yoga (contd) eight progressive steps of yoga -...

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Possible Use Yoga and Meditation in Physical Therapy for the Management of Patients with

Cardiovascular Disease

Pradip K. Ghosh, PT., Ph.D., D.M.S,

Physical Therapy Program

Maryville University, St. Louis, MO.

Copyright@Pradip Ghosh 2012 1

What is Yoga?

• Derived from a Sanskrit root “yuj” that means “to unite”.

• Promotes a connection between the mind, body and spirit

• Yoga philosophy and practice were first described by Patanjali in the 2nd century in the text titled “Yoga Sutras”.


Yoga (Contd)

Through the study of all divisions of yoga we can learn:

1. How to improve our well-being?

2. How to master the senses?

3. How to develop our intellect, and control our emotions so that we function in perfect harmony and health.


Eight Progressive Steps of Yoga

• Patanjali outlined an eightfold path to awareness and enlightenment. These steps are

1. Yama (moral observance; ethical principles for living). The restraints, and what is convenient to avoid.

2. Niyama (inner integrity; ethical principles for living). The observances, what is good for us to practice.

3. Asana: Poses


Eight Progressive Steps of Yoga (Contd)

4. Pranayama: Breathing exercises.

5. Pratyahara: Sensory transcendence

6. Dharana: Mental concentration.

7. Dhyana (contemplation, meditation)

8. Samadhi (bliss, union with the supreme) Complete union.


Disciplines of Yoga

• Based on these principles, different yogic disciplines have developed. They are: 1.Raja yoga (Hatha Yoga is a part of Raja Yoga)

2.Mantra yoga (yoga of chanting)

3.Jnana yoga (yoga of wisdom for intelectual development)

4.Karma yoga (yoga of action for spiritual devolvement)

5.Bhakti yoga (path of devotion for emotional control)


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Common Yoga in the West

• The most common aspects of yoga practiced in the west are Hatha yoga.

• The path of Hatha yoga involves three interconnected threads:

– Asanas (posture)

– Pranayama (breathing)

– Meditation (calming mind through relaxation)


Stress and Diseases

• Stress has become a modern epidemic and a major health issue, eroding our well being, and threatening the quality of life.

• Persistent stress change our various physiologic functions and posing risk of diseases including hypertension, CAD, diabetes.

• Thus chronic stress can contribute illness


Stress

• Stress triggers a continuous stimulus to our heart, sympathetic nervous system and triggers the release of hormones adrenal gland such as epinephrine and cortisol.

• These hormones through bloodstream to all around our body contributing to the “fight or flight” response. For example, the response can

– boost our blood pressure

– release sugars into bloodstream.

– increase sympathetic load to different systems


STRESS

ADRENAL MEDULLA

EPINEPHRINE RELEASE

INCREASED

CARDIAC OUTPUT

INCREASED

LIPOLYSIS

DECREASED

INSULIN

SECRETION

INCREASED

SERUM

CHOLESTEROL

INCREASED

CIRCULATING

FFA INCREASED

BLOOD

GLUCOSE

INCREASED GLUCONEOGENESIS

INCREASED GLYCOGENOLYSIS

STRESS

ADRENAL MEDULLA


STRESS

NOREPINEPHRINE

ACTIVATION OF

SYMPATHETIC

NERVOUS SYSTEM

IMMUNE

SUPPRESSION

INCREASED

BLOOD

PRESSURE

DECREASED

GASTRIC

SECRETION

DILATED

BRONCHIAL

AIRWAYS


STRESS

ANTERIOR PITUITARY

ACTH

ALDOSTERONE ADRENAL CORTEX CORTOSOL

INCREASED

SODIUM & WATER

RETENTION

IMMUNE

SUPPRESSION

INCREASED

GLUCONEOGENESIS

INCREASED

BLOOD GLUCOSE


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PRANAYAMA

• Pranayama makes a subtle link between the body

and the mind and improves brain function

(intelligence and memory).

• It has been found by some researchers that serotonin

level in the brain is increased with regular practice of

pranayama which in turn improves the characteristics

of sleep and reduces depression.


MEDITATION

• It is a self-directed practice for relaxing the body and

calming the mind.

• Practicing meditation can create a balance between

physical, emotional and mental states.

• Benefits of Meditation

– Can help in reducing stress and anxiety.

– Can lower blood pressure

– Can decrease the risk of a heart attack.

– It can improve concentration, clarity of thought.

– Increases well-being


Asanas

• The meaning of asana is “to sit’ or “posture”.

• Yogis knew that placing the body in certain positions would stimulate specific nerves, organs and glands.

• For example, the shoulder-stand posture causes the blood to be directed by gravity to the thyroid gland, and tucking in of the chin causes a gently squeezing action on the gland (thyroid gland) and its effect would be to increase thyroid hormone secretion.


Precise Effects of Asana

• To elongate or to contract certain muscles.

• To give flexibility and movement to certain articulation, even to the spine.

• To influence the blood flow, so that it better irrigates a part of the body or organ.

• Posture in certain position has some massaging effects on an organ or gland and stimulating it.

• Simultaneous deep breathing and visualizing the target area sends an extra supply of prana to the area.


How Asanas Work?

• Deep breathing:

1. While holding the yoga posture we breathe slowly and deeply, moving the abdomen only (abdominal).

2. This increases the oxygen and prana supply to the target organ or gland and thus enhances the effect of the asana.


How Asanas Work?

• Concentration:

1. With the slow and deep breathing, we also focus our attention on the target organ or gland.

2. This brings the mind into play and greatly increases the circulation and prana supply to the target organ or gland.


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Lotus Pose: Padmasana

• This is an extremely good pose for meditation and concentration.

• It has a calming effect on the mind and the nerves.

• It is the most important and very basic yoga posture and has wide range of beneficial effects including benefits on cardiovascular system.

Copyright@Pradip Ghosh 2012 19 Copyright@Pradip Ghosh 2012 20


The Reverse Posture (Viparitkarani Mudra)

• This posture keeps the glands, organs, and skin in a youthful condition and prevent aging.

• This is especially recommended for women who suffer from irregular menstruation, or physical and mental discomfort during menopause.


The Reverse Posture (Viparitkarani Mudra)

• Lie on your back. Raise your legs and back, supporting your body by placing your hands under your hips.

• Close your eyes. Breathe slowly and deeply.

• Stay in this position for about two minutes.


The Plough Posture (Halasana)

• This is a best posture for making the spine flexible.

• The practice of this posture can be helpful in patient suffering from stiffness, obesity, enlarged liver and spleen, constipation, and indigestion.


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The Plough Posture (Halasana)

Technique

• While in the reverse posture, bring both legs over your head until the toes touch the floor behind your head. Try to keep your knees straight.

• Breathe slowly and deeply from the abdomen and concentrate on the spine, especially where you feel the stretch taking place. Stay in this posture for one minute.

• To come out of the posture, just slowly uncurl the spine.


Cobra Pose (Bhujangasana)

• This is a basic yoga posture and can be practiced if the back is not too stiff.

• This pose compliments the shoulder stand and provides stretch to the spine.


Cobra Pose (Bhujangasana)

Benefits:

• Tones ovaries, uterus and liver.

• Muscles of the back, abdomen and entire upper body are strengthened.

• Aids in relief of menstrual irregularities.

• Relieves constipation

• Limbers spine

• Beneficial for backache due to long hours of standing.

• Improve cardiovascular functions Copyright@Pradip Ghosh 2012 27

Vakrasana (spinal twist)


Virabhadrasana


Trikonasana

• Increases flexibility

• Improve GI functions

• Increase endurance

• Improve balance

• Improve cardiorespiratory functions


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Paschimottanasana

• 1. Sit on a mat with your legs stretched straight out in front of you.

• 2. Breathe out and slowly bend forward, trying to touch your feet without bending knees.

• 3. Don't push yourself too hard.

• 4. It is important that you hold this pose. There is no point in just bouncing back and forth.

• 5. Exhale, while returning to normal position.

• Good for diabetes, digestion, ovaries, kidneys.


Bow pose (Dhanurasana)

• This posture is not for persons suffering from hernia, or cases of thyroid or endocrine gland disorders.

• It is good for gastrointestinal disorders, constipation.

• It reduces abdominal fat and good for patients with type II diabetes.


Corpse Pose (Savasana)

• This is an excellent posture that can be used between poses to allow total relaxation.

• It stimulates blood circulation, reduces blood pressure and exercises inner organs.

• This asana alleviates fatigue, nervousness, asthma, neurasthenia (a general worn-out feeling), constipation, poor digestion, insomnia.

• Teaches mental concentration.


Corpse Pose (Savasana)

• Lie down on your back in a quiet place and keep the arms beside the body.

• Keep heels slightly apart.

• Breathe slowly and deeply and concentrate to your breath.


Yoga Breathing

• Synchronization of movement and breath are important in physical postures of Yoga.

• Regular practice of these techniques is thought to clear body energy channels, improve circulation to vital organs, and promote mental stillness and concentration.


Yoga Breathing Exercises

• Surya-Bhedana (Right-nostril breathing):

1. This refers to an exercise in which one inhales through the right nostril and exhales through the left, holding the inhaled breath as long as possible before exhaling. (Beginners should use fingers to close nostrils).

2. The process should be repeated 10-20 times without pausing between cycles.


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Alternate Nostril Breathing (ANB)

• This is done by simply closing off one nostril with the thumb or ring finger of the right hand, inhaling through one nostril and exhaling through the alternate nostril, back and forth.

• Studies suggest that ANB has a balancing effect on the functional activity of the left and right hemispheres of the brain.

• Left nostril breathing showed a reduction of the SNS; right nostril breathing showed an increase in SNS.


Research Based Evidence Effects of Yoga

• Yoga is an antidote to stress.

• Extensive anecdotal reports exists about the effectiveness of yoga for a range of health conditions, including premenstrual syndrome, symptoms of menopause, GI problems, back pain, other musculo-skeletal alterations, insomnia, and respiratory and cardiovascular disease.


What Evidences Do We Have?

• It has been reported that yoga can

– Increase muscular efficiency and endurance (1)

– Increase aerobic capacity (2)

– Reduce perceived exertion after exercise (2,3)

– Reduce stress (4,5)

– Alter autonomic nervous system (6-8)

– Decrease oxidative stress (9,10)


Yoga: Evidences

• Studies that examined the health related aspects of yoga found that an 8 week yoga training program increased muscular strength by 31%, increased muscular endurance by 57%, increased flexibility by 88%, improved oxygen uptake by 7% and reduced cardiovascular risk in healthy adults (11)


Evidences on Effects of Yoga on Cardiovascular System

• Research into the connection between yoga and cardiovascular disease is still in its scientific infancy.

• Several studies have explored the possible benefits of yoga for individual with heart disease, but those trials are mostly small or lack the scientific rigor needed to show cause and effect.


Evidences on Effects of Yoga on Cardiovascular System

• Most of the research findings suggest that yoga may – Reduce high blood pressure

– Reduce and ease palpitations

– Reduce cholesterol levels, stress hormones, blood sugar

– Lower cardiovascular risk

– Improve breathing for patients with COPD.

– Enhance cardiac rehabilitation


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Practice of Yoga: Cardiovascular Response to Exercise

Madanmohan et.al, 2004 (12)

• This study is based on 21 normal boys (age 17-19 y.o).

• Recorded basal heart rate (HR), blood pressure (BP)

• All subjects were asked to step up and down a platform of 45 cm height at a rate of 30/min for 5 min or until fatigue.

• Recorded HR, BP at 1, 2, 3, 4, 5, 7 & 10 min after exercise.

• All subjects practiced Asana and Pranayama for 45 min each day for 2 months (after a training for two weeks)

• At the end of two months, researchers recorded HR and BP before and after Harvard step test

Copyright@Pradip Ghosh 2012 43 Paired T-test between pre and post training values: *P<0.01, **P<0.001,

Paired T test between basal and Post-exercise values: † P< 0.01

0

20

40

60

80

100

120

140

160

Basal 1 2 3 4 5 7 10

HR

(bea

ts/m

in)

Minutes

Effect of Yoga training on Heart rate in response

to exercise and post-exercise recovery Madanmohan et.al. 2004 (12)

Before

After

*

†

**†

** * * * ** **†

†

After step test

44 Copyright@Pradip Ghosh 2012

0

20

40

60

80

100

120

140

160

180

Basal 1 2 3 4 5 7 10

SP (

mm

Hg)

Minutes

Effect of Yoga training on Systolic Pressure in

response to exercise and post-exercise recovery Madanmohan et.al. 2004 (12)

Before

After

After step test

*

***†

***

**

***

***

*** *** †

Paired T-test between pre and post training values: *P<0.05, **P<0.01, ***P<0.001


†


0

10

20

30

40

50

60

70

80

Basal 1 2 3 4 5 7 10

DP

(m

mH

g)

Minutes

Effect of Yoga training on Diastolic Pressure in

response to exercise and post-exercise recovery Madanmohan et.al. 2004 (12)

Before

After

After step test

‡ *†

*** ***

***

+

**

Paired T-test between pre and post training values: *P<0.05, **P<0.01, ***P<0.001

Paired T test between basal and Post-exercise values: +P<0.05, † P< 0.01, ‡P<0.001


Paired T-test between pre and post training values: *P<0.01, **P<0.001


0

50

100

150

200

250

300

Basal 1 2 3 4 5 7 10

RP

P (

un

its)

Minutes

Effect of Yoga training on Rate-pressure product in

response to exercise and post-execrcise recovery Madanmohan et.al. 2004 (12)

Before After

After step test

**

**

** **

*

**†

**†

*

†

†


Practice of Yoga: Cardiovascular Response to Exercise

Madanmohan et.al, 2004 (12)

• Yoga training for 2 months produced significant reduction in basal HR, SBP, DBP, and RPP .

• After 2 months of yoga training the exercise induced increase in all parameters was significantly less when compared to their pre-training response.

• So, yoga training can provide a better exercise tolerance


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Yoga Breathing: Cardiopulmonary Response to Sympathetic Stimulation

Ghosh et.al, 2009 (13)

• Pilot study with Pre and post test design

• Used 14 college students (5 males and 9 females (18-30 y.o) divided into two groups – Experimental group practiced savasana, sukhasana, pranayama for 30

min each day for 4 wks (5 days a week)

– Control group practiced warm-up exercise and comprised of stretching and AROM for 30 min each day for 4 wks

– All participants were tested on 3 times (before the start, at 2 wks and at 4 wks)

• HR, BP, VO2 max were recorded at basal and at 1, 2 and 3 min during treadmill walking at a speed of 4 miles/hr. (to stimulate SNS)




% increase in HR during treadmill

exercise after 2 wk of practice of yoga

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1 min 2 min 3 min

Pre

Post


exercise after 2 wk of warm-up exercise

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1 min 2 min 3 min

Pre

Post




% increase in HR during treadmill exercise

after 4 wk of warm-up exercise

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10

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1 min 2 min 3 min

Pre

Post


exercise after 4 wk of practice of yoga

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1 min 2 min 3 min

Pre

Post




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5

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15

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30

35

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Warm-up (2 wks) Yoga (2 wks) Warm-up (4 wks) Yoga (4 wks)

% In

cre

ase

% increase in SBP following 2 and 4 wks of Yoga

Pre-test

Post-test




Changes in Well-Being inventory score following 2 and 4 wks of yoga

0

50

100

150

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Warm-up (2 wks) Yoga (2 wks) Warm-up (4 wks) Yoga (4 wks)

Well

-Bein

g s

core

Pre-test

Post-test




• It is suggested that the practice of yoga may help reduce sympathetic stimulation in response to physiological stress based on the following observations. – Percentage increase in HR was significantly decreased during the 1st,

2nd and 3rd minute of treadmill walking after 2 weeks and 4 weeks of practicing yoga.

– Percentage increase in SBP were significantly reduced after 3 minutes of walking on the treadmill after 2 wks and 4 wks of practicing

– Self Well-Being Inventory scores were improved after 4 weeks of performing yoga when compared to their pre-test values.

• .


10

Hatha Yoga on Cardiorespiratory Endurance Tran et al, 2000 (14)

• A study to show the effects Hatha yoga health related aspects of physical fitness. – Pre and post test

– 10 healthy volunteers (18-27 y.o)

– Hatha yoga practice twice a week for 8 wks.

– Each session consists of 15 min warm up, 50 min asana and 10 min savasana (corpse pose)

• Researchers evaluated each subject before and after 8 wks of program


Hatha Yoga on Cardiorespiratory Endurance Tran et al, 2000 (14)

• Parameters studied – Muscle strength, endurance and flexibility

– Body composition

– Cardio respiratory endurance

• Results – Isokinetic muscular strength for elbow extension,

elbow flexion, and knee extension increased by 31%, 19%, and 28% respectively.

– Ankle flexibility, sholuder elevation, trunk extension and flexion increased significantly.

– Max O2 uptake increased by 6% (significant)


Values represent means±SEM. *p<0.01

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10

20

30

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50

60

70

80

90

Run Time(min) Expired Ventilation (L.min-1) Maximal oxygen uptake (mL.kg-1.min-1)

Respiratory exchange ratio

Cardiorespiratory Endurance Tran et al, 2000 (14)

Before

After

% Change

*

0

50

100

150

200

250

Before After % Change

Maximal heart rate (beats.min-1)


Effects of Hatha Yoga and Meditation on Cardiorespiratory Performance

Harinath et.al, 2004 (15)

• Used 30 healthy men (25-35 y.o)

• Divided into 2 group – Group 1: Control; performed flexibility exercise for 40o min

and slow running for 20 min in the morning and some games for 1 hour in the evening for 3 months

– Group 2: Yoga; practiced 45 min yoga and 15 min yogic breathing in the morning. Also practiced 15 min of yoga, 15 min yogic breathing and 30 min meditation in the evening for 3 months




• Researchers evaluated following parameters before and after 3 months of practice in both control and yoga group – blood pressure

– heart rate

– respiration rate

– dynamic lung functions

– serum melatonin

– well being score.

•




• They found the yogic practices for 3 months resulted in significant changes in the following:

– Reduction in SBP, DBP and MABP (no change in HR)

– Increased forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1).

– Increased well-being inventory score

– Increased plasma melatonin


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Effects of Yoga and Meditation in Patients with Hypertension

• Several research published to show the effects of practicing yoga, especially Savasana and meditation on reducing the blood pressure in patients with hypertension.

• Studies of yoga treatment in patients with hypertension have demonstrated mean reductions of SBP and DBP of 10-15 mm Hg (16,17)


Yoga and Hypertension Murugesan R et al 2000 (16)

• Used 33 patients with hypertension (35-65 y.o) – Divided into 3 groups (control, medication group and yoga)

– Yoga group practiced 1 hr of yoga in the morning and 1 hr in the evening for 11 wks

– Medication group received only medication under the supervision of physician.

– Control group received only warm-up activities

• These researchers observed that SBP, DBP decreased significantly in both yoga group as well as in medication group


Practice of Yoga on Hypertension Selvamurthy et.al. 1998 (17)

• A Pilot study to show the effects tilt stimulus through yoga asana on restoring baroreceptor sensitivity in patients with essential hypertension.

– 20 male patients with essential hypertension

– Patients discontinued drug therapy

– Group I – Tilt table (70o)

– Group II – Yoga asana


Practice of Yoga on Hypertension Selvamurthy et.al. 1998 (17)

– 30 minutes daily for 3 weeks

• Parameters studied – Blood pressure

– Blood catecholamines (CA)

– Plasma renin activity (PRA)

• Results – Significant decrease in blood pressure, CA and

PRA


How Does the Nature of Breathing Influences Cardiovascular Functions?

• The breathing, relaxation, and meditation components may lead to decreased sympathetic activation and an improvement in baroreflex sensitivity and a reduction in HR variability as a result of chemoreflex response to hypoxia and hypercapnea (18,19)

• Slow breathing is generally believed to decrease basal HR, HR response to standing (20) and BP (21).

• Fast breathing, on the other hand, is known to increase the BP and the HR and enhance sympathetic drive to the myocardium (22)


Effect of Slow and Fast Breathing Exercise in Patients with Essential Hypertension

Mourya M, et. al, 2009 (23)

• A study to show the effects of slow and fast breathing

on autonomic functions in patients with essential

hypertension.

– 60 patients with essential hypertension

– Group 1 – No intervention

– Group 2 – Slow breathing exercise (alternate nostril breathing 5-

6 breath/min)

– Group 3 – Fast breathing exercise (breath quickly with

inhalation and exhalation 1 sec each for 1 min about 4-5 times with 3

min rest between)


12


Mourya M, et al 2009 (23)

– Practiced yoga breathing 15 mins twice daily for 3 months

• Parameters studied – Blood pressure – BP response to cold pressure – BP response to hand grip test

• Results – Baseline reduction in both SBP and DBP in slow

breathing group. – Blood pressure response to cold presser and hand

grip test was lower than normal values.



Mourya M, et al 2009 (23)


Evidence on Left and Right Nostril Breathing

• There is a unique autonomic modulation by uni-nostril breathing that can be used therapeutically.

• It has been documented that pranayama breathing through right nostril results in an increased in sympathetic activity whereas left nostril breathing reduces it (24).

• In the same year, a study reported that unilateral forced right nostril breathing increases HR compared to forced left nostril breathing (25)


Practice of Yoga: Reducing Risk Factors of Cardiovascular Disease

• It can be said that yoga has preventative, promotive as well as curative potential.

• Scientific studies have started giving documented evidence to this belief.

• It is known that hypertension, CAD, obesity are alarmingly on the rise in our modern society.

• Evidence-based research supports the facts that the regular practice of yoga and breathing has profound effects in reducing risk factors for cardiovascular disease.


Yoga: Cardiovascular Disease

• A study by a group of researcher indicated that practice of yoga and meditation for 3 months can reduce total serum cholesterol, LDL cholesterol, and blood pressure. (26)

• Another report published by Vyas and Dikshit in 2002 indicated that practice of meditation and pranayama can reduce lipid profile of patients and thereby reduce the risk of cardiovascular disease (27)


Effects of Yoga on Lipid Profile

• A reduction in risk factors for patients with angina and CAD following regular practice of yoga has also been observed by Mahajan and his groups in 1999 (28)

• In this study, researchers recruited 93 individuals with CAD (52 in yoga group and 41 in control group).

• All participants practiced yoga regularly at home after a training with 4 sessions.

• Researchers measured triglyceride, cholesterol, HDL and LDL at 4, 10 and 14 weeks.

• The subjects practicing yoga showed a regular decrease in all lipid parameters except HDL indicating yoga can be used in reducing the modifiable risk factors in individual with CAD.


13

Effects of Yoga on Reducing Risk Factors

• Another impressive results on 1-year prospective study using 42 men with CAD were published by Manchanda and his groups in 2000 (29)

• This group of researchers showed that use of yoga along with moderate aerobic exercise and diet control can significantly reduce total cholesterol, LDL cholesterol, and triglyceride when compared to the control group.


Practice of Yoga: Effects on C-reactive Protein, IL-6

• It has been known that hypertension is in part an inflammatory disorders and increased level of C-reactive protein (CRP) may be associated with HTN

• It is well established that increased levels of markers of inflammation such as IL-6 and CRP is associated with higher mortality in patients and cardiac dysfunctions.

• A study from Emory University have demonstrated that practice of yoga for 2 months can significantly reduce plasma levels of IL-6 and CRP indicating that yoga may improve endothelial functions by decreasing inflammation and oxidative stress (30)


How Does Yoga and Meditation Work?

How Does Yoga Work?

Stabilizes ANS and Stress Response

Decreases Sensitivity of Chemoreceptor

Increases Release of Prolactin and

Oxytocin

Decreases Resease of Epinephrine, NE

and Cortisol

Shifting to PNS Dominance

Improves baroreflex response


Decreases CRP

IL-6

Conclusion

Practice of Yoga

ANS equilibrium Decrease BP

Decrease HR

Increases Cardiovascular

Efficiency

Decreases Cardiovascular Risk

Decrease Respiratory Rate


Normalizes

Edocrine

Functions

Improves Immune

Functions

References

• 1. Ray US, Hegde KS, Selvamurthy W. Improvement in muscular efficiency as related to a standard task after yogic exercises in middle aged men. Ind J Med Res 1986; 83: 343-348

• 2. Ray US, Sinha B, Tomar OS et al Aerobic capacity and perceived exertion after practice of Hatha yogic exercises. Indian J Med Res 2001; 114: 215-221

• 3. Telles S, Desiraju T. Oxygen consumption during pranayamic type of very slow rate breathing. Indian J Med Res 1991; 94: 357-363

• 4. Raub JA. Psychophysiological effects of Hatha yoga on musculoskeletal and cardiorespiratory function: A leterature review. J Altern Complement Med 2002; 8: 797-812

• 5. Michalsen A, Grossman P, Acil A, et al Rapid stress reduction and anxiolysis among distressed women as a consequence of a three month intensive yoga program. Med Sci Monit 2005; 11: 555-561

• 6. Bhargava R, Gagate MG, Mascarenhas JF. Autonomic responses to breath holding and its variations following pranayama. Indian J Physiol Pharmacol 1988; 32: 257-264


References

• 7. Telles S, Nagarathna R, Nagendra HR. Breathing through a particular nostril can alter metabolism and autonomic activities. Indian J Physiol Pharmacol 1994; 38: 133-137

• 8. Wenger MA, Bagchi BK. Studies of autonomic functions in practitioners of yoga in India. Behav Sci 1961; 6: 312-323

• 9. Bhattacharya S, Pandey US, Verma NS. Improvement in oxidative status with yogic breathing in young healthy males. Indian J Physiol Pharmacol 2002; 46: 349-354

• 10. Yadav RK, Ray RB, et al. Effect of a comprehensive yoga based lifestyle modification program on lipid peroxidation. Indian J Physiol Pharmacol 2005; 49: 358-362

• 11. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of hatha yoga practice on the health related aspects of physical fitness. Prev Cardiol. 2001; 4: 165-170

• 12. Madan Mohan, Udupa K, Bhavanani AB, Shatapathy CC, Sahai A. Modulation of cardiovascular response to exercise by yoga training. Indian J Physiol Pharmacol 2004; 48: 461-465


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References

• 13. Ghosh PK, Hackett L, Eugea R, Gonzales A, Barciszewski A. Effects of Yoga Breathing and Meditation on the Cardiopulmonary Response to Sympathetic Stimulation in College-Aged Students; A Pilot Study. CSM, 2009

• 14. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha Yoga Practice on the Health-Related Aspects of Physical Fitness. Prev. Cardiol. 2001; 4: 165-170

• 15. Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC, Rai L, Sawhney RC: Effects of Hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med. 2004;10:261-268

• 16. Murugesan R, Govindarajulu N, bera TK. Effect of selective yogic practices on the management of hypertension. Indian J Physiol Pharmacol 2000; 44: 207-210

• 17. Selvamurthy W, Sridharan K, Ray US et al A new physiological approach to control essential hypertension. Indian J Physiol Pharmacol 1998; 42: 205-213

• 18. Bernardi L, Gabutti A, Porta C, Spicuzza L. Slow breathing reduces chemoreflex response to hypoxia and hypercapnea, and increases baroreflex sensitivity. J Hypertension 2001; 19: 2221-2229


References

• 19. Bernardi L, Sleight P, Bandinelli G etal. Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study. BMJ. 2001; 323:1446-1449

• 20. Pal GK, Velkumary S, Madan M. Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res 2004; 120: 115-121

• 21. Rosenthal T, Alter A, Peleg E, Gavish B. Device guided breathing exercises reduce blood pressure: Ambulatory and home measurements. Am J Hypertens 2001; 19: 947-958

• 22. Narkiewicz K, Vande Borne P, Montano N et al. Sympathetic neural outflow and chemoreflex sensitivity are related to spon taneous breathing rate in normal men. Hypertension 2006; 47: 51-55

• 23. Mourya M, Mahajan AS, Singh NP, Jain AK. Effect of slow and fast breathing exercises on autonomic functions in patients with essential hypertension. 2009; 15: 711-717


References

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