Kapalabhati pranayama: An answer to modern day polycystic ovarian syndrome and coexisting metabolic syndrome?

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.

Yoga Intervention Improves the Metabolic Parameters and Quality of Life among Infertile Women with Polycystic Ovary Syndrome in Indian Population

Background

The heterogenic manifestations of polycystic ovarian syndrome have led to various treatment approaches that include improving hormonal imbalance, weight management, and improving quality of life (QoL). Yoga therapy being a versatile treatment approach benefits physical and mental well-being and can be recommended to women with polycystic ovary syndrome (PCOS).

Objective

The objective of this study was to study the effect of structured yoga intervention on anthropometric, metabolic, hormonal, biochemical, ovarian morphology, and infertility-related QoL parameters among infertile women with PCOS.

Settings and Design

A prospective, controlled before and after study was conducted at a Multidisciplinary PCOS Clinic in Mumbai, Maharashtra, India.

Methodology

Infertile women with PCOS (26 participants in each group which includes intervention and control arm) seeking treatment for infertility at the Multidisciplinary PCOS Clinic at National Institute for Research in Reproductive and Child Health. The intervention group received 90 min of structured yoga intervention for 3 months.

Statistical Analysis

The median change in parameters between baseline and after 12 weeks of intervention was analyzed using IBM SPSS software, version 26 to perform descriptive analyses and Wilcoxon test to analyze pre- and postintervention parameters in the intervention and control group.

Results

There was a significant difference in the weight, basal metabolic rate, postglucose insulin, anti-Müllerian hormone, cholesterol, high-density lipoprotein, low-density lipoprotein, serum glutamic pyruvic transaminase, ultrasound parameters such as stromal thickness, follicle number per ovary, and QoL in infertility domain in the intervention group compared to the control group. Within 1 year of initiation of the study, 13 participants became pregnant in the yoga intervention group as compared to 7 participants in the control group.

Conclusion

The metabolic comorbidities of PCOS have adverse effects on the QoL and pregnancy outcome among infertile women with PCOS. This pilot study demonstrated that a 12-week yoga intervention brought overall improvement in anthropometric, hormonal, biochemical, ovarian morphology, and infertility-related QoL parameters compared to the control group. Integration of yoga in infertility management will help to improve the QoL and to optimize prepregnancy metabolic parameters among infertile women with PCOS.

Cerebrovascular Dynamics Associated with Yoga Breathing and Breath Awareness

Aims

Breath frequency can alter cerebral blood flow. The study aimed to determine bilateral middle cerebral arterial hemodynamics in high-frequency yoga breathing (HFYB) and slow frequency alternate nostril yoga breathing (ANYB) using transcranial Doppler sonography.

Methods

Healthy male volunteers were assessed in two separate trials before, during, and after HFYB (2.0 Hz for 1 min, n = 16) and ANYB (12 breaths per minute for 5 min, n = 22). HFYB and ANYB were separately compared to breath awareness (BAW) and to control sessions.

Statistical Analysis

The data were analyzed using repeated-measures ANOVA with Bonferroni adjusted post hoc tests.

Results

During HFYB there was a decrease in end-diastolic velocity (EDV) and mean flow velocity (MFV) (P < 0.01 for left and P < 0.05 for right middle cerebral arteries; MCA) with an increase in pulsatility index (PI) for the right MCA (P < 0.05). During ANYB, there was a bilateral decrease in peak systolic velocity (P < 0.05 for left and P < 0.01 for right MCA), EDV (P < 0.01) and MFV (P < 0.01 for left and P < 0.001 for right MCA) and an increase in PI (P < 0.01). During BAW of the two sessions there was a decrease in lateralized flow and end-diastolic velocities (P < 0.05) and an increase in PI (P < 0.05).

Conclusions

Changes in peak flow velocities and pulsatility indices during and after HFYB, ANYB, and BAW suggest decreased cerebrovascular blood flow and increased flow resistance based on different mechanisms.

Study of immediate neurological and autonomic changes during kapalbhati pranayama in yoga practitioners

Background:

Kapalbhati is a fast pace respiratory exercise or pranayam, which is supposed to be practiced by yogis to clean their brain. Pranayamas are well known to improve heart rate variability (HRV) ultimately leading to better autonomic functions. Other studies have observed the immediate effect of kapalbhati on various neurological (brain and spine) and autonomic functions, but their results are varied and inconclusive.

Objective:

The aim of this study is to find out the changes in HRV and brain waves during and after practice of kapalbhati as compared with the baseline values of different parameters.

Methods:

Various parameters were measured at baseline, during and after kapalbhati pranayam with the help of Dinamika HRV-Advanced HRV Test System, Moscow, Russia. Statistical analysis was accomplished employing repeated measures analysis of variance with Bonferroni post-hoc analysis and Holm’s multiple comparisons using the Version 28.0.0.0 of the Statistical Package for the Social Sciences (SPSS) for Windows (190) SPSS Inc., Chicago.

Results:

We found that during and after kapalbhati, changes in HRV were significant in time and frequency domain showing parasympathetic withdrawal and insignificant changes in brain waves as compared with reference point values.

Conclusion:

Kapalbhati is initially energizing, cleansing, and heating. There occurs parasympathetic withdrawal and sympathetic activation during pranayama. There is an increase gamma wave activation post pranayama showing control of the default mode network.

Effect of integrated approach of yoga and naturopathy on polycystic ovarian syndrome: A case study

Owing to stress, sedentary lifestyle and changes in diet pattern, there is an increase in the surge of lifestyle and metabolic disorders. Polycystic ovarian syndrome (PCOS) affects 8–13% of reproductive-aged women. PCOS is characterised by menstrual irregularity, hyperandrogenism and polycystic ovarian morphology (PCOM). The efficacy of yoga as a therapy to tackle the direct and indirect cause of ailment in the management of PCOS is to be documented. This is the case study of a female patient age 25 years, a diagnosed case of PCOS was registered at the Ayurveda, Yoga, Unani,Siddha,Homeopathy (AYUSH), yoga OPD, with complaints of irregular menstruation, treated successfully by Yoga and Naturopathy (Y and N), i.e., yoga, diet and lifestyle modification. This is evident from the reduction in weight, regularisation of the menstrual cycle along with morphological changes in the ovary after a follow-up of 6 months.

Effect of yoga on polycystic ovarian syndrome: A systematic review

Polycystic Ovarian Syndrome (PCOS) is not a disease but a mere syndrome. Many researchers have studied polycystic ovarian syndrome and found that there is no proper cause of that, it may occur due to hormonal imbalance or stress, or due to a sedentary lifestyle. The rate of polycystic ovarian syndrome in Indian women has been increasing rapidly. The symptoms include acne, weight gain, hirsutism, difficulties in fertility, irregular or infrequent periods, immature ovarian eggs that do not ovulate, multiple cysts in the ovary. If left untreated, it may become the cause for heart diseases, diabetes, hypertension, infertility, and even cancer. There are varieties of medical treatments available to treat polycystic ovarian syndrome but they have a temporary effect and if taken for a long time then it may lead to serious side effects. Yoga has proven effects in reducing and managing the symptoms of polycystic ovarian syndrome more effectively along with medicine. This review work has been designed to consider the available literature concerning the effectiveness of yoga in the management of the polycystic ovarian syndrome. It includes some research papers published between 2012 and 2019. By providing yogic treatment effect on several parameters (such as blood lipid level, glucose metabolism, endocrine parameters, quality of life, resting cardiovascular parameters, level of anxiety, depression) on the woman with polycystic ovarian syndrome were measured. After thoroughly studying about 74 research papers, 16 are found most relevant to be reviewed. The studies of these papers concluded the successful use of different yogic limbs for the management of polycystic ovarian syndrome with or without medications.

Assessing the effectiveness of a pharmaceutical care service on the quality of life of women with polycystic ovarian syndrome living in war and non-war countries

RATIONALE, AIMS, AND OBJECTIVES

Polycystic ovarian syndrome (PCOS) is a serious health problem that affects women of all ages worldwide, including their quality of life (QOL). Interventions on lifestyle modification can be a suitable therapy. This study aimed to evaluate the effect of a PCOS pharmaceutical care service on QOL for women diagnosed with PCOS living in Syria (a country affected by war) and Jordan (non-war-zone country).

METHODS

PCOS women from both Syria and Jordan with age above 16 years were recruited in the study. Women randomly allocated into active group received an educational intervention by the pharmacist (via oral and written educational module) with special focus on diet and exercise. Women allocated to the control group did not receive the educational intervention. Both groups were followed for 4 months. Women in both groups completed the QOL questionnaire at both baseline and end of study. Multiple-regression analysis was performed to identify factors associated with change in QOL scores across the study.

RESULTS

PCOS women (n = 118) from both Syria (n = 60) and Jordan (n = 58) were recruited. Unlike control group patients, QOL was significantly improved in the active group at the end of the study for Syrian (102.75 vs 118.50, P < 0.001) and Jordanian women (95.31 vs 112.67, P < 0.001). Study group (active versus control) and difference in anxiety scores across the study were the only independent variables that showed association with the dependent variable, difference in QOL mean scores across the study period.

CONCLUSION

A pharmacist led intervention on lifestyle modification delivered to PCOS women led to positive effects on QOL scores. The intervention was successful in Syria and Jordan. This highlights the significant role that pharmacists can play in improving the life of women with PCOS whether living in war or non-war-zone countries.

Efficacy of a Validated Yoga Protocol on Dyslipidemia in Diabetes Patients: NMB-2017 India Trial

Background: Dyslipidemia is considered a risk factor in Type 2 diabetes mellitus (T2DM) resulting in cardio-vascular complications. Yoga practices have shown promising results in alleviating Type 2 Diabetes pathology. Method: In this stratified trial on a Yoga based lifestyle program in cases with Type 2 diabetes, in the rural and urban population from all zones of India, a total of 17,012 adults (>20 years) of both genders were screened for lipid profile and sugar levels. Those who satisfied the selection criteria were taught the Diabetes Yoga Protocol (DYP) for three months and the data were analyzed. Results: Among those with Diabetes, 29.1% had elevated total cholesterol (TC > 200 mg/dL) levels that were higher in urban (69%) than rural (31%) Diabetes patients. There was a positive correlation (p = 0.048) between HbA1c and total cholesterol levels. DYP intervention helped in reducing TC from 232.34 ± 31.48 mg/dL to 189.38 ± 40.23 mg/dL with significant pre post difference (p < 0.001). Conversion rate from high TC (>200 mg/dL) to normal TC (<200 mg/dL) was observed in 60.3% of cases with Type 2 Diabetes Mellitus (T2DM); from high LDL (>130 mg/dL) to normal LDL (<130 mg/dL) in 73.7%; from high triglyceride (>200 mg/dL) to normal triglyceride level (<200 mg/dL) in 63%; from low HDL (<45 mg/dL) to normal HDL (>45 mg/dL) in 43.7% of T2DM patients after three months of DYP. Conclusions: A Yoga lifestyle program designed specifically to manage Diabetes helps in reducing the co-morbidity of dyslipidemia in cases of patients with T2DM.

Prevalence of anxiety and depression among women with Polycystic Ovary Syndrome living in war versus non-war zone countries: A randomized controlled trial assessing a pharmacist intervention

BACKGROUND

Polycystic ovary syndrome (PCOS) is a serious health problem. In women experiencing PCOS, there are myriad physical and mental health consequences; anxiety/depression are commonly associated with this condition. Community pharmacists are in a pivotal position to identify and help women diagnosed with PCOS.

OBJECTIVES

To investigate the prevalence/severity of anxiety/depression among females diagnosed with PCOS living in Syria (a war-zone country) and Jordan (a non-war zone country). Secondly, to evaluate the impact of a pharmaceutical care service delivered by a clinical pharmacist on participants' anxiety/depression severity.

METHODS

Females, diagnosed with PCOS above the age of 16, were recruited into the study and randomly allocated into either the active or the control group. The active group participants received a PCOS pharmaceutical care service. This service involved the provision of verbal and written educational materials, with a special focus on diet and exercise. The control group participants received only standard counseling. Both groups were followed up for four months. All participants completed the Beck Anxiety Inventory and the Beck Depression Inventory at baseline and follow-up.

RESULTS

Data from study participants (n = 118) from both Syria (n = 60) and Jordan (n = 58) highlighted a high prevalence of anxiety (Syria = 95% vs. Jordan = 98%) and depression (Syria = 83% vs. Jordan = 65%). At follow-up, active group participants, from both countries, showed significant improvements in anxiety and depression mean scores (anxiety: Syria = 34.97 ± 14.8 vs. 30.47 ± 14.3, p < 0.001; Jordan = 26.93 ± 13.7 vs. 23.37 ± 15.2, p < 0.001; depression: Syria = 26.53 ± 12.6 vs. 22.93 ± 12.2, p < 0.001; Jordan = 17.70 ± 11.0 vs. 15.76 ± 11.1, p = 0.049). No significant improvements were evident for control group participants from either countries.

CONCLUSION

Prevalence of anxiety/depression for females with PCOS living in Syria and in Jordan is high and calls for special attention by healthcare specialists and policymakers in both countries. Females, who received the PCOS pharmaceutical care service, showed significant improvements in anxiety/depression scores. Improvements were similar in both countries.