Effects of Various Prāṇāyāma on Cardiovascular and Autonomic Variables

Quran memorisation and heart rate variability: How do they correlate?

BACKGROUND

Heart rate variability (HRV) was shown to be affected by performing religious activities.

AIM

To examine the relationship between the level of Quran (the holy book of Muslims) memorisation and HRV among teenagers.

METHODS

This experimental study included 16 Tahfiz students and 16 non-Tahfiz students (n = 32). The HRV was measured in three tasks: Recalling familiar verses, memorising new verses, and recalling the newly memorised verses of the Quran. HRV analysis was done using these parameters: Standard deviation of N-N (heartbeat peak) interval; low frequency (LF); high frequency (HF) and LF/HF ratio.

RESULTS

There were significant differences between tasks for all parameters (P < 0.05). However, between the groups, only the LF/HF ratio had significant differences, with F = 5.04, P < 0.05. Pearson correlation showed a moderate positive correlation between the number of pages memorised and the LF/HF ratio (r = 0.61, P < 0.05).

CONCLUSION

Quran memorisation increased the HRV and our results suggested that this activity could be developed as an effective sympathovagal modulation training activity.

A study to assess the effect of yoga and diet on Framingham risk score among high-risk cardiovascular subjects

Introduction

Cardiovascular diseases (CVDs) are a cluster of disorders of blood vessels and the heart. As a form of physical activity, yoga postures, and pranayama have been shown to be beneficial in various health conditions, i.e. hypertension, prediabetes, and diabetes among high-risk subjects. This study aimed to evaluate the impact of yoga and diet on the Framingham risk score (FRS) among high-risk cardiovascular subjects.

Materials and Methods

The experimental interventional study was conducted at "RUHS College of Medical Sciences" and Associated Group of Hospitals", Jaipur among high-risk cardiovascular subjects. FRS was used as a measurement for the outcome of interest at baseline and six months of yoga diet intervention in the study and control groups.

Results

Mean age of participants was 48.43 ± 6.4 years. Baseline values (mean ± SD) of FRS 24.59 ± 10.15 after six months of yogic lifestyle 15.1 ± 7.05. After six months of yogic lifestyle FRS scores and estimated 10-year cardiovascular risk were statistically significantly (P < 0.0001) decreased. Pearson correlation analysis results depict that FRS correlation. There was a strong positive correlation between the FRS score and total cholesterol (r = 0.787; P < 0.001) and a negative strong correlation between the FRS score and high-density lipoprotein was observed (r =-0.621; P < 0.002).

Conclusion

The findings of this study conclude that six months of yoga and diet lifestyle intervention significantly decreased FRS among high-risk CVD subjects compared to the control group.

Effectiveness of Yoga in Modulating Markers of Immunity and Inflammation: A Systematic Review and Meta-Analysis

Chronic inflammation is central to the pathogenesis of many chronic inflammatory conditions. This review aims to analyze whether the practice of yoga, or yogic meditation and breathing, has any effect on the levels of inflammatory cytokines and other inflammatory markers in patients with various chronic inflammatory diseases such as rheumatoid arthritis, neoplastic disorders, and asthma, as well as in healthy subjects, compared to usual care or sham interventions. A comprehensive search of databases (PubMed, CENTRAL, Embase, and CINAHL) was performed. Randomized controlled trials (RCTs) that evaluated the effects of yoga as an intervention on inflammatory markers were analyzed. A total of 26 studies were included. Only two studies had a low risk of bias (RoB); 24 other studies had a high RoB. Most studies (n=24) reported a favorable outcome with yoga, irrespective of the type of yoga used, the condition studied, and the duration of the intervention. The commonly reported inflammatory markers included IL-6 (n=17), tumor necrosis factor-alpha (TNF-a) (n=13), and C-reactive protein (CRP) (n=10). Most studies showed a significant reduction in inflammatory markers in the yoga group (YG) compared to the control group (CG). Few studies also showed significant improvement in markers of cellular immunity (interferon gamma (IFN-g), IL-10, and transforming growth factor-beta (TGF-b); n=2 each) and improved mucosal defense (IgA, IL-6, and IL-2; n=2 each). A meta-analysis of IL-6, TNF-a, and CRP showed yoga had a favorable effect on the levels of these markers, but it was not statistically significant. Current evidence suggests that yoga can be a complementary intervention for various chronic inflammatory conditions. However, the quality of the evidence is poor, along with considerable heterogeneity. In the future, investigators should describe the intervention better, with a uniform assortment of outcome measures and treatment conditions, to generate high-quality evidence.

Therapeutic role of yoga in hypertension

Systemic hypertension is an established risk factor for coronary artery disease and cerebrovascular accident and control of blood pressure reduces the risk of a major cardiovascular event. Both non-pharmacological and pharmacological treatment options are available to treat hypertension. Yoga, recently received more attention as a treatment modality for various lifestyle disorders, even though practiced in India since ancient times. In this review, we are analyzing the role of yoga in the treatment of systemic hypertension.

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.

Lessons From India: A Narrative Review of Integrating Yoga Within the US Healthcare System

The ancient practice of yoga has gained worldwide popularity as a way for people to improve their overall health and well-being. This manuscript reviews and examines the history of yoga, its physical and mental health benefits, its incorporation into the Indian healthcare system, and the public perception of yoga in India. Many initiatives for yoga exist, including promoting research on yoga, providing education and information on its benefits, and developing evidence-based standardized yoga therapy guidelines. With this in mind, this narrative review article explores the potential benefits of incorporating yoga into the United States (US) healthcare system and the possible challenges of doing so. It also provides valuable insights for policymakers and healthcare professionals.

Mitochondria: It is all about energy

Mitochondria play a key role in both health and disease. Their function is not limited to energy production but serves multiple mechanisms varying from iron and calcium homeostasis to the production of hormones and neurotransmitters, such as melatonin. They enable and influence communication at all physical levels through interaction with other organelles, the nucleus, and the outside environment. The literature suggests crosstalk mechanisms between mitochondria and circadian clocks, the gut microbiota, and the immune system. They might even be the hub supporting and integrating activity across all these domains. Hence, they might be the (missing) link in both health and disease. Mitochondrial dysfunction is related to metabolic syndrome, neuronal diseases, cancer, cardiovascular and infectious diseases, and inflammatory disorders. In this regard, diseases such as cancer, Alzheimer's, Parkinson's, amyotrophic lateral sclerosis (ALS), chronic fatigue syndrome (CFS), and chronic pain are discussed. This review focuses on understanding the mitochondrial mechanisms of action that allow for the maintenance of mitochondrial health and the pathways toward dysregulated mechanisms. Although mitochondria have allowed us to adapt to changes over the course of evolution, in turn, evolution has shaped mitochondria. Each evolution-based intervention influences mitochondria in its own way. The use of physiological stress triggers tolerance to the stressor, achieving adaptability and resistance. This review describes strategies that could recover mitochondrial functioning in multiple diseases, providing a comprehensive, root-cause-focused, integrative approach to recovering health and treating people suffering from chronic diseases.

Dismantling the Component-Specific Effects of Yogic Breathing: Feasibility of a Fully Remote Three-Arm RCT with Virtual Laboratory Visits and Wearable Physiology

Despite the growing research base examining the benefits and physiological mechanisms of slow-paced breathing (SPB), mindfulness (M), and their combination (as yogic breathing, SPB + M), no studies have directly compared these in a "dismantling" framework. To address this gap, we conducted a fully remote three-armed feasibility study with wearable devices and video-based laboratory visits. Eighteen healthy participants (age 18-30 years, 12 female) were randomized to one of three 8-week interventions: slow-paced breathing (SPB, N = 5), mindfulness (M, N = 6), or yogic breathing (SPB + M, N = 7). The participants began a 24-h heart rate recording with a chest-worn device prior to the first virtual laboratory visit, consisting of a 60-min intervention-specific training with guided practice and experimental stress induction using a Stroop test. The participants were then instructed to repeat their assigned intervention practice daily with a guided audio, while concurrently recording their heart rate data and completing a detailed practice log. The feasibility was determined using the rates of overall study completion (100%), daily practice adherence (73%), and the rate of fully analyzable data from virtual laboratory visits (92%). These results demonstrate feasibility for conducting larger trial studies with a similar fully remote framework, enhancing the ecological validity and sample size that could be possible with such research designs.

Sarveghna Lakshmi. A study on immediate and training effect of Bhramari pranayama on heart rate variability in healthy adolescents

Introduction and Aim: Bhramari pranayama (Humming bee breath) is the most common slow pranayama practice involving inhalation through both nostrils followed by exhalation which produces sound of humming bee. Practicing pranayama reduces the effects of stress on different systems by increasing the vagal tone. With the ongoing COVID-19 pandemic, there are heightened feelings of stress, anxiety and depression and pranayama can be an effective way to improve our mental and emotional well-being. This study has been chosen to assess the effect of Bhramari pranayama on autonomic functions and to compare the immediate and training effects of Bhramari pranayama in the study group. Materials and Methods: An observational study was conducted in a medical college among 110 students aged between 18-22 years for a period of 2 months. The participants were instructed to do 9 rounds of Bhramari pranayama every day for 3 weeks. The immediate and training effect of pranayama practice on HRV (Heart Rate Variability) was assessed. The parameters of HRV (time and frequency domains) were assessed by PHYSIOPAC- PP4 (MEDICAID SYSTEMS, Chandigarh). Results: After training of Bhramari pranayama for 3 weeks, there was a decrease in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and PNN50 and a decrease in frequency domain parameters, LFnu and LF/HF ratio were observed significantly. Conclusion: The study shows the possibility that Bhramari pranayama has a beneficial effect on HRV in medical students, as the autonomic balance produces the improvement of parasympathetic tone.  

Yoga practices in Social Anxiety Disorder (SAnD): A case report WSR to paruresis

Social anxiety disorder has characteristic features of the overwhelming anxiety and apprehensions especially in public gatherings. There is always a false perception in mind that someone is continuously watching, noticing or judging their activities. Many of times the situation is associated with some unusual behavioral problem like shy bladder syndrome, in which the person even cannot urinate in public restrooms. In the present case report, a patient was suffering from paruresis-specific social phobia. After administration of Yogasana, Pranayam, Omkar chanting and meditation practices by him under the supervision of yoga experts, significant improvement was noticed in multiple parameters. Subjective assessment on different scales was done before and after yogabhyasa. By regular yoga practices Liebowitz Social Anxiety Scale (LSAS) score was reduced 60.97%, Social Phobia Inventory (SPIN) score was reduced 56.25%, Shy Bladder Scale (SBS) score was reduced up to 59.42% and WHO Quality of life questionnaire- WHO QoL- BREF score was improved 56.81% in physical domain (D1), 34% in psychological domain (D2), 10.34% in social relationship domain and 27.91% in environment domain (D4). Hence, it can be concluded that yoga and meditation practices may play a good role in Social anxiety cases.

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Paruresis-specific social phobia is rare clinical entity. Here, we managed such a case fighting with this specific problem.

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We administered a specific tailored yoga and meditation module for six months.

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We found improvement in Liebowitz Social Anxiety Scale (LSAS) score, Social Phobia Inventory (SPIN) score, Shy Bladder Scale (SBS) score and WHO QoL- BREF score.

A Preliminary Study on the Effect of Bhramari Pranayama on Voice of Prospective Singers

INTRODUCTION

Bhramari Pranayama (BP) is a yogic breathing technique that involves producing a vibrating constant pitch sound emulating the buzzing of bumblebee. Since BP deals with breathing and humming in the sustained pitch, it is hypothesized that it can have implications for improving voice quality in individuals. However, there is a dearth of research available to support this assumption. Further, there are no published reports on the effect of BP on voice quality in prospective singers group.

AIM

Current study was taken up to explore the effect induced by BP in the voice characteristics/quality of prospective singers.

METHOD

The participants included 30 healthy prospective singers in the age range of 18-35 years who were attending music schools within the state of Karnataka, India. BP regimen was demonstrated to all individuals. The voice recordings of the participants were obtained on day 0 and day 30 of BP practice. Acoustic analysis was performed to obtain AVQI and its constituent parameters and voice parameters from the MDVP program.

RESULT

Among the AVQI and its constituent parameters, Cepstral peak prominence-smoothed, Slope LTAS, and Tilt LTAS showed significant differences before and after BP. MDVP showed a significant difference in tremor measures before and after the practice of BP.

DISCUSSION

Results of the present study indicated positive effects of BP on the voice characteristics of the prospective singers and it is reflected in objective acoustic outcome parameters of AVQI and MDVP. This supports the assumption that BP which involves yogic breathing will have beneficial effects on vocal physiology in turn leading to improved voice quality in these individuals. However, it is of future interest to validate these findings on larger samples and populations with different outcome measures. Also, future studies are warranted to verify the efficacy of BP in improving vocal quality and vocal efficiency of individuals with dysphonia.

Can Breathing Exercise or Pranayama Affect the Intraocular Pressure in the Short-term?

PURPOSE

To demonstrate any transient short-term effect of a particular type of breathing exercise (alternate nostril breathing of Nadi Shuddhi type of pranayama exercise) on the intraocular pressure (IOP) in glaucomatous as well as healthy eyes.

METHODS

A prospective, nonrandomized, observational, cross-sectional study was conducted in a tertiary eyecare hospital setup recruiting 3 groups of subjects-glaucoma group and a normal group that underwent the breathing exercise as well as a normal group that did not. IOP was recorded at baseline, then at 4 minutes after 10 cycles of the breathing exercise and also after 10 minutes of rest-corresponding to IOPb, IOPc, and IOPr of all the study groups. Only those subjects were recruited who were above 18 and under 80 years and were naive to breathing exercise.

RESULTS

A total of 56 normal eyes (28 subjects, Normalb) and 33 glaucomatous eyes (19 subjects) were recruited for the breathing exercise and were compared with the IOP as obtained for 26 eyes of 26 subjects that did not undergo the breathing exercise (Normalnb). IOPb did not differ between both normal groups (13.7±1.4 mm Hg in Normalb vs. 13.9±1.6 mm Hg in Normalnb, P=0.183) but was significantly different between groups (16.7±3.1 mm Hg in the glaucoma group and 13.7±1.4 in Normalb, P<0.001 and Normalnb 13.9±1.6 mm Hg, P<0.001) but analysis of variance was not significant within groups comparing IOPb, IOPc, and IOPr of all the study groups.

CONCLUSION

There is no short-term transient effect of alternate nostril breathing exercise on IOP; a longitudinal study is recommended.

Evaluation of Cardiovascular Functions during the Practice of Different Types of Yogic Breathing Techniques

Introduction:

Yoga is the science of right living practice to promote health. Many studies have documented the cardiovascular effects of various yogic breathing techniques (YBTs), comparing the cardiovascular changes before and after the practice. However, there is a lack of study reporting the cardiovascular changes during the practice of YBT.

Materials and Methods:

Twenty healthy individuals performed four different YBTs (Bhastrika, Bhramari, Kapalbhati, and Kumbhaka) in four different orders. Cardiovascular variables such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO), pulse interval (PI), and total peripheral resistant (TPR) were assessed using a continuous noninvasive blood pressure monitoring system, before, during, and immediately after each YBT. Data were analyzed using repeated measures analysis of variance followed by post hoc analysis with Bonferroni adjustment for multiple comparisons using Statistical Package for the Social Sciences, Version 16.0.

Results:

Results of this study showed a significant increase in DBP, MAP, HR, and CO along with a reduction in PI during Bhastrika; a significant increase in DBP, MAP, HR, and TPR with a reduction in SV, CO, and PI during Bhramari pranayama; a significant increase in SBP, DBP, MAP, HR, and CO with a reduction in PI during Kapalbhati; and a significant increase in SBP, DBP, MAP, and TPR with a reduction in SV and CO during Kumbhaka practice.

Conclusion:

In healthy individuals, cardiovascular changes during the practice of Bhastrika and Kapalbhati are more or less similar to each other and are different from those of Bhramari and Kumbhaka in most of the variables.

Harnessing the Neurobiology of Resilience to Protect the Mental Well-Being of Healthcare Workers During the COVID-19 Pandemic

Healthcare workers are at a high risk of psychological morbidity in the face of the COVID-19 pandemic. However, there is significant variability in the impact of this crisis on individual healthcare workers, which can be best explained through an appreciation of the construct of resilience. Broadly speaking, resilience refers to the ability to successfully adapt to stressful or traumatic events, and thus plays a key role in determining mental health outcomes following exposure to such events. A proper understanding of resilience is vital in enabling a shift from a reactive to a proactive approach for protecting and promoting the mental well-being of healthcare workers. Research in the past decade has identified six areas that provide promising leads in understanding the biological basis of individual variations in resilience. These are: (1) the key role played by the monoamines noradrenaline and serotonin, (2) the centrality of the hypothalamic-pituitary-adrenal axis in influencing stress vulnerability and resilience, (3) the intimate links between the immune system and stress sensitivity, (4) the role of epigenetic modulation of gene expression in influencing the stress response, (5) the role played by certain neuropeptides as a natural “brake” mechanism in the face of stress, and (6) the neurobiological mechanisms by which environmental factors, such as exercise, diet, and social support, influence resilience to subsequent life events. Though much of this research is still in its early stages, it has already provided valuable information on which strategies – including dietary changes, lifestyle modification, environmental modification, psychosocial interventions, and even pharmacological treatments – may prove to be useful in fostering resilience in individuals and groups. This paper examines the above evidence more closely, with a specific focus on the challenges faced by healthcare workers during the COVID-19 pandemic, and provides suggestions regarding how it may be translated into real-world interventions, as well as how the more tentative hypotheses advanced in this field may be tested during this critical period.

Impact of Yoga on Cardiac Autonomic Function and Arrhythmias

With the expanding integration of complementary and alternative medicine (CAM) practices in conjunction with modern medicine, yoga has quickly risen to being one of the most common CAM practices across the world. Despite widespread use of yoga, limited studies are available, particularly in the setting of dysrhythmia. Preliminary studies demonstrate promising results from integration of yoga as an adjunct to medical therapy for management of dysrhythmias. In this review, we discuss the role of autonomic nervous system in cardiac arrhythmia,interaction of yoga with autonomic tone and its subsequent impact on these disease states. The role of yoga in specific disease states, and potential future direction for studies assessing the role of yoga in dysrhythmia.

Autonomic Tone and Baroreflex Sensitivity during 70° Head-up Tilt in Yoga Practitioners

Introduction:

The intervention of yoga was shown to improve the autonomic conditioning in humans evident from the enhancement of parasympathetic activity and baroreflex sensitivity (BRS). From the documented health benefits of yoga, we hypothesized that the experience of yoga may result in adaptation to the orthostatic stress due to enhanced BRS.

Aim:

To decipher the effects of yoga in the modulation of autonomic function during orthostatic challenge.

Materials and Methods:

This was a comparative study design conducted in autonomic function test lab, of the Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. Heart rate variability (HRV), blood pressure variability, and BRS were analyzed on forty naïve to yoga (NY) subjects and forty yoga practitioners with an average age of 31.08 ± 7.31 years and 29.93 ± 7.57 years, respectively. All participants were healthy. Seventy degrees head up tilt (HUT) was used as an intervention to evaluate the cardiovascular variability during orthostatic challenge.

Results:

During HUT, the R-R interval (P = 0.042), root mean square of succesive R-R interval differences (RMSSD) (P = 0.039), standard deviation of instantaneous beat-to-beat R-R interval variability (SD1) (P = 0.039) of HRV, and sequence BRS (P = 0.017) and α low frequency of spectral BRS (P = 0.002) were higher in the yoga group. The delta decrease in RRI (P = 0.033) and BRS (P < 0.01) was higher in the yoga group than the NY group.

Conclusion:

The efferent vagal activity and BRS were higher in yoga practitioners. The delta change (decrease) in parasympathetic activity and BRS was higher, with relatively stable systolic blood pressure indicating an adaptive response to orthostatic challenge by the yoga practitioners compared to the NY group.

Changes in Heart Rate Variability after Yoga are Dependent on Heart Rate Variability at Baseline and during Yoga: A Study Showing Autonomic Normalization Effect in Yoga-Naïve and Experienced Subjects

Background:

Yoga therapy is widely applied to the maintenance of health and to treatment of various illnesses. Previous researches indicate the involvement of autonomic control in its effects, although the general agreement has not been reached regarding the acute modulation of autonomic function.

Aim:

The present study aimed at revealing the acute effect of yoga on the autonomic activity using heart rate variability (HRV) measurement.

Methods:

Twenty-seven healthy controls participated in the present study. Fifteen of them (39.5 ± 8.5 years old) were naïve and 12 (45.1 ± 7.0 years old) were experienced in yoga. Yoga skills included breath awareness, two types of asana, and two types of pranayama. HRV was measured at the baseline, during yoga, and at the resting state after yoga.

Results:

In both yoga-naïve and experienced participants, the changes in low-frequency (LF) component of HRV and its ratio to high-frequency (HF) component (LF/HF) after yoga were found to be correlated negatively with the baseline data. The changes in LF after yoga were also correlated with LF during yoga. The changes in HF as well as the raw HRV data after yoga were not related to the baseline HRV or the HRV during yoga.

Conclusion:

The results indicate that yoga leads to an increase in LF when LF is low and leads to a decrease in LF when it is high at the baseline. This normalization of LF is dependent on the autonomic modulation during yoga and may underlie the clinical effectiveness of yoga therapy both in yoga-naïve and experienced subjects.

Effects of Yoga Respiratory Practice (Bhastrika pranayama) on Anxiety, Affect, and Brain Functional Connectivity and Activity: A Randomized Controlled Trial

Pranayama refers to a set of yoga breathing exercises. Recent evidence suggests that the practice of pranayama has positive effects on measures of clinical stress and anxiety. This study explored the impact of a Bhastrika pranayama training program on emotion processing, anxiety, and affect. We used a randomized controlled trial design with thirty healthy young adults assessed at baseline and after 4 weeks of pranayama practices. Two functional magnetic resonance imaging (MRI) protocols were used both at baseline and post-intervention: an emotion task as well as a resting-state acquisition. Our results suggest that pranayama significantly decreased states of anxiety and negative affect. The practice of pranayama also modulated the activity of brain regions involved in emotional processing, particularly the amygdala, anterior cingulate, anterior insula, and prefrontal cortex. Resting-state functional MRI (fMRI) showed significantly reduced functional connectivity involving the anterior insula and lateral portions of the prefrontal cortex. Correlation analysis revealed that changes in connectivity between the ventrolateral prefrontal cortex and the right anterior insula were associated with changes in anxiety. Although it should be noted that these analyses were preliminary and exploratory, it provides the first evidence that 4 weeks of B. pranayama significantly reduce the levels of anxiety and negative affect, and that these changes are associated with the modulation of activity and connectivity in brain areas involved in emotion processing, attention, and awareness. The study was registered at https://www.ensaiosclinicos.gov.br/rg/RBR-2gv5c2/(RBR-2gv5c2).

Exploring the Therapeutic Benefits of Pranayama (Yogic Breathing): A Systematic Review

Background:

Pranayama (yogic breathing) has demonstrated numerous beneficial health effects. At present, there are no systematic reviews evaluating the beneficial health effects of pranayama alone as a practice.

Aim:

The aim of this study is to perform a systematic review about the beneficial health effects of pranayama.

Methods:

Data were obtained using a stepwise search process by searching the online PubMed, Web of Science, and SciVerse Scopus databases using keywords. Controlled clinical trials in humans, using “Pranayama” as an intervention with an appropriate control group and evaluating health-related outcomes were selected for inclusion.

Results:

Initial database searching indicated 669 potentially eligible articles, of which 18 studies satisfying the inclusion/exclusion criteria were selected. All were controlled trials, of which 13 were randomized and 1 was a crossover study. Number of participants ranged from 16 to 160, and the duration of pranayama practice varied from 4 days to 6 months. Studies demonstrated a significant effect on cardiorespiratory functions, in patients with bronchial asthma, with the improvement of pulse rate, systolic blood pressure, and respiratory function measurements. Furthermore, reduction in the frequency of attacks, severity, and medication requirement was also observed, with improved quality of life (QOL). In patients with chronic obstructive pulmonary disease, symptom, activity, and impact scores were improved. QOL improvement was also noted in cancer patients.

Conclusions:

Available evidence on pranayama indicates physiological and psychological benefits. Beneficial effects were mostly observed in patients with respiratory diseases such as bronchial asthma. It also helped those with cancer and cardiovascular disease. However, further high-quality randomized trials are required to provide definitive evidence.

A Perspective on Yoga as a Preventive Strategy for Coronavirus Disease 2019

The pandemic outbreak of coronavirus disease 2019 (COVID-19) infection caused by severe acute respiratory syndrome-coronavirus 2 has led to profound public health crisis. In particular, individuals with preexisting conditions of heart disease, diabetes, cerebrovascular diseases and the elderly are most vulnerable to succumb to this infection. The current COVID-19 emergency calls for rapid development of potential prevention and management strategies against this virus-mediated disease. There is a plethora of evidence that supports the add-on benefits of yoga in stress management, as well as prevention and management of chronic noncommunicable diseases. There are some studies on the effect of yoga in communicable diseases as well but very few for acute conditions and almost none for the rapidly spreading infections resulting in pandemics. Based on the available scientific evidences on yoga in improving respiratory and immune functions, we have formulated very simple doable integrated yoga modules in the form of videos to be practiced for prevention of the disease by children, adults, and the elderly.

Can Machine Learning Predict Stress Reduction Based on Wearable Sensors’ Data Following Relaxation at Workplace? A Pilot Study

Nowadays, psychological stress represents a burdensome condition affecting an increasing number of subjects, in turn putting into practice several strategies to cope with this issue, including the administration of relaxation protocols, often performed in non-structured environments, like workplaces, and constrained within short times. Here, we performed a quick relaxation protocol based on a short audio and video, and analyzed physiological signals related to the autonomic nervous system (ANS) activity, including electrocardiogram (ECG) and galvanic skin response (GSR). Based on the features extracted, machine learning was applied to discriminate between subjects benefitting from the protocol and those with negative or no effects. Twenty-four healthy volunteers were enrolled for the protocol, equally and randomly divided into Group A, performing an audio-video + video-only relaxation, and Group B, performing an audio-video + audio-only protocol. From the ANS point of view, Group A subjects displayed a significant difference in the heart rate variability-related parameter SDNN across the test phases, whereas both groups displayed a different GSR response, albeit at different levels, with Group A displaying greater differences across phases with respect to Group B. Overall, the majority of the volunteers enrolled self-reported an improvement of their well-being status, according to structured questionnaires. The use of neural networks helped in discriminating those with a positive effect of the relaxation protocol from those with a negative/neutral impact based on basal autonomic features with a 79.2% accuracy. The results obtained demonstrated a significant heterogeneity in autonomic effects of the relaxation, highlighting the importance of maintaining a structured, well-defined protocol to produce significant benefits at the ANS level. Machine learning approaches can be useful to predict the outcome of such protocols, therefore providing subjects less prone to positive responses with personalized advice that could improve the effect of such protocols on self-relaxation perception.

Effects of a short mindful-breathing intervention on the psychophysiological stress reactions of German elementary school children

This research investigates whether a short mindfulness exercise can reduce children’s psychophysiological stress reactions in the face of a performance task. To answer the question, a randomized controlled trial with 106 elementary school children, aged between 5 and 11 years, was conducted. An intervention group completed a two-minute breathing exercise, whilst a comparison group watched a short video, before both groups performed a stress-evoking Stroop test. The stress levels of both groups were measured via galvanic skin response and compared. It was hypothesized that the comparison group would show a higher stress reaction during the stress-evoking task than the intervention group. Contrary to the hypothesis, results show that the intervention group had a higher psychophysiological stress reaction during the task than the comparison group. However, the stress reaction to the announced difficulty of the task was smaller in the mindfulness group than in the comparison group. Results are discussed based on different theoretical mechanisms of mindfulness. Directions for future research include the use of different techniques and durations of mindfulness interventions, different control group activities and stress-test operationalizations, as well as the distinction between age groups.

Default Mode Network, Meditation, and Age-Associated Brain Changes: What Can We Learn from the Impact of Mental Training on Well-Being as a Psychotherapeutic Approach?

Aging is a physiological process accompanied by cognitive decline, principally in memory and executive functions. Alterations in the connectivity of the default mode network (DMN) have been found to participate in cognitive decline, as well as in several neurocognitive disorders. The DMN has antisynchronic activity with attentional networks (task-positive networks (TPN)), which are critical to executive function and memory. Findings pointing to the regulation of the DMN via activation of TPN suggest that it can be used as a strategy for neuroprotection. Meditation is a noninvasive and nonpharmacological technique proven to increase meta-awareness, a cognitive ability which involves the control of both networks. In this review, we discuss the possibility of facilitating healthy aging through the regulation of networks through meditation. We propose that by practicing specific types of meditation, cognitive decline could be slowed, promoting a healthy lifestyle, which may enhance the quality of life for the elderly.

Effectiveness and cost-effectiveness of a Yoga-based Cardiac Rehabilitation (Yoga-CaRe) program following acute myocardial infarction: Study rationale and design of a multi-center randomized controlled trial

BACKGROUND

Cardiac rehabilitation (CR) is a standard treatment for secondary prevention of acute myocardial infarction (AMI) in high income countries (HICs), but it is inaccessible to most patients in India due to high costs and skills required for multidisciplinary CR teams. We developed a low-cost and scalable CR program based on culturally-acceptable practice of yoga (Yoga-CaRe). In this paper, we report the rationale and design for evaluation of its effectiveness and cost-effectiveness.

METHODS

This is a multi-center, single-blind, two-arm parallel-group randomized controlled trial across 22 cardiac care hospitals in India. Four thousand patients aged 18-80 years with AMI will be recruited and randomized 1:1 to receive Yoga-CaRe program (13 sessions supervised by an instructor and encouragement to self-practice daily) or enhanced standard care (3 sessions of health education) delivered over a period of three months. Participants will be followed 3-monthly till the end of the trial. The co-primary outcomes are a) time to occurrence of first cardiovascular event (composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke and emergency cardiovascular hospitalization), and b) quality of life (Euro-QoL-5L) at 12 weeks. Secondary outcomes include need for revascularization procedures, return to pre-infarct activities, tobacco cessation, medication adherence, and cost-effectiveness of the intervention.

CONCLUSION

This trial will alone contribute >20% participants to existing meta-analyses of randomized trials of CR worldwide. If Yoga-CaRe is found to be effective, it has the potential to save millions of lives and transform care of AMI patients in India and other low and middle income country settings.

How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing

Background: The psycho-physiological changes in brain-body interaction observed in most of meditative and relaxing practices rely on voluntary slowing down of breath frequency. However, the identification of mechanisms linking breath control to its psychophysiological effects is still under debate. This systematic review is aimed at unveiling psychophysiological mechanisms underlying slow breathing techniques (<10 breaths/minute) and their effects on healthy subjects.

Methods: A systematic search of MEDLINE and SCOPUS databases, using keywords related to both breathing techniques and to their psychophysiological outcomes, focusing on cardio-respiratory and central nervous system, has been conducted. From a pool of 2,461 abstracts only 15 articles met eligibility criteria and were included in the review. The present systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: The main effects of slow breathing techniques cover autonomic and central nervous systems activities as well as the psychological status. Slow breathing techniques promote autonomic changes increasing Heart Rate Variability and Respiratory Sinus Arrhythmia paralleled by Central Nervous System (CNS) activity modifications. EEG studies show an increase in alpha and a decrease in theta power. Anatomically, the only available fMRI study highlights increased activity in cortical (e.g., prefrontal, motor, and parietal cortices) and subcortical (e.g., pons, thalamus, sub-parabrachial nucleus, periaqueductal gray, and hypothalamus) structures. Psychological/behavioral outputs related to the abovementioned changes are increased comfort, relaxation, pleasantness, vigor and alertness, and reduced symptoms of arousal, anxiety, depression, anger, and confusion.

Conclusions: Slow breathing techniques act enhancing autonomic, cerebral and psychological flexibility in a scenario of mutual interactions: we found evidence of links between parasympathetic activity (increased HRV and LF power), CNS activities (increased EEG alpha power and decreased EEG theta power) related to emotional control and psychological well-being in healthy subjects. Our hypothesis considers two different mechanisms for explaining psychophysiological changes induced by voluntary control of slow breathing: one is related to a voluntary regulation of internal bodily states (enteroception), the other is associated to the role of mechanoceptors within the nasal vault in translating slow breathing in a modulation of olfactory bulb activity, which in turn tunes the activity of the entire cortical mantle.

Therapeutic Role of Yoga in Type 2 Diabetes

Yoga originated in India more than 5,000 years ago and is a means of balancing and harmonizing the body, mind, and emotions. Yoga practice is useful in the management of various lifestyle diseases, including type 2 diabetes. Psycho-neuro-endocrine and immune mechanisms are involved in the beneficial effects of yoga on diabetes. Incorporation of yoga practice in daily life helps to attain glycaemic control and reduces the risk of complications in people with diabetes. In this review, we briefly describe the role of various yoga practices in the management of diabetes based on evidence from various clinical studies.

Influence of Time of Yoga Practice and Gender Differences on Blood Glucose Levels in Type 2 Diabetes Mellitus and Normal Healthy Adults

BACKGROUND

Prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Many studies have demonstrated the effectiveness of yoga in improving glycaemic control, whereas no studies are available showing the impact of time of practice on glucose levels. The current study explores the effect of time of yoga practice on glucose levels in community-dwelling adults with and without T2DM.

MATERIALS AND METHODS

A total of 189 subjects with T2DM and 121 subjects without T2DM underwent a 10-day yoga program which includes practical and theory lecture sessions for 60min every day, either in the morning or evening. Baseline and post-intervention assessments of fasting plasma glucose (FPG) were measured on day-1 and day-10, respectively. Data analysis were done using Statistical Package for the Social Sciences (SPSS), version 16.

RESULTS

Results of the study showed that in individuals with T2DM, a significantly higher reduction in FPG was observed while practicing yoga in the evening sessions than in the morning sessions. Likewise, a significant reduction in FPG was observed only in women who practiced yoga in the evening than in the morning, in non-diabetic healthy individuals, while the reduction was not statistically significant in men.

CONCLUSION

Results of this study suggest that reduction in FPG level was better while practicing yoga in evening than morning. Similarly, women had a better reduction in blood glucose level than men.

Effects of Shambhavi Mahamudra Kriya, a Multicomponent Breath-Based Yogic Practice ( Pranayama), on Perceived Stress and General Well-Being

Stress-induced disorders such as anxiety represent the leading causes of adult disability worldwide. Previous studies indicate that yoga and other contemplative practices such as pranayama, or controlled yogic breathing techniques, may be effective in the treatment of mood disorders and stress. In this study, 142 individuals (mean age = 43 years; SD = 13.90) participated in a 3-day retreat program during which they learned Shambhavi Mahamudra kriya, which is a yogic practice that includes both deep breathing and meditation techniques. Participants were instructed to practice the kriya each day for 21 minutes. After 6 weeks of daily practice, participants reported subjectively lower levels of perceived stress (Perceived Stress Scale) and higher levels of general well-being (General Well-Being Scale) compared to baseline. These results support the notion that Shambhavi Mahamudra kriya may represent a natural treatment for stress reduction.