Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model

A Warm Water Immersion Intervention for Symptoms of PTSD in Military Veterans: A Qualitative Descriptive Study

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is a substantial problem for Veterans and active members of armed forces across the globe, resulting in debilitating mental and physical comorbidities. Evidence-based treatments have demonstrated some success; however, many Veterans remain symptomatic mandating the urgent need for innovative treatment strategies.

PURPOSE

The purpose of this study was to explore the lived experience of military Veterans with PTSD symptoms who participated in a therapeutic warm water immersion intervention aimed at reducing their symptoms.

METHODS AND PROCEDURES

A standardized warm 33 °C (92 °F) water immersion intervention to the chest, lasting 45 min was implemented. Semi-structured interviews were conducted with the 13 participants (age 23-41) after engaging in the intervention. Using a qualitative descriptive design informed by phenomenology, thematic analysis was completed, applying criteria of rigor throughout the process.

RESULTS

Five main themes explicated the participants' experience: the rhythm of relaxed, embracing the properties of the water, the pain floats away, acclimatize to calmness, and a place to set your mind. Participants described a sense of relaxation, calmness, pain reduction, and a means to control intrusive thoughts. All indicated they would recommend the intervention and provided feedback on how to refine it.

CONCLUSIONS

As a component of a larger study, these qualitative findings revealed the potential for therapeutic effects of a novel water immersion intervention. The findings serve to inform revisions to the intervention for future research and practice. Immersion provides a fast-acting, non-stigmatizing adjunct therapy for student Veterans who continue to experience symptoms during and after standard evidence-based treatment.

Effects of traditional Chinese exercises on brain-derived neurotrophic factor in middle-aged and older adults: A systematic review and meta-analysis of randomized controlled trials

Background

Brain-derived neurotrophic factor (BDNF) may help middle-aged and older adults resist age-related neurodegenerative conditions and psychiatric disorders. Recent studies suggested that Traditional Chinese exercises (TCEs) may be a promising strategy to improve the BDNF levels of these populations, while the effectiveness has yet to be definitively confirmed due to the variances in the study designs and observations. Therefore, this systematic review and meta-analysis aimed to examine the effects of TCEs intervention on BDNF in middle-aged and older adults.

Methods

The search was conducted in November 2024 in seven Chinese and English databases. Two reviewers independently reviewed the search results, extracted the data, and assessed the risk of bias and certainty of evidence. Meta-analyses and meta-regressions were performed to determine the overall effect size and the impact of potential moderators.

Results

Ten publications consisting of 543 participants were included. The overall effect size of TCEs on BDNF was large and significant [Hedges'g = 0.82, 95 % CI (0.55, 1.09), p < 0.01]. Subgroup analysis revealed that the effect size was non-significant for participants with mild cognitive impairment (MCI) (p = 0.08), while significant for participants with normal cognitive function (p < 0.01). In the meta-regression, moderators such as the mean age, sex, and baseline BDNF levels of participants, as well as total TCEs time were not associated with outcome variables. The certainty of the evidence was assessed as moderate.

Conclusions

This systematic review and meta-analysis indicates that TCEs intervention could increase the levels of BDNF in middle-aged and older adults with normal cognitive function.

Systematic review registration

www.crd.york.ac.uk/PROSPERO/, identifier: CRD42023484121.

What can the psychoneuroimmunology of yoga teach us about depression's psychopathology?

Depression, the most prevailing mental health condition, remains untreated in over 30% of patients. This cluster presents with sub-clinical inflammation. Investigations trialling anti-inflammatory medications had mixed results. The lack of results may result from inflammation's complexity and targeting only a few of depression's abnormal pathways. Mind-body therapies' biological and neuro-imaging studies offer valuable insights into depression psychopathology. Interestingly, mind-body therapies, like yoga, reverse the aberrant pathways in depression. These aberrant pathways include decreased cognitive function, interoception, neuroplasticity, salience and default mode networks connectivity, parasympathetic tone, increased hypothalamic-pituitary-adrenal (HPA) axis activity, and metabolic hyper/hypofunction. Abundant evidence found yogic techniques improving self-reported depressive symptoms across various populations. Yoga may be more effective in treating depression in conjunction with pharmacological and cognitive therapies. Yoga's psychoneuroimmunology teaches us that reducing allostatic load is crucial in improving depressive symptoms. Mind-body therapies promote parasympathetic tone, downregulate the HPA axis, reduce inflammation and boost immunity. The reduced inflammation promotes neuroplasticity and, subsequently, neurogenesis. Improving interoception resolves the metabolic needs prediction error and restores homeostasis. Additionally, by improving functional connectivity within the salience network, they restore the dynamic switching between the default mode and central executive networks, reducing rumination and mind-wandering. Future investigations should engineer therapies targeting the mechanisms mentioned above. The creation of multi-disciplinary health teams offering a combination of pharmacological, gene, neurofeedback, behavioural, mind-body and psychological therapies may treat treatment-resistant depression.

Mind-Body Interventions Impact Patient Anxiety Levels After Total Knee Arthroplasty (TKA): A Pilot Study

BACKGROUND

Orthopedic surgery can trigger anxiety that negatively impacts patient experience and recovery.

PURPOSE

This pilot study investigated if a compassionate interaction combined with standardized mind-body techniques could reduce patient anxiety levels during the initial postoperative phase for patients undergoing a total knee arthroplasty (TKA).

METHODS

Participants were 36 postsurgical hospital inpatients guided through a 10-minute mind-body breathing and visualization intervention on post-op day zero (POD 0) and on post-op day one (POD 1). Quantitative data included before and after Visual Analogue Scale for Anxiety (VAS-A) reports, heart rate values, and pulse oximetry readings.

RESULTS

Significant decreases in VAS-A and heart rate values as well as increases in pulse oximetry values were demonstrated on both POD 0 and POD 1.

CONCLUSION

These results indicate that a brief mind-body intervention can reduce reported anxiety levels and induce physiologic benefits for hospitalized patients post-TKA and suggest the possibility that such interventions could reduce anxiety in a broader patient population.

Effect of Yoga Therapy on Hypothyroidism: A Systematic Review

Background

Hypothyroidism (HT) is the most prevalent endocrine disorder, affecting approximately one in 10 out of 35 adults, with a higher prevalence in females and the elderly.

Purpose

This systematic review (SR) aimed to discuss the effects of yoga on markers and comorbid conditions of HT.

Methods

The SR was registered with the PROSPERO (PROSPERO 2022 CRD42022312990). Google Scholar, PubMed, Cochrane, and EMBASE were searched for the relevant English language interventional studies published from 31 December 1947 to 31 December 2023 by using the keywords 'meditation OR breath regulation OR yoga OR yoga nidra AND hypothyroidism OR hypothyreosis OR underactive thyroid OR low thyroid'. Of the 4078 screened studies, eight eligible studies (three RCTs, two pilot studies, two pre-post trials, and one case study) with 421 HT patients (392 females and 29 males) and three to six-month yoga interventions were included. Two independent review authors extracted study characteristics and synthesised them descriptively. RCTs and NRSIs were assessed for risk-of-bias (RoB) using Cochrane tools RoB2 and ROBINS-1.

Results

The findings suggest that yoga effectively improves the thyroid profile, lipid profile, heart rate variability, pulmonary functions, anxiety, depression, and quality of life among HT patients.

Conclusion

Yoga may be an inexpensive add-on preventive and therapeutic option for HT. The clinical and methodological heterogeneity among the studies did not allow for meta-analysis (MA). Well-designed MAs are warranted by including rigorous RCTs to draw valid conclusions and defined mechanisms regarding the efficacy of yoga practices/interventions on HT.

Testing the involvement of low-level visual representations during spoken word processing with non-Western students and meditators practicing Sudarshan Kriya Yoga

Previous studies, using the Continuous Flash Suppression (CFS) paradigm, observed that (Western) university students are better able to detect otherwise invisible pictures of objects when they are presented with the corresponding spoken word shortly before the picture appears. Here we attempted to replicate this effect with non-Western university students in Goa (India). A second aim was to explore the performance of (non-Western) meditators practicing Sudarshan Kriya Yoga in Goa in the same task. Some previous literature suggests that meditators may excel in some tasks that tap visual attention, for example by exercising better endogenous and exogenous control of visual awareness than non-meditators. The present study replicated the finding that congruent spoken cue words lead to significantly higher detection sensitivity than incongruent cue words in non-Western university students. Our exploratory meditator group also showed this detection effect but both frequentist and Bayesian analyses suggest that the practice of meditation did not modulate it. Overall, our results provide further support for the notion that spoken words can activate low-level category-specific visual features that boost the basic capacity to detect the presence of a visual stimulus that has those features. Further research is required to conclusively test whether meditation can modulate visual detection abilities in CFS and similar tasks.

A Systematic Review of Breathing Exercise Interventions: An Integrative Complementary Approach for Anxiety and Stress in Adult Populations

Aim: Nurses are well-qualified to deliver integrative complementary therapy interventions, a holistic approach to assist individuals experiencing anxiety and stress. Self-regulated, controlled breathing exercises (a clinical approach) are reported to decrease anxiety and increase stress tolerance. The aim of this systematic review was to evaluate the effectiveness of breathing exercise interventions on the psychological and physiologic outcomes of anxiety and stress among adults and assess the state of the science in the post-COVID-19 population. Methods: A systematic review was conducted, and four scientific databases were searched: PubMed, CINAHL, EMBASE, and Web of Science. Inclusion criteria included: (1) peer-reviewed studies, (2) adults over 18, (3) breathing exercise interventions, and (4) anxiety or stress as outcomes. Results: Out of 309 studies identified, 19 were included. Twelve reported significant improvements in anxiety and nine reported significant improvements in stress following varying breathing exercise interventions (p < .05). No adverse events were reported. Conclusions: Breathing exercises were found to be effective in reducing anxiety and stress in adults, however, there continues to be limited evidence that includes large randomized controlled trials. Breathing exercises are a holistic care approach that can be safely implemented by nurses to decrease symptomatology among adults, including the post-COVID population.

Effects of Sudarshan Kriya Yoga (SKY) on the stress and self-esteem of medical doctors in a tertiary care hospital: a prospective analytical study

Objectives

Sudarshan Kriya Yoga (SKY) is a unique yoga practice incorporated into the Art of Living course. It is found to have a beneficial effect on different psychiatric disorders. This study was conducted to investigate the impact of SKY practice on stress and self-esteem among medical doctors.

Materials and methods

A prospective study was conducted among medical doctors (interns, residents, and consultants) in a tertiary care center. The Perceived Stress Scale and Rosenberg Self-Esteem Scale were used for the assessment of stress and self-esteem levels, respectively. The parameters were assessed at baseline, 3-day and 40-day follow-up of SKY practice. The statistical analysis was performed using Statistical Package for Social Sciences, version 25.

Results

A total of 58 participants were included in the study. The scores for stress decreased (19.07 to 18.62 to 16.33) and self-esteem levels increased (19.09 to 19.64 to 20.81) after the practice signifying the beneficial impact. It was statistically significant (P<0.05) with considerable effect sizes (Cohen's d 0.2-0.5 and >0.5 for self-esteem and stress levels, respectively). On MANOVA, gender (more in male participants) was significantly associated with stress levels even after the practice of SKY (P=0.042).

Conclusion

Amid the hectic schedule, regular practice of SKY is proven beneficial for medical doctors with its positive impact on stress, and self-esteem levels by our study.

Effects of mind-body therapies on depression among adolescents: a systematic review and network meta-analysis

Background

Depression poses significant threats to adolescents' health globally. Research has shown the potential of mind-body therapies to alleviate depression, but limited studies have directly compared the therapeutic effects of different types of mind-body therapies on adolescent depression and the optimal therapy remain unclear. Therefore, we conducted a systematic review and network meta-analysis of randomized controlled trials that met the inclusion criteria to explore the effectiveness of different types of mind-body therapies as interventions to improve depression among adolescents, and to identify the most effective interventions.

Methods

A comprehensive search of databases including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus up to January 2024 was conducted to assess the impact of mind-body therapies on depression among adolescents. The risk of bias of the included studies was evaluated using Cochrane Review Manager 5.4. STATA 18.0 was used for network meta-analysis. The node-splitting method was used to test the local inconsistency of the network meta-analysis. Funnel plots and the Egger's test were utilized to assess the potential impact of bias in this study.

Result

This network meta-analysis included 9 randomized controlled trials involving a total of 955 subjects. The results indicated that yoga, dance therapy and Tai Chi were more effective than other mind-body therapies in reducing symptoms of depression among adolescents. Specifically, according to the SUCRA ranking, yoga was rated to be the optimal intervention for adolescents with depression (SCURA: 82.2%), followed by dance therapy (SCURA: 77.5%) and Tai Chi (SCURA: 64.9%).

Conclusion

This study revealed that mind-body therapies have positive effects on improving depression among adolescents. Yoga may be the most effective intervention among the different types of mind-body therapies. However, due to the small sample size of patients included, the certainty of the results was limited to some extent. Therefore, further investigation is necessary to strengthen the evidence base when more relevant studies become available.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024508774.

A study on the relationship between yoga exercise intervention and the comprehensive well-being of female college students

Background

Due to the influence of theories, tools, and methodologies in studying well-being, sports science has predominantly focused on subjective well-being, with less attention given to psychological well-being and even less to the integrated study of comprehensive well-being. This study aims to analyze the relationship between yoga exercise intervention and the comprehensive well-being of college students and to explore the mechanism of a yoga exercise intervention to improve the comprehensive well-being of female college students.

Methods

With 92 female college students as subjects, the "Comprehensive Well-being Scale" was used, and research methods such as yoga exercise intervention, questionnaire surveys, qualitative analysis, expert interviews, and statistical analysis were employed to investigate the role of a yoga exercise intervention on the comprehensive well-being of female college students.

Results

Among the nine dimensions of comprehensive well-being, the three dimensions of subjective well-being and the two dimensions of psychological well-being (health concern and personality growth) of female college students were significantly improved. Additionally, four other dimensions of psychological well-being also showed significant improvement. Furthermore, the improvement in the life satisfaction of female college students' subjective well-being was mainly achieved through yoga meditation, while partner yoga posture practice could help individuals gradually form a stable pattern of altruistic behavior.

Conclusion

Yoga exercise intervention can improve the comprehensive well-being of female college students and can be an effective counseling method for college students' mental health education.

Effect of Integrated Yoga as an add-on therapy in adults with clinical depression - A randomized controlled trial

BACKGROUND

Depression is a leading cause of disability and the conventional management has several limitations. Recent studies demonstrated the benefits of yoga in psychological disorders.

AIMS

To evaluate the efficacy of the Integrated Yoga Module (IYM) to standard care with added yogic education on lifestyle modification (YELM) in patients with clinical depression.

METHODS

A PROBE trial was conducted at a single tertiary care hospital in India. Adults aged 18 to 64 with clinical depression were randomized to either an IYM or an active control group using a computer-generated mixed block randomization sequence. Both groups received YELM in addition to standard care and the intervention group practiced IYM, for 8 weeks. The primary outcome was the reduction in depression symptoms assessed using the Beck Depression Inventory (BDI-II), and secondary outcomes involved self-compassion, brief resilience, positive and negative experiences, and quality of life, evaluated at 8 weeks.

RESULTS

The mean ± SD age of participants was 32.2 ± 10.0 and 54.3% were females. The IYM group showed statistically significant improvements in BDI-II scores β = -6.7 (95% CI [-10.8, -2.5]; p = .001), resilience β = 0.4 (95% CI [0.02, 0.80]; p = .037), physical health domain of WHOQOL - BREF β = 10.1 (95% CI [0.7, 19.5]; p = .035) and negative emotions (SPANE-N) β = 2.8 (95% CI [0.1, 5.4]; p = .037). However, no significant differences were found in SCS-SF β = -0.3 (95% CI [-0.7, 0.0]; p = .053).

CONCLUSIONS

IYM as an adjunct is superior to conventional medical management in reducing symptoms and improving positive psychological resources in clinical depression.

Link between Yoga and Heart Rate Variability: Can Yoga Enhance the Cardiac Resonance

Cardiac resonance is a complicated phenomenon involving the coordinated oscillations of numerous circulatory system components, such as electrical activity, contraction and relaxation, and blood flow. It is critical for the normal functioning of the heart and for maintaining blood flow throughout the body. Cardiac resonance is defined as a series of tiny waves produced by the heartbeat and overlaid on flow data and airway pressures. A variety of technologies, including cardiac magnetic resonance (CMR) imaging, can be used to identify these waves. CMR is a strong noninvasive method for seeing and quantifying heart anatomy and function in great detail. CMR can be used to assess cardiac resonance in both healthy and heart disease patients. A regular and coordinated pattern of oscillations characterizes cardiac resonance in healthy persons. In patients with heart illness, however, cardiac resonance can be interrupted, resulting in diminished cardiac function and decreased blood flow. The intricate role of cardiac resonance in cardiac health and disease is continuously being studied by researchers. However, it is obvious that cardiac resonance is an exciting area of research that has the potential to change the way to identify and treat heart illness. Yoga is a mind-body practice that has been demonstrated to have numerous cardiovascular health advantages, such as improved heart function, reduced inflammation, and lower blood pressure. Yoga is hypothesized to promote cardiac resonance by encouraging coordinated oscillations of numerous cardiovascular system components. Various researches have shown buoyant results such as yoga can be helpful in improving heart rate variability, cardiac resonance and reducing arterial stiffness. Stress can disrupt cardiac resonance and increase the risk of heart disease. More research is needed to completely understand the mechanisms that impact cardiac resonance and the long-term advantages of yoga for heart health.

Effects of mind-body exercise on perimenopausal and postmenopausal women: a systematic review and meta-analysis

IMPORTANCE

The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women.

OBJECTIVE

This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.

EVIDENCE REVIEW

Four electronic databases-PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science-were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool.

FINDINGS

A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I2 = 7%). In addition, significant improvements were observed in sleep quality (SMD, -0.48; 95% CI, -0.78 to -0.17; P = 0.002, I2 = 76%), anxiety reduction (SMD, -0.80; 95% CI, -1.23 to -0.38; P = 0.0002, I2 = 84%), depressive mood (SMD, -0.80; 95% CI, -1.17 to -0.44; P < 0.0001, I2 = 79%), and fatigue (SMD, -0.67; 95% CI, -0.97 to -0.37; P < 0.0001, I2 = 0%).

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.

Influence of High-frequency Yoga Breathing (Kapalabhati) on States Changes in Gamma Oscillation

Background

Yoga breathing has been shown to enhance neurocognitive function and positive emotions by increasing electrical power in several frequency bands and synchronizing interhemispheric brain waves. The current study examined the immediate impact of practicing Kapalabhati (KBH) on the electrical activity of the brain.

Methods

Thirty-six individuals who met the inclusion and exclusion criteria and ranged in age from 18 to 25 were randomly assigned, 1:1, to the KBH (n = 18) and breath awareness (BAW) (n = 18) groups. Before data collection, both groups received their respective practices for 10 min each day for a total of 15 days. The brain's electrical activities were assessed using 128-channel EEG recording. The electrodes were placed on their scalps according to the international 10-10 system, ensuring optimal coverage of different brain regions. The EEG signals were amplified, digitized, and stored for offline analysis.

Results

The EEG data showed that the practice of KBH significantly increased alpha waves in the frontal and temporal regions. Moreover, gamma waves increased significantly in the frontal, temporal, and occipital regions after the practice of KBH when compared with BAW.

Conclusion

The results suggest the involvement of frontal and temporal regions, which highlights the importance of KBH in enhancing higher-order cognitive processes. These results provide valuable insights and support for the use of KBH as a potential intervention for individuals seeking to enhance their cognitive abilities.

Remote Short Sessions of Heart Rate Variability Biofeedback Monitored With Wearable Technology: Open-Label Prospective Feasibility Study

BACKGROUND

Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach.

OBJECTIVE

The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being.

METHODS

To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV.

RESULTS

In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant.

CONCLUSIONS

In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions.

Examining the impact of a restorative breath-based intervention "Sudarshan Kriya Yoga" at work: a field experiment

Background

Human capital plays a crucial role in the success of an organization and further contributes to the broader goals of growth and development of society. In this regard, it is essential to ensure the well-being of employees at the workplace. Given the positive impact of yoga on psycho-physiological aspects of health, this study aims to examine the impact of a breath-based yogic intervention, Sudarshan Kriya Yoga (SKY), on stress, anxiety, thriving, general health, emotional well-being, social well-being, and psychological well-being among employees of a leading manufacturing firm in India.

Methods

Undertaking a randomized-control experiment design (n = 64), we examined the impact of SKY on stress, anxiety, thriving, general health, and emotional, social, and psychological well-being. Two certified instructors conducted the SKY intervention in a retreat format over 3 days.

Results

The analysis demonstrated positive outcomes across various aspects of participants' well-being, i.e., it significantly reduced their stress and anxiety and increased the levels of thriving, general health, and emotional, social, and psychological well-being. These findings are valuable for understanding the potential benefits of the SKY intervention.

Discussion

The findings provide support for considering SKY as a potential well-being intervention for employers at the workplace and society at large. Further exploration, implementation, and research in diverse contexts will be crucial to fully understand the long-term impact and scalability of the SKY intervention in promoting holistic well-being.

Influence of yogic breathing in increasing social connectedness among Indian adults

BACKGROUND

Loneliness is quickly becoming an enormous problem among individuals of all age groups. The onset of Covid-19 has worsened this situation. Therefore, there is urgent need for a practical intervention, which may improve the social well-being of an individual addressing the root cause of loneliness.

AIM

In this study we examine the benefits of Sudarshan Kriya Yoga (SKY), a yogic breathing practice to enhance social connectedness among individuals by reducing stress.

METHODOLOGY

473 participants registering for the SKY program enrolled in the current open feasible trial. Assessment of social connectedness was done using Social Connectedness Scale (SCS). Stress was measured using the Perceived Stress Scale (PSS) pre- and post- SKY intervention. Outcomes were measured at three different time points namely, baseline (pre-program), post-program, and day 40. Day 40 was 40 days after the completion of the Sudarshan Kriya program.

RESULTS

Significant increase in SCS scores (p value <0.001) was found immediately after the SKY intervention. The SCS scores improved positively with regular practice of the intervention with a large effect size (p value <0.001, measured on day 40). The Stress scores significantly reduced post-intervention (p value <0.001).

CONCLUSION

The study suggested a positive connection between the SKY practice and subsequent improvement in social connectedness. The reduction in stress levels post SKY program as indicated in the study may be a reason of enhanced social connectedness. Large scale studies with inclusion of control group can further affirm the study results.

Integrative Treatment for Substance Use Disorders: Improving Outcomes Through Evidence-based Practice of Yoga-derived Breathwork and Meditation

BACKGROUND

Among 20.4 million US adults diagnosed with substance use disorders (SUDs), up to 60% return to use despite treatment or attempted abstinence. Standard care for SUDs is pharmacotherapy and/or behavioral interventions in either an inpatient or outpatient setting. Both national and international epidemiological data suggest this approach to treatment is insufficient and use of an integrative protocol can better promote recovery.

OBJECTIVE

To determine the efficacy of integrating yoga-derived breathwork and meditation into substance use treatment with emphasis on a specific practice, Sudarshan Kriya yoga (SKY).

METHODS

Literature review conducted in PubMed, OVID, and SCOPUS. The initial search term was " Sudarshan Kriya" alone. Subsequent searches combined the search term " Sudarshan Kriya" with a series of substance use-related terms using AND to link the terms.

RESULTS

SKY practice impacts quality of life, well-being, functioning, and substance use behavior. In patients with alcohol use disorder, SKY contributes to significant reduction in depressive symptoms, stress biomarkers, and alcohol use up to 6 months after treatment completion. SKY practitioners engaging in opioid partial agonist therapy may experience buprenorphine potentiation such that concurrent nonprescribed opioid use is eliminated. SKY practitioners can achieve tobacco cessation at a rate comparable to bupropion pharmacotherapy.

CONCLUSION

SKY has established efficacy in the treatment of anxiety, depression, and posttraumatic stress disorder. Currently available evidence also supports integration of SKY into the management of SUDs, and expanded SKY research can ensure optimal use of this promising intervention within this clinical subspecialty.

Yoga Nidra for hypertension: A systematic review and meta-analysis

BACKGROUND

Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity.

OBJECTIVE

The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension.

METHODS

A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively.

RESULTS

Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias.

DISCUSSION

This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted.

CONCLUSION

This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.

Effect of breathing exercises on blood pressure and heart rate: A systematic review and meta-analysis

Background

Breathing exercises have been reported to have positive physiological effects on the body. The incidence of hypertension has become a major risk factor for cardiac complications leading to higher morbidity and mortality. Our aim was to conduct a systematic review and meta-analysis to study the effect of breathing exercises on blood pressure (BP) and heart rate (HR).

Methods

A systematic review and meta-analysis analyzing randomized clinical trials (RCTs) about the effect of breathing exercises on blood pressure was conducted (PROSPERO Registration ID: CRD42022316413). PubMed, ScienceDirect, WebofScience, and Cochrane Library databases were screened for RCTs from January 2017 to September 2022. The main search terms included "breathing exercise", "Pranayam", "Bhramari", "alternate nostril breathing", "deep breathing", "slow breathing", "hypertension", and "high blood pressure". The primary outcome was the value of the systolic blood pressure and diastolic blood pressure after the intervention. The effect on heart rate was also analyzed as a secondary outcome.

Results

A total of 15 studies were included in the meta-analysis. Breathing exercises have a modest but significant effect on decreasing systolic blood pressure (-7.06 [-10.20, -3.92], P = <0.01) and diastolic blood pressure (-3.43 [-4.89, -1.97], P = <0.01) mm Hg. Additionally, breathing exercises were also observed to cause a significant decrease in the heart rate (-2.41 [-4.53, -0.30], P = 0.03) beats/minute.

Conclusion

In a comprehensive systematic review and meta-analysis of breathing exercises and its effect on BP and HR, there is a moderate but significant positive effect. The studies are not deprived of bias.

Effects of slow breathing training on hemodynamic changes, cardiac autonomic function and neuroendocrine response in people with high blood pressure: A randomized control trial

BACKGROUND

High blood pressure (BP) is a non-communicable disease that is a risk factor for cardiovascular disease and is the leading cause of mortality and morbidity worldwide. High BP can be managed by both pharmacological and non-pharmacological interventions. Non-pharmacological treatment, such as slow-breathing training (SBT), has been shown to reduce BP. However, there are few studies on the effect of SBT on both cardiac activation and oxidative stress in people with high BP.

OBJECTIVES

To explore the effect of SBT on cardiac autonomic function (i.e., heart rate variability: HRV) and neuroendocrine response (i.e., salivary cortisol).

METHODS

One hundred people (including 89 women) with high BP were randomly assigned to either a control (n = 50) or intervention group (n = 50). The intervention program was conducted for 30 min per day, for 5 days per week, for 4 weeks, with a total of 20 sessions of the SBT at the rate of 10 times per minute, whereas the control group was required to continue with their daily routine. HRV, BP, and salivary cortisol were measured before and after the intervention program. A two-way mixed ANOVA was performed for within-group and between-group comparisons over time.

RESULTS

Of the 100 participants, 71 individuals completed the study. The participants in the intervention group had a lower BP and salivary cortisol levels compared to those in the control group (p < .05). Further, those participants showed an increase in the standard deviation of normal R-R intervals after the 4-week intervention program (p < .05).

CONCLUSION

This study provided evidence demonstrating the effect of SBT on cardiac autonomic and stress reactivity, which has important implications for health promotion in people with high BP.

CLINICAL TRIAL REGISTRATION NUMBER

TCTR20180302008.

High ventilation breathwork practices: An overview of their effects, mechanisms, and considerations for clinical applications

High Ventilation Breathwork (HVB) refers to practices employing specific volitional manipulation of breathing, with a long history of use to relieve various forms of psychological distress. This paper seeks to offer a consolidative insight into potential clinical application of HVB as a treatment of psychiatric disorders. We thus review the characteristic phenomenological and neurophysiological effects of these practices to inform their mechanism of therapeutic action, safety profiles and future clinical applications. Clinical observations and data from neurophysiological studies indicate that HVB is associated with extraordinary changes in subjective experience, as well as with profound effects on central and autonomic nervous systems functions through modulation of neurometabolic parameters and interoceptive sensory systems. This growing evidence base may guide how the phenomenological effects of HVB can be understood, and potentially harnessed in the context of such volitional perturbation of psychophysiological state. Reports of putative beneficial effects for trauma-related, affective, and somatic disorders invite further research to obtain detailed mechanistic knowledge, and rigorous clinical testing of these potential therapeutic uses.

Breathing Practices for Stress and Anxiety Reduction: Conceptual Framework of Implementation Guidelines Based on a Systematic Review of the Published Literature

Anxiety and stress plague populations worldwide. Voluntary regulated breathing practices offer a tool to address this epidemic. We examined peer-reviewed published literature to understand effective approaches to and implementation of these practices. PubMed and ScienceDirect were searched to identify clinical trials evaluating isolated breathing-based interventions with psychometric stress/anxiety outcomes. Two independent reviewers conducted all screening and data extraction. Of 2904 unique articles, 731 abstracts, and 181 full texts screened, 58 met the inclusion criteria. Fifty-four of the studies' 72 interventions were effective. Components of effective and ineffective interventions were evaluated to develop a conceptual framework of factors associated with stress/anxiety reduction effectiveness. Effective breath practices avoided fast-only breath paces and sessions <5 min, while including human-guided training, multiple sessions, and long-term practice. Population, other breath paces, session duration ≥5 min, and group versus individual or at-home practices were not associated with effectiveness. Analysis of interventions that did not fit this framework revealed that extensive standing, interruptions, involuntary diaphragmatic obstruction, and inadequate training for highly technical practices may render otherwise promising interventions ineffective. Following this evidence-based framework can help maximize the stress/anxiety reduction benefits of breathing practices. Future research is warranted to further refine this easily accessible intervention for stress/anxiety relief.

The Effectiveness of A Slow-Paced Diaphragmatic Breathing Exercise in Children's Daily Life: A Micro-Randomized Trial

OBJECTIVE

Breathing exercises have been proposed as an effective intervention to improve subjective well-being and manage anxiety symptoms. As they are comparatively easy to learn and to implement, breathing exercises may be particularly beneficial for children. Although breathing exercises are ultimately supposed to provide salutary effects in individuals' everyday lives, immediate effects of breathing exercises in naturalistic contexts have received limited empirical attention. The purpose of this study was to examine immediate effects of slow-paced diaphragmatic breathing on negative affect as well as on relaxation in an ecologically valid setting. To that end, we conducted a micro-randomized trial in children's daily life.

METHOD

On each of 15 days, children (N = 171, aged 9-13 years, 54% female) were randomized to different conditions: performing a video-guided slow-paced diaphragmatic breathing exercise (experimental condition), watching a different video (active control condition), or a passive control condition.

RESULTS

The breathing exercise had no immediate effects on negative affect or relaxation compared to both control conditions. However, in situations when children reported higher levels of worries than usual, relaxation was higher when children performed the breathing exercise compared to the passive control condition. Compared to the active control condition, the breathing exercise did not result in higher levels of relaxation in situations when children worried more than normally.

CONCLUSIONS

Findings highlight that context-specific factors can modulate the effectiveness of breathing exercises and should be taken into account to tailor interventions to individuals' needs.

Efficacy of mHealth aided 12-week meditation and breath intervention on change in burnout and professional quality of life among health care providers of a tertiary care hospital in north India: a randomized waitlist-controlled trial

Introduction

Burnout is "Chronic workplace stress that has not been successfully managed." Professional quality of life (PQL) includes work related experiences of compassion satisfaction and compassion fatigue. Healthcare providers (HCPs) are highly susceptible to burnout and compassion fatigue due to their demanding work, which lowers PQL. Burnout leads to poor care, medical errors, and patient safety across healthcare disciplines. Yoga has been shown to improve resilience, reduce stress, and increase self-compassion and psycho-physiological coherence. This study compared HCPs in a mHealth-aided 12-week yoga-based meditation and breath intervention to waitlist controls for HCP burnout and PQL at a north Indian tertiary care hospital.

Methods

This was randomized waitlist-controlled trial. Total 98 HCPs (62 males and 36 females) with an average age of 28.26 ± 3.547 years were enrolled consecutively from March 2021 to November 2022. Randomization was done with opaque sealed envelopes numbered in a computer-generated sequence. The experimental group (n = 49) received 12 online weekly yoga sessions and performed daily home practice (6 days a week). The waitlisted control group (n = 49) continued their daily routine. Maslach's burnout inventory (MBI), professional quality of life (PQL) and anthropometric measurements were assessed at baseline and after 12 weeks.

Results

After 12 weeks, the MBI outcomes of emotional exhaustion, depersonalization, and personal accomplishment showed a highly significant difference between the two groups (p < 0.001). PQL outcomes of compassion satisfaction, burnout, and secondary trauma also differed significantly (p < 0.001). Within group analysis showed that MBI and PQL outcomes improved significantly (p < 0.001) for the experimental group after 12 weeks.

Conclusion

The current study contributes to the existing evidence on the effectiveness of Yoga in managing stress and developing resilience among doctors, nurses, and other medical professionals. Integrating yoga into healthcare settings is crucial for addressing the detrimental impact of burnout on decision-making and promoting positive patient outcomes. mHealth technologies have the potential to enhance the user-friendliness of yoga-based interventions by personalizing the practice space and time. Yoga-based interventions and mHealth technologies can effectively address physician burnout, in a simple and implementable manner.

Daily heart rate variability biofeedback training decreases locus coeruleus MRI contrast in younger adults in a randomized clinical trial

As an arousal hub region in the brain, the locus coeruleus (LC) has bidirectional connections with the autonomic nervous system. Magnetic resonance imaging (MRI)-based measures of LC structural integrity have been linked to cognition and arousal, but less is known about factors that influence LC structure and function across time. Here, we tested the effects of heart rate variability (HRV) biofeedback, an intervention targeting the autonomic nervous system, on LC MRI contrast and sympathetic activity. Younger and older participants completed daily HRV biofeedback training for five weeks. Those assigned to an experimental condition performed biofeedback involving slow, paced breathing designed to increase heart rate oscillations, whereas those assigned to a control condition performed biofeedback to decrease heart rate oscillations. At the pre- and post-training timepoints, LC contrast was assessed using turbo spin echo MRI scans, and RNA sequencing was used to assess cAMP-responsive element binding protein (CREB)-regulated gene expression in circulating blood cells, an index of sympathetic nervous system signaling. We found that left LC contrast decreased in younger participants in the experimental group, and across younger participants, decreases in left LC contrast were related to the extent to which participants increased their heart rate oscillations during training. Furthermore, decreases in left LC contrast were associated with decreased expression of CREB-associated gene transcripts. On the contrary, there were no effects of biofeedback on LC contrast among older participants in the experimental group. These findings provide novel evidence that in younger adults, HRV biofeedback involving slow, paced breathing can decrease both LC contrast and sympathetic nervous system signaling.

Reducing Stress with Yoga: A Systematic Review Based on Multimodal Biosignals

Stress is an enormous concern in our culture because it is the root cause of many health issues. Yoga asanas and mindfulness-based practices are becoming increasingly popular for stress management; nevertheless, the biological effect of these practices on stress reactivity is still a research domain. The purpose of this review is to emphasize various biosignals that reflect stress reduction through various yoga-based practices. A comprehensive synthesis of numerous prior investigations in the existing literature was conducted. These investigations undertook a thorough examination of numerous biosignals. Various features are extracted from these signals, which are further explored to reflect the effectiveness of yoga practice in stress reduction. The multifaceted character of stress and the extensive research undertaken in this field indicate that the proposed approach would rely on multiple modalities. The notable growth of the body of literature pertaining to prospective yoga processes is deserving of attention; nonetheless, there exists a scarcity of research undertaken on these mechanisms. Hence, it is recommended that future studies adopt more stringent yoga methods and ensure the incorporation of suitable participant cohorts.

Methods for Heart Rate Variability Biofeedback (HRVB): A Systematic Review and Guidelines

Heart Rate Variability Biofeedback (HRVB) has been widely used to improve cardiovascular health and well-being. HRVB is based on breathing at an individual's resonance frequency, which stimulates respiratory sinus arrhythmia (RSA) and the baroreflex. There is, however, no methodological consensus on how to apply HRVB, while details about the protocol used are often not well reported. Thus, the objectives of this systematic review are to describe the different HRVB protocols and detect methodological concerns. PsycINFO, CINALH, Medline and Web of Science were searched between 2000 and April 2021. Data extraction and quality assessment were based on PRISMA guidelines. A total of 143 studies were finally included from any scientific field and any type of sample. Three protocols for HRVB were found: (i) "Optimal RF" (n = 37), each participant breathes at their previously detected RF; (ii) "Individual RF" (n = 48), each participant follows a biofeedback device that shows the optimal breathing rate based on cardiovascular data in real time, and (iii) "Preset-pace RF" (n = 51), all participants breathe at the same rate rate, usually 6 breaths/minute. In addition, we found several methodological differences for applying HRVB in terms of number of weeks, duration of breathing or combination of laboratory and home sessions. Remarkably, almost 2/3 of the studies did not report enough information to replicate the HRVB protocol in terms of breathing duration, inhalation/exhalation ratio, breathing control or body position. Methodological guidelines and a checklist are proposed to enhance the methodological quality of future HRVB studies and increase the information reported.

Effects of Sudarshan KriyaYoga and Advanced Meditation Program on Genetic Expression of Pro-inflammatory and Antioxidants Genes

Background Stress leads to immune system dysregulation and dyshomeostasis at the gene level. Mind-body practices are known to influence genomic expression, leading to better health and quality of life. Objective To assess the effect of Advanced Meditation Program (AMP) on the mRNA expression of pro-inflammatory and antioxidative genes among those already practicing Sudarshan Kriya Yoga (SKY). Methods A total of 97 healthy volunteers participated in the study, distributed into two groups. The Group I SKY practitioners attended a four-day AMP (50 participants with an average age of 38.8 ± 11.9 consisting of 37 females and 13 males); they are first-time participants of the AMP. Group II SKY practitioners, on the other hand, consisted of 47 participants with an average age of 36.4 ± 9.3 with 43 females and four males. At day 0, day 5, and day 90, the mRNA expression of pro-inflammatory genes, namely interleukin (IL) 1β, IL6, and the tumor necrosis factor (TNF), and the expression of antioxidative genes, namely superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) was observed. The data were analysed in two phases due to the emergence of coronavirus disease 2019 (COVID-19): (i) pre-COVID-19 and (ii) during COVID-19. Results In the pre-COVID-19 data set, IL1β, IL6, and TNF were found to have decreased in both groups. There is a significant increase in the expression of SOD and catalase in Group I and a decrease in Group II by day 90. During COVID-19, pro-inflammatory genes increased in Group I and had no significant change in Group II. All three antioxidant genes had decreased expression by day 90 in Group I; SOD decreased in Group II. Interpretation and conclusions Reduced expression of pro-inflammatory genes and increase in the expression of antioxidative genes during the pre-COVID-19 time suggest that the practice of SKY and added AMP may enhance antioxidative defense and may reduce the chance of getting diseases related to inflammation in the body.

Breath-centered virtual mind-body medicine reduces COVID-related stress in women healthcare workers of the Regional Integrated Support for Education in Northern Ireland: a single group study

Background

During the COVID-19 pandemic, healthcare workers endured prolonged stress affecting their psychological well-being. Objectives: (1) Evaluate the effects of the Breath-Body-Mind Introductory Course (BBMIC) on COVID-related stress among employees of the Regional Integrated Support for Education, Northern Ireland, (2) Reduce the risk of adverse effects from COVID-related stress, and (3) Evaluate the effects of BBMIC on indicators of psychophysiological states and the consistency with hypothesized mechanisms of action.

Methods

In this single group study, a convenience sample of 39 female healthcare workers completed informed consent and baseline measures: Perceived Stress Scale (PSS), Stress Overload Scale-Short (SOS-S), and Exercise-Induced Feelings Inventory (EFI). Following the online BBMIC 4 h/day for 3 days and the 6 week solo (20 min/day) and group practice (45 min weekly), repeat testing plus the Indicators of Psychophysiological State (IPSS) and Program Evaluation were obtained.

Results

Baseline (T1) mean PSS score was significantly elevated compared to a normative sample: PSS = 18.2 vs. 13.7 (p < 0.001) and improved significantly 11 weeks post-BBMIC (T4). SOS-S mean score declined from 10.7(T1) to 9.7 at 6 week post-test (T3). The SOS-S proportion of High Risk scores found in 22/29 participants (T1), dropped to 7/29 (T3). EFI mean subscale scores improved significantly from T1 to T2 and T3 for Revitalization (p < 0.001); Exhaustion (p < 0.002); and Tranquility (p < 0.001); but not Engagement (p < 0.289).

Conclusion

Among RISE NI healthcare workers affected by COVID-related stress, participation in the BBMIC significantly reduced scores for Perceived Stress, Stress Overload, and Exhaustion. EFI Revitalization and Tranquility scores significantly improved. More than 60% of participants reported moderate to very strong improvements in 22 indicators of psychophysiological state, e.g., tension, mood, sleep, mental focus, anger, connectedness, awareness, hopefulness, and empathy. These results are consistent with the hypothesized mechanisms of action whereby voluntarily regulated breathing exercises change interoceptive messaging to brain regulatory networks that shift psychophysiological states of distress and defense to states of calmness and connection. These positive findings warrant validation in larger, controlled studies to extend the understanding of how breath-centered Mind-body Medicine practices could mitigate adverse effects of stress.

Divulging the Impetus of Yoga on Cardiorespiratory Fitness and Its Persona in Alleviating Anxiety Experienced by Youth: A Cohort Interventional Study

BACKGROUND

 Globalization endangers youngsters worldwide with new standards and possibilities. Hereat of being exposed to greater demands and expectations, when it comes to performance review, their life may become more distressed. Yoga with revolutionary methods may assist youngsters in bettering their physical health regarding their maximal oxygen uptake, and also help manage their anxiety. This study ascertains the effect of yoga on youth's anxiety levels and cardio-respiratory fitness.

METHODS

 It was a longitudinal interventional study recruiting 99 medical students wherein VO₂ max (maximal oxygen uptake) on the treadmill/ergometer exercise and anxiety scores through Spielberger's anxiety scale was assessed at baseline and evaluated after 6 months of a regular yogic regime. The VO₂ max was recorded by the metabolic module of Labchart software (Bella Vista, New South Wales, Australia).

FINDINGS

 The VO₂ max evaluated by incremental exercise to volitional fatigue was found to be 2.64 ± 0.49 L/min in males and 1.51 ± 0.44 L/min in females pre-yoga and 2.81 ± 0.52 L/min in males and 1.69 ± 0.47 L/min in females post yoga. The difference in the endline and baseline VO₂ max values of yoga-performing males (t=6.595, p<0.001) and females (t = 2.478, p = 0.017) was found to be significantly higher than non-yoga performers. The METS value obtained in males was 11.96 and in females was 7.68 before yoga. Post-yoga values were 13.44 and 8.37, respectively. The difference in total anxiety scores post-intervention was 34.6 which was statistically significant (t= 4.959, p <0.001).

CONCLUSION

 From the viewpoint of a physiologist, higher VO₂ max in young adults links to better physical fitness which is the potential outcome of regular yogic practice. As a result of regular yogic practice, initial soaring anxiety levels of subjects culminated in a drastic observable reduction in anxiety, which helped inculcate a judicious acumen in youngsters.

Summary of the effect of an exercise intervention on antenatal depression and the optimal program: a systematic review and Meta-analysis

OBJECTIVE

This study aimed to examine the effect of exercise intervention for antenatal depression using meta-analysis and to propose the best exercise intervention program.

METHODS

Review Manager 5.3 was used to analyze 17 papers with 2224 subjects by setting five moderators, including type, time, frequency, period, and format of exercise intervention, and a random-effects model was used to test for overall effect, heterogeneity, and publication bias.

RESULTS

(1) The effect size of the exercise intervention on antenatal depression was d = -0.56, which reached a good effect and was statistically significant; b (2) The effect size of the exercise type on antenatal depression was Yoga and a combination of aerobic exercise in order of intervention; (3) the single intervention duration of 10-75 min all had a good effect on antenatal depression, and 30-60 min had the best effect; (4) the intervention frequency of 3 to 5 times/week had the greatest amount of intervention effect on maternal depression; (5) exercise lasting 6-10 weeks had a good intervention effect on antepartum depression, and the amount of effect decreased gradually with the extension of time; (6) In terms of exercise format, the amount of intervention effect on maternal depression was in the order of group exercise, individual + group exercise.

CONCLUSIONS

Exercise intervention can significantly alleviate antenatal depression symptoms. The best exercise program for exercise intervention for antenatal depression is: Yoga and a combination of aerobic exercise intervention effects are more prominent, and the intervention effect of Yoga is the best. The use of group exercise 3-5 times per week for 30-60 min for 6-10 weeks was more likely to achieve the desired intervention effect of improving antenatal depression.

Combined effect of transcutaneous auricular vagus nerve stimulation and 0.1 Hz slow-paced breathing on working memory

Background

Previous research has found that transcutaneous auricular vagus nerve stimulation (taVNS) can improve working memory (WM) performance. It has also been shown that 0.1 Hz slow-paced breathing (SPB, i.e., breathing at a rate of approximately 6 breaths/min) can significantly influence physical state and cognitive function via changes in autonomic afferent activity. In the present study, we investigated the synergistic effects of taVNS and SPB on WM performance.

Methods

A total of 96 healthy people participated in this within-subjects experiment involving four conditions, namely taVNS, SPB, combined taVNS with SPB (taVNS + SPB), and sham. Each participant underwent each intervention for 30 min and WM was compared pre- and post-intervention using the spatial and digit n-back tasks in a random order four times. Permutation-based analysis of variance was used to assess the interaction between time and intervention.

Results

For the spatial 3-back task, a significant interaction between time and intervention was found for the accuracy rate of matching trials (mACC, p = 0.03). Post hoc analysis suggested that both taVNS and taVNS + SPB improved WM performance, however, no significant difference was found in the SPB or sham groups.

Conclusion

This study has replicated the effects of taVNS on WM performance reported in previous studies. However, the synergistic effects of combined taVNS and SPB warrant further research.

Effects of Suryanamaskar, an Intensive Yoga Exercise Routine, on the Stress Levels and Emotional Intelligence of Indian Students

The inability of an individual to identify, assess, and manage emotions and levels of stress has adverse individual and societal consequences. Previous studies have shown that yoga-based interventions can successfully treat stress, anxiety, and depression, and can enhance emotional control. The aim of the current study was to assess the effect of a specific, intensive, yoga-based intervention, Dynamic Suryanamaskar, on the levels of perceived stress and emotional intelligence in Indian male school students. One hundred and five students with a median age of 17.15 ± 1.42 years were assessed. Practice took place over 12 weeks (n = 70 workouts). The Perceived Stress Scale (PSS) questionnaire and the emotional intelligence (EQ) questionnaire, developed for the Indian population, were used to measure stress and emotional levels at the start and end of the study. The Solomon four-group design was used to ensure statistical reliability. The post-study univariate analysis of covariance ANOVA between groups (p < 0.001) and the t-test for independent samples (p < 0.05) indicated that, for those using the Dynamic Suryanamaskar protocol, there was a significant reduction in stress levels and a significant (p < 0.01) increase in the levels of emotional intelligence. This study thus provides further evidence of the benefits of the practice of Dynamic Suryanamaskar.

Feasibility, acceptability and evaluation of meditation to augment yoga practice among persons diagnosed with schizophrenia

OBJECTIVE

To design a meditation protocol and test its feasibility, acceptability and efficacy in conjunction with yoga training (YT) for persons with schizophrenia (SZ).

METHODS

The meditation protocol consisted of Anapana (observing normal respiration) and Yoga Nidra (supine, restful awareness). In a single-blind randomised controlled trial, medicated and clinically stable outpatients diagnosed with SZ were randomised to receive treatment as usual (TAU), TAU augmented with YT or TAU augmented with meditation and yoga training (MYT) for 3 weeks (N = 145). Acceptability, clinical, social and cognitive functions were assessed after 3-week and 3-month post-randomisation using within-group and between-group analyses with repeated measures multivariate tests.

RESULTS

No group-wise differences in compliance, study discontinuation, major/serious side effects or adverse events were noted. For six assessed clinical variables, the direction of changes were in the desired direction and the effect sizes were greater in the MYT group compared with the TAU group at both time points. Changes in social function variables were greater at 3 months than at 3 weeks. Nominally significant improvement in individual cognitive domains were noted in all groups at both time points. All effect sizes were in the small to medium range.

CONCLUSION

MYT is feasible and acceptable and shows modest benefits for persons with SZ. MYT can also improve quality of life and clinical symptoms. Larger studies of longer duration are warranted.

When Lights Can Breathe: Investigating the Influences of Breathing Lights on Users' Emotion

Light can significantly influence users' physiological and behavioural performance. However, how light breathing influences users' mood regulation remains unknown. To fill this gap, this study conducted a 2-by-2 experiment (N = 20) with light breathing as the between-subject factor and light condition as the within-subject factor. Both physiological indicators and subjective indicators are measured to reflect mood regulation. The data were analysed using a generalised linear mixed model. The results showed that breathing lights are effective in regulating users' moods. More specifically, breathing lights help users lower their electrodermal values and heart rates. Users did not report any significant difference in terms of subjective measures, which suggest that the influence of a breathing light happens unconsciously. Furthermore, this effect is significant for both cold and warm colour temperatures. Designers and engineers can use the research findings to manage user emotion when necessary.

The positive effects of combined breathing techniques and cold exposure on perceived stress: a randomised trial

A pranayama-inspired breathing technique, cold exposure, and their combined application were assessed for their potential to reduce perceived stress in adults and compared to a control group. An experiment involving four groups was conducted, yielding separate cells for breathing technique-only and cold exposure-only, as well as a combined treatment and a control group. Eighty-six individuals participated in the study. Perceived stress is measured employing the 10-item version of the Perceived Stress Scale (PSS-10) and the 20-item version of the Perceived Stress Questionnaire (PSQ). The instruments exhibit a substantial correlation (r = 0.842, p < 0.001). The combined group exhibited a medium to large positive effect on perceived stress compared to the control group. The breathing technique and cold exposure on their own were not found to yield substantial effects, indicating synergies between both exercises. Combinations of breathing techniques and cold exposure may be employed to decrease individuals' perceived stress.

Physical and mental health at high altitude of individuals doing yogic practices

Objectives

There is an increase trend in the past few years, in the number of people traveling to high altitude for recreational activities such as pilgrims, mountaineering, and climbing and for occupational purposes such as defense and mining which have resulted in increasing in hypoxia conditions and anxiety-related medical problems at high altitude. As it is known that mental stress affects brain and heart functions, a recent research performed on Sudarshan Kriya Yoga (SKY) further validated the effectiveness of SKY on participants (practicing SKY) as compared to control after quantifying mental stress. To study the physiological effect of SKY advance breathing technique when immediately ascends to high altitude, we wanted to study the level of stress and mental well-being of lowlanders at high altitude.

Materials and Methods

It is an interventional study performed at high altitudes, with low landers as participants where their biochemical and psychological parameters are being assessed.

Results

The result for biochemical parameter cholesterol, triglycerides, low-density lipoproteins (LDLs), high-density lipoproteins (HDLs), very low-density lipoproteins, LDL-HDL ratio, and cholesterol-HDL ratio showed a significant decrease in the pre- and post-analyses values with P ≤ 0.001. Acute mountain sickness (AMS), Warwick-Edinburgh Mental Well-being Scale, and State and Trait Anxiety Inventory (STAI) also show a decreasing trend with significant result in AMS, mental well-being, and non-significant in STAI p value is P = 0.016, P = 0.055, and P = 0.125, respectively.

Conclusion

We observed positive outcome both in for biochemical and stress-related parameters with SKY advance program practitioners who have rapidly ascend to high altitude.

Positive Psychological Changes at High Altitude Shown by the Low Landers after the Yoga Intervention—Sudarshan Kriya Yoga (SKY)

Background

Immediate assent to high altitude affects the cognitive performance and mood of an individual, which is followed by depression and anxiety. It also affects the sleep quality, general health, and happiness quotient of an individual. Sudarshan Kriya Yoga (SKY) is a cyclical breathing technique, which has been proven successful in managing stress, depression, anxiety, and helps in the improvement of sleep quality.

Purpose

The current study was to understand the role of SKY meditation on psychological parameters, happiness quotient of low landers at high altitude (Leh).

Methods

It is a two-armed pre–post study with experimental and control group both are lowlanders, and their psychological parameters are being assessed when they immediately assent to high altitude (Leh). There are two groups experimental group (SKY) was from AOL SKY–AMP and has prior SKY meditation experience. The control group does not have any yoga or meditation experience. SKY–AMP is a 4 days protocol done at high altitude by the SKY group. Both groups reach Leh through air mode transportation.

Results

Oxford Happiness Questionnaire (OHQ) showed a significant result in the SKY group with P ≤ .001, whereas it is nonsignificant in the control group. We also observed anthropometric and physiological changes in the participants showing significant effects on weight, BMI, waist circumference, hip circumference, and blood pressure; with no significant effect in the control group. It is one of the first studies done with both two groups, where yoga and meditation are done at high altitude and then seen the changes in the groups at physical and psychological level.

Conclusion

Yogic practices can be helpful in having positive psychological change in the lowlanders at high altitude.

Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of post-traumatic stress disorder in military veterans

OBJECTIVE

Test whether Sudarshan Kriya Yoga (SKY) was non-inferior to cognitive processing therapy (CPT) for treating symptoms of post-traumatic stress disorder (PTSD) among veterans via a parallel randomised controlled non-inferiority trial.

SETTING

Outpatient Veterans Affairs healthcare centre.

PARTICIPANTS

85 veterans (75 men, 61% white, mean age 56.9) with symptoms of PTSD participated between October 2015 and March 2020: 59 participants completed the study.

INTERVENTIONS

SKY emphasises breathing routines and was delivered in group format in a 15-hour workshop followed by two 1-hour sessions per week for 5 weeks. CPT is an individual psychotherapy which emphasises shifting cognitive appraisals and was delivered in two 1-hour sessions per week for 6 weeks.

MEASURES

The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). The secondary measures were the Beck Depression Inventory-II (BDI-II) and Positive and Negative Affect Scale (PANAS).

RESULTS

Mean PCL-C at baseline was 56.5 (±12.6). Intent-to-treat analyses showed that PCL-C scores were reduced at 6 weeks (end of treatment) relative to baseline (SKY, -5.6, d=0.41, n=41: CPT, -6.8, d=0.58, n=44). The between-treatment difference in change scores was within the non-inferiority margin of 10 points (-1.2, 95% CI -5.7 to 3.3), suggesting SKY was not inferior to CPT. SKY was also non-inferior at 1-month (CPT-SKY: -2.1, 95% CI -6.9 to 2.8) and 1-year (CPT-SKY: -1.8, 95% CI -6.6 to 2.9) assessments. SKY was also non-inferior to CPT on the BDI-II and PANAS at end of treatment and 1 month, but SKY was inferior to CPT on both BDI-II and PANAS at 1 year. Dropout rates were similar (SKY, 27%, CPT, 34%: OR=1.36, 95% CI 0.51 to 3.62, p=0.54).

CONCLUSIONS

SKY may be non-inferior to CPT for treating symptoms of PTSD and merits further consideration as a treatment for PTSD.

TRIAL REGISTRATION NUMBER

NCT02366403.

The Effects of Yoga on Bipolar Disorder: A Systematic Review

Bipolar disorder (BD) is a mood disorder characterized by severe mood swings and or periods of depression. This study examined the role that practicing yoga has on the symptoms of BD. One of the main goals was to identify if patients with BD believe that yoga is a viable treatment option. Six research databases were searched using the keywords "yoga" AND "therapy" AND "BD" AND "bipolar depression." Articles published in 2005 and later were included in the search. After duplicates were removed, and inclusion and exclusion criteria were applied, five articles were analyzed and included in this literature review. Results of this review indicate that yoga has been shown to be associated with both benefits and risks for the treatment of BD. Studies have shown that yoga might relieve some symptoms of BD and depression. However, due to the lack of research on the impact of yoga on BD and the small number of studies included in this review, results should be approached with caution. Overall, yoga was well-tolerated in the studies reviewed in this article. Yoga may relieve the symptoms of depression. Future research should analyze the long-term impact of yoga on bipolar depression. Yoga instructional standards should also be considered.

Overcoming the impact of physiologic tremors in ophthalmology

PURPOSE

Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All humans have physiologic tremors that are of low amplitude and not discernible to the naked eye; they do not adversely affect the majority of the population's daily functioning. However, during microsurgery, such tremors can be problematic. In this review, we focus on the impact of physiological tremors on ophthalmic microsurgery and offer a comparative discussion on the impact of such tremors on other surgical specialties.

METHODS

A single investigator used the MEDLINE database (via PubMed) to search for and identify articles for inclusion in this systematic review. Ten key factors were identified as potentially having an impact on tremor amplitude: beta-blockers, muscle fatigue, robotic systems, handheld tools/micromanipulators, armrests/wrist supports, caffeine, diet, sleep deprivation, consuming alcohol, and workouts (exercise). These key terms were then searched using the advanced Boolean search tool and operators (i.e., AND, OR) available on PubMed: (*keyword*) AND (surgeon tremor OR microsurgery tremor OR hand steadiness OR simulator score).

RESULTS

Ten studies attempted to quantify the baseline severity of operator physiologic tremor. Approximately 89% of studies accessing the impact of tremors on performance in regards to surgical metrics reported an improvement in performance compared to 57% of studies concluding that tremor elimination was of benefit when considering procedural outcomes.

CONCLUSIONS

Robotic technology, new instruments, exoskeletons, technique modifications, and lifestyle factors have all demonstrated the potential to assist in overcoming tremors in ophthalmology.

Slow-Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot

Purpose

Nearly one in three US adolescents meet the criteria for anxiety, an issue that has worsened with the COVID-19 pandemic. We developed a video-based slow diaphragmatic breathing stress-reduction curriculum for high school students and evaluated its feasibility, tolerability, and preliminary effectiveness.

Methods

This cluster-randomized feasibility pilot compared 5-min slow diaphragmatic breathing for 5 weeks with treatment-as-usual control among four 12th-grade public high school classes. Students individually participated after school during COVID-19-related hybrid teaching, with slow diaphragmatic breathing three times/week and breath science education once/week. Feasibility was based on completion of breathing exercises, breath science education, and preliminary effectiveness assessments, and ease/tolerability was based on qualitative assessments. Preliminary effectiveness was measured with the State-Trait Anxiety Inventory (STAI) and a timed-exhale carbon dioxide tolerance test (CO₂TT) of physiological stress response. Descriptive statistics and repeated analysis of variance were performed to quantify and compare outcomes between time periods. Human subjects research approval was granted through Western IRB–Copernicus Group (WCG IRB) [ClinicalTrials.gov, Identifier: NCT05266833.]

Results

Forty-three students consented to participate. Breath practice compliance ranged from 29 to 83% across classes and weeks, and decreased on average over the 5 weeks. Compliance with the breath science videos ranged from 43 to 86%, and that with the weekly STAI-State and CO₂TT measures varied from 36 to 86%. Compliance with ease/tolerability assessments ranged from 0 to 60%. Preliminary effectiveness assessments' compliance varied across classes from 83 to 89% during baseline, and 29 to 72% at follow-up. The curriculum was rated as somewhat-to-definitely useful/beneficial, and definitely-to-very easy/tolerable. Students reported enjoying the diaphragmatic breathing, CO₂TT, and breath science education; some found the extended exhales challenging and the curriculum and assessments time-consuming. Preliminary effectiveness analyses indicated no significant changes in STAI or CO₂TT from baseline to followup or from before to after breathing exercises (p > 0.05 for all).

Conclusions

Implementation of this 5-week slow breathing curriculum was feasible and tolerable to this cohort. Compliance, tolerability, and effectiveness may be improved with in-class participation. Future research on simple and accessible slow-breathing exercises is warranted to address today's adolescent stress-management crisis.

Trial Registration

ClinicalTrials.gov, Identifier: NCT05266833

Session of yoga, with and without slow (Ujjayi) breathing, reduces anxiety; no change on acute pain sensitivity and endogenous pain modulation

OBJECTIVES

Yoga is an increasingly popular mode of exercise that boasts health promoting effects including pain relief. A single bout of exercise induces a reduced sensitivity to noxious heat, but the mechanism for this effect and whether it occurs after a single session of yoga is unexplored. The primary aim of this study was to test, using a post-test only between-subjects design, main and interactive effects of yoga and slow breathing on both sensitivity to heat pain and endogenous pain modulation processing in healthy young women DESIGN: Fifty-four women were block randomized into one of four conditions: yoga with slow breathing instructions (Vinyasa), yoga with no breathing instructions, seated rest with slow breathing instructions and seated rest with no breathing instructions. The conditions were completed alone is a small room in which participant followed video-based instructions and models. The yoga was perceived as low-to-moderate intensity.

RESULTS

Two factor ANOVA demonstrated no significant association between yoga postures and slow breathing, and there was no significant interaction observed for sensitivity to heat pain or endogenous pain modulation. These findings were unchanged in ANCOVAs that controlled for four potential confounding variables: post-condition reduction in systolic blood pressure or state anxiety, pain induced by the conditions and expectations. Compared to the non-yoga conditions, participant in yoga conditions resulted in a significant reduction in state anxiety scores.

CONCLUSIONS

It is concluded that a single session of low-to-moderate intensity yoga with, or without slow breathing, reduces state anxiety but has no effect on heat pain sensitivity or endogenous pain modulation.

Postural Control Adaptations in Yoga Single-Leg Support Postures: Comparison Between Practitioners and Nonpractitioners

This paper investigates whether a group of regular Yoga practitioners shows postural control differences compared with healthy controls while performing single-leg Yoga postures. Ten Yoga practitioners were compared with a control group of 10 nonpractitioners performing two single-leg support Yoga postures: Vrksasana (tree posture) and Natarajasana (dancer posture). Rambling and trembling decomposition of the center of pressure trajectories was implemented using a genetic algorithm spectral optimization that avoids using horizontal forces and was validated with bipedal posture data. Additionally, the center of mass was estimated from body kinematics using OpenSim and compared with the rambling outputs. During Natarajasana, no postural control adaptations were observed. For Vrksasana, the Yoga practitioners showed a lower center of pressure ellipse confidence interval area, center of pressure anteroposterior SD, and smaller rambling SD in the mediolateral direction, suggesting possible supraspinal feed-forward motor adaptations associated with Yoga training.

Breathing Exercises for Improving Cognitive Function in Patients with Stroke

Patients with stroke may experience a certain degree of cognitive decline during the period of recovery, and a considerable number of such patients have been reported to show permanent cognitive damage. Therefore, the period of recovery and rehabilitation following stroke is critical for rapid cognitive functional improvements. As dysfunctional breathing has been reported as one of the factors affecting the quality of life post stroke, a number of studies have focused on the need for improving the breathing function in these patients. Numerous breathing exercises have been reported to enhance the respiratory, pulmonary, cognitive, and psychological functions. However, scientific evidence on the underlying mechanisms by which these exercises improve cognitive function is scattered at best. Therefore, it has been difficult to establish a protocol of breathing exercises for patients with stroke. In this review, we summarize the psychological, vascular, sleep-related, and biochemical factors influencing cognition in patients and highlight the need for breathing exercises based on existing studies. Breathing exercises are expected to contribute to improvements in cognitive function in stroke based on a diverse array of supporting evidence. With relevant follow-up studies, a protocol of breathing exercises can be developed for improving the cognitive function in patients with stroke.