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.

Effect of Right Nostril Breathing on Cardiorespiratory Parameters and Reaction Time in Young, Healthy Humans: An Interventional Study

Background and Objective

Yogic breathing helps in reduction of stress and strain in the body. Right and left nostril breathings (RNB and LNB, respectively) have different effects on cardiorespiratory parameters. The study was performed to examine the effect of RNB exercise on cardiorespiratory parameters and reaction time in young, healthy human volunteers.

Materials and Methods

In this prospective, interventional study, 110 young healthy volunteers underwent systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), respiratory rate (RR), vital capacity (VC), peak expiratory flow rate (PEFR), and reaction time (RT) examination before and after 2 weeks of performing 45 min of RNB exercise daily.

Results

There was notable increment in SBP (113.39 ± 17.72 vs. 117.74 ± 10.83 mmHg, P = 0.002) and DBP (67.64 ± 10.32 vs. 71.27 ± 8.68 mmHg, P = 0.002). PR increased nonsignificantly (86.44 ± 12.65/min vs. 87.32 ± 13.43/min, P = 0.476). Significant decrease in RR (14.40 ± 2.48/min vs. 12.31 ± 2.23/min, P < 0.0001) was observed. VC (3.57 ± 0.57 vs. 3.82 ± 0.55 L/min, P < 0.0001) and PEFR (441.36 ± 50.22 vs. 468.91 ± 53.66 L/min, P < 0.0001) also increased significantly. Substantial reduction in auditory reaction time (ART) (165.58 ± 32.18 vs. 147.42 ± 23.39 ms, P < 0.0001) and visual reaction time (VRT) (191.04 ± 37.94 vs. 165.86 ± 28.74 ms, P < 0.0001) was seen. After engaging in cardiorespiratory exercise, the maximal heart rate (MHR) remained unchanged (P = 0.929).

Conclusion

RNB results in increase in blood pressure, heart rate, VC, and PEFR and decrease in ART and VRT. Further studies in patients with cardiorespiratory diseases are necessary to understand its clinical utility.

Effects of Pranayama on Cancer Patients: A Narrative Review of Clinical Outcomes

Pranayama, a set of yogic breathing techniques, is being studied as a potential supportive care option for cancer patients. This review intends to evaluate the effectiveness of Pranayama in enhancing the quality of life and well-being of cancer patients based on evidence from randomized controlled trials. We thoroughly searched databases for studies published between 2013 and 2023. We focused on randomized controlled trials that compared Pranayama interventions with non-yoga control groups. We assessed the primary outcomes, including psychological well-being, quality of life, physiological parameters, and treatment-related side effects. The review indicates that practicing Pranayama can lead to significant improvements in antioxidant levels, stress, anxiety, sleep quality, and overall quality of life for cancer patients. However, the evidence comes from a limited number of studies, which vary in sample sizes and methodologies. Pranayama shows promise as a complementary therapy for cancer patients, potentially enhancing their well-being and quality of life. Nonetheless, the current evidence base is limited, necessitating further research with larger sample sizes and more rigorous study designs to confirm these findings and elucidate the underlying mechanisms.

Effect of Pranayama as Adjuvant to Medical Treatment on Severity, Frequency, and Duration of Headache in Migraine Patients: An Open-Label Randomized Controlled Trial

Background

Migraine is the second leading cause of disability worldwide with high rates of dissatisfaction for allopathic treatment among patients. Pranayama is an easy, convenient, and cost-effective method that can supplement existing standard medical treatment of migraine.

Objective

To study the effect of pranayama as an adjuvant to standard medical treatment of migraine on clinical outcome variables of migraine.

Materials and Methods

This was a randomized controlled trial conducted on 80 consecutive migraine patients who were diagnosed as per International Classification of Headache Disorders-3 (ICHD-3) criteria and were randomly allocated into two groups, that is, standard medical treatment (SMT) group and standard medical treatment plus pranayama (SMT + P) group. The effect of pranayama on clinical outcome variables of migraine was evaluated by using standardized questionnaires. The data was statistically analyzed using SPSS Statistics 20 software. A P value of ≤0.05 was considered statistically significant.

Results

Intragroup analysis showed all clinical outcome variables of migraine reduced significantly in the SMT + P group whereas all clinical outcome variables of migraine except the duration of headache episodes reduced significantly in the SMT group. Although statistically non-significant, intergroup analysis demonstrates that reduction in headache severity, duration of headache episodes, and headache impact test-6 (HIT-6) score was more in the SMT + P group whereas reduction in headache frequency and migraine disability assessment (MIDAS) score was more in the SMT group.

Conclusion

Pranayama supplements the standard medical treatment of migraine by reducing the duration of headache episodes in addition to the reduction in headache severity, headache frequency, HIT-6 scores, and MIDAS scores.

Wearable Device for Yogic Breathing with Real-Time Heart Rate and Posture Monitoring

Background:

Yogic breathing also called as “Pranayama” is practiced with inhalation (Pooraka), holding the breath for some time (Kumbhaka) and then exhalation (Rechaka). The effective methods of yogic breathing keep oneself healthy and also improves immunity power. The yogic breathing can be practiced irrespective of one's age and gender and even in the office which helps to reduce the stress. To get the best results through yoga, a person has to follow certain timings and sit in a correct posture. Although many devices are existing in the market to monitor heart rate, posture and breathing during physical activity, there is a need of a device which is simple, cheap, and easy to use without an additional requirement of a smartphone. Moreover, the proposed device is able to evaluate the breathing data by transmitting it to a webpage through a Wi-Fi hotspot of the Microcontroller.

Methods:

The developed device has two subsystems: (i) A wrist subsystem to measure the heart rate, visual aid of breathing and vibration feedback for kapalabhati. (ii) A waist subsystem to monitor the posture with help of flex sensor and the results are displayed on the display of the wrist device. It also provides vibration feedback. The inertial measurement unit is used for breath detection. The subsystems are communicated through SPI communication. The breathing data are transmitted to a webpage through a Wi-Fi hotspot of the microcontroller.

Results:

The various yogic breathing and normal breathing exercises are tested on different normal subjects using the developed device and analyzed. The heart rate and beats per minute are evaluated. The heart rate sensor is validated using a standard medical device and it is observed that there was a 97.4% accuracy.

Conclusion:

The results show that the device is able to accurately monitor different kinds of breathing and additionally provide heart rate and posture information while performing the breathing exercises.

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.

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.

Yogic Breathing Instruction in Patients with Treatment-Resistant Generalized Anxiety Disorder: Pilot Study

Aim:

This study aims to evaluate the feasibility and effects of instruction in yogic breathing techniques (Pranayama) in patients with treatment-resistant generalized anxiety disorder (GAD) in UK secondary mental health services settings.

Materials and Methods:

Participants were adult primary or secondary care patients with a primary diagnosis of GAD (with or without comorbidity) and persistent anxiety symptoms of at least moderate intensity, despite prior treatment with two or more medications of proven efficacy. Patients participated in group-delivered yogic breathing training and practice for 12 weeks. Structured assessments were performed at baseline, after 1, 2, and 6 weeks of instruction, and at end-point. Participants also completed the antisaccade (emotional variant) task and startle response task at baseline and end-point.

Results:

At baseline, participating patients (n = 9) had moderate-to-severe anxiety symptoms and mild-to-moderate depressive symptoms, they attended 84% of offered sessions and provided positive feedback on the content and delivery of treatment. Symptom severity reduced significantly from baseline to end-point. There were greater errors on negative trials compared to neutral trials in the antisaccade task at baseline, and a significant reduction in antisaccade errors for negative stimuli as compared to neutral stimuli between baseline and end-point: but there were no significant differences in either mean heart rate or startle response between baseline and end-point.

Limitations:

The absence of a control group and small sample size.

Conclusion:

Yogic breathing techniques proved simple to learn and may be beneficial in reducing anxiety and depressive symptoms in patients with treatment-resistant GAD. Yogic breathing had no effect on autonomic arousal, but the reduction in errors to negative stimuli in the antisaccade task suggests an improvement in attention control during the intervention accompanying the reduction in symptoms.

Stress monitoring through non-invasive instrumental analysis of skin conductivity

BACKGROUND

This paper envelops the notion of yogic breathing and its applications as one of the techniques for stress management through regulation of skin conductivity among Indian engineering students. Stress perturbs the normal physiological or psychological functioning of an individual. Thus, it is extremely vital to manage stress.

OBJECTIVE

To explore the consequence of yogic breathing on skin conductivity using galvanic skin response sensor meter (GSRSM) on engineering students, of different universities.

METHODS

The study uses stratified random sampling technique for the experimental study undertaken to measure skin conductivity. 471 Engineering students, in the age group of 18-22 years who gave informed written consent were screened, of which 71 (15%) dropped out and 400 students (84.9%) completed the study. The GSRSM was used to record skin conductivity (pre and post) among experimental (n = 200) and Control group (n = 200) each comprising of 52 females (26%) and 148 males (74%). The Experimental group underwent yogic breathing whereas the Control group did not do so.

RESULTS

The experimental group reported reduction in mean value in skin conductivity after deep breathing for the time period (t = 300 sec) as compared to the control group, and this was significant (p < 0.01 and p < 0.05).

CONCLUSION

It is recommended that, this uncomplicated and yet extremely effectual ancient technique of yogic breathing could be included in core curriculum to reduce and manage stress among engineering students. The paper thus highlights the use of yogic technique as an effective mode for Stress Management amongst Indian Engineering students.

A cluster randomized controlled trial of a brief tobacco cessation intervention for low-income communities in India: study protocol

BACKGROUND

India has 275 million adult tobacco users and tobacco use is estimated to contribute to more than a million deaths in the country each year. There is an urgent need to develop and evaluate affordable, practicable and scalable interventions to promote cessation of tobacco use. Because tobacco use is so harmful, an increase of as little as 1 percentage point in long-term quit success rates can have an important public health impact. This protocol paper describes the rationale and methods of a large randomized controlled trial which aims to evaluate the effectiveness of a brief scalable smoking cessation intervention delivered by trained health professionals as an outreach programme in poor urban communities in India.

METHODS/DESIGN

This is a pragmatic, two-arm, community-based cluster randomized controlled trial focused on tobacco users in low-income communities. The treatment arm is a brief intervention comprising brief advice including training in craving control using simple yogic breathing exercises (BA-YBA) and the control arm is very brief advice (VBA). Of a total of 32 clusters, 16 will be allocated to the intervention arm and 16 to the control arm. Each cluster will have 31 participants, making a total of 992 participants. The primary outcome measure will follow the Russell Standard: self-report of sustained abstinence for at least 6 months following the intervention confirmed at the final follow-up by salivary cotinine.

DISCUSSION

This trial will inform national and international policy on delivery of scalable and affordable brief outreach interventions to promote tobacco use cessation in low resource settings where tobacco users have limited access to physicians and medications.

Sudarshan kriya yoga: Breathing for health

Breathing techniques are regularly recommended for relaxation, stress management, control of psychophysiological states, and to improve organ function. Yogic breathing, defined as a manipulation of breath movement, has been shown to positively affect immune function, autonomic nervous system imbalances, and psychological or stress-related disorders. The aim of this study was to assess and provide a comprehensive review of the physiological mechanisms, the mind–body connection, and the benefits of Sudarshan Kriya Yoga (SKY) in a wide range of clinical conditions. Various online databases searched were Medline, Psychinfo, EMBASE, and Google Scholar. All the results were carefully screened and articles on SKY were selected. The references from these articles were checked to find any other potentially relevant articles. SKY, a unique yogic breathing practice, involves several types of cyclical breathing patterns, ranging from slow and calming to rapid and stimulating. There is mounting evidence to suggest that SKY can be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder, depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders.

Influence of alternate nostril breathing on heart rate variability in non-practitioners of yogic breathing

Background:

Long-term alternate nostril breathing (ANB) has been shown to enhance autonomic control of the heart by increasing parasympathetic modulation. However, there is no information on the immediate effects of ANB on autonomic control compared to paced breathing (PB) at the same rate in individuals who are inexperienced with yogic breathing.

Aim:

To examine cardiac autonomic modulation following ANB in comparison to that following PB in individuals who were inexperienced in ANB.

Materials and Methods:

Twenty healthy individuals (22.3 ± 2.9 years) with no prior experience with ANB engaged in

Results:

Analysis of covariance revealed lnTP, lnLF and lnHF were greater during both post-ANB and post-PB compared to PRE (P<0.05). MAP and lnLF/lnHF did not significantly differ between conditions.

Conclusions:

These data suggest that there was an immediate increase in cardiac autonomic modulation following ANB and PB without a shift in autonomic balance in individuals inexperienced with yogic breathing. To our knowledge, this is the first investigation to investigate the autonomic effects of ANB in this population and also to compare the effects of ANB and PB at the same respiratory rate.