ‘featherless bipeds’ running around and do not come by the dozen. And yet these
this planet today seem to be endowed with this very same people can at times be boring,
combination in plenty. irritating, petulant, selfish, angry, or depressed.
To avoid disillusionment with human nature, we
No wonder Lord Krishna warns us, “Better is
must first give up our illusions about it. This is
one’s own duty, though devoid of merit, than
so similar to Lord Krishna’s teachings when he
the duty of another well discharged. Better is
says, “One should not abandon, O Arjuna, the
death in one’s own duty; the duty of another is
responsibility to which one is born, though faulty;
fraught with fear” (shreyaan swadharmo vigunah
for all undertakings are enveloped by defects, as
paradharmaat swanushthitaat swadharme
fire by smoke”!
nidhanam shreyah paradharmo bhayaavahah).
He continues by saying “Each one, devoted to his
own duty, attains perfection”. He concludes by SELF ACTUALISATION
telling us that we become qualified for the dawn AND YOGA
of Self-knowledge and perfection though the Maslow’s hierarchy of needs deals with life as
performance of our own duty. This idea of work- a pyramid of growth or self evolution from the
ship as worship is so relevant in this day and age. lower physical needs to safety needs, need for
love and belonging, need for self esteem and
SWADHARMA: then self actualization. When a human being
SELF RESPONSIBILITY ascends the steps of the pyramid he reaches
self actualization. At the bottom of the pyramid
The Yogic concept of SWADHARMA or ‘self are the “Basic needs or Physiological needs” of
responsibility’ and the psychological concept a human being, food and water and sex. The
of Self-actualization have many similarities. Self next level is “Safety Needs: Security, Order, and
actualization is a term originally introduced Stability.” These two steps are important to the
by Kurt Goldstein for the motive to realize one’s physical survival of the person. Once individuals
full potential. In his view, it is the organism’s have basic nutrition, shelter and safety, they
master motive, the only real motive. However, the attempt to accomplish more. The third level
concept was brought most fully to prominence of need is “Love and Belonging,” which are
in Abraham Maslow’s hierarchy of needs theory psychological needs; when individuals have taken
as the final level of psychological development care of themselves physically, they are ready to
that can be achieved when all basic and mental share themselves with others. The fourth level is
needs are fulfilled, and the “actualization” of the achieved when individuals feel comfortable with
full personal potential takes place. what they have accomplished. This is the “Esteem”
Abraham Maslow studied the greatest people of level, the level of success and status. The “Need
his generation in an attempt to identify the AUTUMN 2018 MARCH - MAY 17
for Self-actualization,” occurs when individuals The Gotras that are named after these Rishis are
reach a state of harmony and understanding. Self used to identify the different families that have
actualization is at the top of Maslow’s hierarchy sprung from their progeny. These seven great
of needs - becoming ”fully human”...maturity or seers of this age are Kashyapa Maharishi, Atri
self-actualization - and is considered a part of the Maharishi, Jamadagni Maharishi, Bharatwaja
humanistic approach to personality. Maharishi, Vishwamitra Maharishi, Vashishta
Maharishi and Gauthama Maharishi. They have
been immortalized by a constellation of seven
stars being named the Sapta Rishi Mandalam
(constellation of seven Rishis).
The great minds of our Indian culture have
given us thoughts about responsibility in such a
lovely poetic manner. One such example is the
Purananuru that is a Tamil poetic work belonging
to the Sangam period corresponding to
between 200 BCE – 100 CE. Purananuru is
part of the Ettuthokai anthology which is the
oldest available collection of poems of Sangam
literature in Tamil. Purananuru contains 400
Maslow based his study on the writings of
poems of varying lengths in the Akaval meter.
other psychologists, Albert Einstein and people
More than 150 poets wrote the poems. It is not
he knew who clearly met the standard of self
known when or who collected these poems
actualization. Maslow used Einstein’s writings and
into these anthologies. Purananuru is a source of
accomplishments to exemplify the characteristics
information on the political and social history of
of the self-actualized person. He realized
pre-historic Tamil Nadu. Purananuru poems deal
that all the individuals he studied had similar
with the puram (external or objective) concepts
personality traits. All were “Reality Centered”, able
of life such as war, politics, wealth, as well as
to differentiate what was fraudulent from what
aspects of every-day living.
was genuine. They were also “problem centered”,
meaning that they treated life’s difficulties as I give to the right one of the most famous songs
problems that demanded solutions. These from therein with special highlight (mine) on
individuals also were comfortable being alone the fact that we are responsible for all the good
and had healthy personal relationships. They had things (punya phala) and bad (papa phala) that
only a few close friends and family rather than comes upon us. It also states so beautifully
a large number of shallow relationships. One that both the cause of the pain as well as the
historical figure Maslow found to be helpful in his antidotal remedy for it lies within our own very
journey to understanding self actualization was selves. It is very interesting to contrast this with
Lao Tzu, The Father of Taoism. A tenet of Taoism is the prevalent modern idea that “I am the poor
that people do not obtain personal meaning or innocent victim”.
pleasure by seeking material possessions.
It is too bad Maslow didn’t study any of the SELF TRANSFORMATION
realised souls of India for there have been so AS A PREPARATION
many such ‘self actualised’ masters from time The evolutionary Yogic process of culturing
immemorial! Each age or Manvantara has ourselves in order to attain the highest state of
seven great Rishis. The seven great Rishis of “universal perfection” deals with both the external
the first Manvantara are said to be Marichi, Atri, as well the internal aspects of our individuality
Angiras, Pulaha, Kratu, Pulastya and Vashista. The that are cultured in a step-by-step manner to
Sapta Rishis of the present Manvantara are the integrate all levels thus producing completeness
forefathers of all present day Brahmanas. of our whole being.
18
யாவ$m ேக(r ,யா*m ஊேர, Man’s pains and pain’s relief are from within,
!"m ந%&m πறrதர வாரா, Death’s no new thing, nor do our blossoms thrill
ேநாத/m த0த/m அவ2ேறா ர%ன When joyous life seems like a luscious draught.
வா-தl ,சாத1m 2*வ* அ4ேற
When grieved, we patient suffer; for, we deem
µ784 ,இ7*என ம=-nத4?m இலேம
π4ெனாC ,இ4னா* எ4ற1m இலேம
This much-praised life of ours a fragile raft
வானm தD *( தைலஇ ஆனா* Borne down the waters of some mountain stream
கl ெபா$* இரŋIm மlலl ேபrயாJ? That o’er huge boulders roaring seeks the plain
KrவLp பCஉm 2ைணேபாl ஆ$Pr Tho’ storms with lightning’s flash
µைறவLp பCஉm எ4ப* Qறேவாr
from darkened skies.
காRSP4 ெத(nதனm ஆதT4 மாRSP4
ெபUேயாைர 8யtத1m இலேம, Descend, the raft goes on as fates ordain.
SWேயாைர இக-தl அத7Xm இலேம. Thus have we seen in visions of the wise!
-2ற நாZ? ,க[ய4 \ŋI4ற4, 192 We marvel not at the greatness of the great;
Still less despise we men of low estate.
To us all towns are one, all men our kin,
Life's good comes not from others' Kaniyan Poongundran, Purananuru – 192
gifts, nor ill, (Translated by G.U.Pope, 1906)
The regular practice of Yoga as a ‘Way of Life’ intellect), Vairagya (dispassionate dedication
helps reduce our physical, mental and emotional with detachment or non-attachment to worldly
stresses that are destabilizing us. The Yogic ‘way of pursuits), Shat Sampat (the six noble virtues) and
life’ lays emphasis on right thought, right action, Mumukshatwa (a burning desire of aspiration
right reaction and right attitude. No wonder Pujya for self-realization). The Shat Sampat or six noble
Swamiji, Gitananda Giri Guru Maharaj has defined virtues that are part of the important qualities
Yogic living as the “right-use-ness of body, emotions necessary for a spiritual aspirant are Sama, Dama,
and mind” – a life of righteousness indeed. Uparti, Titiksha, Shraddha and Samadhana. Sama
is mental poise, Dama, sensory control, Uparti,
An integration of multiple factors needs to
selflessness, and Titiksha is endurance. Shraddha
occur both externally and internally. Our higher
is faith and Samadhana is the surrender to the
mind needs to be tapped and the inherent
Divine will. These are real spiritual qualities that
powers released with the flowering of higher
are found lacking in most modern seekers and
consciousness. The three powers of Buddhi
that is why frustration overcomes them and
(discriminatory intellect) are the Iccha Shakti
they stray off the path. These qualities were in
(power of will), Kriya Shakti (power of action) and
abundance in ancient society when men lived
Jnana Shakti (power of wisdom). Many persons
a natural life and unless and until these qualities
have the will but not the power to act. Many have
are cultivated, there is no chance for spiritual
the will as well as the power to act but do not
evolution. Strict Gurus of ancient days would not
know right from the wrong. Only the best of us is
accept disciples who didn’t have these qualities,
endowed with all three and know what is right as
but in today’s world which Guru can afford to
well as have both the will and the power to act in
refuse a disciple on such grounds especially when
the right manner.
they themselves don’t possess them in the first
We need to get our selves ready and that is a place?
great effort in preparation too. When the student
As my dear Guru-father Pujya Swamiji
is ready the Guru will appear, and this means
Gitananda Giri Guru Maharaj so rightly said,
that the sincere sadhaka should get themselves
ready by cultivating the required characteristics.
“Only the responsible will evolve while the
The four-fold essential qualifications necessary others continue to stagnate”!
in a spiritual aspirant are Viveka (discriminating
AUTUMN 2018 MARCH - MAY 19
Book Review
Model, Methods, and Perspectives in Yoga

Author: Prof. TM Srinivasan
Publisher: Swami Vivekananda Yoga Prakashana, Bengaluru, India.
Year: 2017
Pages: 296
Price: Rs 250
Very rarely does one find someone who truly breathes role. He substantiates this argument by further stating, “In
yoga and science at the same time, and that too with such the last hundred years, the scientific paradigm has changed
beauty, skill, and dignity. Such a unique human being is completely from a deterministic world to a probabilistic
Prof. TM Srinivasan, one of the great yogi scientists of one”.
modern India. Currently, serving as honorary professor of
He gives ample space for his discussions on energy
yoga and physical sciences at S‑VYASA, he has seamlessly medicine and stresses the need for entraining the biological
brought together in his life vast experience in yoga as well systems for health, wellbeing, and holistic wellness.
as modern science in the field of biomedical engineering, I enjoyed his new look at many traditional concepts, and
having served with distinction at both the IIT, Madras and this is well brought out in his discussion on the importance
the Fetzer Institute in Michigan, USA. of using the new term “homeodynamics” rather than the
This book is a compilation of 45 papers published by him traditional homeostatic concepts as the sense of dynamics
in Yoga Sudha, the monthly magazine from S‑VYASA in most vital in living systems. Similarly, his introduction of
recent years and are arranged as 45 chapters divided into the novel perspective of asana being a noninstrumental
three parts, namely, model, methods, and perspectives in feedback system is very well taken. Similarly, his
part I, II, and III, respectively. statement that the autonomic functions in the body can
be changed through proper thinking reiterates Maharishi
In part I, he brings forth some interesting models that can Patanjali’s teachings of pratipaksha bhavanam and chatur
enhance our understanding of yoga as the original science bhavanam (maitri‑karuna‑mudita‑upekshanam). I am also
of holism as it deals with a multidimensional model of very glad that he called a spade a spade when he states,
the human being encompassing the karana, sukshma, and “what normally passes as meditation in English language
stoola aspects of consciousness, mind, and the body. Many is really concentration or focussed awareness.” Someone
concepts from quantum physics are explored as he leads us has to bell the cat, and he does so in a very distinguished
through the journey of understanding that what matters, is manner.
more than just the mind. He repeatedly emphasizes the true
nature of yoga as a holistic science that deals with direct He goes on to give numerous models that would be
perception (pratayaksha), logical inference (anumaana), useful for young yogi scientists in the future including the
and intuitive learning through reliable testimony (aagama). lateralization of brain functions in swara yoga; the role
He compares and contrasts yoga and modern science and of muscle stretch in rehabilitation; cerebral hemodynamic
even goes to the extent of aptly termed modern medicine changes in pranayama, as well as theoretical postulates
as “trauma medicine” while extolling yoga as “Lifestyle of quantum mechanics and consciousness. In this, he
Medicine.” He stresses the need to redevelop our inherent reveals his role as a visionary mentor who is laying the
and intrinsic connection with nature, especially if we are groundwork for the young scientists of the future to follow
to evolve as a race. Intriguingly, he refers to both the with zeal. He motivates us further by stating, “Sciences
so‑called exact sciences and spiritual sciences as both being separate, quantum mechanics interconnects, while true
experiential and stresses the need for internal consistency spirituality integrates.”
for anything to be valid. In Chapter 3, he actually goes to As a medical doctor and yoga therapist, I have often been
the extent of categorizing yoga as being “objective” and surprised at the seeming lack of common sense in our
contrary to common belief labels modern science as being clinical practice. Even when magnetic resonance imaging
“subjective.” This is surely something that may rankle scans of patients report that their intervertebral discs are
many diehard scientists but will immensely gladden the dehydrated, no doctor tells them to drink more water!
hearts of anyone who has experienced the deepest levels No one ever tells them to learn to breathe efficiently! Yet
of yoga where vairagya and metacognition play a great these two, good hydration and efficient respiration, are the
258 © 2018 International Journal of Yoga | Published by Wolters Kluwer ‑ Medknow

Book Review
foundations of optimal health. I am heartened to hear him a backflow that in turn could improve cardiac blood
state the same and also connect it with the copious supply supply. He mentions the use of kapalabhati in this regard
of elections that can prevent free radical damage. He also and suggests further studies to elucidate both mechanisms
goes on to recommend barefoot walking, and this will help and potential benefits. Similarly, in Chapter 35, he gives
in so many ways as we have for most part divorced our well thought‑out suggestions on using forced unilateral
inherent connection to our Mother Earth. nostril breathing to induce a functional vagotomy
and reduce intraocular pressure, thus minimizing the
He ends Part I in a beautiful poetic flow describing the
occurrence of glaucoma, one of the preventable causes of
components of the mind: “Chitta are the waves of the ocean
blindness.
that are seen on the surface, ever present and ever restless.
Manas is like the depth of the ocean wherein there is no I personally enjoyed his description of “self‑adjustments”
movement, even physical light penetrates only partially. through yoga where he suggests that sensory input such
Buddhi is like the total silence at the depth unaffected by as pressure at different levels of the spinal cord may
even a storm at the surface”. elicit spinal waves that would be useful in health and
disease. He goes on to postulate that this can be done as a
The second part of the book deals with various methods
“self‑therapy” through yogic breathing, abdominal pumping
and includes novel approach toward somatic dysfunction,
as well as through neck flexion and extension done in
use of vagal nerve stimulation through pranayama, the
various forward and backward bending asanas. Such
role of mirror neurons and ample discussion on the
practices could thus facilitate healing and recovery in those
electromagnetic fields highlighting the positive and negative
who have suffered spinal injuries and this would be a great
implications of these “subtle rays” that are part and parcel
asset in rehabilitation.
of our modern life. Concepts of epigenetics find a pride of
place as this is now a current hot topic and he details the The third part of the book deals with perspectives and rare
role of yoga in manipulating the mind‑body complex to gems such as “science separates, spirituality unites” are
recast genetic information right down to the cellular level. found here. He elucidates concepts of quantum physics in
He quotes, “The foods we eat and the lifestyle behaviours a lucid manner, and we realize that “interconnectedness”
we choose are literally instructing our genomes.” He goes is a major concept that helps bridge the scientific and
on to a later state, “Practising yoga regularly strengthens spiritual worlds through holistic medicine and holism. He
through neuroplasticity, one’s positive attitudes to society, dwells deeply on how yogis try to “go against” nature in
and environment.” It is heartening to hear him state that in their search for liberation (pratiprasava heyah/gunavritti
all the yoga programs at S‑VYASA, lifestyle changes are virodachcha) and at the same time have deep respect and
introduced as a vital method to control and overcome many gratitude for nature as their Mother. The journey from
psychosomatic problems. He postulates that yoga practices the “undifferentiated to the differentiated” in the context
designed to cater to the five‑layer model of humans should of Yoga and Sankya is elaborated, and he provides a new
be practiced along with fasting and behavioral changes interpretation of the tanmatras as being of the nature of
to positively influence genetic, epigenetic, and pregenetic energies such as magnetic (gandha), electrical (rasana),
problems. electromagnetic (roopa), kinetic (sparsha), and
gravitational (shabda) rather than merely smell, taste,
He does not limit his methodology to the higher “spiritual”
sight, touch, and sound. In the Chapter on “Psychology and
aspects alone and dwells deeply into concepts of muscle
Vedanta,” he makes a statement that may be controversial
activity in yoga asanas, body mechanics, and even the
to many when he says, “There is no answer to the
important aspects of fascial yoga dealing with the stretching
problems faced by a person if one follows the model of
of the superficial, deep, and internal fascia layers through
modern psychology.” It will be interesting to see how
yoga comparing and contrasting it with similar mechanisms
modern psychologists take to this statement. He does, later
in Qigong. His section on spinal mechanisms and role
on, admit that a one‑to‑one comparison of concepts from
of the paraspinal muscles in protecting the core makes
across cultures is always fraught with difficulties (p. 268).
interesting reading and gives indications for future work
He makes a very valid point when toward the end of
in this field. Information transfer between cells and the
Chapter 42 he says, “Unlike in the West, in the Eastern
role of yoga in enhancing such a seamless processing of
outlook, there is a complete lack of conflict between
information “within” and “without” the system are brought
religion and science.” He quotes Jung as attributing this
out in an understandable manner.
to the fact that “Eastern religions are not based on faith
A very practical application of yoga is indicated in the but have a character of a kind of cognitive religion or
Chapter on cardiac assist through yoga practices wherein religious cognition.” To this extent, he provides an in‑depth
he details the possible applications of yoga techniques elaboration of the concept of Lord Nataraja, the dancing
in enhancing cardiac perfusion. He recommends Shiva in Chapter 43, “Yoga of Divine Dance” where he
pawanmuktasana and all inverted postures and suggests defines the Lord as the dancer who is the activator of the
that any asana that compresses the abdomen could achieve dancing particles!
International Journal of Yoga | Volume 11 | Issue 3 | September‑December 2018 259

Book Review
Many phrases brought a smile to my face and one Puducherry, India.

that really stood out was in Chapter 4 where he
talks about the “Molecules of Ananda” and terms
N‑arachidonoylethanolamine as the Anandamide! I also
found a sense of lightness manifest in my heart when I read This is an open access journal, and articles are distributed under the terms of the Creative
his ideas about the need to grow and develop our happiness Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non-commercially, as long as appropriate credit is
quotient after having focused for long on our intelligence, given and the new creations are licensed under the identical terms.
emotional, and spiritual quotients, respectively.
All in all, this is a marvelous book that will inspire,
Quick Response Code:
motivate, and provide a framework for the young yogi Website:
scientists of the world to future explore the great breadth and www.ijoy.org.in
depth of this art‑science‑philosophy‑psychology‑lifestyle
that has stood the test of time. DOI:
10.4103/ijoy.IJOY_21_18
As said by Yogamaharishi Dr. Swami Gitananda Giri, “May
we all be blessed by Yoga, the mother of all sciences.” Hari
om tat sat! How to cite this article: Bhavanani AB. Model, methods and perspectives
in yoga. Int J Yoga 2018;11:258-60.
Centre for Yoga Therapy, Education and Research, Sri Balaji Vidyapeeth, Received: April, 2018. Accepted: April, 2018.
260 International Journal of Yoga | Volume 11 | Issue 3 | September‑December 2018

Books and Proceedings
DVDs and CDs
News Paper Cuttings
Awards and
Recognitions
Photographs

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A THESIS OF

COMPILATION OF RESEARCH PAPERS, ARTICLES

Doctor of Science (Yoga)

SWAMI VIVEKANANDA YOGA ANUSANDHANA SAMSTHANA

Doctor of Science (Yoga)

SWAMI VIVEKANANDA YOGA ANUSANDHANA SAMSTHANA

Selected Published Research papers

Selected Published Articles

Books and Proceedings

DVDs and CDs

News Paper Cuttings

Awards and Recognitions

I am blessed to be mentored by towering Yogic personalities who are inspirations

I thank my dear students and able colleagues Yogachemmal Dr. Meena

Yogacharya Dr Ananda Balayogi Bhavanani

NAME : Yogacharya Dr. ANANDA BALAYOGI BHAVANANI

PARENTS NAME : Yogamaharishi Dr. Swami Gitananda Giri Guru Maharaj

 “YOGACHARYA” title received from Yogamaharishi Dr Swami Gitananda Giri on

III. VIDEO PRODUCTIONS IN YOGA AND YOGA THERAPY:

IV. MUSIC ALBUMS:

V. PUBLISHED PAPERS IN YOGA AND YOGA THERAPY: (197)

VI. SCIENTIFIC ABSTRACTS IN YOGA AND YOGA THERAPY: (76)

VII. PUBLISHED NUMEROUS ARTICLES IN:

PHD GUIDE / CO-GUIDE /EXAMINER:

BHARATA NATYAM ARTISTE, TEACHER AND CHOREOGRAPHER:

YOGA AND YOGA THERAPY RESEARCH EXPERIENCE:

MAJOR PAPER PRESENTATIONS (YOGA AND YOGA THERAPY) AT

YOGA AND YOGA THERAPY TEACHING EXPERIENCE:

 Member, Selection Committee, INDIAN COUNCIL FOR CULTURAL RELATIONS

10. RESOURCE PERSON IN YOGA AND YOGA THERAPY:

13. CYTER, MGMCRI, SBV– from July 2013 till date.

TRADITIONAL YOGA EXPERIENCE:

EXPERIENCE in YOGA SPORT COMPETITIONS:

EFFECT OF YOGA TRAINING ON HANDGRIP, RESPIRATORY

MANDANMOHAN*, LAKSHMI JATIYA, KAVIRAJA UDUPA

( Received on February 5, 2003 )

Abstract : Although there are a number of reports on the effect of yoga

Key words : yoga training pulmonary functions

INTRODUCTION (PEFR) (1, 2, 3, 4, 5). However, very few

Respiratory pressures : MEP was

Yoga group Control group

DISCUSSION involve sustained isometric contraction of

u n t r a i n e d o n e s . H o w e v e r, t h e p r e s e n t (both men and women), Birkel and Edgren

respiratory pressures and spirometric values of Science and Technology, Government of

MODULATION OF STRESS INDUCED BY ISOMETRIC HANDGRIP

VIJAYALAKSHMI P.*, MADANMOHAN, BHAVANANI A. B.,

Department of Physiology and † Staff & Students’ Health Centre,

( Received on February 15, 2003 )

Abstract : 13 essential hypertensive patients aged 41 to 60 years were

Key words : yoga training blood pressure heart rate

INTRODUCTION yoga is effective for prevention as well as

Pranayams : pranava, chandra anuloma and

Comparison P value Comparison P value

Before yoga training After yoga training

training schedule consisting of shavasan as and HR by 6 beats/min before yoga training.

LETTER TO THE EDITOR

EFFECT OF SIX WEEKS OF SHAVASAN TRAINING ON SPECTRAL

In an earlier work from our laboratory, v a r i a b i l i t y ( 7 ) . T h e e f f e c t o f shavasan

The shavasan and control groups were RR interval fluctuations occurring at

Baseline After 6 weeks

HR 73± 10 71± 11 68± 10*** 68± 11

fluctuations due to baroreflex-mediated changes in vagal nerve traffic to the heart.

MADANMOHAN*, A. B. BHAVANANI, E. S. PRAKASH,