Sudarshan kriya yoga: Breathing for health

Efficacy of yoga for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials

Yoga is an increasingly popular complementary intervention to reduce posttraumatic stress disorder (PTSD) symptoms and related comorbidities, but its safety and treatment efficacy are not firmly established. We conducted a systematic review and meta-analysis of existing randomized control trials (RCTs) of yoga interventions for PTSD and related secondary outcomes (e.g., depression). Initial search results found over 668 potential papers. Twenty met inclusion criteria (e.g., RCTs on adult participants with PTSD that evaluated safety or efficacy outcomes). Meta-analysis indicated that, compared to control interventions, participation in yoga interventions significantly improved self-report PTSD (standardized mean difference [SMD]: -0.51; 95 % confidence interval [CI]: -0.68, -0.35) and immediate (SMD: -0.39; 95 % CI: -0.56, -0.22) and long-term (SMD: -0.44; 95 % CI: -0.74, -0.13) depression symptoms. However, using clinician-reported assessments, yoga interventions were not associated with improved PTSD symptoms. Type of yoga differentially predicted outcomes. Sensitivity analysis showed consistent effect sizes when omitting each study from main analyses. Six studies reported whether any serious adverse events occurred. None were indicated. No publication bias was found, although individual intervention studies tended to be high in bias. Results suggest yoga is likely a safe and effective complementary intervention for reducing PTSD and depressive symptoms in individuals with PTSD. More rigorous RCTs are warranted.

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.

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.

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.

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.

A feasibility (pilot) mixed methods study of an innovative non-pharmacological breath-based yoga and social-emotional intervention program in an at-risk youth sample in London, Canada

BACKGROUND

Various service provision models for youth at risk of homelessness have been researched and implemented, including access to housing and physical and mental health resources. However, even with these interventions, we remain unaware of how best to manage symptoms of depression and anxiety and the rate of drug use in these populations primarily because of a lack of feasibility data.

METHODS

This paper presents the results of a mixed-methods study in London, Canada, that examined the feasibility of implementing a biopsychosocial intervention, SKY Schools, in at-risk youth aged between 16 and 25 (n = 49). The study also recorded qualitative responses about the program's usefulness from the perspective of the service users. The SKY Schools intervention consisted of social-emotional learning combined with Sudarshan Kriya Yoga, a standardized yoga-based breathing exercise routine. The intervention program was divided into two phases: an active learning phase and a reinforcement phase. The following feasibility outcome measures were collected: (1) the number of potential participants approached per month, (2) number (proportion) who were successfully screened, (3) the proportion of screened participants who enrolled, (4) the rate of retention in the study, (5) rate of adherence to study protocol, (6) proportion of planned ratings that were completed, (7) intervention cost per case, (8) completeness of final data for analysis, (9) length of time to collect all data, (10) quality of all collected data, (11) determining if partnering community organizations were willing to conduct the study as per study protocol, (12) determining if there were any capacity issues with partners providing intervention and investigators being able to perform the tasks that they were committed to doing, (13) determining if there were any problems of entering the data into a computer, (14) preliminary data about the safety of the intervention, and (15) preliminary estimate of treatment effects.

RESULTS

All feasibility outcome measures were collectible. In the city of London, Canada it was feasible to conduct a pilot study in this population of youth at risk of homelessness. Foremost among the findings was a high retention rate (61.2%) and overall positive qualitative feedback with a number of potential suggestions to improve the delivery and quality of the intervention. However, we had a significantly low recruitment rate (0.27 participants per week) suggesting that multiple sites will be needed to achieve an adequate sample size for a subsequent definitive trial.

CONCLUSIONS

Future researchers may consider the findings of this feasibility study when designing a randomized control trial to further assess the efficacy and tolerability of SKY Schools.

TRIAL REGISTRATION

Trial registration: Clinicaltrials.gov, identifier NCT02749240. Registered April 22, 2016, https://clinicaltrials.gov/ct2/show/NCT02749240 .

Long Sudarshan Kriya Yoga enhances cardiovascular and respiratory synchronization: An observational study

BACKGROUND

Sudarshan Kriya Yoga (SKY - a rhythmic cyclic breathing) is known to produce several physiological changes in human body. Earlier it has been reported that SKY improves cardiovascular modulations, namely increase in heart rate variability.

OBJECTIVE

To observe the synchronization in oscillatory modulations in cardiac autonomic tone and ventilatory exchange during Long Sudarshan Kriya Yoga (LSKY). LSKY is a sequential combination of pranayama in ujjayi breath, bhastrika, and cyclic rhythmic breathing followed by yog-nidra.

METHODS

Regular LSKY practitioners from the Art of Living community with more than two years of experience participated in the study (n = 22; age 40.09 ± 12.68). The Electrocardiogram (ECG), respiration, oxygen saturation, and concentrations of oxygen and carbon-di-oxide from exhaled air were recorded before and during LSKY. The time domain parameters of heart rate variability (HRV) were calculated from ECG. All parameters were compared and correlated at each stage of LSKY.

RESULTS

Highly significant reciprocal correlation was found between HRV parameters and respiration rate during LSKY. Both O2 consumption and CO2 production increased significantly during three stages of pranayama and decreased towards the end of cyclic breathing. We also saw increased SPO2 simultaneously.

CONCLUSION

The autonomic parameters exhibited reciprocal response to respiratory rate and correlated well to the ventilatory parameters. Further during LSKY we observed enhanced synchronization. In conclusion the LSKY has a potential to influence cardiorespiratory parameters for improving the performance of both systems. LSKY - enhances oscillations in HRV that resets the autonomic system, indicative of better cardiac health and prepares body for better metabolic response. Such changes are capable of inducing resilience along with physiological, psychological relaxation and emotional well-being.

Proposed physiological mechanisms of pranayama: A discussion

BACKGROUND

Pranayama, or yogic breathing technique, is now well-known worldwide by ordinary people, doctors, and scientific communities for its immediate and long-term physiological effect. However, no comprehensive physiological mechanisms explained pranayama. The present study proposed these physiological mechanisms to interpret the underlying science behind pranayama.

METHOD

The author searches PubMed/Medline internet sources for authentic scientific data and articles to acquire evidence following specific keywords. The author reviewed a total of seventy-three papers, following PRISMA guidelines. 17 full articles, including seven systematic reviews, five clinical trials, two observational studies, and three randomized control trials, have been selected to discuss proposed physiological mechanisms.

DISCUSSION

This study proposes physiological mechanisms of pranayama. It is commenced from Step 1. Activation of mechanoreceptors and chemoreceptors in the respiratory system; then Step 2. Activation of mechanoreceptors and chemoreceptors in the circulatory system, followed by Step 3. Activation of brain respiro-circulatory control centre; Step 4. Activation of the cerebellum; Step 5. Activation of the limbic system and finally end with; Step 6. Activation of the cerebral cortex. The physiological adjustment and adaptation mechanisms due to pranayama of all these six proposed areas have been discussed. Authentic scientific evidence has also been presented to support these proposed physiological mechanisms of pranayama. The author stated the study's limitations and suggested future specific scientific experiments in this area of proposed physiological mechanisms of pranayama.

CONCLUSION

These prospective proposed physiological mechanisms of pranayama in the future may provide the best scientific background for therapeutic rehabilitation and for the healthy population to maintain their general wellness.

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.

Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders

Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.

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.

Specifying the Efficacy of Digital Therapeutic Tools for Depression and Anxiety: Retrospective, 2-Cohort, Real-World Analysis

BACKGROUND

Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using cognitive behavioral therapy have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outcomes. However, there is a limited understanding of the association between digital platform components and clinical outcomes.

OBJECTIVE

The aim of the study is to investigate the contribution of specific digital engagement tools to mental health conditions. We hypothesized that participation in coaching sessions and breathing exercises would be associated with a reduction in depression and anxiety.

METHODS

Depression and general anxiety symptoms were evaluated in real-world data cohorts using the digital health platform for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform-based treatment followed two cohorts of people: (1) users who started with moderate levels of depression and completed at least 2 depression assessments (n=519) and (2) users who started with moderate levels of anxiety and completed at least 2 anxiety assessments (n=474). Levels of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) were tracked throughout the first 16 weeks. A piecewise mixed-effects model was applied to model the trajectories of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 mean scores in 2 segments (1-6 weeks and 7-16 weeks). Finally, simple slope analysis was used for the interpretation of the interactions probing the moderators: coaching sessions and breathing exercises in both depression and anxiety cohorts.

RESULTS

Analysis revealed a significant decrease in depression symptoms (β=-.37, 95% CI -0.46 to 0.28; P≤.001) during the period of weeks 1-6 of app use, which was maintained during the period of 7-16 weeks. Coach interaction significantly moderated the reduction in depression symptoms during the period of weeks 1-6 (β=-.03, 95% CI -0.05 to -0.001; P=.02). A significant decrease in anxiety symptoms (β=-.41, 95% CI -0.50 to -0.33; P≤.001) was revealed during the period of 1-6 weeks, which was maintained during the period of 7-16 weeks. Breathing exercises significantly moderated the reduction in anxiety symptoms during the period of 1-6 weeks (β=-.07, 95% CI -0.14 to -0.01; P=.04).

CONCLUSIONS

This study demonstrated general improvement followed by a period of stability of depression and anxiety symptoms associated with cognitive behavioral therapy-based digital intervention. Interestingly, engagement with a coaching session but not a breathing exercise was associated with a reduction in depression symptoms. Moreover, breathing exercise but not engagement with a coaching session was associated with a reduction of anxiety symptoms. These findings emphasize the importance of using a personalized approach to behavioral health during digital health interventions.

The role of non-ordinary states of consciousness occasioned by mind-body practices in mental health illness

BACKGROUND

Research with hallucinogens suggests that non-ordinary states of consciousness (NOSCs), particularly mystical-type experiences, predict improvements in various affective disorders and substance use disorders (SUDs). Little is known, however, about the therapeutic potential of NOSCs induced by mind-body practices such as meditation, yoga and breathwork.

METHODS

We conducted a literature review in online databases (PubMed, Scopus, Google Scholar) and preprint databases (SSRN, bioRxiv) to identify studies of NOSCs induced by mind-body practices and their effects in affective disorders and SUDs.

RESULTS

A wide variety of mind-body practices involving physical movement (i.e., shamanic drumming, yoga) and hyper-focused immersive mental experiences (i.e., meditation, breathwork) have been reported in the literature. Preliminary evidence, mostly from qualitative studies and open label studies, suggest that mind-body practices produce NOSCs. Such experiences have been associated with short-term reduced levels of anxiety and depression, increased motivation to quit addictive behaviors, and enhanced self-awareness and spiritual well-being.

LIMITATIONS

Findings are limited by the scarcity of literature in this field. Further rigorous and methodologically sound empirical research is needed, including comparative studies of NOSCs occasioned by different methods.

CONCLUSIONS

Mind-body practices may represent a promising approach for treating mental health disorders. The NOSCs induced by such practices may lead to beneficial shifts in perceptions, values, beliefs, and behaviors. Given the challenges with hallucinogen-based therapies, mind-body practices may represent a more accessible and acceptable way of eliciting potentially helpful NOSCs in clinical practice.

The Effects of Yoga Practice on Lung Function and sIL-2R Biomarkers in Individuals Working and Living in the Lonavala Industrial Area: A Randomized Controlled Trial

Context

Pollution-related health hazards are very common among people living and/or working in industrial areas, particularly near industries and metro cities. These air pollutants contribute to allergens, increase inflammation, and affect lung function.

Aim

The present study aimed to examine the effect of yoga training on lung functions and inflammation in terms of soluble interleukin-2 receptor (sIL-2R) in people working and living in a polluted area.

Settings and Design

This is a randomized controlled interventional pilot study.

Methods and Materials

Forty-eight male volunteers from the industrial area, aged 20-50 years, were randomly assigned to the experimental group and the control group. Each group comprises 24 study participants. Lung function and sIL-2R were studied at the baseline and post-yoga intervention period of 16 weeks.

Statistical Analysis Used

Study data were analyzed using descriptive methods, a one-tailed t-test, a paired t-test, and an independent t-test.

Result

Study results showed directional and significant improvements in forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow rate compared to the control group participants. The results pertaining to sIL-2R showed a directional and significant decrease in the experimental group compared to the control group.

Conclusion

The present study showed that yoga helps to promote better health, improve lung function and reduce inflammation among people residing in polluted environments.

Effect of breathwork on stress and mental health: A meta-analysis of randomised-controlled trials

Deliberate control of the breath (breathwork) has recently received an unprecedented surge in public interest and breathing techniques have therapeutic potential to improve mental health. Our meta-analysis primarily aimed to evaluate the efficacy of breathwork through examining whether, and to what extent, breathwork interventions were associated with lower levels of self-reported/subjective stress compared to non-breathwork controls. We searched PsycInfo, PubMed, ProQuest, Scopus, Web of Science, ClinicalTrials.gov and ISRCTN up to February 2022, initially identifying 1325 results. The primary outcome self-reported/subjective stress included 12 randomised-controlled trials (k = 12) with a total of 785 adult participants. Most studies were deemed as being at moderate risk of bias. The random-effects analysis yielded a significant small-to-medium mean effect size, g = - 0.35 [95% CI - 0.55, - 0.14], z = 3.32, p = 0.0009, showing breathwork was associated with lower levels of stress than control conditions. Heterogeneity was intermediate and approaching significance, χ211 = 19, p = 0.06, I2 = 42%. Meta-analyses for secondary outcomes of self-reported/subjective anxiety (k = 20) and depressive symptoms (k = 18) showed similar significant effect sizes: g = - 0.32, p < 0.0001, and g = - 0.40, p < 0.0001, respectively. Heterogeneity was moderate and significant for both. Overall, results showed that breathwork may be effective for improving stress and mental health. However, we urge caution and advocate for nuanced research approaches with low risk-of-bias study designs to avoid a miscalibration between hype and evidence.

Quantitative electroencephalography interpretation of human brain activity after COVID-19 before and after Sudarshan Kriya Yoga

The COVID-19 pandemic has affected the entire world. The SARS-CoV-2 virus is wreaking havoc globally, leading to serious health problems and even death. The purpose of this study is to present the brainwave variability pattern using QEEG after exposure to COVID-19 and to introduce the subject of the Sudarshan Kriya Yoga (SKY)-based breathing technique. QEEG is one of the basic neurological examinations through which we can compare the changes in the nervous system after SARS-CoV-2 virus infection and observe the variation of brainwave frequencies with a breathing technique.

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.

Beyond mindfulness: Arousal-driven modulation of attentional control during arousal-based practices

Here we report meditative techniques, which modulate attentional control by arousal-driven influences and not by monitoring continuous thought processes as during mindfulness-related practices. We focus on Vajrayana (Tantric Buddhism) practices, during which a sequence of generation (self-visualization as a deity - Yidam) or completion with sign (inner heat -Tummo) stages necessarily precedes non-dual awareness (NDA) Tantric Mahamudra. We compared the electrocardiographic and electroencephalographic correlates of Mahamudra performed after rest (non-Tantric Mahamudra) with Mahamudra performed after Yidam (Tantric Mahamudra) in 16 highly experienced Vajrayana practitioners, 10 of whom also performed Tummo. Both Yidam and Tummo developed the state of PNS withdrawal (arousal) and phasic alertness, as reflected by HF HRV decreases and Alpha2 power increases, later neurophysiologically employed in Tantric Mahamudra. The latter led to the unique state of high cortical excitability, “non-selective” focused attention, and significantly reduced attentional control, quantified by power reductions in all frequency bands, except Theta. In contrast, similar to mindfulness-related practices, non-Tantric Mahamudra was performed in a state of PNS dominance (relaxation), tonic alertness, and active monitoring, as suggested by Alpha1 power increases and less pronounced decreases in other frequency bands. A neurobiological model of meditation is proposed, differentiating arousal-based and mindfulness-related practices.

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Arousal-based meditations involve the state of PNS withdrawal and phasic alertness.

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Top-down control during arousal-based practices is modulated by arousal.

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Mindfulness-based practices involve the state of PNS dominance and tonic alertness.

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Top-down control during mindfulness-based practices is regulated by monitoring.

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NDA practices aim at non-selectivity of attention and reduction of top-down control.

An Observational Study on the Effect of Yoga and Sudarshan Kriya in Type 2 Diabetes Mellitus Patients

Introduction

One of the major health problems in many countries including India is type 2 diabetes. Yoga is being explored as an alternative therapy for the management of diabetes.

Methods

Among the total of 137 participants who successfully completed the ‘Living Well’ workshop by the Art of Living, 84 with type 2 diabetes were assessed for change in random blood sugar levels, systolic and diastolic blood pressure levels (SBP/DBP), and pulse rate over seven days. In the Living Well workshop, the participants performed a comprehensive Yogic Breathing Program that included yogic movements and postures (Asana), relaxation practice, three-stage Pranayama, Sudarshan Kriya Yoga (SKY), breathing techniques, and discussion of stress relieving principles over those seven days. The parameters were recorded at the time of enrollment and after the completion of seven days of the workshop.

Results

There was a greater (p<0.05) percent reduction in the mean blood sugar level in diabetics as compared to non-diabetic individuals. However, the reduction in SBP and DBP were similar (p>0.05) in diabetics and non-diabetics. The percent reduction in the pulse rate however was greater (p<0.05) in diabetics than non-diabetics.

Conclusion

Comprehensive yogic breathing practices comprising SKY may be beneficial in patients with type 2 diabetes mellitus.

Improvements in well-being and cardiac metrics of stress following a yogic breathing workshop: Randomized controlled trial with active comparison

ObjectiveCompare two distinct psychosocial stress-management workshops.ParticipantsUndergraduate and graduate students (n = 69 for analysis, completed April 2017).MethodsParticipants were randomized to one of two workshops (Sudarshan Kriya Yoga, SKY; Wisdom On Wellness, WOW), matched in terms of duration, group size, etc. Outcomes were questionnaires and psychophysiological response to laboratory stress induction at pre, post, and 3-month follow-up.ResultsSKY and WOW participants demonstrated similar workshop ratings and retention rates. SKY demonstrated greater improvements on a number of self-report measures relative to WOW, including perceived stress, sleep, social connectedness, distress, anxiety, depression, conscientiousness, self-esteem, and life satisfaction. Both groups improved in terms of heart rate measures of stress reactivity, however, these outcomes were partially related to changes in resting values at post-workshop and follow-up.ConclusionsThese findings offer insight into unique patterns of change between yogic breathing, acceptance-based approaches to stress management versus cognitively based approaches.

[Welche Behandlungs-Optionen wurden von COVID-19 infizierten Yoga-Übenden als hilfreich empfunden? - Ergebnisse einer Querschnittsanalyse]

Einführung: Die meisten COVID-19 Infizierten machen die Infektion im häuslichen Umfeld durch und werden vermutliche Maßnahmen zur Symptomlinderung anwenden, die aus dem Bereich der Selbstverordnung kommen. Von Interesse ist daher, welche Maßnahmen von COVID-19 Infizierten genutzt werden. Methoden: Anonyme Querschnittsanalyse, bei der die eigenen Behandlungsoptionen in Bezug zu acht Hauptsymptomen mit Hilfe von Freitextfeldern erfasst und kategorisiert werden. Einbezogen wurden Datensätze von Yoga-Übenden als spezifische Zielgruppe, die sich in den Zeiträumen der drei dominanten Virus-Varianten infiziert hatten (n=208: 89% Frauen; Altersmittel 49 ± 11). Die Aussagen wurden deskriptiv dargestellt und die Inhalte der Freitextfelder nach inhaltsanalytischen Gesichtspunkten kategorisiert und den jeweiligen Hauptsymptomen einer COVID-19 Infektion zugeordnet. Ergebnisse: In Bezug auf die acht Symptomgruppen ergab sich ein differenziertes Bild der als hilfreich empfundenen Behandlungsoptionen. Die meisten Nennungen hatte die Kategorie Zeit/Ruhe/Schlaf, insbesondere bei Schwäche/Erschöpfung und Rumpf-/Gliederschmerzen, gefolgt von Atemübungen (Pranayama), die insbesondere bei Atemnot/Kurzatmigkeit und Husten zur Anwendung kamen. Yoga-Übungen wurden insbesondere bei Rumpf-/Gliederschmerzen sowie Schwäche/Erschöpfung genutzt. Die konventionelle Schmerzmedikation stand bei Kopfschmerzen sowie Rumpf-/Gliederschmerzen im Vordergrund. Bewegung an der frischen Luft und Spaziergänge zur Regeneration waren relevant bei Schwäche/Erschöpfung, Atemnot/Kurzatmigkeit sowie Husten. Phytotherapeutische Anwendungen waren insbesondere bei Husten bedeutsam. Ätherische Öle und Riechtraining hatten ihren Schwerpunkt bei Geruchs-/Geschmacksstörungen und Husten. Schlussfolgerungen: In Bezug auf das angewendete Spektrum der unterstützenden Therapieoptionen im Sinne des Selbstmanagements wurden einige sehr häufig und differenziert angewendet. Hier könnte man eine subjektiv empfundene "Nützlichkeit" annehmen. In der Literatur lassen sich für einige dieser Optionen auch Hinweise für eine mögliche Wirksamkeit finden, für andere nicht ohne weiteres. Diese unterstützenden Therapieoptionen könnten außerdem eine Möglichkeit sein, um einer abwartenden Hilflosigkeit proaktiv entgegenzuwirken.

Online guided meditation training (Isha Kriya) improves self-reported symptoms of anxiety and depression within 2 weeks of practice-An observational study

INTRODUCTION

Anxiety and depression have increased dramatically 2-3-fold with the COVID-19 pandemic. There is an urgent need for safe, cost-effective, and scalable approaches to alleviate this parallel mental health pandemic. Meditation has previously been shown to reduce stress, anxiety, and depression symptoms. Furthermore, online delivery of mind-body interventions will be impactful in addressing disparities in access to mental healthcare. In this observational pilot study, we investigate the impact of a digitally delivered guided meditation followed by daily practice on symptoms of anxiety and depression.

METHODS

Initially, 57 male and 202 female subjects enrolled in this study. Participants attended a webinar where they learned the Isha Kriya meditation practice. They were subsequently requested to perform the intervention daily for 6 weeks. Subjects were given scales to assess anxiety and depression at baseline, 2, 4, and 6 weeks following the training. The changes in the self-reported anxiety and depression scores were examined by the linear mixed effect models.

RESULTS

Participants completed survey responses for the following time points: baseline (n = 82), week 2 (n = 58), week 4 (n = 37), and week 6 (n = 28). During the 6 weeks of the study over 68% of subjects were compliant with their daily practice. When comparing baseline with week 2, the mean anxiety scores decreased from 25.4 to 16.8 (p < 0.01, d = 1.31). Similarly, mean depression scores decreased from 15 to 8.81 (p < 0.01, d = 0.9). The reduced scores for both anxiety and depression were maintained at weeks 4 and 6.

CONCLUSION

This preliminary study assesses the effectiveness of online meditation training on self-reported symptoms of anxiety and depression. After 2 weeks of practice, those with baseline anxiety and depression showed significant improvement with a large effect size. The results from weeks 4 and 6 show sustained reduced anxiety and depression symptoms. These findings suggest that daily Isha Kriya practice could alleviate symptoms of these conditions. Future studies utilizing randomized control trials should be conducted to rigorously evaluate the benefits of this meditation practice on anxiety and depression.

TRIALS REGISTRATION

ClinicalTrials.gov, identifier: NCT05065476.

Role of Ayurveda and Yoga-Based lifestyle in the COVID-19 Pandemic - A Narrative Review

The COVID-19 pandemic has posed an immense challenge to health care systems around the globe in terms of limited health care facilities and proven medical therapeutics to address the symptoms of the infection. The current health care strategies have primarily focused on either the pathogen on the environmental factors. However, efforts towards strengthening the host immunity are important from public health perspective to prevent the spread of infection and downregulate the potency of the agent. While a vaccine can induce specific immunity in the host, non-specific ways of improving overall host immunity are the need. This scenario has paved the way for the use of traditional Indian therapies such as Ayurveda and Yoga. This review aims at collating available evidence on Ayurveda, Yoga and COVID-19. Further, it draws inferences from recent studies on Yoga and Ayurveda on immunity, respiratory health and mental health respectively to approximate its probable role in prophylaxis and as an add-on management option for the current pandemic.

Impact of yoga intervention on menopausal symptoms-specific quality of life and changes in hormonal level among menopausal women

AIM

The menopause transition is experienced by women often involves troublesome symptoms due to changes in the level of reproductive hormones. Non-hormonal therapies are more commonly accepted by women than hormonal therapy for coping with the climacteric symptoms. The aim of the study was to evaluate the effects of yoga practice on menopausal symptoms, specific quality of life, and changes in hormonal levels among menopausal women.

METHOD

A single-blinded randomized control trial was conducted among 80 participants aged 40 of 50 years and was randomly divided into two study arms, that is, Sudarshan Kriya Yoga (SKY) and brisk walking intervention, to find the effect on the hormonal changes and menopausal quality of life (measured by MENQOL tool). The significant improvements in the outcome measures were measured by using repeated measures analysis of variance and McNemar's test.

RESULTS

Significant improvements in the menopausal-specific quality of life were observed in the domain of vasomotor, psychosocial, and physical symptoms (p < 0.05). The antioxidant enzymes (superoxide dismutase and glutathione peroxidase (GPX) were significantly elevated after 1 year of regular practice of SKY compared to walking intervention (p < 0.05). In contrast, no significant improvement was observed in follicle-stimulating hormone and dehydroepiandrosterone sulfate levels. The women reported no adverse events after SKY practice or brisk walking.

CONCLUSION

The study concluded that 1 year of SKY practice could be one of the preferred non-hormonal, lifestyle-modifying regimens for improving the overall quality of life in menopausal women.

Association Between Sudarshan Kriya Yoga and Healthy Lifestyle Practices Among Working Adults: A Cross-Sectional Study from Singapore

Objectives: There is a paucity of research on the association between yogic breathing and healthy lifestyle factors in working adults. Also, there is very little information about the frequency of yogic breathing practice and its benefits. The authors investigated the relationship between Sudarshan Kriya Yoga (SKY) frequency and the likelihood of leading a healthier lifestyle among practitioners and nonpractitioners. Design: Cross-sectional investigation on non-SKY and SKY practitioners, SKY was categorized into non-, monthly, weekly, and daily practitioners. Confounding variables included age, gender, ethnicity, marital status, and education level. A multivariate logistic regression model was used to compare practice frequencies with the odds of having a healthier lifestyle. Settings: Community centers, community events, workplaces, and universities throughout Singapore Subjects: Of the 531 working adults (54.8% female), 50.1% had a healthier lifestyle ≥ 4 healthy lifestyle factors). Outcome Measure: Having a healthier lifestyle was defined as having ≥ 4 healthy lifestyle factors out of seven (smoking, alcohol, diet, exercise, sleep, stress, and weight). Results: Multivariate analysis demonstrated that those who practiced SKY ≥ 4 days/week had significantly higher odds of having a healthier lifestyle (odds ratio = 3.62; 95% confidence interval = 2.10-6.23). The p for trend analysis demonstrated that as the frequency of practice increased the likelihood of having a healthier lifestyle also increased ( p < 0.001). Conclusion: The practice of yogic breathing may promote a healthier lifestyle in working adults. Further experimental and longitudinal investigations are warranted.

Impact of breathing and relaxation training (Sudarshan Kriya) on cases of alcohol dependence syndrome

BACKGROUND

Alcohol abuse is a public health problem and the course of alcohol dependence syndrome (ADS) is known for its relapsing nature. Additional interventions with empirical evidence are worthy of consideration. Breathing and Relaxation Training, like Sudarshan Kriya (SK) is recommended for stress management, and have been shown to positively affect outcomes in stress-related disorders. The aim of this study was to assess the effect of an intervention of Breathing and Relaxation Training, on drinking behavior in patients of ADS.

METHODOLOGY

Eighty in-patients diagnosed with ADS were included after obtaining informed consent, in this prospective study and were randomized into two groups. They were administered Alcohol Use Disorder Identification Test (AUDIT) at admission and 6-months after discharge. The Study group (n = 40) underwent a 6-day intervention of Breathing and relaxation Training (SK) apart from the standard therapy. "WHO-5 Well-Being Index" was administered before and after the training. The Control group was exposed to the standard therapy for ADS. A follow-up on a monthly basis and finally at 6-month interval was done to assess alcohol consumption status.

RESULTS

Socio-demographically both the groups were comparable. The breathing and relaxation training (study) group had a significant rise in "WHO-5 Well-Being Index" (P < 0.001). There was a significant reduction in AUDIT scores after 6 months in both groups. AUDIT scores were significantly lower in the study group (11.20 ± 2.81) than the control group (15.30 ± 4.05) after 6 months (P < 0.001). The study group also reported fewer days of drinking (P = 0.004) and reduced overall drinking in the intervening period (P < 0.001).

CONCLUSION

The addition of Breathing and Relaxation Training (SK) in the management of ADS provided additional therapeutic benefits in the form of fewer days of drinking and reduced total alcohol consumption.

Feasibility and outcome of an online streamed yoga intervention on stress and wellbeing of people working from home during COVID-19

BACKGROUND

The outbreak of COVID-19 and its associated measures has resulted in a sizeable working population transitioning to working from home (WFH), bringing additional challenges, and increasing work-related stress. Research has indicated that yoga has promising potential in reducing stress in the workplace. However, there are very few studies exploring the impact of online streamed yoga on stress management for people-WFH.

OBJECTIVE

To investigate the feasibility and outcome of an online streamed yoga intervention on stress and wellbeing of people-WFH during COVID-19.

METHODS

A six-week pilot randomized controlled trial (RCT) yoga intervention was designed with yoga (n = 26) and a wait-list control group (n = 26). A mixed two-way ANOVA was used to assess changes in standardised outcome measures at baseline and post-intervention. Likert and open-ended questions assessed enjoyment, acceptability and perceived benefits of the program, which were analysed thematically.

RESULTS

Compared with the control, the yoga group reported significant improvements in perceived stress, mental wellbeing, depression and coping self-efficacy, but not stress and anxiety. Participants experienced physical and mental health benefits and reported high acceptability and enjoyment of the intervention.

CONCLUSIONS

An online yoga intervention can help people WFH manage stress and enhance wellbeing and coping abilities.

Effect of Yoga on Glucose Control and Quality of Life in Patients of Prediabetes

Objective: The objective of this study was to evaluate effect of yoga on fasting plasma glucose (FPG), postprandial plasma glucose, and hemoglobin A1C (HbA1C) and also on quality of life (QoL). Research Design and Methods: This was a cohort study in which 100 diagnosed cases of prediabetes were recruited for doing specific yoga, and they themselves act as control for the study. The measurement and comparison of FPG, prandial plasma glucose (PPG), and HbA1C were done at three different time intervals, that is, baseline, 3 months, and at 6 months. The assessment of QoL was done using SF-36 scale. Results: One hundred prediabetic cases were selected for the study in which impaired fasting glucose (IFG) was present more in younger population compared to impaired glucose tolerance (IGT) and IFG plus IGT both of which are more prevalent in middle age group. The yoga therapy was found to have favorable effect on FPG, PPG, and HbA1C along with various anthropometry measures studied in this study. After adjusting correlation coefficient for various anthropometry measures, yoga was found to be effective for controlling glycemic parameters in prediabetics. Conclusions: Yoga is a type of exercise known to improve glycemic control by changing anthropometry measures, but our study aids in knowledge about the beneficial effect beyond this known fact through other mechanisms yet to be explored.

From Precision Metapharmacology to Patient Empowerment: Delivery of Self-Care Practices for Epilepsy, Pain, Depression and Cancer Using Digital Health Technologies

To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering “medicinal” self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.

Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?

Many countries introduced the requirement to wear masks in public spaces for containing SARS-CoV-2 making it commonplace in 2020. Up until now, there has been no comprehensive investigation as to the adverse health effects masks can cause. The aim was to find, test, evaluate and compile scientifically proven related side effects of wearing masks. For a quantitative evaluation, 44 mostly experimental studies were referenced, and for a substantive evaluation, 65 publications were found. The literature revealed relevant adverse effects of masks in numerous disciplines. In this paper, we refer to the psychological and physical deterioration as well as multiple symptoms described because of their consistent, recurrent and uniform presentation from different disciplines as a Mask-Induced Exhaustion Syndrome (MIES). We objectified evaluation evidenced changes in respiratory physiology of mask wearers with significant correlation of O2 drop and fatigue (p < 0.05), a clustered co-occurrence of respiratory impairment and O2 drop (67%), N95 mask and CO2 rise (82%), N95 mask and O2 drop (72%), N95 mask and headache (60%), respiratory impairment and temperature rise (88%), but also temperature rise and moisture (100%) under the masks. Extended mask-wearing by the general population could lead to relevant effects and consequences in many medical fields.

Can Yogic Breathing Techniques Like Simha Kriya and Isha Kriya Regulate COVID-19-Related Stress?

The global impact of Coronavirus Disease 2019 (COVID-19) is tremendous on human life, not only affecting the physical and mental health of population but also impacting the economic system of countries and individual itself. The present situation demands prompt response toward COVID-19 by equipping the humans with strategies to overcome the infection and stress associated with it. These strategies must not only be limited to preventive and therapeutic measures, but also aim at improving immunity and mental health. This can be achieved by yogic breathing techniques. In this perspective, we emphasize the importance of yogic breathing, Simha Kriya and Isha kriya, the simple yet effective breathing techniques.

Association of yogic breathing with perceived stress and conception of strengths and difficulties in teenagers

BACKGROUND

Mental health problems are increasing at an alarming rate throughout the world, and teenagers are no exception. They experience high levels of stress in their formative years which often leads to poor social behavior. In the present study, we examine the effect of Sudarshan Kriya Yoga (SKY), a yogic breathing technique on perceived stress and social behavior of school going teenagers.

METHOD

A cross-sectional survey was conducted. Teenagers who practiced SKY daily constituted the study group and teenagers who did not practice any form of yoga or meditation formed the control group. Child Perceived Stress scale (C-PSS) and Strength and Difficulty questionnaire (SDQ) were used to evaluate the mental health and social behavior of both groups.

RESULTS

Lower stress scores were observed among students who practiced SKY compared to their peers. A significant difference was observed between the groups with respect to emotional problems, conduct problems, peer problems, and pro-social behavior. Gender wise comparison highlighted that the females from the SKY group scored lower on emotional problems sub-scale compared to their counterparts from control group. Results also highlighted an improved peer to peer interaction among both boys and girls in the SKY group.

CONCLUSION

The results indicate the practice of SKY is associated with reduced stress, improved self-awareness, and social behavior.

Impact of a Yogic Breathing Technique on the Well-Being of Healthcare Professionals During the COVID-19 Pandemic

Background

The COVID-19 pandemic has created unprecedented challenges for healthcare globally, the brunt of which has been borne by the health care providers (HCPs). These challenges are felt more keenly in India, as they stretch an insufficiently resourced healthcare system. The long hours, cross over of responsibilities, lack of resources to adequately care for patients, and concerns around safety of self and loves ones, have led to a spike in anxiety, depression, insomnia and other stress - related disorders in healthcare providers. Sudarshan Kriya Yoga (SKY) is a mind-body intervention that has been studied in multiple clinical populations. Prior to this study, there has been no exploration of the impact of SKY on healthcare providers, specifically the impact of a mind-body intervention like SKY on HCPs during a pandemic.

Objective

This study aims to investigate the impact of SKY on the well-being of HCPs during the COVID-19 pandemic.

Methods

We conducted a pilot feasibility study with a single arm pre-post design. SKY was taught to participants in a 4-day online breath and meditation workshop. We measured outcomes related to depression, anxiety, resilience, life satisfaction, and quality of sleep.

Results

Ninety-two subjects completed the study survey before and after the intervention. A significant reduction was observed in the levels of stress, anxiety and depression immediately after the program. In addition, the participants reported sig1nificant improvement in life satisfaction, resilience, and the quality of their sleep.

Conclusion

The results indicate that SKY breathing technique had a positive impact on the well-being of healthcare professionals during the pandemic. Participants experienced improved quality of sleep, enhanced satisfaction with life, and increased resilience after SKY. This pilot study provides important data for future multi-site randomized controlled trials to study the impact of yogic techniques on well-being of the HCPs.

Sudarshan Kriya Yoga: A Breath of Hope during COVID-19 Pandemic

Important counter measures to combat an infectious disease pandemic include vaccination, antiviral therapy, and immunomodulation therapy. Vaccinations are disease specific and moreover strain specific, so the protection provided is also specific and limited. Antiviral therapies are costly and require bulk production of drugs, hence globally there is an increased interest toward low-risk, cost-effective complementary alternative therapies, such as Yoga and Ayurveda to tackle the infectious pandemic, coronavirus disease 2019 (COVID-19). There is clinical evidence available on the potential complementary role of yogic practices in the management of noncommunicable and communicable diseases. Various online databases were searched for articles published between 2000 and 2020. Databases explored were Medline, EMBASE, Indian Citation Index, PsycINFO, Index Medicus for South-East Asia Region, and Google Scholar. All search results were screened, and articles related to keywords such as COVID-19, yoga therapy, and Sudarshan Kriya Yoga (SKY) were selected for data extraction. Quality of the studies included was evaluated on the basis of the construct validity, content validity, relevance, bias, credibility relating to information, and data sources. SKY is a unique yogic practice that includes specific sequential breathing techniques. It balances the autonomic nervous system and thus can alleviate anxiety, routine stress, depression, stress-related medical disorders, and posttraumatic stress. It potentiates natural host immune defenses that are essential to tackle a plethora of microbial infections. This narrative review article provides an overview of potential therapeutic benefits that SKY can offer to the population at large during this COVID-19 pandemic.

Sudarshan Kriya Yoga Program in Posttraumatic Stress Disorder: A Feasibility Study

Background:

Sudarshan Kriya Yoga (SKY), a breath-based yoga intervention, has demonstrated safety and efficacy in posttraumatic stress disorder (PTSD) patients subsequent to natural disaster or war, but has not been explored in civilians with PTSD from a wider range of trauma. We hypothesized that it would be feasible to conduct a clinical trial of SKY in PTSD resulting from a wide range of trauma.

Methods:

Outcomes were feasibility measures including rates of enrollment and retention, adherence to study protocol; as well as changes in PTSD symptoms, other mood symptoms, and physiological measures. Male and female participants aged 18–75 years were enrolled in a feasibility trial. They attended a 6-day learning phase of SKY followed by 7 sessions over 11 weeks as an adjunct to their usual treatment.

Results:

Forty-seven participants were screened and 32 were enrolled over 9 months. Consistent with retention rates of other PTSD trials, 13 withdrew from the study prior to week 12. Twenty-one participants met intervention attendance requirements, completed 95% of planned study assessments and were included in final analyses. Participants experienced clinically significant decrease in PTSD symptoms on the posttraumatic stress disorder checklist (PCL-5) scores at week 12 mean difference, M_diff (standard deviation [SD]) = −10.68 (14.03), P = 0.004; Cohen's d = 0.58, which was sustained at week 24 M_diff (SD) = −16.11 (15.20), P < 0.001; Cohen's d = 0.91.

Conclusions:

It is possible to conduct a clinical trial of SKY in a routine psychiatry clinic serving patients with PTSD due to a wide range of trauma. Future studies should include an RCT design.

Effect of Sudarshan Kriya Yoga (SKY) on daytime and situational sleep propensity in novice practitioners: a prospective cohort study

OBJECTIVES

Hectic, late-night lifestyle has reduced 90 min sleep in 20% adults resulting in insomnia and excessive daytime sleepiness (EDS). We assess the scope of Sudarshan Kriya Yoga (SKY), a 4-component, breathing process in reducing EDS, generally and situationally.

METHODS

This is a prospective, controlled study involving randomized subjects without any sleep-wake cycle anomalies and prior experience in SKY. Subjects (n=52) performed 30 min of SKY for 6 days/week for 8 weeks, while controls (n=53) performed sitting activity and Suryanamaskar for 4-weeks each. Epworth Sleepiness Scale (ESS) was used to measure EDS at 0, 4, and 8 weeks.

RESULTS

SKY group showed significant ESS score improvements between 0-4 weeks and 4-8 weeks of 1.22 (p=0.0001) and 1.66 (p=0.001) respectively. Controls however failed to improve with score differences of 0.02 (p=0.892) and 0.02 (p=0.8212) respectively. SKY group showed significant ESS score improvement over controls at 4-weeks (difference=1.74; p=0.013) and 8-weeks (difference eight; p=0.0001). Improvement was most for obese people and those sitting in a halted car.

CONCLUSIONS

Improvement in subjects' nighttime sleep and daytime wakefulness in SKY practitioners can be attributed to polyvagal theory. Increased heart rate variability (HRV) alterations and sympathetic hyperarousal in chronic insomnia; and cholinergic and GABAergic dysregulation in anxiety disorders are countered by regulated vagal nerve stimulation post SKY. Our study establishes effectivity of SKY in reducing EDS (total and situational), provides a clinical correlation for prior polysomnographic evidence and paves way for larger trials directed towards SKY prescriptions for insomnia.

Implementing Mobile HRV Biofeedback as Adjunctive Therapy During Inpatient Psychiatric Rehabilitation Facilitates Recovery of Depressive Symptoms and Enhances Autonomic Functioning Short-Term: A 1-Year Pre-Post-intervention Follow-Up Pilot Study

OBJECTIVE

New treatment options for depression are warranted, due to high recurrence rates. Recent research indicates benefits of heart rate variability biofeedback (HRVBF) on symptom recovery and autonomic functioning in depressed individuals. Slow-paced breathing-induced amplification of vagus nerve activity is the main element of HRVBF. Thus, the latter represents a safe and non-invasive complementary depression treatment. However, its efficacy in patients undergoing inpatient psychiatric rehabilitation receiving highly comprehensive treatments has not been evaluated.

METHODS

Ninety-two inpatients were randomly assigned to an intervention group (IG) or control group (CG). While the latter received the standard treatment only, adjunctive HRVBF was provided to the IG over 5 weeks. Depression severity and heart rate variability (HRV) were assessed before (pre) and after 5 weeks (post). Moreover, 1-year follow-up depression scores were available for 30 participants.

RESULTS

Although depression improved in both groups, the IG exhibited significantly larger improvements at post-assessment ( η p 2 = 0.065) and significant increases in resting LF-HRV (d = 0.45) and cardiorespiratory coherence (d = 0.61). No significant effects for RMSSD, SDNN, HF-HRV, or HR were found (ps > 0.05). Additionally, the IG showed a medium- to large-sized reduction in resting respiratory rate from 13.2 to 9.8 breaths per minute (p < 0.001, d = 0.86), with the CG exhibiting only a small decrease from 13.5 to 12.4 (p = 0.49; d = 0.35). While the IG exhibited significantly lower depression scores at post-assessment (p = 0.042, d = 0.79), this effect decreased during follow-up (p = 0.195, d = 0.48).

CONCLUSION

HRVBF as adjuvant therapy during inpatient psychiatric rehabilitation facilitated depression recovery. Additionally, amplified LF-HRV as well as cardiorespiratory coherence at rest and a decrease in resting breathing frequency was observed in the HRVBF group. These findings emphasize HRVBF's value as complementary therapy regardless of concurrent treatments. Moreover, these incremental benefits could serve as resource even after the actual training period. However, the additional antidepressant gains vanish during the long-term follow-up, indicating the need for more intense training or regular practice afterward, respectively. Thus, future studies are warranted to examine how the initial benefits of HRVBF during inpatient psychiatric rehabilitation can be preserved post discharge.

Promoting Mental Health and Psychological Thriving in University Students: A Randomized Controlled Trial of Three Well-Being Interventions

This study aimed to address the decline in mental health on U.S. university campuses by examining the effects of three interventions. University students suffer from high levels of anxiety, depression, and suicide. Counseling centers on university campuses are struggling to meet increased demand. The cost to students and universities could be buffered by offering preventative, psychoeducational, and skill-building training programs that promote mental health and psychological thriving. To date, the research literature has not yielded systematically evaluated and recommendable preventative mental health and well-being programs for university students. In a registered, randomized controlled trial, 131 university students were either placed in a non-intervention control group (N = 47) or received training in one of three 30-hour, eight-week semester-long well-being programs: SKY Campus Happiness ("SKY"; N = 29), Foundations of Emotional Intelligence ("EI"; N = 21) or Mindfulness-Based Stress Reduction ("MBSR"; N = 34). Compared to the control group and controlling for variance of baseline measurements and multiple comparisons, SKY Campus Happiness showed the greatest impact, benefiting six outcomes: depression, stress, mental health, mindfulness, positive affect and social connectedness. EI benefited one outcome: mindfulness. The MBSR group showed no change. Delivering SKY or EI to university students may be a cost-effective and efficient way to proactively and preventatively address mental health for university students and reduce the financial strain on universities.

High-Frequency Cerebral Activation and Interhemispheric Synchronization Following Sudarshan Kriya Yoga as Global Brain Rhythms: The State Effects

Context:

Respiration is known to modulate neuronal oscillations in the brain and is measured by electroencephalogram (EEG). Sudarshan Kriya Yoga (SKY) is a popular breathing process and is established for its significant effects on the various aspects of physiology and psychology.

Aims:

This study aimed to observe neuronal oscillations in multifrequency bands and interhemispheric synchronization following SKY.

Settings and Design:

This study employed before- and after-study design.

Subjects and Methods:

Forty healthy volunteers (average age 25.45 ± 5.75, 23 males and 17 females) participated in the study. Nineteen-channel EEG was recorded and analyzed for 5 min each: before and after SKY. Spectral power for delta, theta, alpha, beta, and gamma frequency band was calculated using Multi-taper Fast Fourier Transform (Chronux toolbox). The Asymmetry Index was calculated by subtracting the natural log of powers of left (L) hemisphere from the right^® to show interhemispheric synchronization.

Statistical Analysis:

Paired t-test was used for statistical analysis.

Results:

Spectral power increased significantly in all frequency bands bilaterally in frontal, central, parietal, temporal, and occipital regions of the brain after long SKY. Electrical activity shifted from lower to higher frequency range with a significant rise in the gamma and beta powers following SKY. Asymmetry Index values tended toward 0 following SKY.

Conclusions:

A single session of SKY generates global brain rhythm dominantly with high-frequency cerebral activation and initiates appropriate interhemispheric synchronization in brain rhythms as state effects. This suggests that SKY leads to better attention, memory, and emotional and autonomic control along with enhanced cognitive functions, which finally improves physical and mental well-being.

Effect of mindfulness meditation protocol in subjects with various psychometric characteristics at high altitude

INTRODUCTION

Incidence of high altitude-related sickness is increasing due to more number of people visiting the areas of high altitude which may result in life-threatening conditions including acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), high altitude cerebral edema (HACE), and High-altitude pulmonary hypertension (HAPH). We hypothesized that an advanced yoga regimen may be beneficial in dealing with the physiology of acclimatization.

METHODS

Anthropometric, Biochemical, and Psychological assessments were carried out in 48 participants before and after the advance meditation program (AMP) in the experimental group. Individuals with an age range of 20-65 years with no comorbidities were included in the study. Participants were exposed to AMP for 4 days. All assessments were carried out at the baseline and after the course. Prakriti was constituted for all participants using a standard questionnaire. The study was carried out after obtaining the written informed consent as per the guidelines outlined by the Institute Ethics Committee.

RESULTS

Po2 and glucose levels were found significantly reduced along with changes in the Happiness index, anxiety, and mental well-being. However, participants with lowered Po2, after 4 days of mindfulness intervention, showed a positive outcome measured by the established scales of anxiety, happiness, and information processing. Psychometric or Prakriti wise analysis revealed that subject with "Pitta" constitution exposed to high altitude and advance meditation showed changes in more parameters than "Vatta" or "Kapha" Constitution.

CONCLUSIONS

Advance meditation in the high altitude zone confers biochemical and neuro-cognitive benefits. Molecular studies may require to understand the role of hypoxic condition in improving the disease state.

Primer for Mainstreaming Mind-Body Techniques for Extreme Climates-Insights and Future Directions

Background: The deprivation of oxygen reaching the tissues (also termed as hypoxia) affects the normal functioning of the body. This results in development of many diseases like ischemia, glaucoma, MCI (Mild Cognitive Impairment), pulmonary and cerebral edema, stress and depression. There are no effective drugs that can treat such diseases. Despite such failure, alternative interventions such as mind-body techniques (MBTs) have not been adequately investigated. Methods: The first part of this review has been focused on philosophical aspects of various MBTs besides evolving an ayurgenomic perspective. The potential of MBTs as a preventive non-pharmacological intervention in the treatment of various general and hypoxic pathologies has been further described in this section. In the second part, molecular, physiological, and neuroprotective roles of MBTs in normal and hypoxic/ischemic conditions has been discussed. Results: In this respect, the importance of and in vivo studies has also been discussed. Conclusions: Although several studies have investigated the role of protective strategies in coping with the hypoxic environment, the efficacy of MBTs at the molecular level has been ignored.

Gender and Ethnicity: Are they Associated with Differential Outcomes of a Biopsychosocial Social-Emotional Learning Program?

Context:

Social-emotional learning (SEL) program outcomes may be enhanced when programs take into account gender and ethnicity differences, yet few studies directly examine these variables. The limited literature further suggests improved outcomes accrue by integrating physiological techniques, such as yoga and meditation, directly into SEL curricula to reduce stress.

Aims:

This study investigated the association between outcomes of a yogic breath-based biopsychosocial SEL intervention across gender and ethnicity.

Methods:

Fifty-nine high school students were evaluated on 4 positive (self-esteem, identity formation, anger coping ability, planning, and concentration) and 3 negative SEL outcomes (impulsivity, distractibility, and endorsement of aggression). Using a repeated-measures design, group differences between gender and ethnicity were assessed.

Results and Conclusions:

Significant improvements on all 7 outcomes were found for the sample, suggesting that participants performed better after the intervention. There were neither significant differences between males and females on outcomes nor between different ethnic groups with the exception of African-Americans scoring lower on one of three emotion regulation outcomes. This study, one of the first to directly analyze SEL outcomes by sociodemographic variables, demonstrated the program's biopsychosocial approach was associated with beneficial SEL outcomes across genders and ethnicities. Future studies of biopsychosocial programs taking into account sociodemographics will allow SEL programs to be more effective across diverse populations.

Effect of Sudharshan Kriya Pranayama on Salivary Expression of Human Beta Defensin-2, Peroxisome Proliferator-Activated Receptor Gamma, and Nuclear Factor-Kappa B in Chronic Periodontitis

Introduction

Sudharshan kriya pranayama (SKP) is a form of yoga that reduces inflammation and contributes to general health. Very few prior studies have examined the role of pranayama on oral health. We evaluated the clinical status and inflammatory biomarkers in patients with chronic periodontitis before and after SKP.

Materials and methods

Ninety male subjects were considered for the study and divided into three groups: subjects with a healthy periodontium (Group1), subjects with chronic gingivitis (Group2), and subjects with chronic periodontitis (Group3). The clinical parameters included plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and salivary markers human beta-defensin-2(HBD-2), peroxisome proliferator-activated receptor gamma (PPAR-γ), and nuclear factor-kappa B (NF-κB). These parameters and markers were evaluated before and after 90 days of SKP. The data obtained were statistically evaluated by McNemar's test, paired sample t-test, and one-way analysis of variance.

Results

There was a significant improvement in PI in all three groups. GI showed an improvement in Groups 2 and 3. PPD and CAL also showed an improvement in Group 3. HBD-2 and NF-κB decreased with SKP, whereas PPAR-γ expression increased after the intervention. In Groups 2 and 3 with the decrease in GI, there was a corresponding decrease in HBD-2. In Group 3 with an improvement in PPD and CAL, there was an improvement in PPAR-γ expression.

Conclusions

The results show that SKP can significantly decrease periodontal inflammation and improve periodontal status. It also effectively improves the expression of PPAR-γ, thereby decreasing salivary levels of HBD-2 and NF-κB, respectively. Based on our results, pranayama can be an effective adjunct in maintaining oral health.