diff --git a/subfolder_0/A Cross-National Survey on Health Perceptions and Adopted Lifestyle-Related Behavior during the COVID-19 Pandemic.txt b/subfolder_0/A Cross-National Survey on Health Perceptions and Adopted Lifestyle-Related Behavior during the COVID-19 Pandemic.txt new file mode 100644 index 0000000000000000000000000000000000000000..d50d2adacf91a514d129fb59e00951ebc3bac67d --- /dev/null +++ b/subfolder_0/A Cross-National Survey on Health Perceptions and Adopted Lifestyle-Related Behavior during the COVID-19 Pandemic.txt @@ -0,0 +1,1550 @@ +Original Paper +Health Perceptions and Adopted Lifestyle Behaviors During the +COVID-19 Pandemic: Cross-National Survey +Nandi Krishnamurthy Manjunath1, PhD; Vijaya Majumdar1, PhD; Antonietta Rozzi2, MA; Wang Huiru3, PhD; Avinash +Mishra4, PhD; Keishin Kimura5; Raghuram Nagarathna1, MD; Hongasandra Ramarao Nagendra1, PhD +1Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, India +2Sarva Yoga International, Sarzana SP, Italy +3Shanghai Jiao Tong University, Shanghai, China +4Vivekananda Yoga China, Shanghai, China +5Japan Yoga Therapy Society, Yonago City, Japan +Corresponding Author: +Vijaya Majumdar, PhD +Swami Vivekananda Yoga Anusandhana Samsthana University +#19, Eknath Bhavan, Gavipuram Circle +KG Naga +Bengaluru, 560019 +India +Phone: 91 08026995163 +Email: vijaya.majumdar@svyasa.edu.in +Abstract +Background: Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these +measures are implemented for a long period of time, they can result in adverse modification of people’s health perceptions and +lifestyle behaviors. +Objective: The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to +changes in lifestyle behavior during the crisis of the COVID-19 pandemic. +Methods: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The +settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as +perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined +as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical +activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses. +Results: We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and +377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores +were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). +Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception +of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60, +respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents +adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of +interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents +(odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across +all the countries, most prominently by approximately 6-fold in China and Italy. +Conclusions: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted +lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered +through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, +controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. +However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic +variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown +period are preliminary, and real insight could only be obtained from a longer follow-up. +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 1 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +(JMIR Form Res 2021;5(6):e23630) doi: 10.2196/23630 +KEYWORDS +health behavior; self-report; cross-national survey; COVID-19; behavior; perception; lifestyle; nutrition; real-time +Introduction +The World Health Organization (WHO) declared the outbreak +of COVID-19 a pandemic on March 11, 2020 [1]. As of March +24, 2020, the most affected regions in the world were the +Western Pacific region (China, the Republic of Korea, Japan, +etc), with a total of 96,580 reported confirmed cases, and the +European region (Italy, Spain, Germany, the United Kingdom, +etc), which accounted for a total of 195,511 positive cases [2]. +There was a global panic due to the shifting of the COVID-19 +epicenters from China to Europe, mainly Italy, which reported +the worst outcomes up to March 25, 2020 (69,176 reported cases +and the maximum number of COVID-19 deaths of 6820) [2]. +Global disease outbreaks impact varied aspects of physical and +mental health, even suicidality [3-5]. As observed in the +infectious disease epidemic of severe acute respiratory syndrome +(SARS) in 2003, exposure to new pathogens can manifest as a +qualitatively distinct mental impact [6]. Social isolation +measures +(large-scale +quarantines, +long-term +home +confinements, and nationwide lockdowns) [7-11], although +essential for controlling viral spread, go against the inherent +human instinct of social relationships [12,13]. If these measures +are implemented for a long duration, they can be detrimental +to mental health, as observed in recent reports from China and +Vietnam [14-17], and they are expected to result in modification +of people’s lifestyle behaviors, such as increased adoption of +unhealthy dietary habits and sedentary behavior. These changes +can exacerbate the burden of the “pandemics” of behavioral and +cardiovascular diseases that already prevail in modern societies +[18,19]. The latest trends of re-emergences of such infectious +disease outbreaks merit timely preparedness involving +community engagement and focus on healthy lifestyle behaviors +[20,21]. Although the mental impact of the COVID-19 pandemic +is being addressed in a timely fashion [22,23], the associated +real-time influences on people’s health perceptions and lifestyle +choices remain underresearched [24,25]. Careful consideration +of the demographic and cultural impact of tailored public health +intervention strategies on human behavior is also greatly needed +when designing such strategies. Here, we report the findings of +a cross-national survey that aimed to generate rapid perspectives +on the status of health-related perceptions and their influence +on the likelihood of adoption of healthy lifestyle choices during +the COVID-19 pandemic. The settings were China and Japan, +two nations in the Western Pacific region that were greatly +impacted by COVID-19; Italy, from the European region; and +India, a highly populous South Asian country that was a +potential threat region at the time of the survey [2,7-9,11]. +Methods +Sampling and Data Collection +Given the restricted mobility restrictions and confinement due +to +the +COVID-19 +lockdown, +we +conducted +a +cross-sectional survey using a web-based platform. We +disseminated the survey through the circulation of a Google +Form via institutional websites and private social media +networks, such as Facebook and WhatsApp. We also used the +group email lists of a few social organizations, universities, +academic institutions, and their interconnections to share the +questionnaire links, which further facilitated the snowball +sampling. The respondents were residents of China, Japan, Italy, +and India who were aged 18 years or older. We anonymized +the data to preserve and protect confidentiality. The study was +approved by the institutional review boards and institutional +ethics committees of the respective nations: Swami Vivekananda +Yoga Anusandhana Samsthana (SVYASA), India; Sarva Yoga +International, Italy; Shanghai Jiao Tong University, China; and +Japan Yoga Therapy Society, Japan. Respondents were informed +about the objectives of the survey and the anonymity of their +responses. Informed consent was obtained through a declaration +of the participants of their voluntary participation, the +confidentiality of the data, and the use of the collected +information for research purposes only. The survey period was +April 3-28, 2020. Once submitted, the responses were directly +used for the analysis, and revisions of the responses were not +allowed. +Questionnaire Structure +We chose a short format for the questionnaire, with 19 questions +to facilitate rapid administration. The first set of questions +(Q1-Q5) were related to the respondents’ demographic details: +age, gender, country of residence, working status, and the +presence of any chronic illness or disability diagnosed by a +physician. The next set (Q6-Q14) contained perception-related +questions on self-rated physical and mental health, sleep quality, +coping ability, energy status (a psychological state defined as +an individual's potential to perform mental and physical activity +[26,27]), coping flexibility, and perceptions related to +interpersonal relationships as well as the fear of the pandemic. +The questions were phrased as statements, with responses +recorded on 3- or 5-point scales. For example, the respondents +were requested to self-rate their mental and physical health +status with the questions “How do you rate your physical health +at present as” and “How do rate your mental health at present +as” with answer modalities of (1) excellent, (2) very good, (3) +good, (4) average, and (5) poor. These single-item self-health +assessment questions are validated tools used in national surveys +and epidemiological studies to assess health perceptions among +individuals, strongly related to various morbidities, and +mortality, and they have been validated across various ethnicities +[28-33]. A further set of questions (Q15-Q19) focused on items +related to the respondents’ recent lifestyle behavior choices: +eating habits, engagement in physical activity or exercise, and +substance use. Permitted responses for these behavior-related +questions were either yes or no. For eating habits, the +respondents provided self-rated scores for their time of eating; +nourishment related to intake of vegetables and fibers; and daily +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 2 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +intake of “junk food” (described as packaged and processed +sweets or salty snacks); the combined scores were dichotomized +into “good” (score ≥3) and “poor” (score ≤2). +Data Analysis +An exploratory factor analysis using the principal axis factoring +and varimax rotation suggested that three factors were present +in the data. Items related to health perceptions were used to +form a scale for perceived health status (the health scale); the +scores were represented as mean (SD). For the remaining two +factors, we could not form scales, as they scored Cronbach α +values <.6; instead, we used the most relevant single item to +represent the factor. The two primary outcomes of the study +were the health scale and the adoption of healthy lifestyle +choices. The health scale was derived as mentioned above; +further health scale scores were categorized based on tertile +distribution into low (poor), middle (average), and high (good) +scores. Adoption of healthy lifestyle choices was defined as the +engagement of the respondent in any two of three healthy +lifestyle choices (eating habits, substance use, and exercise). +Multivariate linear and logistic regression analyses were used +to test the influence of the perceptions and the personal variables +on the primary outcomes. Most of the items in the survey were +recorded as 3-point responses. Hence, to achieve homogeneity +in the analyses of the survey items, the 5-point Likert responses +of the self-rated health items, excellent, very good, good, +average, and poor, were collapsed into three categories: (1) very +good/excellent, (2) good, and (3) average/poor. Analysis of +variance was used to assess comparisons between continuous +variables, and P<.05 was considered significant. Chi-square +analysis was used for cross-country comparisons for categorical +variables. +Results +The aim of this survey was to understand the cross-national +psychosocial and behavioral impact of the lockdowns and social +isolations imposed due to the COVID-19 pandemic. We received +3370 responses: 1342 from India (39.8%), 983 from China +(29.2%), 669 from Italy (19.8%), and 377 from Japan (11.2%). +The demographic profiles of the respondents are presented in +Table 1. +Table 1. Countrywise representation of the personal characteristics of the survey participants. +P valuea +Italy (n=669) +Japan (n=377) +China (n=983) +India (n=1342) +Overall (N=3371) +Variable +<.001 +48.43 (13.65) +53.49 (9.35) +29.77 (11.98) +29.42 (12.29) +36.04 (15.54) +Age (years), mean (SD) +<.001 +Age group (years), n (%) +31 (4.7) +1 (0.3) +490 (49.8) +685 (51.0) +1200 (35.6) +18-24 +84 (12.5) +4 (1.1) +152 (15.5) +267 (19.9) +503 (14.9) +25-34 +309 (46.2) +217 (57.5) +314 (32.0) +330 (24.6) +1176 (34.9) +35-54 +169 (25.2) +98 (26.0) +21 (2.1) +40 (3.0) +330 (9.8) +55-64 +76 (11.4) +57 (15.1) +6 (0.6) +20 (1.5) +162 (4.8) +>65 +<.001 +506 (75.6) +348 (92.0) +802 (81.6) +880 (65.6) +2535 (75.2) +Female gender, n (%) +<.001 +395 (59.0) +335 (89.0) +406 (41.3) +582 (43.4) +1709 (50.7) +Working, n (%) +<.001 +314 (46.9) +151 (40.0) +84 (8.5) +169 (12.6) +647 (19.2) +Has a chronic illness, n (%) +aCross-country comparisons for categorical variables were conducted using chi-square analysis. Analysis of variance was conducted to assess comparisons +among the continuous variable of age. A P value <.05 was considered significant. +The mean age of the respondents was 36.04 years (SD 15.54) +(Table 1); the average age of the Indian and Chinese respondents +(29.42 years, SD 12.29, and 29.77 years, SD 11.98, respectively) +was lower than that of the Japanese and Italian respondents +(53.49 years, SD 9.35, and 48.43 years, SD 3.65, respectively). +Overall, there was a higher representation of the female gender +(2535/3371, 75.2%). Japan had the highest representation of +women (348/377, 92.0%) and working people (335/377, 89.0%) +(Table 1). Italy and Japan had the highest representations of +respondents with a known status of chronic illness (314/669, +46.9%, and 151/377, 40.0%, respectively). +Table 2 shows the countrywise status of the perceptions of health +and psychosocial factors reported in response to the ongoing +outbreak of COVID-19. The health status score was highest for +Indian respondents (9.43, SD 2.43) and lowest for Japanese +respondents (6.81, SD 3.44). Overall, 846/3371 (25.1%) of the +respondents had good health status; Japanese and Chinese +respondents had the highest representation of low health status +(236/377, 62.6%, and 562/983, 57.2%, respectively). Sleep +quality was perceived well by the majority of Indians (917/1342, +68.3%), and the majority of Japanese and Chinese respondents +perceived their sleep quality as average/poor (264/377, 70%, +and 554/983, 56.3%, respectively). Italian respondents had +almost equal representations of good and average sleep qualities. +Coping abilities during social isolation were perceived as good +by 1264/3371 (37.5%) of the overall population, with the +countrywise trend of India (672/1342, 50.1%) > Italy (283/669, +42.3%) > Japan (131/377, 34.8%) > China (178/983, 18.1%). +Fear response was almost equally distributed in positive or +intermediate categories for most of the country respondents, +except for Italians, among whom the intermediate or partial fear +response was the most evident (469/669, 70.1%). Coping +flexibility responses were very similar across all the countries +except Japan, wherein the majority of respondents (317/377, +84.1%) reported experiencing little challenging response to +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 3 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +sudden changes in living norms. Responses to interpersonal +relationships followed the trend of India (733/1342, 54.6%) > +Japan (183/377, 48.5%) > Italy (287/669, 42.9%) > China +(337/983, 34.3%). Adopted lifestyle behavior yielded the trend +of India (1129/1342, 83.9%) > Italy (361/669, 54.0%) > China +(436/983, 44.4%) > Japan (137/377, 36.2%). +Based on the regression analysis on the perceived health status, +female respondents had a 0.14 lower score compared to male +respondents (Table 3). Participants with a positive history of +chronic illness and those who were not working also had lower +health status scores, by 0.11 and 0.04, respectively, compared +to their counterparts. Increased personal relationships and +positive fear response were associated with increases in health +status across all the countries, particularly Japan, which showed +the highest value of β (.60). For Indian respondents, an increase +in age was significantly associated with increase in health status +by a score of 0.12. +Increased interpersonal relationships was a significant predictor +of adoption of health lifestyle choices across the respondents +in all the countries except for Italy (adjusted OR 1.93, 95% CI +0.65-5.79) (Table 4). Positive perception of fear was +significantly associated with likelihood of adoption of healthy +lifestyle choices only in Indian respondents (adjusted OR 2.41, +95% CI 1.18-4.96). Perceived health status categories were +significantly associated with the likelihood of adoption of +healthy lifestyle choices across all the countries; most +prominently, high health status increased adoption of healthy +lifestyle choices by approximately 6-fold in China and Italy. +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 4 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +Table 2. Countrywise representation of perceptions and behavioral changes among the survey respondents related to the COVID-19 outbreak. +P valuea +Italy (n=669) +Japan (n=377) +China (n=983) +India (n=1342) +Overall +(N=3371) +Perception or behavior and response +First factorb +.01 +8.43 (2.56) +6.81 (3.44) +7.09 ( 2.92) +9.43 (2.43) +8.26 (3.36) +Health status, mean (SD) +150 (22.4) +69 (18.3) +71 (7.2) +556 (41.4) +846 (25.1) +High, n (%) +Medium, n (%) +225 (33.6) +72 (19.1) +350 (35.6) +413 (30.8) +1062 (31.5) +294 (43.9) +236 (62.6) +562 (57.2) +413 (30.8) +1463 (43.4) +Low, n (%) +<.001 +Self-rated physical health, n (%) +173 (25.9) +88 (23.3) +467 (47.5) +629 (46.9) +1357 (40.2) +Excellent/very good +375 (56.0) +135 (35.8) +200 (20.3) +573 (42.7) +1283 (38.1) +Good +121 (18.1) +154 (40.8) +316 (32.1) +140 (10.4) +731 (21.7) +Poor/average +<.001 +Self-rated mental health, n (%) +206 (30.8) +93 (24.7) +0 (0) +645 (48.1) +944 (28.0) +Excellent/very good +371 (55.4) +122 (32.4) +642 (65.3) +535 (39.9) +1670 +(49.5) +Good +92 (13.8) +162 (43.0) +341 (34.7) +162 (12.1) +757 (22.5) +Poor/average +<.001 +Self-rated sleep quality, n (%) +328 (49.0) +113 (29.9) +429 (43.6) +917 (68.3) +1787 (53.0) +Good +240 (35.9) +234 (62.1) +477 (48.5) +354 (26.4) +1305 +(38.7) +Average +101 (15.1) +30 (8.0) +77 (7.8) +71 (5.3) +279 +(8.3) +Poor +<.001 +Self-rated coping abilities, n (%) +283 (42.3) +131 (34.8) +178 (18.1) +672 (50.1) +1264 (37.5) +Good +298 (44.5) +139 (36.8) +516 (52.5) +539 (40.1) +1492 (44.3) +Average +88 (13.2) +107 (28.5) +289 (29.4) +131 (9.8) +615 (18.2) +Poor +Second factor , n (%) +<.001 +Fear/anxiety related to COVID-19c +125 (18.7) +157 (41.6) +470 (47.8) +628 (46.8) +1380 (40.9) +Not at all (positive) +469 (70.1) +213 (56.5) +485 (49.3) +662 (49.3) +1829 (54.3) +Partially (intermediate) +75 (11.2) +7 (1.9) +28 (2.8) +52 (3.9) +162 (4.8) +Extremely (negative) +<.001 +Self-perception of low energy +261 (39.0) +239 (63.4) +282 (28.7) +667 (49.7) +1449 (43.0) +Never +390 (58.3) +132 (35.0) +672 (68.4) +641 (47.8) +1835 (54.5) +Sometimes +18 (2.7) +6 (1.6) +29 (3.0) +34 (2.5) +87 (2.6) +All the time +<.001 +Challenging response to sudden changes in living norms (coping flexibility) +144 (21.5) +44 (11.7) +221 (22.5) +436 (32.5) +845 (25.1) +Least/not at all/little +309 (46.2) +317 (84.1) +411 (41.8) +417 (31.1) +1454 (43.1) +Little +216 (32.3) +16 (4.2) +351 (35.7) +489 (36.4) +1072 (31.8) +Extremely/somewhat +Third factor, n (%) +<.001 +Interpersonal relationshipsc +287 (42.9) +183 (48.5) +337 (34.3) +733 (54.6) +1540 (45.7) +Increased +310 (46.3) +179 (47.5) +550 (56.0) +533 (39.7) +1572 (46.6) +Not changed +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 5 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +P valuea +Italy (n=669) +Japan (n=377) +China (n=983) +India (n=1342) +Overall +(N=3371) +Perception or behavior and response +72 (10.8) +15 (4.0) +96 (9.8) +76 (5.7) +259 (7.7) +Reduced +<.001 +Motivating influence of COVID-19 on lifestyle +221 (33.0) +132 (35.0) +217 (22.1) +605 (45.1) +1175 (34.8) +Completely +360 (53.8) +223 (59.2) +695 (70.7) +641 (47.8) +1919 (57.0) +Partially +88 (13.2) +22 (5.8) +71 (7.2) +96 (7.1) +277 (8.2) +Not at all +<.001 +485 (72.5) +283 (75.1) +750 (76.3) +1126 (83.9) +2643 (78.4) +Adoption of ≥2 healthy lifestyle choices +<.001 +361 (54.0) +137 (36.3) +436 (44.4) +867 (64.6) +1801 (53.4) +Adoption of healthy eating behavior +<.001 +623 (93.1) +355 (94.1) +918 (93.4) +1277 (95.2) +3173 (94.1) +Decreased dependency on and use +of tobacco, alcohol, or any other +substances +<.001 +426 (63.7) +272 (72.1) +672 (68.4) +910 (67.8) +2280 (67.6) +Increased engagement in exercise +or similar activities +aCross-country comparisons for categorical variables were conducted using chi-square analysis; all the P values were significant. +bAn exploratory factor analysis using principal axis factoring and varimax rotation suggested that there were 3 factors present in the data. The first +factor consisted of health-related perceptions; composite scores for perceived health were generated as summative scores of the included items. +cFor the remaining 2 factors, scales could not be formed; rather, the single items that were thought to best summarize the respective factors were +considered for further association analyses. +Table 3. Multivariate linear regression analysis (β coefficients, standard errors, and t and P values) of the association between health status, personal +variables, and perceptions. +Italy +Japan +China +India +Overall +Predic- +tors +P +t +SE +β +P +t +SE +β +P +t +SE +β +P +t +SE +β +P +t +SE +β +Demographic variables +.51 +–0.66 +0.02 +–.07 +0.12 +1.55 +0.02 +.08 +.07 +1.79 +0.01 +.07 +<.001 +3.74 +0.01 +.12 +<.001 +5.12 +0.01 +.14 +Age +Gender (reference: male) +.97 +–0.03 +0.52 +<.001 +0.77 +–0.30 +0.64 +.01 +.72 +–0.35 +0.23 +–.01 +<.001 +–3.24 +0.14 +–.09 +<.001 +–7.51 +0.12 +–.14 +Fe- +male +Working status (reference: working) +.72 +–0.36 +0.55 +–.03 +0.48 +–0.71 +0.56 +–.04 +.59 +–0.54 +0.23 +–.02 +.75 +–0.32 +0.15 +–.01 +.04 +–2.04 +0.13 +–.04 +Not +work- +ing +Chronic illness (reference: no) +.34 +–0.96 +0.47 +–.09 +0.01 +–2.81 +0.35 +–.14 +.04 +–2.04 +0.31 +–.06 +<.001 +–6.12 +0.20 +–.16 +<.001 +–5.63 +0.15 +–.11 +Yes +Perceptions +Interpersonal relationships (reference: decreased) +.03 +2.17 +0.68 +.27 +<.001 +4.86 +0.85 +.60 +<.001 +4.12 +0.31 +.21 +<.001 +6.48 +0.28 +.38 +<.001 +10.76 +0.21 +.37 +In- +creased +.12 +1.56 +0.66 +019 +0.01 +2.66 +0.84 +.33 +.28 +1.08 +0.29 +.05 +<.001 +3.71 +0.29 +.21 +<.001 +4.15 +0.21 +.14 +No +change +Fear response (reference: poor) +<.001 +3.03 +1.02 +.50 +0.01 +2.72 +1.38 +.54 +<.001 +8.02 +0.52 +.71 +<.001 +8.69 +0.33 +.59 +<.001 +10.84 +0.30 +.54 +Posi- +tive +.08 +1.77 +0.97 +.30 +0.20 +1.30 +1.37 +.26 +<.001 +4.35 +0.51 +.38 +<.001 +5.22 +0.33 +.35 +<.001 +5.82 +0.30 +.29 +Fair +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 6 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +Table 4. Role of perceptions in the adoption of healthy lifestyle choices. +Italy +Japan +China +India +Overall +Perception +Adjusted OR +(95% CI) +OR +(95% CI) +Adjusted OR +(95% CI) +OR +(95% CI) +Adjusted OR +(95% CI) +OR +(95% CI) +Adjusted OR +(95% CI) +OR +(95% CI) +AdjustedbOR +(95% CI) +ORa +(95% CI) +Health status (reference: low) +6.22 +(1.90- 20.40) +3.33 +(2.01- +5.51) +2.83 +(1.18-6.77) +3.64 +(1.59- +8.37) +5.83 +(2.30-4.79) +6.02 +(2.38- +15.20) +2.62 +(1.75-3.92) +2.98 +(2.07- +4.28) +3.42 +(2.51-4.64) +3.67 +(2.87- +4.68) +High +2.46 +(1.03-5.83) +2.10 +(1.42- +3.12) +1.06 +(0.54-2.08) +1.33 +(0.72- +2.45) +2.43 +(1.72-3.45) +2.61 +(1.85- +3.69) +1.57 +(1.07-2.31) +1.76 +(1.24- +2.50) +2.00 +(1.59-2.50) +2.09 +(1.72- +2.54) +Medium +Interpersonal relationshipsc (reference: decreased) +1.93 +(0.65-5.79) +1.86 +(1.07- +3.22) +5.25 +(1.46-8.92) +4.43 +(1.49- +13.15) +1.77 +(1.03-3.05) +2.01 +(1.18- +3.41) +2.16 +(1.15-4.08) +1.86 +(1.03- +3.37) +2.42 +(1.70-3.45) +2.21 +(1.64- +2.98) +In- +creased +1.40 +(0.50-3.96) +1.59 +(0.93- +2.73) +1.88 +(0.54-6.52) +1.87 +(0.65- +5.42) +0.99 +(0.61-1.62) +1.03 +(0.64- +1.68) +1.18 +(0.63-2.21) +1.09 +(0.60- +1.97) +1.18 +(0.84-1.66) +1.25 +(0.94-1.7) +Not +changed +Fear responsec (reference: poor) +2.20 +(0.41-11.71) +1.62 +(0.86- +3.04) +4.85 +(0.73-32.19) +1.84 +(0.34- +9.99) +2.18 +(0.96-4.94) +2.38 +(1.06- +5.33) +2.41 +(1.18-4.96) +2.72 +(1.38- +5.36) +2.50 +(1.54-4.05) +2.43 +(1.69- +3.50) +Positive +1.25 +(0.27-5.80) +1.34 +(0.80- +2.27) +1.97 +(0.31-12.55) +0.93 +(0.18- +4.93) +1.32 +(0.59-2.96) +1.46 +(0.66- +3.23) +1.32 +(0.65-2.65) +1.37 +(0.71- +2.65) +1.33 +(0.83-2.14) +1.36 +(0.95- +1.93) +Fair +aOR: odds ratio. +bAdjusted for sex, age, work status, and history of chronic illness. +cFactor represented by a single item that was thought to best represent the underlying notion. +Discussion +The aims of this short cross-national behavioral survey study +were to generate rapid ideas regarding perspectives on health +and lifestyle behavior and to provide initial insights into +designing global but culturally tailored public health policies. +Health Perceptions: Countrywise Status +A differential countrywise response was observed toward +perceived health status across the survey participants; Indians +had a better representation of high health status (41.4%) +compared to respondents from other countries (China, 7.2%, +Japan, 18.2%, and Italy, 22.5%). Despite the inconsistencies in +health perceptions, there was a consistent influence of social +support measured by perceptions of interpersonal relationships +and fear of perceived health status. However, there were +countrywise differences in the magnitude of the impact of +perceptions on health status; perception of interpersonal +relationships was most pronounced in the comparatively older +Italian and Japanese respondents (β=.68 and .60, respectively) +and that of fear in the Chinese respondents (β=.71). These +findings favor the implementation of regularized virtual +interpersonal interactions toward combating the adverse health +impact of the pandemic, particularly in countries with a higher +proportion of older people [34]. Controlling the fear response +through counseling would also aid the improvement of health +outcomes in populations affected by pandemics. The findings +of this survey related to the influence of gender on health +perceptions (the health status score of female respondents was +lower by 0.14 units compared to that of male respondents) are +in line with the global trend of poorer health perception in +women than in their male counterparts [35]. These real-time +findings observed during the pandemic also relate with reports +documented before the COVID-19 pandemic, with a generally +higher prevalence of adverse mental health symptoms in women +compared to men [36]. Overall, there seemed to be a differential +influence of demographic variables on health perceptions across +the global population during the pandemic. +The comparatively high scores of the perceived health status in +Indian respondents could be underlined by an early phase of +the pandemic with slower progression in India during the survey +period [11]. The younger age of the Indian respondents (mean +age 29.42 years, SD 12.29) seemed to further facilitate +interpersonal relationships (54.6%) during the lockdown, which +also explains their better health status (β=.38) [34,37]. Younger +age identity has been associated with well-being and better +perceptions of health [38]. However, in this survey, an +unexpectedly positive linear relationship was observed between +increasing age and better perception of health status (β=.12) in +young Indian respondents. This finding can be attributed to the +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 7 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +compounding effect of the COVID-19 pandemic on already +existing emotional distress among young adults (related to their +examinations, uncertainties, social relationships, etc) [39]. +Unfortunately, in line with previous reports [14,15], we could +also observe a continued/posttraumatic impact of the pandemic +in Chinese respondents, reflected in their comparatively low +perception of health status (poor health status was reported by +57.2% of these respondents). We believe the poor health +perceptions in the Chinese respondents is due to the underlying +influence of fear perceptions (β=.71). Further, since the country +had successfully emerged from the first wave of the pandemic +during the survey, and social norms had also almost returned +to normal, with fewer imposed lockdowns, the moderate increase +in interpersonal relationships (34.3%) may not be sufficient to +facilitate health status. +The observed low status of perceived health in the Japanese +respondents (low health status, 62.6%) is in accord with a health +paradox in that country, which is a tendency to perceive health +poorly despite the advanced economy [40,41]. Although this +influence is not direct, an indirect influence of the comparatively +old, middle-aged demographic profile of the Japanese +respondents along with the mediatory impact of chronic diseases +on health status (β=–.14) could also underlie the lower health +perceptions of the Japanese respondents [42]. The perception +of poor sleep quality in the Japanese respondents also needs +attention, as this finding is in line with reports of the suicidal +tendencies in this country [43]. +On a positive note, amid the aggravated pandemic at the time +of the survey, the majority of the Italian respondents who were +middle-aged perceived only partial fear of the pandemic (70.1% +response), and they reported better health perceptions (health +status score 8.43, SD 2.56) than Japanese respondents (health +status score 6.81, SD 3.44) and Chinese respondents (health +status score 7.09, SD 2.92). Approximately 55% of the responses +for self-rated physical and mental health were in the +moderate/fair tier, which is in accord with the reported tendency +of Italian people toward intermediate categories of health +perception [44]. The lack of negative influence of middle age +and chronic illness on health perception can be attributed to the +highly efficient medical care and adequate access to social +support provided in Italy during the lockdown (improved +interpersonal relationships were reported by 42.9% of Italian +respondents). +Role of Perceptions in the Adoption of Lifestyle +Choices: Countrywise Comparisons +Despite the imposed social isolation and home confinement and +the prevailing fear during the COVID-19 pandemic, we observed +a positive behavioral response toward lifestyle. Overall, 78.4% +of the respondents adopted at least 2 healthy lifestyle choices +during the COVID-19 pandemic. The majority of the +respondents (67.6%) reported increased engagement in physical +activity or exercise as opposed to the expected sedentary +behavior due to home confinement. This favorable although +unexpected outcome can be attributed to the timely release of +the advisory recommendations made by various global and +government agencies, including the WHO, on home-based or +other easy‐to‐perform exercises under physical restrictions +[45,46]. One of the crucial affirmative responses observed in +this survey was the overwhelming response toward substance +use (94.1%), which is more justifiable by lack of availability +[47] than motivational influence. Along similar lines, in a recent +survey on the immediate response to COVID-19, a 3% reduction +in smoking was reported in Italians, which was attributed to the +fear of increased risk of respiratory distress or mortality [48]. +To this end, we suggest the implementation of internet-based +and cost-effective behavioral therapies, particularly cognitive +behavioral therapy, which may aid the successful alleviation of +maladaptive coping tendencies, thereby reducing the risk of +future health catastrophes in the post–COVID-19 era [49,50]. +Social connectedness is an important dimension that controls +population health and healthy lifestyle behavior [51]. In this +cross-national survey, perception of increased social support +and capital, manifested through enhanced interactions among +close friends and family members (measured as interpersonal +relationships in the survey), seemed to fill the void of missing +social connectedness and encouraged the adoption of healthy +lifestyle choices (adjusted OR 2.42, 95% CI 1.70-3.45). The +substantial representation of the adoption of healthy lifestyle +choices in Chinese and Japanese respondents (~75%), +irrespective of their overall poor health perceptions, could be +related to reverse causality. In the Japanese respondents (who +had an older, middle-aged demographic profile), their working +status (OR 4.37, 95% CI 1.19-16.02) (Table S1, Multimedia +Appendix 1) and interpersonal relationships (OR for the +adoption of healthy lifestyle choices 5.25, 95% CI 1.46-18.92) +also seemed to contribute significantly to the adoption of healthy +lifestyle behavior. +The influence of interpersonal relationships on the adoption of +healthy lifestyle choices was not consistent across different +countries and was absent in the Italian respondents. However, +this finding aligns with the previously reported relationship +between a healthy lifestyle and self-perceived health in the +European population [52]. Perception of good health was a +prominent predictor of adoption of a healthy lifestyle (adjusted +OR 6.22, 95% CI 1.90-20.40) in the middle-aged Italian +respondents, with a 36.6% proportion of older individuals (>55 +years). Even intermediate scores of health perceptions (health +status) also significantly predicted the likelihood of the adoption +of healthy lifestyle choices (OR 2.43, 95% CI 1.72-3.45) in the +Chinese respondents compared to the respondents from other +countries, explained by their demographic characteristic of +younger age. These countrywise differential cultural influences +of perceptions on health and health behaviors during pandemics +indicate that endorsement of the same, such as family support +and togetherness, should consider existing disparities, especially +for western countries [13]. +The findings of this report, particularly those regarding varied +health perceptions and their differential influence on the +likelihood of adopting healthy lifestyle choices, should be +considered within the purview of the survey period with +countrywise phase variations of the pandemic. Chinese +respondents displayed the continued impact of the pandemic, +as they had already witnessed one phase of the pandemic [2]. +Younger Indian respondents scored better for their health- and +behavior-related perceptions due to the stable and early phase +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 8 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +of the pandemic (as of April 22, there was a comparatively +steady expansion of COVID-19 cases in India compared to other +countries, with 18,985 confirmed cases [11]). However, the +responses of Japanese and Italian respondents related to their +older age; these countries were also witnessing rising waves of +COVID-19 at the time of the survey [7,53]. Japan was under +an extended state of national emergency, as the number of +“untraceable” cases was soaring [7]. Italy was also under an +extended period of lockdown and was one of the hardest-hit +nations, with an apparent mortality rate of approximately 13% +[53,54]. +The observed predominantly female participation in the survey +indicates a lack of stringent sampling but also highlights the +active involvement of women, who are considered to be at high +risk of socioeconomic vulnerability toward disease outbreaks +such as the COVID-19 pandemic. The positive response for +self-care in women is also a sign of improving gender equity +toward health awareness. The observed overwhelmingly female +participation level (75.2%) could not be ascribed to the gender +representation of countries such as India and China [55] but +could be ascribed to the high readiness of the female population +to interactively use the internet, in particular to research +health-related information and programs, as observed in recent +reports [56-58]. +The study is limited by the lack of inclusion of perceptions of +preventive behaviors and did not compare the respondents’ +views on precautionary measures, such as the use of face masks +[59]. In a recent cross-country comparison between Polish and +Chinese respondents, higher use of face masks in Chinese +respondents (Polish respondents, 35.0%; Chinese respondents, +96.8%; P<.001) was found to be associated with better physical +and mental impact of the COVID-19 pandemic [59]. Further, +the observations of the adopted lifestyle choices presented here +are derived from a short lockdown period during the COVID-19 +pandemic and are preliminary, influenced mostly by +self-perception; demographic and cultural differences and +realistic insight could only be obtained from a longer follow-up. +Due to the self-reported nature of the observations, positive +behavioral responses toward lifestyle are likely to be inflated. +Good perceived health was associated with improved +interpersonal relationships. Older respondents were least likely +to report a positive relationship change, as observed in the +responses of Italian and Japanese survey participants. However, +there was a strong influence of improved interpersonal +relationships on perceived health as well as adoption of healthy +lifestyle choices in Japanese respondents. These findings +indicate the potential of regularized virtual interpersonal +interactions to attenuate the adverse psychosocial impact of +such pandemics. +In conclusion, the key finding of the survey is that the consistent +positive influence of increased interpersonal relationships and +good perceptions of health were found to have a significant +influence on adopted lifestyle behaviors during the adverse time +course of the COVID-19 pandemic. These favorable behavioral +perceptions should be bolstered through enhanced health +awareness, and regularized virtual interpersonal interactions, +particularly in countries with an overall middle-aged or older +population. Simultaneously, controlling the fear response +through counseling would also help improve health outcomes +in nations affected by pandemics. However, the observed human +behavior has cultural influences, and it may not be globally +generalizable. +Data Availability Statement +The data that support the findings of this study are available on +request from the corresponding author. +Acknowledgments +The authors gratefully acknowledge the contributions of Dr Ravi Kulkarni and Dr Kousthubha for facilitating the data processing +and providing technical support for preparing Google Forms, etc. There was no funding source for this study. +Authors' Contributions +MNK conceptualized the survey, performed the literature search, collected data from public sources, and contributed to the +manuscript writing. VM wrote the manuscript and performed the literature search and statistical analyses. NR conceptualized the +study and revised the manuscript. HR reviewed the manuscript. MNK and VM finalized the manuscript. 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Front Psychiatry 2020 Sep 9;11:569981 [FREE Full text] [doi: 10.3389/fpsyt.2020.569981] [Medline: 33033485] +Abbreviations +SARS: severe acute respiratory syndrome +SVYASA: Swami Vivekananda Yoga Anusandhana Samsthana +WHO: World Health Organization +Edited by G Eysenbach; submitted 18.08.20; peer-reviewed by P Mathur, R Ho, A Videira-Silva; comments to author 26.10.20; revised +version received 03.12.20; accepted 11.04.21; published 01.06.21 +Please cite as: +Manjunath NK, Majumdar V, Rozzi A, Huiru W, Mishra A, Kimura K, Nagarathna R, Nagendra HR +Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey +JMIR Form Res 2021;5(6):e23630 +URL: https://formative.jmir.org/2021/6/e23630 +doi: 10.2196/23630 +PMID: 33900928 +©Nandi Krishnamurthy Manjunath, Vijaya Majumdar, Antonietta Rozzi, Wang Huiru, Avinash Mishra, Keishin Kimura, Raghuram +Nagarathna, Hongasandra Ramarao Nagendra. Originally published in JMIR Formative Research (https://formative.jmir.org), +01.06.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License +(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, +provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, +a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included. +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 12 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX diff --git a/subfolder_0/A Pilot Study on Evaluating Cardiovascular Functions during the Practice of Bahir Kumbhaka (External Breath Retention).txt b/subfolder_0/A Pilot Study on Evaluating Cardiovascular Functions during the Practice of Bahir Kumbhaka (External Breath Retention).txt new file mode 100644 index 0000000000000000000000000000000000000000..23d4e052af277306013175e8a8a085e2baaac2fc --- /dev/null +++ b/subfolder_0/A Pilot Study on Evaluating Cardiovascular Functions during the Practice of Bahir Kumbhaka (External Breath Retention).txt @@ -0,0 +1,349 @@ +Original Research Paper +A pilot study on evaluating cardiovascular functions during the practice +of Bahir Kumbhaka (external breath retention) +L. Nivethitha*, A. Mooventhan, N.K. Manjunath +Department of Research and Development, S-VYASA University, Bengaluru, Karnataka, India +A R T I C L E +I N F O +Article history: +Received 21 October 2016 +Received in revised form 16 January 2017 +Accepted 17 January 2017 +Available online xxx +Keywords: +Cardiovascular functions +Kumbhaka +Pranayama +A B S T R A C T +Background: Breath is the dynamic bridge between body and mind and Pranayama (breathing techniques) +is one of the most important yogic practices. There is a lack of scientific evidence on cardiovascular +functions during the practice of pranayama techniques, especially Kumbhaka. Hence, this present study +aims at evaluating the cardiovascular functions of healthy volunteers during the practice of Bahir +Kumbhaka (BK) (external breath retention). +Materials and methods: Nineteen healthy volunteers with the mean (standard deviation) age of 23.53 +(3.08) were recruited. All the subjects were asked to perform BK for the duration of 30 s (1 round) and +repeat the same for 3-rounds with the rest period of 1 min between each round. Baseline, during and post +assessments were taken before, during and immediately after the practice. Statistical analysis was +performed using repeated measures of analysis of variance with the use of statistical package for the +social sciences, version 16. +Results: Result of this study showed a significant increase in systolic blood pressure (SBP) and rate +pressure product (RPP) during the practice of BK which was revert back to normal after the practice; and a +significant increase in diastolic blood pressure (DBP), mean arterial pressure (MAP) and double product +(Do-P) during the practice of BK which did not revert back to normal even after the practice. +Conclusion: The result of this pilot study suggests that the practice of BK increases the SBP, DBP, MAP, RPP +and Do-P during the practice. +© 2017 Elsevier Ltd. All rights reserved. +1. Background +Yoga is an ancient Indian science and the way of life, which +includes the practice of specific posture (asana), regulated +breathing (Pranayama) and meditation. Breath is the dynamic +bridge between body and mind and Pranayama is an art of +prolongation and control of breath which is one the most +important yogic practices [1]. It consists of 4-important aspects +like 1) Pooraka (inhalation), 2) Rechaka (exhalation), 3) Antar +kumbhaka (internal breath retention), and 4) Bahir Kumbhaka +(external breath retention) [2]. +Previous studies reported the effect of various pranayamas such +as breath awareness, right nostril breathing, left nostril breathing +[3], +alternate +nostril +breathing [3,4], +Kapalabhati, +Bhastrika, +Kukkuriya, Savitri, Pranav [4] and Bhramari Pranayama [5] on +cardiovascular variables before and after the practice. Only very +few studies have reported the cardiovascular effect of particular +pranayama technique during the practice [6]. +Though Kumbhaka (breath retention) is one of the important +aspects of pranayama, it should only be practiced for as long as is +comfortable and is not recommended for people with cardiovas- +cular diseases (CVD) and high blood pressure (BP) [2]. The scientific +reason for not recommending it to such people is less known and to +the best of our knowledge there is no known study reported the +cardiovascular +effect +of +Kumbhaka +practice +especially +Bahir +(External) Kumbhaka (BK) either in healthy or people with CVD. +Hence, this present pilot study aims at evaluating the cardiovas- +cular effect of BK in healthy volunteers. +2. Materials and methods +2.1. Subjects +Nineteen healthy volunteers with the mean (standard devia- +tion) age of 23.53 (3.08) were recruited from a university, South +India based on the following inclusion and exclusion criteria. +Inclusion criteria: age = 18 years and above; gender = both male and +female; subjects who are willing to participate in the study. +Exclusion criteria: subject with the history of any systemic and +* Corresponding author. +E-mail address: dr.nivethithathenature@gmail.com (L. Nivethitha). +http://dx.doi.org/10.1016/j.aimed.2017.01.001 +2212-9588/© 2017 Elsevier Ltd. All rights reserved. +Advances in Integrative Medicine xxx (2016) xxx–xxx +G Model +AIMED 105 No. of Pages 3 +Please cite this article in press as: L. Nivethitha, et al., A pilot study on evaluating cardiovascular functions during the practice of Bahir +Kumbhaka (external breath retention), Adv Integr Med (2017), http://dx.doi.org/10.1016/j.aimed.2017.01.001 +Contents lists available at ScienceDirect +Advances in Integrative Medicine +journal homepage: www.elsevier.com/locate/aimed +mental illness; regular use of medication for any diseases; chronic +smoking or alcoholism; subject who is unable to perform BK. The +study protocol was approved by the institutional ethical commit- +tee and a written informed consent was obtained from each +participant. +2.2. Design of the study +This is a single group repeated measure study, in which all the +subjects were asked to perform BK. The baseline, during and post +assessments were taken before, during and after the practice. +2.3. Assessment +Height: By using a standard measuring tape, height in cm of +each subject was measured. +Weight: By using a standard weighing machine, the weight in kg +of each subject was measured. +Body mass index (BMI): It has been derived by using height and +weight in the formula of weight in kg divided by height in meter +square [1]. +Cardiovascular variables: +A beat to beat changes in the cardiovascular variables such as +systolic blood pressure (SBP), diastolic blood pressure (DBP), mean +arterial pressure (MAP), heart rate (HR), stroke volume (SV), left +ventricular ejection time (LVET), cardiac output (CO), pulse interval +(PI), and total peripheral resistant (TPR) were assessed in sitting +position using non-invasive blood pressure monitoring system +(Finapres +Continuous +Non-Invasive +Blood +Pressure +Systems, +Netherlands). A finger cuff of suitable size was placed on the left +middle finger, in between the interphalangeal joints. A Non- +invasive blood pressure cuff was placed on the upper arm of the +same hand at the level of the heart and the marker on the cuff was +directly above the brachial artery. The hand was placed at the knee +and flexed at the elbow. A brachial correction was also made for +each subject before assessment. Assessments were taken at rest +before starting of the pranayama (baseline), during and after each +pranayama practice. Data were extracted in off-line and exported +to Microsoft excel 2007. +Assessments such as pulse pressure (PP), rate pressure product +(RPP), and double product (Do-P) were derived by using following +formulas. PP was calculated as (SP  DP); RPP as (HR  SP/100); and +Do-P as (HR  MP/100) [7]. +2.4. Intervention +Bahir Kumbhaka (BK) (External breath retention): Subjects were +asked to perform breath holding/retention after exhalation [2] for +the duration of 30-s. This is one round and it was repeated for 3- +rounds with a rest (normal breath) period of 1-min between each +round. +2.5. Data analysis +Statistical analysis was performed using repeated measures of +analysis of variance and post hoc analysis with Bonferroni +adjustment for multiple comparisons with the use of Statistical +Package for the Social Sciences (SPSS) for Windows, Version 16.0. +Chicago, SPSS Inc. p-value <0.05 was considered as significant. +3. Results +Demographic variables of the study group have been provided +in Table 1. Results of this present study showed a significant +increase in SBP and RPP during the practice of BK that revert back +to normal after the practice; and a significant increase in DBP, MAP +and Do-P during the practice of BK that did not revert back to +normal even after the practice; and no such significant changes +were observed in rest of the variables (Table 2). +4. Discussion +SBP, DBP, PP, and MAP are known as the best predictors of CVD +risks [8]. Results of this present study showed a significant increase +in SBP during the practice of BK and revert back to normal after the +practice. It might attribute to the combined effect of increased level +of CO due to increased level of HR and increased level of TPR during +the practice of BK because SBP = CO  peripheral resistance (PR) +[7]. +A significant increase in DBP, MAP during the practice of BK +might attribute to the increase in TPR during the practice but these +changes did not revert back to normal even after the practice and +even though there was a reduction in TPR after the practice of BK. +Hence, the mechanism behind the sustained effect of increased +level of DBP and MAP even after the practice is unclear. +The increase in RPP and Do-P might attribute to the increase in +HR and BP. RPP and Do-P are the important indirect indicators of +myocardial oxygen consumption and load on the heart [7]. A +significant increase of these variables in this study indicates strain +increasing effects of BK on the heart during the practice and +relieved after the practice. +Since Yoga is becoming popular throughout the world, people +are +very +much +interested +in practicing +various +techniques +especially the advanced techniques which include Kumbhaka +practice within a short span of period. According to a Yogic text, the +practice of advanced techniques should begin only after we +become master over the basic techniques. And these advanced +techniques has to be practiced gradually in order to get adopt the +body and mind with the practice, to reach the final stage. If, it is not +followed then that might lead to certain adverse effects [2]. This +Table 1 +Demographic variables of the study group (n = 19). +Variables +Study group (n = 19) +Age (years) +23.53  3.08 +Gender +Males (n = 18) and female (n = 1) +Height (m) +1.70  0.09 +Weight (kg) +60.42  8.60 +Body mass index (kg/m2) +20.90  2.30 +Table 2 +Cardiovascular changes while practicing Bahir Kumbhaka (n = 19) (RMANOVA). +Variables +Baseline +During +Post +SBP (mmHg) +115.93  14.35 +129.22  18.53* +119.53  12.75 +DBP (mmHg) +71.54  8.87 +80.84  11.12* +74.05  8.77* +MAP (mmHg) +88.74  10.24 +100.07  13.75* +92.01  9.81* +PP (mmHg) +44.39  8.23 +48.38  9.86 +45.48  7.30 +RPP (Units) +97.91  16.71 +113.31  23.21* +103.35  15.65 +Do P (Units) +74.97  12.29 +87.72  17.27* +79.67  12.69* +HR (beats/mint) +84.61  10.82 +87.94  13.68 +86.82  11.92 +SV (l) +70.42  13.35 +69.95  12.36 +70.20  13.03 +LVET (ms) +267.86  17.03 +259.49  20.82 +261.90  18.86 +Cardiac output (l/mint) +5.89  1.24 +6.07  1.40 +6.00  1.15 +Pulse interval (ms) +730.50  98.08 +712.26  133.55 +716.63  116.19 +TPR (mmHg min/l) +1.04  0.29 +1.11  0.31 +1.02  0.27 +Note: All values are in mean  standard deviation. SBP = systolic blood pressure; +DBP = diastolic blood pressure; MAP = mean arterial pressure; PP = pulse pressure; +RPP = rate pressure product; Do-P: double product; HR = heart rate; SV = stroke +volume; LVFT = left ventricular ejection time; TPR = total peripheral resistant. +* p < 0.05. +2 +L. Nivethitha et al. / Advances in Integrative Medicine xxx (2016) xxx–xxx +G Model +AIMED 105 No. of Pages 3 +Please cite this article in press as: L. Nivethitha, et al., A pilot study on evaluating cardiovascular functions during the practice of Bahir +Kumbhaka (external breath retention), Adv Integr Med (2017), http://dx.doi.org/10.1016/j.aimed.2017.01.001 +present study results also supporting the above mentioned +concept by showing the increased level of SBP, DBP, MAP, RPP +and Do-P during the practice of BK (one of the advanced aspects of +pranayama) even in healthy volunteers. Hence, in order to avoid +complications of high-BP, this kind of practices should not be +recommended suddenly to the people with hypertension and other +CVD. Care must be taken in administrating this breathing +technique by mastering over the basic practices (slow/yogic +breathing techniques) and then a gradual increase in the duration +of practice to get adopt with the practice. Because, regular practice +of slow inspiration and expiration for longer duration would help +in training the stretch receptors of respiratory muscles, chest wall +and walls of the alveoli to support the breath holding along with +acclimatizing the central and peripheral chemoreceptors for both +hypercapnoea and hypoxia. +Breath holding time is one of the most important variables used +to measure the respiratory function [9]. Longer the breath holding +time, better the pulmonary function. Since, BK is one of the breath +holding techniques that was shown to increase BP as well as RPP +and Do-P (indirect measure of cardiac workload), regular practice +of BK alone or along with other pranayama practices might be +considered in cardio-respiratory training of healthy individuals to +strengthen the system and to prevent the various cardio- +respiratory problems. +Strengths of this present study: First study evaluating the +cardiovascular effect of BK during the practice itself; Beat to beat +changes in the blood pressure was measured using standard +advanced non-invasive blood pressure monitoring systems. +Limitations of this study: Small sample size; subjects were +healthy volunteers which is limiting the scope of this study in +people with pathological conditions; autonomic function assess- +ments such as heart rate variability, galvanic skin resistance, pulse +plethesmogram; baroreflex sensitivity would have provided more +information. Hence, further studies are required with larger +sample size using all the above mentioned objective variables in +both healthy and people with pathological conditions for the better +understanding. +5. Conclusion +The result of this study suggests that the practice of BK +increases the SBP, DBP, MAP, RPP and Do-P during the practice. +Source of funding +Nil. +Conflict of interest +None declared. +References +[1] A. Mooventhan, V. Khode, Effect of Bhramari pranayama and OM chanting on +pulmonary function in healthy individuals: a prospective randomized control +trial, Int. J. Yoga 7 (2014) 104–110. +[2] S. Saraswati, Asana Pranayama Mudra Bandha, 4th rev. edition, Yoga +Publications Trust, Munger, Bihar, India, 2008. +[3] P. Raghuraj, S. Telles, Immediate effect of specific nostril manipulating yoga +breathing practices on autonomic and respiratory variables, Appl. +Psychophysiol. Biofeedback 33 (2008) 65–75. +[4] V.K. Sharma, M. Trakroo, V. Subramaniam, M. Rajajeyakumar, A.B. 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Nivethitha, et al., A pilot study on evaluating cardiovascular functions during the practice of Bahir +Kumbhaka (external breath retention), Adv Integr Med (2017), http://dx.doi.org/10.1016/j.aimed.2017.01.001 diff --git a/subfolder_0/A randomized controlled study on assessment of health status, depression, and anxiety in coal miners with copd.txt b/subfolder_0/A randomized controlled study on assessment of health status, depression, and anxiety in coal miners with copd.txt new file mode 100644 index 0000000000000000000000000000000000000000..2218147a6fdca295ecf3022d102659327985bc3f --- /dev/null +++ b/subfolder_0/A randomized controlled study on assessment of health status, depression, and anxiety in coal miners with copd.txt @@ -0,0 +1,940 @@ +137 +© 2016 International Journal of Yoga | Published by Wolters Kluwer - Medknow +A randomized controlled study on assessment of health +status, depression, and anxiety in coal miners with chronic +obstructive pulmonary disease following yoga training +Rajashree Ranjita, Sumati Badhai, Alex Hankey, Hongasandra R Nagendra +Division of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana Yoga University, Bengaluru, Karnataka, India +Address for correspondence: Dr. Rajashree Ranjita, + +Swami Vivekananda Yoga Anusandhana Samsthana, No. 19, Eknath Bhavan, Gavipuram Circle, + +Kempegowda Nagar, Bengaluru ‑ 560 019, Karnataka, India. + +E‑mail: drrajashreeyoga@gmail.com +increasingly affect the psychological well‑being of working +populations,[4] coal miners being more susceptible due to +highly risky and stressful working environments.[5] Prior +studies have documented association of depression and +anxiety among COPD patients[6‑9] more than non‑COPD +individuals.[10] Clinically significant symptoms of +depression were found in around half COPD patients[11,12] +while the prevalence of anxiety has been estimated at +INTRODUCTION +Chronic obstructive pulmonary disease (COPD) is a +complex, treatment‑resistant disease with multiple +comorbidities, depression, and anxiety being the two of +the most important and least treated among them.[1] Other +than cigarette smoking, there is an increasing evidence +of occupational exposures as a major risk factor for +COPD[2,3] found the prevalence of COPD in nonsmoking +coal miners was 19% in a study. Depression and anxiety +Original Article +Context: Psychological comorbidities are prevalent in coal miners with chronic obstructive pulmonary disease (COPD) and +contribute to the severity of the disease reducing their health status. Yoga has been shown to alleviate depression and anxiety +associated with other chronic diseases but in COPD not been fully investigated. +Aim: This study aimed to evaluate the role of yoga on health status, depression, and anxiety in coal miners with COPD. +Materials and Methods: This was a randomized trial with two study arms (yoga and control), which enrolled 81 coal miners, +ranging from 36 to 60 years with stage II and III stable COPD. Both groups were either on conventional treatment or combination +of conventional care with yoga program for 12 weeks. +Results: Data were collected through standardized questionnaires; COPD Assessment Test, Beck Depression Inventory and +State and Trait Anxiety Inventory at the beginning and the end of the intervention. The yoga group showed statistically significant +(P < 0.001) improvements on all scales within the group, all significantly different (P < 0.001) from changes observed in the +controls. No significant prepost changes were observed in the control group (P > 0.05). +Conclusion: Yoga program led to greater improvement in physical and mental health status than did conventional care. Yoga +seems to be a safe, feasible, and effective treatment for patients with COPD. There is a need to conduct more comprehensive, +high‑quality, evidence‑based studies to shed light on the current understanding of the efficacy of yoga in these chronic conditions +and identify unanswered questions. +Key words: Anxiety; COPD assessment test; chronic obstructive pulmonary disease; depression; yoga. +ABSTRACT +Access this article online +Website: +www.ijoy.org.in +Quick Response Code +DOI: +10.4103/0973-6131.183714 +How to cite this article: Ranjita R, Badhai S, Hankey A, +Nagendra HR. A randomized controlled study on assessment of health +status, depression, and anxiety in coal miners with chronic obstructive +pulmonary disease following yoga training. Int J Yoga 2016;9:137-44. +This is an open access article distributed under the terms of the Creative +Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows +others to remix, tweak, and build upon the work non‑commercially, as long as the +author is credited and the new creations are licensed under the identical terms. +For reprints contact: reprints@medknow.com +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Ranjita, et al.: Effect of yoga on depression, anxiety in COPD +International Journal of Yoga • Vol. 9 • Jul-Dec-2016 +138 +40%.[13‑15] About one‑third of COPD sufferers is afflicted +by both.[16] The presence of these comorbid symptoms +significantly contributes to the impaired health status +in patients with COPD[17,18] irrespective of the degree of +airflow limitation.[19] Therefore, optimizing the health +status is an important goal in COPD management.[20] In a +systematic review, it has been reported that comprehensive +pulmonary rehabilitation benefits in a reduction in +short‑term depression and anxiety.[21] Limited evidence is +available on the effect of mindfulness‑based treatments +such as yoga for the management of depression and anxiety +in COPD patients. +Yoga is a way of life, mainly has four primary +components: Physical postures to develop strength and +flexibility, breathing exercises to enhance respiratory +functioning, deep relaxation techniques to cultivate the +ability to release anxiety, and meditation/mindfulness +practices to promote emotion and stress regulation +skills.[22] Psychosomatic ailments arise due to a +disturbance in the mind.[23] The level of documented +evidence of yoga’s psychophysiological benefits for +depression and anxiety is progressively increasing.[24‑32] +Similarly, some research has been conducted on +yoga’s application to COPD[33‑37] but no study has been +published assessing the effect of yoga on coal miners, +for whom the condition is a major work‑related health +hazard. Hence, this study was aimed to evaluate the +effects of a 12 weeks program of the Integrated Approach +of Yoga Therapy (IAYT) on health status, depression, and +anxiety of COPD in coal miners compared to controls on +conventional care, based on the hypothesis that it would +improve the health status by decreasing depression and +anxiety symptoms. IAYT is a combination of breathing +practices, physical postures, pranayama, kriya, +meditation, relaxation techniques, and lectures.[22] Its +therapeutic applications as a supplementary therapy +for chronic health conditions in asthma,[38] cancer,[39] +diabetes,[40] schizophrenia,[41] and low back pain[42] are +well established. +MATERIALS AND METHODS +Participants +Eighty‑one male nonsmoking coal miners with ages ranging +from 36 years to 60 years were recruited for the study. +They were all present coal miners of Rampur Colliery, +Odisha. A total of 279 coal miners were screened, of +whom 36 declined to sign the informed consent form. +Rest 243 underwent clinical examination, of these 162 met +any one of exclusion criteria and finally 81 registered for +the trial and were randomized into two groups, yoga and +waitlist controls. Figure 1 depicts the flow diagram of +the study, showing screening, enrollment, intervention, +assessments, and analysis. +Inclusion criteria +The inclusion criteria were as follows: Physician diagnosed +COPD with spirometric evidence of chronic airflow +limitation (forced expiratory volume in 1 s/forced vital +capacity, post bronchodilator <0.70), Global initiative for +Obstructive Lung Disease (GOLD) stage I and II COPD;[1] +clinically stable for at least 3 months; literate to complete +the questionnaires. +Exclusion criteria +Exclusion criteria were: Prior experience of yoga; recent +COPD exacerbation; cognitive impairment; myocardial +infarction or recurrent angina within the previous +6 months; hospitalization within 3 months; and respiratory +tract infection within 1 month of enrollment. +Informed consent +The aim of the study was conveyed to those agreeing to +participate in the study; signed informed consent was +obtained from all participants prior to baseline assessment. +Design +This is a randomized, waitlist control, single‑blind clinical +trial in which 81 participants were assigned to two groups +(yoga and control) using a computer generated random +number table obtained from http://www.randomizer.org. +Numbered opaque envelopes were used to implement +the random allocation to conceal the sequence until +interventions were assigned. +Study protocol +At enrollment, medical, exposure histories, pulmonary +symptoms, and information about current pharmacological +treatments were obtained, and clinical examinations +performed by a specialist physician. Comorbid diagnoses +were established from clinical histories and examination +findings, supported by reviews of available medical +records. The yoga group practiced a set of integrated +yoga practices specially designed for COPD for 90 min +daily, 6 days/week for 12 weeks. Participants of control +group continued conventional therapy, completing all +assessments at the same times as the yoga group; they +were offered yoga at the end of the study. All participants +were asked to refrain from participating in any other yoga +classes during the study period. +Blinding and masking +Double blinding is not considered possible for yoga +interventions, where participants and trainer can +recognize group assignment. However, giving and scoring +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Ranjita, et al.: Effect of yoga on depression, anxiety in COPD +139 +International Journal of Yoga • Vol. 9 • Jul-Dec-2016 +the assessments were masked wherever feasible. The +statistician responsible for randomization, and subsequent +data analysis was not involved in administering the +intervention and was thus blind to the source of the data. +The clinical psychologist who administered and scored the +psychological questionnaires and the staff, who carried out +assessments, were blind to membership of the intervention +groups. Coded answer sheets were analyzed only after the +study’s completion. +Study approval +The study was approved by the Institution Ethics +Committee (Swami Vivekananda Yoga University, +Bangalore) through RES/IEC/28/2014 in accordance with +the Helsinki Declaration. +Intervention +The IAYT module was developed by Swami Vivekananda +Yoga Anusandhana Samasthana specifically for COPD. It +included simple and safe practices at physical, mental, +emotional, and intellectual levels. The yoga practice +protocol was designed in consultation with S‑VYASA’s +Medical Director. The daily schedule is detailed in +Table 1. +Assessments +Assessments were made on both groups before and after +the 12 weeks of intervention. The following questionnaires +were completed by all participants. +COPD assessment test +COPD Assessment Test (CAT) is a short questionnaire +developed for assessing and monitoring COPD in +routine clinical practice. It provides a valid, reliable, and +standardized measure of the impact of COPD on a patient’s +health and well‑being.[43,44] It consists of 8 items rated using +a Likert‑type scale of 0–5, providing a score out of 40, +higher scores representing the poorer quality of life (QoL). +Despite the small number of items, it covers a broad range +of effects on patients’ health. It takes less time to complete +than other health‑related QoL questionnaires.[45] CAT is +sensitive to changes in disease progression over time and +to the effectiveness of treatments.[46,47] Internal consistency +is excellent with Cronbach’s α =0.88 and test‑retest +reliability good in stable patients (ICCC = 0. 8).[43] +Beck depression inventory +All participants completed the Beck Depression +Inventory (BDI), 2nd edition.[48] BDI‑II is a self‑report +Total patients screened +(n = 279) +Declined informed consent +(n = 36) +Underwent clinical examination +(n = 243) +Did not meet the inclusion +criteria (n = 162) +Random assignment (n = 81) +Yoga group +(n = 41) +Control group +(n = 40) +Intervention 12 +weeks +Drop outs +(n = 5) +Drop outs +(n = 4) +Incomplete questionnaires +(n = 1) +Illness (n = 2) +Out of station (n = 1) +Reasons for +drop out +Incomplete questionnaires +(n = 2) +Illness (n = 1) +Less attendance (n = 2) +Final analysis +Yoga (n = 36) +Final analysis +Control (n = 36) +Figure 1: Flow of participants over study period +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Ranjita, et al.: Effect of yoga on depression, anxiety in COPD +International Journal of Yoga • Vol. 9 • Jul-Dec-2016 +140 +questionnaire of 21 items scored from 0 to 3. It is +designed to assess depressive symptoms experienced +within the previous 2 weeks. It has high internal +consistency (Cronbach’s α =0.92); mean test‑retest +reliability is 0.72.[49] BDI‑II scores range from 0 to 63, +with categorical depression ratings of “minimal” (0–13), +“mild” (14–19), “moderate” (20–28), and “severe” +(29–63). BDI is considered a valid measure of depressed +mood for diverse populations. +State trait anxiety inventory +State and Trait Anxiety Inventory (STAI) is a reliable, +valid, and widely used measure of anxiety for clinical +practice and research, with a high degree of internal +consistency.[50] Cronbach’s α is 0.85 for the total scores.[51] +It includes separate measures of state anxiety and trait +anxiety each comprising 20 items rated on a 4 point +scale from 0 to 3 which range from 20, minimum, to 80, +maximum. Form S evaluates state anxiety, how subjects, +feel “at this moment;” while Form T assesses trait anxiety, +how the respondent feels “most of the time.” In India, +its reliability and validity are well established following +extensive use in adult populations. State anxiety reflects +subjective and transitory emotional states characterized +by consciously perceived feelings of nervousness, tension, +worries, and apprehension, and heightened autonomic +nervous system activity. In contrast, trait anxiety refers +to relatively stable individual differences in anxiety +proneness as a personality attribute that denotes general +tendency to respond with anxiety to perceived threats in +the environment. +Data collection +Clinical and demographic information were collected +using medical records and study‑specific forms. Adherence +and compliance were monitored through the use of daily +patient diaries and attendance records kept by the yoga +instructors. No make‑up sessions were provided for missed +classes. All participants were instructed to continue their +routine daily activities during the 12‑week intervention +period but were asked not to start a new yoga or exercise +regimen on their own during that time. A feedback form +was used to assess enjoyment and helpfulness of the +yoga intervention, and to ask whether participants would +recommend it to others. +Table 1: Integrated approach of yoga therapy for +chronic obstructive pulmonary disease used in this study +Name of the practices +Duration (min) +Breathing practices +10 +Standing +Hands in and out breathing +1 +Hands stretch breathing +1 +Ankle stretch breathing +1 +Sitting +Dog breathing +1 +Rabbit breathing +1 +Tiger breathing +1 +Sasäìkäsana breathing (moon pose) +1 +Prone +Bhujaìgäsana breathing +1 +Śalabhāsana breathing +1 +Supine +Straight leg raising breathing +1 +Loosening practices +10 +Forward and backward bending +1 +Side bending +1 +Twisting +1 +Pawanmuktäsana kriyä (alternate leg) +1×2 +Rocking and rolling +1×2 +Surya Namaskära × 3 rounds +1×3 +Yogäsanas (physical postures) +20 +Standing +Ardhakati cakräsana (lateral arc pose) +2 +Pädahastäsana (forward bend pose) +2 +Ardha cakräsana (half wheel pose) +2 +Sitting +Vakräsana (twisting posture) +2 +Ardhamatsyendräsana (half spinal twist posture) +2 +Paścimottānāsana (sleeping thunderbolt posture) +2 +Prone +Bhujaìgäsana (serpent pose) +2 +Śalabhāsana (locust pose) +2 +Supine +Sarväìgäsana (shoulder stand pose) +2 +Matsyäsana (fish pose) +2 +Yogä chair breathing +10 +Instant relaxation technique +1 +Neck muscle relaxation with chair support +1 +Neck movements in Vajräsana +1 +Sasäìkäsana movement +1 +Relaxation in Tadäsana +1 +Neck movements in Tadäsana +1 +Ardha cakräsana - Pädahastäsana +1 +Quick relaxation technique +3 +Präëäyäma +10 +Kapälabhäti (frontal brain cleansing) +2 +Vibhägiya präëäyäma (sectional breathing) +2 +Näòéśodhana präëäyäma (alternate nostril +breathing) +2 +Ujjayi präëäyäma (diaphragmatic breathing) +2 +Bhrämaré präëäyäma (bee breathing) +2 +Meditation +10 +Nädänusandhäna (alternate day) +10 +Om Meditation (alternate day) +10 +DRT in Çaväsana (corpse pose) +10 +Yogic counseling/lectures +10 +Yoga philosophy and health, basis and applications +of yoga, Pancakoña viveka (five layers of existence), +COPD causes, complications and relation to +stress, Stress reaction and its management. Lifestyle +modification, diet and exercise, emotion and coping +Table 1: Contd... +Name of the practices +Duration (min) +Kriyä (once a week) +90 +Theory on kriyä +10 +Jala Neti +20 +Sutra Neti +20 +Vamana Dhouti +25 +DRT +15 +DRT = Deep relaxation technique, COPD = Chronic obstructive pulmonary disease +Contd... +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Ranjita, et al.: Effect of yoga on depression, anxiety in COPD +141 +International Journal of Yoga • Vol. 9 • Jul-Dec-2016 +Statistical analysis +Data were analyzed using SPSS version 18.0 +(IBM Corporation, USA). Within group changes and between +group treatment effects associated with participation in the +yoga intervention were evaluated using Chi‑square tests +for categorical data and paired t‑tests and independent +sample t‑tests for continuous data. P < 0.05 was considered +significant. +RESULTS +Descriptive features +The study population initially consisted of 81 coal miners +with COPD. Five and four participants dropped out of +yoga and control group, respectively, for personal reasons +unrelated to the study, giving a final sample size of 72 (36 +in each group). Total participants in GOLD stage II category +were 52.8% in yoga and 58.3% in controls, and in GOLD +stage III 47.2% in yoga and 41.7% in controls. Demographic +variables of patient’s average age, duration of employment +in coal mines, and duration of disease since diagnosis were +comparable as were initial test scores at baseline (all P > +0.05) [Table 2]. +COPD assessment test +The practice of yoga for 12 weeks has significantly +lowered the CAT scores (P < 0.001) in the yoga group, +indicating better health status, whereas no significant +difference was observed in the control group (P = 0.294). +The results further revealed that the change occurred in +the yoga group was 23.05% and in the control group was +− 2.52%. Between‑group differences were statistically +significant (P < 0.001, independent t‑test) [Table 3]. +Beck depression inventory +In both the groups, mean depression scores were reduced, +but the magnitude of change is statistically significant +and higher (P < 0.001, 25.53%) in the yoga group as +compared to the control group (P = 0.095, 3.23%). In +addition, significant group mean differences were observed +between yoga and control group’s post intervention scores +(P = 0.002) [Table 3]. +State and trait anxiety inventory +The yoga group showed significantly lower scores in both +state and trait anxiety (P < 0.001), but controls showed no +significant change (P = 0.192 and P = 0.383, respectively). +State anxiety decreased by 15.98% in yoga and increased +by 1.98% in controls. A similar trend was observed in trait +anxiety also. It decreased by 13.35% in yoga and increased +by 1.46% in controls. Independent t‑tests gave statistically +significant differences between groups at posttest, P = 0.032 +and P = 0.034, respectively. Overall anxiety score was +significantly reduced by 14.64% within the yoga group +(P < 0.001), whereas and there was slight increase by 1.71% +(P = 0.054) reported in the control group [Table 3]. +DISCUSSION +To the best of our knowledge, this is the first +randomized‑controlled study investigating physical and +psychological health benefits associated with yoga practice +on coal miners with COPD. The study evaluated the impact +of yoga on their disease‑specific health status, depression, and +anxiety levels. Results suggested that IAYT practice facilitates +improvements in health status and reduces self‑reported +depression and anxiety levels after 12 weeks of practice. +The results are consistent with previously reported +interventions based on yoga, which demonstrated positive, +beneficial effects on psychological and psychosocial +factors in diverse conditions such as diabetes,[40] cancer,[52] +CAD,[53] low back pain,[54] osteoarthritis of the knee,[55] and +pregnancy.[56,57] It is reported in a study that pranayama +(yogic breathing) mitigates posttraumatic stress disorder +and depression.[58] Another study on patients who +participated in education and stress management in +addition to exercise training during a 12‑week intervention +reported reductions in depression and anxiety.[59] +A study reported that changes in depression and state and +trait anxiety did not significantly differ between the two +interventions (6 weeks of weekly yoga classes together +with exercise, compared to a 6 weeks weekly group +exercise) (GDS15, P = 0.749, STAI‑S, P = 0.595, STAI‑T, +P = 0.407).[60] Another study has similarly obtained unclear +effects following yoga intervention.[61] +The pathophysiology of depression and anxiety among +COPD patient is complex and poorly understood. The +Table 2: Baseline characteristics of participants in both +yoga and control group +Variables +Mean±SD +P (independent +sample t-test) +Yoga +(n=36) +Control +(n=36) +Age +53.69±5.66 +54.36±5.40 +0.611* +Duration of employment +in coal mines +28.36±4.62 +27.72±4.23 +0.543* +Duration of disease +since diagnosis +9.92±3.25 +10.69±2.54 +0.262* +CAT +20.69±5.53 +21.81±5.48 +0.395* +BDI +22.25±8.47 +24.14±9.21 +0.368* +STAI (S) +39.61±8.73 37.92±10.92 +0.469* +STAI (T) +41.06±7.82 +39.86±8.88 +0.547* +STAI (total) +80.67±16.06 77.78±19.27 +0.492* +*Not significant. CAT = COPD assessment test, BDI = Beck depression inventory, +STAI = State-trait anxiety inventory, STAI (S) = State anxiety, STAI (T) = Trait anxiety, +SD = Standard deviation, COPD = Chronic obstructive pulmonary disease +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Ranjita, et al.: Effect of yoga on depression, anxiety in COPD +International Journal of Yoga • Vol. 9 • Jul-Dec-2016 +142 +physical, emotional, and social impact of COPD may cause +a self‑perpetuating cycle that has a severe impact on a +patient’s physical and mental health status.[21] It has been +shown that high scores on perceived stress and anxiety +are related to increase in hypothalamic‑pituitary‑adrenal +(HPA) axis activity.[62] The effects of yoga in our results can +be explained by reduction in levels of psychophysiological +arousal via triggering neurohormonal mechanisms +that suppress sympathetic activity,[63,64] balance in the +autonomic nervous system responses,[65] alterations in +neuroendocrine arousal[66,67] through better regulation +of the HPA axis[68] resulting in reductions in stress and +anxiety.[32] Better psychological health resulting from stress +reduction might be due to relaxation techniques[69] which +contribute to the observed improvements in CAT scores in +our study. Thus, these psychological changes may explain +the physiological changes observed as better outcomes +seen in previous studies on integrated yoga in asthma.[38] +Yoga unites body, mind, and spirit; and enhances attention +by calming down the restless mind.[22] Thus, the deep +physiological rest that is achieved by the components of +pranayama, meditation, and other mindfulness practices +incorporated in the integrated yoga program could be +the major factors explaining observed benefits. Overall, +antidepressant effects of yoga programs can be attributed +to stress reduction.[70] Another study concluded the +practice of meditation strengthens the mental resolve +and hence decreases anxiety.[71] Yoga practices decrease +parasympathetic nervous system and GABAergic activity +that underlies stress‑related disorders which result in +amelioration of disease symptoms.[72] Reductions in +psychological hyper‑reactivity and emotional instability +achieved by yoga may be due to reduced efferent vagal +reactivity[73] already recognized as a main psychosomatic +factor in asthma,[74] might have similar physiology in +COPD also. +This study is the first of its kind to conclude that integrated +yoga can act as an imperative line of therapy in the +management of COPD in coal miners. The novel aspects +of this study were (a) the randomized control design, +(b) good sample size, (c) incorporation of integrated yoga +approach, and (d) good compliance. A major constraint of +the study is the lack of an active control group. It would +have been valuable to include physiological measures of +stress such as Galvanic Skin Response and Heart Rate +Variability to overcome the subjectivity of self‑report +and to throw light on the mechanisms. In spite of the +aforementioned limitations, significant results were +manifested in a short time suggesting yoga therapy could +be a non‑pharmacological alternative for the management +of COPD. The current state of understanding necessitates +further assessment to evaluate benefits of yoga for COPD in +diverse populations, especially associated with depression +and anxiety followed over longer time periods. Robust +effectiveness and implementation studies are required +to determine whether yoga therapy can decrease medical +utilization. In addition, the findings of this study may +also provide evidence supporting the incorporation of +yoga into standardized pulmonary rehabilitation programs +as a practical adjunct to improve the management of +psychosocial symptoms associated with COPD. +CONCLUSION +In this study, 12 weeks of integrated yoga enhanced health +status and reduced depression and anxiety in coal miners +with COPD. Any system that can bring symptomatic relief +and improve different aspects of QoL of COPD patients +merits incorporation into standard COPD treatments. +Further research is warranted to confirm these preliminary +findings and facilitate implementation in clinical settings. +Acknowledgment +The authors would like to express gratitude Mr. Rajeev Lochan +and Soubhagyalaxmi Mohanty for assisting with manuscript +preparation. Thanks are due to Mr. Kunja Bihari Badhai, +senior yoga instructor for his experienced support and +advice. Also to Mr. Arjun Biswal for coordinating the +program. Special thanks to Dr. R Nagarathna, who offered +critical and thoughtful recommendations in the initial +development of the program and Dr. Balaram Pradhan, Ph.D. +for statistical analysis. +Table 3: Change scores within yoga and control, and difference between groups with 95% CI +Variables +Yoga (n=36) +Control (n=36) +Between group +Pre$ +Post$ +Pre$ +Post$ +Post +versus +post# +P +Group × +time +interaction +P +Mean±SD +CI (LB-UB) +Mean±SD +CI (LB-UB) +Mean±SD +CI (LB-UB) +Mean±SD +CI (LB-UB) +CAT +20.69±5.53 18.82-22.56 15.92±6.51*** 13.71-18.12 21.81±5.48 19.95-23.66 22.36±5.65 20.45-24.27 0.001 +<0.001 +BDI II +22.25±8.47 19.38-25.12 16.56±7.03*** 14.18-18.93 24.14±9.21 21.02-27.25 23.36±10.49 19.81-26.91 0.002 +<0.001 +STAI (S) +39.61±8.73 36.66-42.56 33.28±9.92*** 29.92-36.63 37.92±10.92 34.22-41.61 38.67±10.92 34.97-42.36 0.032 +<0.001 +STAI (T) +41.06±7.82 38.41-43.70 35.58±9.14*** 32.49-38.67 39.86±8.88 32.49-38.67 40.44±9.89 37.10-43.79 0.034 +<0.001 +STAI total 80.67±16.06 75.23-86.10 68.86±17.96*** 62.79-74.94 77.78±19.27 71.26-84.30 79.11±19.77 72.42-85.80 0.024 +<0.001 +$Paired t-test; #Independent t-test. BDI = Beck depression inventory, STAI = State-trait anxiety inventory, STAI (S) = State anxiety, STAI (T) = Trait anxiety, SD = Standard +deviation, CI = Confidence interval, LB = Lower bound, UB = Upper bound, CAT = COPD assessment test, COPD = Chronic obstructive pulmonary disease. +***Highly significant +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Ranjita, et al.: Effect of yoga on depression, anxiety in COPD +143 +International Journal of Yoga • Vol. 9 • Jul-Dec-2016 +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +REFERENCES +1. +GOLD. Global Strategy for the Diagnosis, Management and Prevention +of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic +Obstructive Lung Disease; 2015. Available from: http://www.goldcopd.org/ +uploads/users/files/GOLD_Report_2015.pdf. [Last accessed on 2015 Mar 09]. +2. +Hu Y, Chen B, Yin Z, Jia L, Zhou Y, Jin T. 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J Asthma +1986;23:123‑37. +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] diff --git a/subfolder_0/A review of the scientific studies on cyclic meditation.txt b/subfolder_0/A review of the scientific studies on cyclic meditation.txt new file mode 100644 index 0000000000000000000000000000000000000000..4bfbbacebd7a8ca07a26329e74bc416b0971bfa7 --- /dev/null +++ b/subfolder_0/A review of the scientific studies on cyclic meditation.txt @@ -0,0 +1,336 @@ +IJOY +Online full text at +http://www.ijoy.org.in +Published by Medknow Publications +International +Journal of Yoga +0973-6131 +Volume 2 | Issue 2 | Jul-Dec 2009 +C o n t e n t s +} +The power of Prana +} +A review of the scientific studies on cyclic meditation +} +Cardiovascular and metabolic effects of intensive Hatha Yoga training in middle-aged and older women from +northern Mexico +} +Effect of yogic education system and modern education system on memory +} +Motion analysis of sun salutation using magnetometer and accelerometer +} +Normative data for the digit-letter substitution task in school children +} +Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial +International Journal of Yoga + y + Vol. 2: + y + Jul-Dec-2009 +46 +A review of the scientifi + c studies on cyclic meditation +Pailoor Subramanya, Shirley Telles +Indian Council of Medical Research, Center for Advanced Research in Yoga and Neurophysiology, SVYASA, Bangalore, India +Address for correspondence: Dr. Shirley Telles, +Patanjali Yogpeeth, Maharishi Dayanand Gram, Bahadrabad, +Haridwar-249 402, Uttarakhand, India. +E-mail: shirleytelles@gmail.com +DOI: 10.4103/0973-6131.60043 +Review Article +GENERAL +Yoga is an ancient science, originating in India, which +has components of physical activity, instructed relaxation +and interoception.[1] Yoga includes diverse practices, +such as physical postures (asanas), regulated breathing +(pranayama), meditation and lectures on philosophical +aspects of yoga.[2-3] Meditation is the seventh of eight +steps prescribed to reach an ultimate stage of spiritual +emancipation (Patanjali, circa 900 B.C.).[4] While many +practitioners do learn meditation directly, others find it +easier to first pass through the other stages - learn yoga +postures (asanas) and regulated breathing (pranayamas). +It is postulated that when a novïce attempts to meditate +directly, there could be two responses based on the quality +of the mind viz., (i) a rajasic – active (personality) mind +would be restless all through the session and (ii) a tamasic +– a mind with inertia could fall asleep. This problem +of the mind is addressed in the Mandukya Upanishad. +Based on this a technique of ‘moving meditation’, which +combines the practice of yoga postures with guided +meditation was evolved, called cyclic meditation (CM), by +H.R. Nagendra, Ph.D., which has its’ origin in an ancient +Indian text, Mandukya Upanishad.[5] It is interesting to +note that CM does induce a quiet state of mind, which is +compatible with the description of meditation (dhyana +or effortless expansion), according to Patanjali. The +description states: ‘Tatra pratyayaikatanata dhyanam’ +(Patanjali’s Yoga Sutras, Chapter 3: Verse 2). This means +that the uninterrupted flow of the mind towards the object +chosen for meditation is dhyana.[4] Indeed, all meditations, +irrespective of the strategies involved are believed to help +reach this state. There are several strategies in meditation +which include breath awareness, awareness of internal +sensations, directing the attention to a mantra or a koan, +and keeping the eyes open with the gaze fixed on the object +of meditation. +The verse on which CM is based, states: ‘In a state of mental +inactivity awaken the mind; when agitated, calm it; between +these two states realize the possible abilities of the mind. +If the mind has reached states of perfect equilibrium do +not disturb it again’. The underlying idea is that, for most +persons, the mental state is routinely somewhere between +the extremes of being ‘inactive’ or of being ‘agitated’ and +hence to reach a balanced/relaxed state the most suitable +technique would be one which combines ‘awakening’ and +‘calming’ practices. +In CM, the period of practicing yoga postures constitutes +the ‘awakening’ practices, while periods of supine rest +comprise ‘calming practices’. An essential part of the +practice of CM is being aware of sensations arising in +the body.[6] This supports the idea that a combination +of stimulating and calming techniques practiced with +a background of relaxation and awareness (during CM) +may reduce psycho physiological arousal more than +resting in a supine posture for the same duration. The +practice of CM, includes yoga postures (asanas) which +involve muscle stretching and this has diverse benefits. +The effects, benefits and possible mechanisms underlying +CM are given below. +SCIENTIFIC STUDIES ON CM +The studies described below were all carried out at the +Swami Vivekananda Yoga Research Foundation, Bangalore, +India, where the technique was devised. +Studies on autonomic and respiratory variables +In a previous study, heart rate variability (HRV) was +studied in 42 male volunteers in CM and supine rest +(SR) sessions. The high frequency (HF) power of the +HRV increased during both CM and SR practice, which +is considered to suggest increased vagal tone.[7] However, +there was a marginally greater increase during CM (4.4 +%) compared to during SR (1.0 %). In the same study the +low frequency (LF) power which is believed to correlate +with sympathetic activity was significantly less during +both CM (1.8 % decrease) and SR (0.3 % decrease). The +study showed parasympathetic dominance. The exact +mechanism underlying the effect of CM on the autonomic +nervous system is difficult to determine. The effect may be +47 +International Journal of Yoga + y + Vol. 2: + y + Jul-Dec-2009 +brought about by reduced cortical activity, which in turn +may modify the activity at the level of the hypothalamus. +An earlier study on 35 male volunteers (between 20- +46 yrs of age) showed a significant decrease in oxygen +consumption and increase in breath volume were +recorded after guided relaxation practiced for 10 minutes +compared to the equal duration of supine rest. During +guided relaxation the power of the LF component of the +heart-rate variability spectrum reduced, whereas the +power of the HF component increased, suggesting reduced +sympathetic activity.[8] However, another study on 40 male +volunteers (16 to 46 yrs) showed that Isometric relaxation +technique practiced for a minute showed a reduction in +the physiological signs of anxiety and stress.[9] +More recently, a study on 30 male volunteers (20 to 33 years) +showed a decrease in heart rate (HR), low frequency power +(LF power), LF/HF ratio, and an increase in the number of +pairs of Normal to Normal RR intervals differing by more +than 50 ms divided by total number of all NN intervals +(pNN50) following the practice of cyclic meditation (CM) +suggestive of a shift towards sympatho-vagal balance in +favor of parasympathetic dominance during sleep.[10] +Studies on applications in reducing occupational stress +levels +In a subsequent study correlating CM and heart +rate variability, a two-day CM program decreased +occupational stress levels and baseline autonomic +arousal in 26 asymptomatic, male, middle managers,[11] +suggesting significant reduction in sympathetic activity. +The mechanisms underlying the decrease in occupational +stress levels may be related to decreased autonomic arousal +(sympathetic activation) as well as psychological factors, +though this remains a speculation. +Studies on metabolism and oxygen consumed +An earlier study on oxygen consumption showed that a +period of CM significantly reduced oxygen consumption +to a greater degree (32.1%) than a comparable period of +supine rest.[12] A recent study also showed that after the +practice of CM oxygen consumption decreased (19.3 %) +compared to following SR (4.8 %). Also, the change in +oxygen consumption suggested that after the practices (but +not during) there was a period of physiological relaxation +which was more after CM compared to SR.[13] +The energy expenditure (EE), respiratory exchange ratio +(RER) and heart rate (HR) of 50 male volunteers were +assessed before, during, and after the sessions of CM and +sessions of supine rest. CM reduced the energy expenditure +more than supine rest alone.[14] The studies cited above +were conducted using the self-as-control design. Reduction +in oxygen consumption due to CM practice could be related +to decreased oxygen consumption of the brain and the +skeletal muscles (which are probably more relaxed with +the practice of CM). +Studies on attention and electrophysiology +Earlier studies showed that despite the changes suggestive +of parasympathetic dominance following CM, there was a +decrease in the P300 peak latency and an increase in the +P300 peak amplitude when the P300 was obtained using +an auditory oddball paradigm.[15] The P300 component of +event-related brain potentials (ERPs) is generated when +persons attend to and discriminate stimuli which differ +in a single aspect. More recently, middle latency auditory +evoked potentials (0-100ms range) were examined in 47 +male volunteers before and after the practice of CM which +has resulted in prolonged latencies of evoked potentials +generated within the cerebral cortex, supporting the idea +of cortical inhibition after CM.[16] The studies cited above +were conducted using the self-as-control design. The +mechanism by which CM may improve attention while +reducing sympathetic tone may be related to increased +proprioceptive input (during the practice of asanas) to the +Reticular Activating System (RAS), which in turn keeps +cortical areas receptive and active.[17] This is difficult to +understand as generally increased alertness and vigilance +is associated with an increase in sympathetic tone. +Studies on performance in cancellation task +In a previous study, the effect of CM practice on +performance in a letter cancellation task, was assessed +in 69 male volunteers (whose ages ranged from 18 to +48 years).[18] There was improved performance in the +task which required selective attention, concentration, +visual scanning abilities, and a repetitive motor response +following CM. The results were interpreted to suggest +that the improved performance after CM suggests that the +practice not only globally enhances performance but also +selectively reduces the probability of being distracted. +Again, it is difficult to understand how CM practice, +associated with reduced sympathetic activity, increases the +performance in an attention task. As described above this +may be via increased proprioceptive input to the reticular +activating system. +Study on memory and anxiety +In a recent study 57 male volunteers (group average age +± S.D., 26.6 ± 4.5 years) the immediate effect of CM +and SR were studied on memory and state anxiety. A +cyclical combination of yoga postures and supine rest +in CM improved memory scores immediately after the +practice and decreased state anxiety more than rest in a +classical yoga relaxation posture (shavasana).[19] Like the +Scientifi + c studies on CM +International Journal of Yoga + y + Vol. 2: + y + Jul-Dec-2009 +48 +P300 event-related potential and the letter cancellation +task, performance in the memory task requires increased +alertness. The mechanism (as described above) remains +speculative. +Study on polysomnography +In a recent study, whole night polysomnography measures +and the self-rating of sleep were assessed on the night +following a day in which 30 male volunteers practiced +CM twice (approximately 22:30 minutes each time). This +was compared to another night when they had two, equal +duration sessions of supine rest (SR) on the preceding day. +The percentage of slow wave sleep (SWS) was significantly +more in the night following CM practice than the night +following SR; percentage of rapid eye movement (REM) +sleep and the number of awakenings per hour were less. +The practice of CM during day time has been shown +to increase the percentage of slow wave sleep in the +subsequent night.[20] CM has a number of components +which may facilitate sleep such as increased physical +activity, muscle stretching, interoception, and guided +relaxation. +CONCLUSION +The practice of CM in general appears to bring about a +state of low physiological activation, as described above, +with reduced oxygen consumption and a shift in the +sympathovagal balance towards vagal dominance. A period +of CM practice significantly reduces oxygen consumption +and energy expenditure to a greater degree (32.1%) than +a comparable period of supine rest. The CM program has +also been shown to decrease occupational stress levels and +baseline autonomic arousal. There is also an improved +performance in a letter cancellation task which requires +selective attention, concentration, visual scanning abilities, +and a repetitive motor response following CM. Moreover, a +study of the P300 following CM suggested that participants +showed a better ability to discriminate auditory stimuli +of different pitches in a P300 auditory oddball task. The +prolonged latencies of evoked potentials, generated within +the cerebral cortex after the practice of CM, supported the +idea of cortical inhibition after CM. The practice of CM +during day time has been shown to increase the percentage +of slow wave sleep in the subsequent night. This +suggests that CM practice (i) reduces autonomic arousal, +(ii) improves attention, and (iii) improves quality of sleep. +ACKNOWLEDGMENT +The authors gratefully acknowledge H.R. Nagendra, Ph.D. who +derived the cyclic meditation technique from ancient yoga texts. +REFERENCES +1. +Vivekananda Kendra. Yoga the science of holistic living. Chennai: +Vivekananda Kendra Prakashan Trust; 2005. +2. +Nagendra HR. Yoga its’ basis and applications. Bangalore: Swami +Vivekananda Yoga Prakashana; 2004. +3. +Saraswati Niranjanananda Swami. Prana, Pranayama, Pranavidya. Munger, +Bihar: Yoga publication trust, Bihar School of yoga; 1994. +4. +Taimini IK. The science of yoga. Madras, India: The Theosophical Publishing +House; 1986. +5. +Chinmayanada Swami. Mandukya Upanishad. Bombay, India: Sachin +Publishers; 1984. +6. +Nagendra HR, Nagarathna R. New perspectives in stress management. +Bangalore, India: Swami Vivekananda Yoga Prakashana; 1997. +7. +Sarang P, Telles S. Effects of two yoga based relaxation techniques on heart +rate variability. Int J Stress Manag 2006;13:460-75. +8. +Vempati RP, Telles S. Yoga based guided relaxation reduces sympathetic +activity in subjects based on baseline levels. Psychol Rep 2002;90:487-94. +9. +Vempati RP, Telles S. Yoga based relaxation versus supine rest: A study of +oxygen consumption, breath rate and volume and autonomic measures. J +Indian Psychol 1999;17:46-52. +10. Patra S, Telles S. Heart rate variability during sleep following the practice +of cyclic meditation and supine rest. Appl Psychophysiol Biofeedback 2009; +In Press. +11. +Vempati RP, Telles S. Baseline occupational stress levels and physiological +responses to a two day stress management program. J Indian Psychol +2000;18:33-7. +12. Telles S, Reddy SK, Nagendra HR. Oxygen consumption and respiration +following two yoga relaxation techniques. Appl Psychophysiol Biofeedback +2000;25:221-7. +13. Sarang PS, Telles S. Oxygen consumption and respiration during and +after two yoga relaxation techniques. Appl Psychophysiol Biofeedback +2006;31:143-53. +14. Sarang, SP, Telles S. Cyclic meditation: A moving meditation-reduces energy +expenditure more than supine rest. J Indian Psychol 2006;24:17-25. +15. Sarang SP, Telles S. Changes in P300 following two yoga-based relaxation +techniques. Int J Neurosci 2006;116:1419-30. +16. Subramanya P, Telles S. Changes in midlatency auditory evoked potentials +following two yoga-based relaxation techniques. Clin EEG Neurosci +2009;40:190-5. +17. Kandel ER, Schwartz JH, Jessell TM. Principles of neural science. 4th ed. +New York, USA: McGraw- Hill; 2000. +18. Sarang SP, Telles S. Immediate effect of two yoga based relaxation +techniques on performance in a letter-cancellation task. Percept Mot Skills +2007;105:379-85. +19. Subramanya P, Telles S. Effect of two yoga-based relaxation techniques on +memory scores and state anxiety. Biopsychosoc Med 2009;3:8. +20. Patra S, Telles S. Positive impact of cyclic meditation on sleep. Med Sci +Monit 2009;15:CR375-81. +Subramanya and Telles diff --git a/subfolder_0/A self-rating scale to measure tridos.as in_unlocked.txt b/subfolder_0/A self-rating scale to measure tridos.as in_unlocked.txt new file mode 100644 index 0000000000000000000000000000000000000000..4b826b043362932e860dde5fd885266f4d9840a2 --- /dev/null +++ b/subfolder_0/A self-rating scale to measure tridos.as in_unlocked.txt @@ -0,0 +1,1111 @@ +Original Article + +Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 +85 +A self-rating scale to measure tridos +.as in +children +S.P. Suchitra, H.R. Nagendra1 +Life Sciences, 1Vice Chancellor, Swami Vivekananda Yoga Anusandhana Samsthana, Yoga University, Bangalore +INTRODUCTION +A +yurveda, the ancient life science is an aspect of Vedic lore +is broadly based on the principles of tridoṣas‑ vāta, pitta +and kapha. Tridoṣas are fundamental principles which maintain +bodily function (just as the sun, moon and air maintain the +universe, somatic functions are maintained by the dos +.as).[1‑9] +Western psychologists propose type and trait theories +for personality. Father of modern medicine, Hippocrates +ABSTRACT +Background: Self  –  rating inventories to assess the +Prakr +.ti (constitution) and personality have been developed +and validated for adults. To analyze the effect of personality +development programs on Prakr +.ti of the children, standardized +scale is not available. Hence, present study was carried out to +develop and standardize Caraka Child Personality inventory (CCPI). +Materials and Methods: The 77‑ item CCPI scale was developed +on the basis of translation of Sanskrit verses describing va +-taja (a), +pittaja (b) and kaphaja prakr +.ti (c) characteristics described in +Ayurveda texts and by taking the opinions of 5 Ayurveda experts +and psychologists. The scale was administered on children of the +age group 8-12 years in New Generation National public school, +Bangalore. +Results: This inventory was named CCPI and showed excellent +internal consistency. The Cronbach’s alpha for A, B and C scales +were 0.54, 0.64 and 0.64 respectively. The Split ‑ Half reliability +scores for A, B and C subscales were 0.64. 0.60 and 0.66 +respectively. Factor validity coefficient Scores on each item was +above 0.4. Scores on va +-taja, pittaja and kaphaja scales were +inversely correlated. Test-retest reliability scores for A,B and C +scales were 0.87,0.88 and 0.89 respectively. The result of CCPI was +compared with a parent rating scale Ayurveda Child Personality +Inventory (ACPI). Subscales of CCPI correlated significantly +highly (above 0.80) with subscales of ACPI which was done for +the purpose of cross‑validation with respect to ACPI. +Conclusions: The prakr +.ti of the children can be measured +consistently by this scale. Correlations with ACPI pointed toward +concurrent validity. +KEY WORDS: Tridosha, prakriti, va +-ta, pitta, kapha, Ayurveda +classifies individuals as choleric, melancholic, sanguine, and +phlegmatic based on the predominance of bodily humors. +This comes close to Ayurveda’s description of personalities +except for the description of vāta in the latter. Sheldon’s +Somato‑type classification ectomorphic, endomorphic, +mesomorphic types of personalities have been correlated +with Ayurveda prakṛti.[12] Other psychologists do not +consider wide‑ranging aspects of the personality.[10] +Ayurveda classics[1‑9] propose a comprehensive analysis of +personality, encompassing physical‑physiological aspects +like color of the eyeball, texture of hair, appetite, sleep, +behavior, attitudes and interests, memory, intelligence, +mental stamina of an individual to come to a conclusion +about the tridoṣa state of the individual. The biological +qualities of tridoṣas also influence mental and behavioral +qualities. The texts suggest seven types of personality (vāta, +pitta, kapha, vāta–pitta, vāta–kapha, pitta–kapha, sama) +determined by predominance of a single, a pair, or all of +the doṣas. +Ayurveda considers the balanced state (sama) of Tridoṣa +as health. Person with predominance of single and +double doṣas will certainly be vulnerable to diseases, as +vitiation of tridoṣas is the cause for the manifestation of +disease.[3] Accordingly, Ayurveda recommends specific +diet and daily regimen for different types of personalities +to maintain health.Studies have discussed the importance +of Ayurveda[11], tridoṣas.[12] A Statistical model of doṣa prakṛti +based on analysis of a questionnaire has been developed.[13] +An analysis of the tridoṣa physiology, linking it to processes +of cellular physiology has been carried out. These studies +postulate the correspondence of functions of Vāta with +input/output  (homeostasis); Functions of Pitta with +Access this article online +Quick Response Code: +Website: +www.ancientscienceoflife.org +DOI: +10.4103/0257-7941.139042 +[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82] +86 +Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 +Suchitra and Nagendra: Self rating scale to asses prakr +.ti +turnover (negative entropy production); and functions of +kapha with storage of the cellular functions.[14‑16] Similarly, a +genetic basis of tridoṣa constitution has been postulated.[17‑20] +A study comparing the Ayurveda personality concepts and +western psychology concepts is available.[21‑22] Ayurveda +tridoṣa theory and four elements of Buddhist medicine, +Chinese humorolgy has been compared.[23,24] Importance +of prakṛti in ageing has been discussed.[25] Effect of +isotonic exercise on different types of prakṛti has been +observed.[26] A difference in metabolism of different prakṛti +has been explained.[27] Left and right hemisphere chemical, +dominance has been observed with predominance of +doṣas.[28] Another study postulated  ADP‑induced maximal +platelet aggregation was highest among the vāta‑pitta +prakṛti individuals.[29] Relationship between vāta prakṛti +and Parkinson’s disease has been studied.[30] A scale to +measure tridoṣas in psychotic patients has been developed.[31] +Ayurveda Child Personality Inventory (ACPI), a parent +rating scale to measure tridoṣas in children has been +standardized.[32] Chinese humorology and cosmology have +been compared showing that as humors control all the +activities of the body similarly in other form they control the +universe. [33] Scale to measure tridoṣas in psychotic patients +has been developed and standardized.[34] Ayurveda guṇa +inventory has been developed and standardized.[35] +The scale has been developed based on Sanskrit verses +quoted in nine texts and content validitation of 10 +Ayurveda experts and three psychologists had three +subscales ‑ vāta (number of items in scale‑46), pitta (number +of items in scale‑44), kapha (number of items in scale‑47). It +was associated with good Cronbach’s alpha (above 0.5) and +the Split‑Half scores for all subscales (above 0.6 except pitta +scale which was 0.39). Factor validity coefficient Scores on +each items was above 0.5. +However, a simple self ‑ rating scale to assess the personality +of children, (as parents are often not available during +personality development camps etc) according to Āyurvedic +comprehensive concepts is not available. +Aims of the present study were +(i) + +To develop a self‑rating scale Caraka child personality +inventory (CCPI) +(ii)  +To measure tridoṣas in children and to compare with +criterion ACPI, parent rating scale to establish of +validity of the scale. +MATERIALS AND METHODS +Ethical clearance was approved by research board of +SVYASA  (Yoga University). The CCPI was developed +based on 522 characteristics from nine authoritative ancient +Ayurveda texts in Sanskrit describing characteristics typical +of vātaja, pittaja and kaphaja prakṛti. Item reduction was +carried out by deleting the repeated items, ambiguous +items, and by selecting those items specifically suitable for +children [Table 1]. +155 items were shortlisted out of 522 in the texts and, +translation in English, were presented to ten Ayurveda +experts. They were asked to judge the correctness of each +statement and to check (1) whether any of the item was +repeated or if any item should be added? (2) Whether the +features of vātaja, pittaja and kaphaja prakṛti selected for the +scale are correct and (3) if the items constructed represented +acceptable translation of the Sanskrit in the original texts. +147 items were retained. Out of which, some of items were +changed and refined [Table 2].[36] +Based on the final list of statements from the Sanskrit texts, +77 questions of CCPI were framed by the researcher. The +scale was again presented to five Ayurveda experts and +one psychologist, who reviewed the format of this scale +and recommended a two point scoring (zero and one), +this was adopted in the final CCPI. Suggestions about the +Table 1: Texts and number of items +Text +Vāta prakr +. ti +Pitta prakr +. ti +Kapha prakr +. ti +a +b +c d a +b +c d a +b +c d +Caraka Sam +. hitā +28 1 (27) 1 2 21 +0 +2 5 21 0 (21) 6 1 +Suśruta sam +. hitā +25 13 (12) 2 0 21 8 (14) 3 0 28 7 (21) 3 1 +As +.t +.ān +. ga samgraha +25 16 (9) 3 0 26 19 (7) 0 0 40 19 (21) 3 0 +As +.t +.ān +. ga hṛdaya +24 20 (4) 2 1 31 26 (5) 1 1 43 38 (5) 4 0 +Bhela Sam +. hitā +16 11 (5) 3 0 18 10 (8) 1 0 24 14 (0) 8 0 +Bhāvaprakāśa +8 +7 (1) +0 0 8 +8 (0) 0 0 6 +6 (0) +0 0 +Harita Sam +. hitā +16 +7 (9) +2 0 16 9 (7) 0 0 16 +9 (7) +4 0 +Śārangadhara Sam +. hitā +6 +6 (0) +0 0 5 +5 (0) 0 0 5 +4 (1) +1 0 +Kāśyapa Sam +. hitā +28 28 (0) 0 0 21 21 (0) 0 0 21 21 (0) 0 0 +Number of initial items (Sanskrit) collected from Nine Ayurveda texts with number +of repeated, ambiguous items and items not concerned with children. a: Initial +number of items, b: Repeated (retained) number if items, c: Ambiguous items, +d: Items not concerned with children +Table 2: Content validity by experts +Experts +Comment +1 (RH) +Agreed all questions except 3,4,5 questions +2 (AH) +Agreed all questions +3 (SUG) +Agreed all questions 4,5 questions +4 (RA) +Agreed for all items except 10,11 questions +5 (SHK) +Agreed for all items except 11,12 questions +6 (AAJ) +Suggested changes in the format of questions +RH: Raju H, AH: Ahalya, SUG: Suguna, RA: Ramesh A, SHK: Shekahr K, AAJ: +Arati Jaggannath +[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82] + +Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 +87 +Suchitra and Nagendra: Self rating scale to asses prakr +.ti +phrasing of questions were incorporated. All questions +which were agreed upon by three to four Ayurveda experts +and psychologist, were retained. +The final CCPI had 77 items ‑ 26 items for vātaja prakṛti +(A‑scale) 24 items for pittaja prakṛti (B‑scale) and 27 items +for kaphaja prakṛti (C‑scale) subscales. The questionnaire was +to be answered by the children (Appendix 2). +Data collection and analysis +Item difficulty level was analyzed by administering the +scale on 30 children on the age group 8‑12 years. Informed +consent of the children and parents was taken in prescribed +format (See Appendix‑3). For testing the internal consistency +and validity, the scale was administered on children who +were the students of New generation National Public school +in Bangalore, of both sexes between the age of 8 to 12 years +[Table 3]. +The final 77 item CCPI was administered on 200 children. +Ayurveda child personality inventory (ACPI), a parent +rating scale was administered on 30 parents of the children. +Comparison was done for the purpose of cross‑validation. +To assess Test‑retest reliability, CCPI was administered on +30 children, after an interval of 15 days. +The Statistical Package for Social Sciences (SPSS‑16.0) was +used for data analysis. The data was analyzed for reliability. +The split‑half and Cronbach’s alpha tests were applied for +internal consistency analysis. Pearson’s correlation analysis +was done to check the degree of association between +vāta, pitta and kapha scores and Test and Retest reliability. +Principal component analysis (factor analysis) was done to +check the validity. +RESULTS +Content validity +Amongst six experts, who served as judges all 77 questions +were agreed upon by four to five experts.[38] +Item difficulty level +This is defined as the presence of a said symptom expressed +as the percentage of children who score positive to that +item.[20‑22] The results obtained from the administration of +ACPI on parents of 60 children showed 136 items that had +a coefficient less than 0.9 (answered yes by the most) and +more than 0.3 (answered yes by the least number of subjects) +were retained. +Internal consistency +An analysis of the data collected from 200 children showed +the Cronbach’s alpha for V, P and K scales were 0.54, 0.64 +and 0.64 respectively. The Split‑Half reliability for V, P and K +scale were 0.64, 0.60 and 0.66 respectively. This shows that +the three scales have acceptable internal consistency.[37,39] +Test‑Retest reliability +Scores on 30 Children revealed V, P and K scales have good +correlation, 0.87,0.88 and 0.89 respectively before and after +15 days of assessment. +Correlations +The subscales (Vāta, Pitta, Kapha) correlated significantly +(negatively) with each other [Table 4]. +Factor analysis +Factor analytic co‑efficient obtained for each items in +the V‑scale, P‑scale, and K‑scale for total score was +more than 0.3. [Table 3]. +Correlation with ACPI –parent rating scale +V, P, K subscales correlated significantly positively with V, +P, K scales of parent rating scale [Table 5]. +Table 3: Demographic data +Sample +Boys +Girls +Total +Gender (boys) +104 +96 +200 +Age range +8‑12 years +8‑12 years +8‑12 years +Mean±SD +10.13±1.23 +10.0±1.18 +10.27±1.28 +Mean and standard deviation of demographics. Out of 200, children 104 were +boys, 96 were girls, aged around 8‑12 years. Mean age being 10.27. Studying in +3rd standard to 7th standard, mean education being 4.65. SD: Standard deviation +Table 4: Correlation among subscales +Scales +Correlation +Significance +Vāta vs Pitta +−0.31** +P<0.01 +Vāta vs Kapha +−0.49** +P<0.01 +Pitta vs Kapha +−0.66** +P<0.01 +(**) r‑Pearson correlation values and significance of correlation between subscales +which is at 99% confidence level. Pitta highly negatively correlating with Kapha, +Vāta having less correlation with Pitta +Table 5: Correlation with ACPI +Vp vs Vc +r=0.89** +Pp vs Pc +r=0.85** +Kp vs Kc +r=0.90** +Pearson correlation (r) of each subscales of CCPI with subscales of parent rating +scale ACPI (**P<0.01). Vāta, Pitta, Kapha subscales of CCPI correlated highly +positively with Vāta, Pitta, Kapha subscales of ACPI (Parent rating scale) +[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82] +88 +Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 +Suchitra and Nagendra: Self rating scale to asses prakr +.ti +DISCUSSION +The present study has described the development and +initial standardization of 77 items, self‑ rating, the CCPI +as an instrument to assess the personality (prakṛti) of the +children. +The reliability of subscales was substantiated by Cronbach’s +Alpha co‑efficient ranged from 0.54 to 0.64 and Split‑half +analysis ranging from 0.60 to 0.66. This provided the +evidence of homogeneity of items.[40] +For the ACPI (a parent rating scale to assess the prakṛti of +the children of the age group 6‑12 years), Cronach’s alpha +ranged from 0.55 to 0.84, spilt‑half coefficient ranged from +0.39 to 0.84. The construct validity of items of subscales was +supported by Factor –analysis which was done to check the +association of the items with subscales. Factor loadings for +Vāta scale ranged from 0.41‑0.7, for pitta scale 0.47 ‑0.72, for +kapha scale 0.41‑0.76 Appendix‑1.While of ACPI, 0.55‑0.86, +0.55‑0.78, 0.46‑0.77 respectively for vāta, pitta and kapha +scales. This proved to be a good correlation of items with +respective subscales. +Correlation between vātaja, pittaja and kaphaja scale +scores was negative, suggesting discriminative validity. +Values ranging from 0.31 to 0.66, significance at 99% +confidence for all correlations. Although of ACPI was +0.16 to 0.82, significance for vāta‑ pitta correlation was at +95% confidence. +Correlation with parent rating scale provided evidence +of concurrent validity. Classical texts of Ayurveda state +that when vāta and kapha (cold) increases, pitta decreases., +similarly when vāta decreases kapha increases. +Applying the inventory to children, further helped to +measure the prakṛti of the children. Among selected +sample 27% were vāta‑pitta, 27%were pitta‑kapha, +33% were vāta‑kapha, 9% were kapha, 2%were sama, 2% were +pitta [Table 6]. +Changes in scores were observed between boys and +girls [Table 7]. Most girls scored high in kapha, vāta‑kapha +and pitta‑kapha prakṛti scales. Similarly Boys scored high in +pitta, vāta‑pitta prakṛti scales. Boys score was high in Pitta +indicating high aggressiveness and Girls scores were high +in Kapha indicating higher patience. +Subscales of CCPI correlated highly (‘r’above 0.8), positively +with subscales of ACPI, parent rating scale  [Table  5], +suggesting criterion related validity. +The difference in the results of self‑rating and parent‑rating +scales, may be because of discrepancy in types of prakṛti +of children, which was different in parent rating scale +study and self‑rating study, as both inventories were +administered in different schools, and variance in + +race was observed [Ayurveda texts claim that prakṛti can be +influenced by race/ethnicity].[3] +The Strength of the study is that it is the first attempt to +develop a consistent, self –rating scale to measure prakṛti of +the children. Knowing one’s prakṛti is the first step towards +maintaining one’s health.[1‑9] A  balanced state of three +doṣas is considered as health.[4] A tool as developed in this +study will be useful in assessing the clinical significance of +prakṛti based regimen in prevention of somatic and mental +illnesses. +Though published scales are available to assess the +prakṛti of an individual,[11] they have been designed +for adultswhereas children require a different mode of +questioning. Hence, CCPI can be potentially used to +identify the predominant doṣas in children, and thus will +help to plan suitable regimens at an early age to maintain +health of the children. +A study has revealed significant effect of Yoga on +tridoṣas.[32] And treatment modalities are different for +Table 7: Mean differences between Boys and Girls +Sample +Vāta +Pitta +Kapha +Boys +11.3 +11.8* +11.8 +Girls +11.2 +10.0 +13.6* +Mean scores of Boys and Girls in each subscales. Showing high scores on kapha +in girls (13.6, for boys it is 11.8), high scores on pitta in Boys (11.8, for girls it is +10.0). Changes were significant P<0.05 (One sample t‑test). *P<0.001 +Table 6: Mean dos +.a scores for three different diagnostic groups +Doṣa→ +Diagnosis↓ +Vātaja +Pittaja +kaphaja +Vāta‑pitta (n=17) +14.3 +13.8 +7.0 +Pitta‑kapha +7.1 +13.5 +14.9 +Vāta‑Kapha +13.6 +7.0 +14.4 +Kapha +7.0 +7.1 +20.8 +Pitta +7.0 +20.7 +7.2 +Sama +11.4 +11.5 +12 +Distribution of different categories of prakṛti children (who particularly scored high +in one or two subscales) sample scores in each subscales.Children scoring high +in Vāta‑Pitta scored 14.3 and 13.8 in respective Vāta‑Pitta scales., who scored +high in Pitta‑Kapha scored 13.5 amd 14.9 in respective scales and who scored +high in Vāta‑kapha scored 13.6 and 14.4 in respective scales. And who were +predominant in single dosahs, scored 20.8 (kapha prakṛti) ,20.7 (Pitta prakṛti) in +respective scales. Who were of sama prakṛti scored 11.4,11.5,12 in vāta, pitta, +kapha scales respectively +[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82] + +Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 +89 +Suchitra and Nagendra: Self rating scale to asses prakr +.ti +different prakṛti.[1‑9] Thus, the study is a initial step towards +positive health. +Limitations of the study: Though CCPI is a consistent, +valid instrument, it has not addressed the  norms of the +scale. Further studies are needed to confirm whether the +items used in the inventory are sensitive enough to assess +prakr +.ti with predominance of a particular doṣa. Studies +should be done on more number of samples and norms +should be established. +CONCLUSIONS +A CCPI is a consistent and valid instrument. Its reliability +to assess the prakṛti should be further studied. Tridoṣa +measure may point out to diet and regimen plans +management to prevent the disease and maintain the +health of the children. +ACKNOWLEDGMENT +We thank, Dr.Kishore, Dr. Aarti Jagannathan, Dr.Uma and +Āyurveda experts in Hubli, Bengaluru Ayurveda College, for their +support and participation in the study. +REFERENCES +1. +Tripati R. Ashtanga sangraha: Hindi commentary. Second edition. +New Delhi: Choukamba publications; 2001. +2. +Tripati B. Ashtanga Hradaya: Hindi commentary. Second edition. +New Delhi: Choukamba publications; 1997. +3. +Panday  GS. Caraka samhita: Hindi commentary. Fifth edition. +New Delhi: Choukamba publications; 1997. +4. +Shastry KA. Sushruta Samhita: Hindi vyakhya. Fifteenth edition. +New Delhi: Choukamba publications; 2002. +5. +Brahmashankaramishra. Bhavaprakash: Hindi Vyakhya. Tenth +edition. Varanasi: Chaukamba smaskrita bhavan; 2002. +6. +Pandit Parashram shastri. Sharangadhara samhita: Samskrita vyakhya. +Sixth edition. 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J Altern Complement Med +2005 Apr;11:221‑5. +15. Hankey A. A test of the systems analysis underlying the scientific +theory of Ayurveda Tridosa. Journal of Alternative and Complementary +Medicine 2005;11:385‑390. +16. Hankey  A. Establishing the Scientific Validity of Tridosha +part  1: Doshas, Subdoshas and Dosha Prakritis. Anc Sci Life. +2010 Jan;29:6‑18. +17. Patwardhan B., Joshi K., Chopra A. Classification of Human Population +Based on HLA Gene Polymorphism and the Concept of Prakriti in +Ayurveda. Journal of Alternative and Complementary Medicine +2005;11:349 ‑353. +18. Patwardhan B., Bodeker G. Ayurvedic genomics: Establishing a genetic +basis for mind‑body typologies. J Altern Complement Med 2008 Jun; +14:571‑6. +19. Prasher B, Negi S, Aggarwal S, Mandal AK, Sethi TP, Deshmukh SR, +et al. Whole genome expression and biochemical correlates of +extreme constitutional types defined in Ayurveda. J Transl Med +2008 Sep 9;6:48. +20. Mishra L, Singh BB, Dagenais S: Healthcare and disease management +in Ayurveda. Altern Ther Health Med 2001 Mar;7:44‑50. +21. Aggarwal  S, Negi  S, Jha  P, Singh  PK, Stobdan  T, Pasha  MA, et +al. EGLN1 involvement in high‑altitude adaptation revealed +through genetic analysis of extreme constitution types defined +in Ayurveda. Proc Natl Acad Sci U S A 2010 Nov 2;107:18961‑6. +Epub 2010 Oct 18. +22. Dube KC, Kumar A, Dube S: Personality types in Ayurveda. Am J Chin +Med 1983;11:25‑34. +23. Dube KC: Nosology and therapy of mental illness in Ayurveda. Comp +Med East West 1979 Fall; 6:209‑28. +24. Scharfetter C: Ayurveda; Schweiz Med Wochenschr. 1976 Apr +24;106:565‑72. +25. Tripathi  PK, Patwardhan  K, Singh G: The basic cardiovascular +responses to postural changes, exercise, and cold pressor test: Do they +vary in accordance with the dual constitutional types of ayurveda? +Evid Based Complement Alternat Med 2011;2011:251850. Epub +2010 Aug 30. +26. Ghodke Y, Joshi K, Patwardhan B: Traditional Medicine to Modern +Pharmacogenomics: Ayurveda Prakriti Type and CYP2C19 Gene +Polymorphism Associated with the Metabolic Variability. Evid Based +Complement Alternat Med 2009 Dec 16. [Epub ahead of print]. +27. Kurup  RK, Kurup PA: Hypothalamic digoxin, hemispheric +chemical dominance, and the tridosha theory. Int J Neurosci +2003 May;113:657‑81. +28. Trawick  M. An Ayurvedic theory of cancer. Med Anthropol +1991 Jun;13:121‑36. +29. Purvya MC, Meena MS. A review on role of prakriti in aging. Ayu +2011 Jan;32:20‑4. +30. Manyam  BV,  Kumar  A. Ayurvedic constitution  (prakruti) +identifies risk factor of developing Parkinson’s disease. J Altern +Complement Med  2013 Jul;19:644‑9. doi: 10.1089/acm. 2011.0809. +Epub 2013 Mar 07. +31. Supriya Bhalerao,  Tejashree Deshpande,  Urmila Thatte. Prakriti +(Ayurvedic concept of constitution) and variations in platelet +aggregation: BMC Complementary and Alternative Medicine 2012. +32. Endo J, Nakamura T. Comparative studies of the tridosha theory in +Ayurveda and the theory of the four deranged elements in Buddhist +medicine. Kagakushi Kenkyu 1995;34:1‑9. +33. Mahdihassan  S. A  comparative study of Chinese cosmology +cum‑humorology with eight elements. Am J Chin Med +1990;18:181‑4. +34. Suchitra SP, Devika HS, Gangadhar BN, Nagarathna R, Nagendra HR, +Kulkarni  R. Measuring the tridosha symptoms of unmāda +(psychosis): A preliminary study; J Altern Complement Med. +2010 Apr;16:457‑62. +35. Suchitra SP, Nagendra HR. Development and initial standardization +of Ayurveda Child Personality Inventory: International Conference on +Non‑communicable diseases. 2012 Februvary. +36. Frank S. Freeman.Theory and Practice of Psychological Testing. Third +edition. New Delhi: Surjeet publications; 2006. +37. Rutherford B. Cattell R.Hand book for the children’s personality +questionnaire (CPQ). Illinois. Indian economy edition; Institute of +Personality and Ability testing. 1999. +38. AK Singh. Tests, Measurements and Research methods in Behavioral +[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82] +90 +Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 +Suchitra and Nagendra: Self rating scale to asses prakr +.ti +sciences. Fifth edition. Patna: Bharati Bhavan publishers and +distributers; 2006. +39. Anastasi A., Urbina S. Psychological testing. 7th Edition. Pearson +Education; 2005. +40. Nunnaly JC. Psychometric theory. (2nd ed.). New York: Mc‑grow‑hill; +1978. +Address for correspondence: +S.P +. Suchitra, +Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Eknath +Bhavan, No.19, Gavipuram Circle, Kempegowda Nagar, +Bangalore - 560 019, India. +E-mail: ayursuch@rediffmail.com +How to cite this article: Suchitra SP, Nagendra HR. A self-rating scale +to measure tridos +.as in children. Ancient Sci Life 2013;33:85-91. +Source of Support: Nil. Conflict of Interest: None declared. +Table 1: Factor analytic coefficients of each item +Vāta +Loadings +Pitta +Loadings +Kapha +Loadings +v1 +0.665 +p1 +0.698 +k1 +0.616 +v2 +0.575 +p2 +0.727 +k2 +0.618 +v3 +0.566 +p3 +0.574 +k3 +0.679 +v4 +0.553 +p4 +0.607 +k4 +0.646 +v5 +0.580 +p5 +0.837 +k5 +0.510 +v6 +0.608 +p6 +0.673 +k6 +0.567 +v7 +0.614 +p7 +0.520 +k7 +0.414 +v8 +0.417 +p8 +0.447 +k8 +0.612 +v9 +0.490 +p9 +0.528 +k9 +0.764 +v10 +0.578 +p10 +0.423 +k10 +0.693 +v11 +0.443 +p11 +0.617 +k11 +0.536 +v12 +0.631 +p12 +0.555 +k12 +0.628 +v13 +0.540 +p13 +0.590 +k13 +0.521 +v14 +0.550 +p14 +0.565 +k14 +0.625 +v15 +0.453 +p15 +0.559 +k15 +0.529 +v16 +0.589 +p16 +0.586 +k16 +0.764 +v17 +0.548 +p17 +0.615 +k17 +0.600 +v18 +0.569 +p18 +0.740 +k18 +0.602 +v19 +0.580 +p19 +0.704 +k19 +0.646 +v20 +0.476 +p20 +0.781 +k20 +0.605 +v21 +0.651 +p21 +0.644 +k21 +0.581 +v22 +0.573 +p22 +0.638 +k22 +0.582 +v23 +0.713 +p23 +0.471 +k23 +0.608 +v24 +0.587 +p24 +0.491 +k24 +0.596 +v25 +0.540 +k25 +0.680 +v26 +0.635 +k26 +0.421 +k27 +0.579 +Factor loadings‑correlations of each item with respective subsales +APPENDIX‑1 +APPENDIX ‑2 +Caraka child personality inventory +For children +Instructions: There is no right or wrong answer. Select the +appropriate answer suitable to you and give explanation where +necessary +A‑scale +1 +I get skin problems easily +Yes/No +2 +I am thin +Yes/No +3 +Green lines (veins) are visible over +my arm than others +Yes/No +4 +My hair is rough and split +Yes/No +5 +Usually I hear some sound in my +knee while walking +Yes/No +6 +My nails grow faster than others +Yes/No +7 +Time taken by me to button my +cloth usually is +_____ +8 +I eat food fast +Yes/No +9 +I eat _____ and _____ for +my breakfast (tell how much +also) (e.g.: 2 idlis, 2 dosa etc.) +10 +I get tired easily during exercise +Yes/No +11 +I usually wake‑up in between sleep +Yes/No +12 +I usually talk in low pitch +Yes/No +13 +I can understand, what teacher +teaches faster than others +Yes/No +14 +I usually forget the issues faster +than others +Yes/No +15 +I have some plans for this year +Yes/No +16 +Sometimes I like my relatives, +sometimes not +Yes/No +17 +If a classmate doesn’t behave +properly with me +I will be silent/I will also +behave badly with him +18 +When my parents ask me to stop +watching television do, I do it +immediately +Yes/No +19 +If my brother/sister/friend are +praised in front of me +I beat them/I will +become concerned +unhappy/I am not much +20 +I usually finish my home‑work, +before playing +Yes/No +contd... +[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82] + +Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2 +91 +Suchitra and Nagendra: Self rating scale to asses prakr +.ti +APPENDIX ‑3 +Format of Informed consent +I have been informed completely about the scale which is +about to measure the personality of My Son/Daughter…… +………………….I am agreeing completely for the analysis +of His/Her personality. +Signature of the parent/Guardian +Appendix ‑2: Contd... +21 +I usually don’t think much about +person who have helped me +Yes/No +22 +I usually don’t like to make new +friends +Yes/No +23 +I like hard chapatti, bread much +Yes/No +24 +I like hot drinks much +Yes/No +25 +I can give stage performance easily +Yes/No +26 +I bite my teeth when not allowed +to do what I like to do +Yes/No +B‑scale +1 +I get body pain after heavy exercise +Yes/No +2 +My body color is‑brown +Yes/No +3 +I usually have bad – breath +Yes/No +4 +Color of my eyes is brown +Yes/No +5 +Color of my nails is pink +Yes/No +6 +Color of my lips is pink +Yes/No +7 +I have small, brown eye‑lashes +Yes/No +8 +Color of my hair is brown +Yes/No +9 +I feel hungry in every +______hours +10 +Time taken for taking bath by me is +______ +11 +I eat _____ and _____ for +lunch (tell how much also) +(e.g.,‑2 chapatis, one bowl rice etc.) +12 +I drinks more water than others +Yes/No +13 +I sweat a lot compared to others +Yes/No +14 +I go for urine often +Yes/No +15 +I usually get prizes in sports +Yes/No +16 +I usually get head‑ache, eye‑pain if +I read for longer duration +Yes/No +17 +I change my decisions easily +Yes/No +18 +I can learn new subjects easily +Yes/No +19 +I usually get ______ grade in tests +Yes/No +20 +I usually admit my mistakes +Yes/No +21 +When my sister/brother/friend are +paid more attention in front of me +I get angry/I want to +behave such a way, +parents pay attention +to me +22 +My health gets upset when I eat +excessive sour taste foods +Yes/No +23 +I like cold drinks a lot +Yes/No +24 +My anger comes down quickly +Yes/No +C‑scale +1 +I get leg and arm pain often +Yes/No +2 +I am liked by some friends/all friends +3 +My body color is bright white +Yes/No +Appendix ‑2: Contd... +4 +My eyes are big +Yes/No +5 +My hair is curly and thick +Yes/No +6 +My chest is wider comparatively +Yes/No +7 +My forehead is bigger +Yes/No +8 +My eye‑brows are big +Yes/No +9 +I usually take _____ minutes to +wear a dress +10 +I eat food slowly +Yes/No +11 +I sweat less than others +Yes/No +12 +I will not get tired after exercise +for longer time +Yes/No +13 +I can wait, if food is delayed +sometimes +Yes/No +14 +I usually sleep good for longer time +Yes/No +15 +When my brother/sister/cousin +quarrels with me +I also want to quarrel/I +want to keep quite +16 +I usually talk in loud voice +Yes/No +17 +I usually get adjusted to new +school easily +Yes/No +18 +I usually can remember issues +happened years back as it is +Yes/No +19 +When my friend/classmate helps me +I feel very thankful/I +want to remember for +always +20 +I remember the scolding of my +parents a lot +Yes/No +21 +I want to give money to the beggars +Yes/N +22 +I like spicy foods +Yes/No +23 +I like to share my things with my +brother/sister +Yes/No +24 +I can withstand/tolerate pain +Yes/No +25 +I want to become ______ in my life +26 +I like to serve my guests +Yes/No +27 +If my parents give money to me I +want to spend on: +____ +contd... +[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82] diff --git a/subfolder_0/AUTONOMIC CHANGES WHILE MENTALLY REPEATING TWO SYLLABLES.txt b/subfolder_0/AUTONOMIC CHANGES WHILE MENTALLY REPEATING TWO SYLLABLES.txt new file mode 100644 index 0000000000000000000000000000000000000000..cacb1a05312e14ab640ecca5ecd71212623aefc2 --- /dev/null +++ b/subfolder_0/AUTONOMIC CHANGES WHILE MENTALLY REPEATING TWO SYLLABLES.txt @@ -0,0 +1,21 @@ + + + + + + + + + + + + + + + + + + + + + diff --git "a/subfolder_0/AWARENESS OF COMPUTER\302\254USE RELATED HEALTH RISKS IN SOFTWARE COMPANIES IN BANGALORE.txt" "b/subfolder_0/AWARENESS OF COMPUTER\302\254USE RELATED HEALTH RISKS IN SOFTWARE COMPANIES IN BANGALORE.txt" new file mode 100644 index 0000000000000000000000000000000000000000..ccdcc574ad54c950c5814daff1c6056939a2d1cf --- /dev/null +++ "b/subfolder_0/AWARENESS OF COMPUTER\302\254USE RELATED HEALTH RISKS IN SOFTWARE COMPANIES IN BANGALORE.txt" @@ -0,0 +1,71 @@ + +Indian J Med Sci Vol. 58 No.5, May 2004 + +AWARENESS OF COMPUTERUSE RELATED HEALTH RISKS IN SOFTWARE +COMPANIES IN BANGALORE + +SHIRLEY TELLES, RAJENDRA DEGINAL & LOKESH HUTCHAPPA + +Sir, +There are important physiological, biochemical, somatic and psychological indicators of stress +related to work where human computer interaction occurs '. Prevention is the best management +of computer-related ailments since it is more effective, lasts longer, and costs less." Among +software development organizations worldwide, several are in India, in Bangalore city." Hence +this study evaluated the awareness of computer-use related health risks in software companies in +Bangalore. + +Forty-three software companies in Bangalore were contacted. Twenty companies participated +and the manager for human resource development (HRD) filled in a questionnaire. + +The questions were: (1) Are you aware that using a computer for over 5 hours a day can cause +health problems (yes/no)?; (2) If your answer was 'yes', what was the source of your +information? (books/ newspapers/ television/ experience of yourself or others/ other source +(specify)); (3) Name three health problems which you think are the most likely to occur; (4) In +your company are you using any lifestyle modification strategy? (yes/no); (5) If your answer was +'yes', what strategy does the company use? (6) If your answer to Question (4) was 'no', which of +the following was the most important reason for not using any strategy? (time constraints/ lack of +belief in such strategies/ poor response/ financial constraints/ lack of infrastructure/ no access to +a trained person/ any other reason (specify)). + +In fifteen companies the number of software engineers was between 100 and 500 and five +companies had between 500 and 1000 employees. Seventeen out of twenty HRD managers were +aware of the health risks. Eleven had got the information from newspapers, five from the +employees' experience, and one from a television program. When asked about the three most +likely complaints, fifteen out of seventeen mentioned (i) visual strain, (ii) back pain, and (iii) +other musculoskeletal pains. Two mentioned 'psychological strain' and 'weight gain' as other +likely hazards. Two others did not know the likely problems. Ten out of seventeen were using +some lifestyle modification strategy, while seven were not. The following strategies were used: +indoor and outdoor games, yoga including meditation, health checkups, health advice, +recreational facilities, and a 'rooftop cafeteria'. The use of these strategies was optional. In the +case of the seven companies where no strategy was used, five of them gave the reason that they +had 'no access to a trained person to administer the strategy' and for two of them 'time +constraints' were the limiting factor. + +Hence HRD managers in most software companies are aware of health risks of prolonged +computer use and which complaints are most probable. However the management strategies did +not seem adequate. In view of the increasing number of software companies across India this +topic requires attention. + + + + + +ACKNOWLEDGMENT + +The project was funded by a grant from the Central Council of Research in Yoga and +Naturopathy (CCRYN), Ministry of Health & Family Welfare, Govt. of India. + +SHIRLEY TELLES, RAJENDRA DEGINAL & LOKESH HUTCHAPPA +Vivekananda Yoga Research Foundation, Bangalore, India E-mail: anvesana@vsnl.com + +REFERENCES + +1. Smith MJ, Conway FT, Karsh B10 Occupational stress in human computer interaction. Ind +Health. 1999;37:157-73. +2. Bawa J. Computers and your health. 1996. +Celestial Arts: Berkeley,CA. +3. Killcrece G., Kossakowski K-P, Ruefle R. et al. +Organizational models for computer security incident response teams (CSIRTs). Handbook +Carnegie-Mellon University(CMU)/Software Engineering Institute-2003-HB-001-15213- +3890. 2003. SEI: Pittsburgh, PA. + diff --git a/subfolder_0/Add-on Effect of Hot Sand Fomentation to Yoga on Pain, Disability, and Quality of Life in Chronic Neck Pain Patients.txt b/subfolder_0/Add-on Effect of Hot Sand Fomentation to Yoga on Pain, Disability, and Quality of Life in Chronic Neck Pain Patients.txt new file mode 100644 index 0000000000000000000000000000000000000000..7126677c206ba0434dfae680a20c400cc45bb6db --- /dev/null +++ b/subfolder_0/Add-on Effect of Hot Sand Fomentation to Yoga on Pain, Disability, and Quality of Life in Chronic Neck Pain Patients.txt @@ -0,0 +1,696 @@ + +Current Problems in Diagnostic RadiologyIIMB Management ReviewJournal of Cardiac FailureJournal of Exotic Pet MedicineBiology of +Blood and Marrow TransplantationSeminars in Spine SurgerySeminars in Arthritis & RheumatismCurrent Problems in Pediatric and +Adolescent Helath CareSolid State Electronics Letters +Accepted Manuscript +Add-on effect of hot sand fomentation to yoga on pain, disability, and +quality of life in chronic neck pain patients +B. Nandini , A. Mooventhan Senior Medical Officer , +NK. Manjunath Professor +PII: +S1550-8307(17)30363-4 +DOI: +10.1016/j.explore.2018.01.002 +Reference: +JSCH 2294 +To appear in: +The End-to-end Journal +Received date: +11 October 2017 +Revised date: +5 January 2018 +Accepted date: +5 January 2018 +Please +cite +this +article +as: +B. Nandini , +A. Mooventhan Senior Medical Officer , +NK. Manjunath Professor , Add-on effect of hot sand fomentation to yoga on pain, disability, and quality +of life in chronic neck pain patients , The End-to-end Journal (2018), doi: 10.1016/j.explore.2018.01.002 +This is a PDF file of an unedited manuscript that has been accepted for publication. As a service +to our customers we are providing this early version of the manuscript. The manuscript will undergo +copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please +note that during the production process errors may be discovered which could affect the content, and +all legal disclaimers that apply to the journal pertain. +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +Highlights: + Addition of hot sand fomentation (HSF) to yoga provides a better reduction in pain +and disability in patients with non-specific neck pain than yoga alone. + All the subjects were actively participated in intervention + No adverse effects were reported throughout the study period. + Intervention is feasible, easy, safe and cost-effective + + + + +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +Add-on effect of hot sand fomentation to yoga on pain, disability, and quality of life in +chronic neck pain patients +Running Title: Hot sand fomentation for neck pain +B. Nandini,1 A. Mooventhan,2 NK. Manjunath3 + +1Department of Yoga and Naturopathy, The School of Yoga and Naturopathic medicine, S- +VYASA University, Bengaluru, Karnataka, India +2Senior Medical Officer, Department of Yoga, Center for Integrative Medicine and Research +(CIMR), All India Institute of Medical Sciences (AIIMS), New Delhi, India +3Professor, Division of Yoga and Life Sciences, & Head, Department of Research and +Development, S-VYASA University, Bengaluru, Karnataka, India +Number of Tables: 03 +Number of Figures: 0 +Word Count: +Abstract +: 250 +Manuscript +: 2895 +Corresponding contributor: +Dr. A. Mooventhan, +Senior Medical Officer, Department of Yoga, Center for Integrative Medicine and Research +(CIMR), All India Institute of Medical Sciences (AIIMS), New Delhi, India. +Mobile: +91 9844457496 +E-mail: dr.mooventhan@gmail.com +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +Add-on effect of hot sand fomentation to yoga on pain, disability and quality of life in +chronic neck pain patients +ABSTRACT: +Background: Neck pain is one of the commonest complaints and an important public health +problem across the globe. Yoga has reported to be useful for neck pain and hot sand has +reported to be useful for chronic rheumatism. The present study was conducted to evaluate +the add-on effect of hot sand fomentation (HSF) to yoga on pain, disability, quality of sleep +(QOS) and quality of life (QOL) of the patients with non-specific neck pain. +Materials and Methods: A total of 60 subjects with non-specific or common neck pain were +recruited and randomly divided into either study group or control group. Both the groups +have received yoga and sesame seed oil (Sesamum Indicum L.) application. In addition to +yoga and sesame seed oil, study group received HSF for 15-minutes per day for 5-days. +Assessments were taken prior to and after the intervention. +Results: Results of the study showed a significant reduction in the scores of visual analogue +scale for pain, neck disability index (NDI), The Pittsburgh Sleep Quality Index (PSQI), and a +significant increase in physical function, physical health, emotional problem, pain, and +general health both in study and control groups. However, reductions in pain and NDI along +with improvement in social functions were better in the study group as compared with control +group. +Conclusion: Results of this study suggest that addition of HSF to yoga provides a better +reduction in pain and disability along with improvement in the social functioning of the +patients with non-specific neck pain than yoga alone. +Keywords: Chronic pain; Fomentation; Naturopathy; Neck pain; Yoga +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +BACKGROUND: +Back pain and neck pain are the major musculoskeletal problems in modern society causing +considerable costs in health care.[1] Non-specific[2] or common neck pain[3] is defined as the +pain with a postural or mechanical basis[2] caused by altered neck mechanics, advanced age- +related changes, additional load on the neck, occupational hazards as in computer +professionals or call center workers, faulty sleeping habits and sudden violent jerking injuries +to the neck as in whiplash injury and not due to any organic lesions.[3] It is an important public +health problem across the globe.[4] About two-thirds of people will experience neck pain at +some time with women being affected more than men.[2] The prevalence of neck pain has been +reported to be up-to 20% of the working populations worldwide[4] in which common neck pain +accounts for more than 80%.[3] It is often associated with marked disability[5] and sickness +absenteeism[3,5] that could disrupt a nation’s economy apart from disrupting the personal and +professional life of a patient.[3] Most patients with chronic neck pain were reported to use +alternative or complementary methods for their pain relief. Yoga (physical postures, breathing +exercises, meditation, and relaxation) was reported to be a safe and effective complementary +therapy for pain relief including chronic neck pain.[4] In a hydrotherapy textbook, the sand bath +was reported to be useful in cases of chronic rheumatism. It also reported that the local +applications of the sand bath may be made by heating the sand in an oven and heaping it about +the desired part as a hot sand application or fomentation.[6] Hot sand fomentation (HSF) is +commonly employed in various naturopathic hospitals for pain management. There are +various studies reporting the effect of a combination of exercise plus infrared, exercise plus +pillow; exercises plus manipulation; hot or cold packs plus massage; and heat combined with +other physical treatment for chronic neck pain management.[2] Though yoga was reported to +be useful for neck pain[4] and hot sand is reported to be useful for chronic rheumatism,[6] to the +best of our knowledge there is no known study reporting the combined effect of yoga and HSF +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +in patients with non-specific neck pain. Thus, the present study was conducted to evaluate the +add-on effect of HSF to yoga on pain, disability, quality of sleep (QOS) and quality of life +(QOL) in patients with non-specific neck pain. + MATERIALS AND METHODS +Study Design: +This is a parallel group randomized controlled study. All the subjects were randomly (1:1 +ratio) divided into either study group (n=30) or control group (n=30). The study group +received HSF for 15-minutes a day for the period of 5-days along with yoga and sesame seed +oil application while the control group received yoga and sesame seed oil application alone +for the same period. Assessments were taken prior to and after the intervention. +Subjects: +A total of 60 subjects with non-specific or common neck pain age range from 24 to 56 years +were recruited from a holistic health centre in South India, based on the following inclusion +and exclusion criteria. Inclusion criteria: Subjects with the age range of 20-60 years with +non-specific or common neck pain due to ligament strain, sprain of the neck muscles or +spasm (myalgia), cervical spondylosis without any neurological impairment and who were +willing to participate in the study were included in the study. Exclusion criteria: Subjects +with uncommon neck pains due to organic causes such as congenital conditions like wry neck +also known as torticollis (a twisted and tilted neck), inflammatory conditions like rheumatoid +arthritis, metabolic disorders like osteoporosis, neoplastic conditions, infective conditions like +tuberculosis, and posttraumatic conditions with ligament or bone injuries; subjects with the +history of mental illness; and those who underwent yoga and other naturopathy treatments for +the past 1 month were excluded from the study. The study was conducted in Anvesana +research laboratories that include an inpatient holistic healthcare centre, S-VYASA +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +University, Bengaluru, India. The study protocol was approved by the institutional ethics +committee (RES/IEC-SVYASA/106/2017) and a written informed consent was obtained +from each subject. +Interventions: +Both Study and Control Groups: Practice of Yoga (Loosening practices, asanas, pranayama, +relaxation and meditation techniques and lecture on yoga philosophy), low fat and low salt +vegetarian diet and application of sesame seed oil (also called as Gingelly oil) [the oil that is +derived from the seeds of plant species Sesamum Indicum L., a herbaceous annual belonging +to the Pedaliaceae family. It has been reported to have anti-inflammatory effect. The main +constituents of sesame seed oil include fatty acids (palmitic acid, palmitoleic acid, stearic +acid, oleic acid, linoleic acid, linolenic acid, and eicosanoic acid), lignans, and antioxidants, +such as ??-tocopherol.][7] were common for both study group and control group (Table 1). +Study Group: Along with yoga and sesame seed oil application, study group subjects have +received HSF that consists of approximately 250 gm. of sand devoid of thorns, shells and +pebbles heated up to tolerable temperature (39-40oC) using a pan placed on the stove. The +procedure of the preparation of HSF is as follows: As soon as the sand in the vessel was +properly heated it was poured at the centre of the double layer cotton cloth of dimensions 15 x +15 cm to tie it as a bolus. A strong thick thread was used to tie up the upper portion of the +bolus to avoid the outflow of the sand from small openings during the treatment procedure. +The free end of the cloth is then folded and tied to form a handle. Then the fomentation was +given by means of keeping it over (5 seconds) and taking it away from the painful region (2 +seconds) which was continued for the duration of 15 minutes a day in the evening between +5:00 pm and 6:00 pm for the period of 5 consecutive days. In order to maintain the +temperature, the HSF bag was replaced by a new HSF bag every 5 minutes. Thus, we used 3 +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +HSF bags to complete one session. The intervention was given by two (1 male and 1 female) +institutionally qualified therapists. +Control Group: Control group subjects were under their normal routine and did not receive +HSF for the same period. +Assessments: +The primary (visual analog scale for pain and neck disability index) and secondary outcome +[quality of sleep (QOS), and quality of life (QOL)] measures were taken before and after the +intervention as mentioned below: +Visual analog scale (VAS) for pain: It was used to evaluate subject’s intensity of pain on a +scale of 0 to 10, where 0 indicates no pain and 10 indicates worst pain. Subjects were advised +to mark on the scale to indicate their pain intensity before and after the intervention.[8] +Cronbach’s alpha = 0.95[9] +Neck Disability Index (NDI): It is a measurement tool used to measure 10 dimensions of +neck-specific disability, namely pain intensity, personal care, lifting, reading, headache, +concentration, work, driving, sleeping, and recreation. Each dimension is assessed with 1 +item, measured on a 6-point scale from 0 (no disability) to 5 (full disability). The sum score +out of all 10 items is multiplied by 2 to obtain a score out of 100%. The score 0-20, 21-40, +41-60, 61-80, and 80-100 represents the normal, mild, moderate, severe and complete or +exaggerated disability. Cronbach’s alpha = 0.864. [10,11] +The Pittsburgh Sleep Quality Index (PSQI): It consists of seven components in 9-items +sleep questionnaire, which was used to evaluate subject’s QOS. The total score 0-4 indicates +good sleep quality, 5-10 indicate poor sleep quality, and >10 indicates the sleep disorder. +Cronbach’s alpha = 0.83.[12,13] +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +Short Form-36 Version 2 (SF-36 V2) Health Survey: +It consists of 36-items questionnaire, which measures the health in eight dimensions. For +each dimension, item scores were noted, averaged, and transformed into a scale of 0-100 +where 0 indicates worst possible health and 100 indicates best possible health.[13,14] +Cronbach’s alpha = 0.85[15] +Sample size: +A total of 60 subjects with non-specific or common neck pain age range from 24 to 56 years +were recruited. The sample size was not calculated based on any previous study or pilot study +which is one of the limitations of the study. +Randomization: +All the subjects were randomly divided into either study group or control group using +computerized randomization available at http://www.randomization.com/. A simple +randomization procedure was performed for 60 subjects with 1:1 ratio to get a sample size of +(n=30) in each group. Random allocation of the intervention was kept in opaque sealed +envelopes until interventions were assigned. The randomization was performed by one of the +authors who did not involve in any part of the investigation. +Blinding: +It was not possible for us to blind the subjects from the intervention. However, the +investigator was kept blind to the study group and control group. +Data Analysis: Statistical analysis of within-group was performed using Wilcoxon signed +rank test and between groups analysis was performed using Mann Whitney-U-test with the use +of Statistical Package for the Social Sciences (SPSS) for Windows, Version 16.0. Chicago, +SPSS Inc. +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +RESULT +The details of the demographic variables of the study and control groups have been given in +table 2. Baseline characteristics were comparable and no significant differences were observed +between the groups in all the variables except pain and SF-36 health survey’s physical health +and energy scales. Results of the study showed a significant reduction in the scores of pain, +NDI, and social function in the study group compared to the control group. Within-group +analysis showed a significant reduction in VAS score for pain, NDI, PSQI and a significant +increase in physical function, physical health, emotional problem, pain, and general health +both in study and control groups, while a significant increase in energy level and social +functioning was observed only in study group unlike control group and no such significant +change was observed in emotional well being both in study and control groups (Table 3). The +compliance of the participants to the therapies was good due to voluntary participation and +there were no dropouts and none of the subjects reported any adverse effects during the study +period. +DISCUSSION +Research shows that spinal pain has become the largest category of medical claims, placing a +major burden on individuals and health care system. Yoga is quite commonly used as a +complementary therapy for spinal pain including neck pain.[1] Self-assessment questionnaires +are widely used to assess the outcome of medical management and interventions.[11] In the +present study, we used self-assessment questionnaires such as VAS for pain, NDI, PSQI and +SF-36 Healthy survey to assess the add-on effect of HSF on neck pain and disability, QOS and +QOL of patients with non-specific neck pain. +Results of this study showed a significant increase in the energy level and social functioning +only in the study group while no such significant changes were observed in the control group. +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +Moreover, the significant reduction in VAS score for pain and NDI score and the significant +increase in social functions were better in the study group compared with control group. It +suggests that the improvement in pain, neck disability, general energy level and the social +functioning of the people with the neck pain were better in the subjects who received HSF +along with yoga rather than the subjects who received yoga alone. It should be noted that +there was a significant baseline difference in pain between the groups and that might have +influenced the significant difference in the post-test analysis as well. However, the reduction +in the pain (mean score) was better in the study group (from 7.81 to 2.63; Difference = 5.18) +compared with control group (from 7.33 to 5.79; Difference = 1.54). Similarly, though there +was a significant baseline difference in SF-36 health survey’s energy level scale in between +groups, within group analysis showed a significant improvement in energy level in the +subjects those who received yoga plus HSF rather than the subjects those who received yoga +alone. This suggests that HSF might have additional effect in reducing pain and in improving +energy level of the patients with neck pain. +The better reduction in pain and neck disability in the study group compared with the control +group might attribute to the pain reducing and muscle relaxing effect of HSF. Improvement +in the energy level and social functioning of the study group unlike the control group might +attribute to the better reduction of pain and neck disability in the study group compared with +the control group. As mentioned in a previous study,[3] the tension that is associated with +stress is stored mainly in the neck muscles, diaphragm and the nervous system. Stress is +reported to produce spasm by interfering with coordination of different muscle groups +involved in the functioning of the neck. Thus, if these areas are relaxed, stress can get +reduced or if the stress reduced, these areas can be relaxed and these help in minimizing the +impact of stress in people with neck pain. In a previous study, yoga has been found to be an +effective tool in reducing stress levels that might have helped in reducing the pain and +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +disability by reducing the tension over the neck muscles indirectly.[3] According to a +hydrotherapy text, hot applications were reported to be effective in reducing pain and muscle +tension directly.[6] This explains the reason, why there was a better reduction in pain and +disability in the study group compared with control group. +Within group analysis of the present study showed a significant reduction in the scores of +VAS for pain, NDI, and PSQI and a significant increase SF-36 health survey especially in +physical function, physical health, emotional problem, pain, and general health both in study +and control groups. It suggests that practice of yoga with or without HSF was effective in +improving the problems that are associated with chronic neck pain such as neck pain, +disability, QOS and QOL. +The previous study on one of the advanced guided yoga relaxation techniques called “mind +sound resonance technique (MSRT)” was reported to add significant complimentary benefits +to conventional physiotherapy by reducing pain, tenderness, disability and providing +improved flexibility in patients with common neck pain.[3] Regular yoga practice has shown +to produce a significant reduction in time to fall asleep, decreased sleep disturbance during +night time, better sleep quality, decreased use of medications for sleep and improve overall +QOS[16] and also felt more rested and energetic in the morning.[17] Previous studies on yoga +practices showed improvement in pain, neck-related disabilities and health-related QOL in +patients with chronic non-specific neck pain.[18-20] And, sustained yoga practice seems to be +the most important predictor of long-term effectiveness in neck patients. A systematic review +has reported that the yoga can decrease pain and increase functional ability in patients with +spinal pain including neck pain.[1] Thus, the findings of the present study are consistent with +the reports of the previous studies. +Non-specific neck pain has reported to be associated with anxiety, depression[2] stress and +tension.[3] Yoga is fast advancing as an effective therapeutic tool in physical, psychological +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +and psychosomatic disorders. And the practice of yoga was found to be effective in reducing +stress, anxiety, pain[3] (by down regulating the hypothalamic pituitary adrenal axis and the +sympathetic nervous system)[4] and disability.[3,4] Moreover, yoga has shown to influence the +functional status of neck muscles of patients with neck pain[19] and reported to be an effective +method for treating neck pain by improving strength, flexibility and endurance that is a basic +goal of most rehabilitation programs for neck pain.[1] Thus, the reduction in pain and +disability and the improvement in QOS and QOL after yoga with or without HSF might +attribute to the effect of yoga on stress, anxiety, modulation of the hypothalamic pituitary +adrenal axis and the sympathetic nervous activity. +A qualitative study reported that the chronic neck pain patients those who have participated in +yoga intervention have changed on five dimensions of human experience: 1) Physically, most +participants cited renewed body awareness, both during yoga practice and in daily lives, 2) +Cognitively, participants reported increased perceived control over their health, 3) +Emotionally, they noted greater acceptance of their pain and life burdens, 4) Behaviourally, +they described enhanced use of active coping strategies, and 5) Socially, they reported +renewed participation in an active life.[21] In a previous study, intake of the vegetarian diet +has shown to be effective in reducing pain, tenderness, inflammatory markers and in +improving physical functioning of patients with rheumatoid arthritis.[22] Thus, the vegetarian +diet provided in the present study might also have attributed to the reduction in pain and +improvement in the health-related problems of neck pain. +Strength of the study: This is the first study evaluating the add-on effects of HSF to yoga in +patients with non-specific neck pain, the standard study design was adopted, and no adverse +effects were reported by the subjects throughout the study period. Limitations of the study: +Small sample size, short-term intervention, and lack of objective variables and assessments +such as stress, anxiety, muscle tension, flexibility, sleep architecture. Hence, long-term +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +studies are required with larger sample size and above-mentioned variables for the better +understanding of the effect and its underlying mechanisms. +CONCLUSION +Result of this study suggests that yoga with or without HSF is effective in reducing pain, +disability, and in improving QOS and QOL of patients with non-specific neck pain. However, +an addition of HSF to yoga provides a better reduction in pain and disability along with +improvement in the social functioning of the patients with non-specific neck pain than yoga +alone. +SOURCE OF FUNDING: Nil, +CONFLICT OF INTEREST: None declared + + + + + + + + + + +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +REFERENCES: +1. Crow EM, Jeannot E, Trewhela A. Effectiveness of Iyengar yoga in treating spinal +(back and neck) pain: A systematic review. Int J Yoga. 2015;8(1):3-14. doi: +10.4103/0973-6131.146046. +2. Binder AI. Neck pain. BMJ Clin Evid. 2008;2008. pii: 1103. +3. Yogitha B, Nagarathna R, John E, Nagendra H. Complimentary effect of yogic sound +resonance relaxation technique in patients with common neck pain. Int J Yoga. +2010;3(1):18-25. doi: 10.4103/0973-6131.66774. +4. Kim SD. Effects of yoga on chronic neck pain: a systematic review of randomized +controlled trials. J Phys Ther Sci. 2016;28(7):2171-4. doi: 10.1589/jpts.28.2171. +5. Cramer H, Lauche R, Langhorst J, Dobos GJ, Michalsen A. Validation of the German +version of the Neck Disability Index (NDI). BMC Musculoskelet Disord. 2014;15:91. +doi: 10.1186/1471-2474-15-91. +6. Kellogg JH. Rational Hydrotherapy. 2nd ed. Pune: National Institute of Naturopathy; +2005. +7. Hsu DZ, Liu CT, Chu PY, Li YH, Periasamy S, Liu MY. 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The Pittsburgh +Sleep Quality Index: A new instrument for psychiatric practice and research. +Psychiatry Res 1989;28:193-213. +13. Mooventhan A, Nivethitha L. Effects of acupuncture and massage on pain, quality of +sleep and health related quality of life in patient with systemic lupus erythematosus. J +Ayurveda Integr Med 2014;5:186-9. doi: 10.4103/0975-9476.140484. +14. Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version +2 in the United Kingdom. J Epidemiol Community Health 1999;53:46-50. +15. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, et al. +Validating the SF-36 health survey questionnaire: new outcome measure for primary +care. BMJ. 1992;305(6846):160-4. +16. Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self-rated sleep in a +geriatric population. Indian J Med Res. 2005;121:683-90. +17. Bankar MA, Chaudhari SK, Chaudhari KD. Impact of long term Yoga practice on +sleep quality and quality of life in the elderly. J Ayurveda Integr Med. 2013;4:28-32. +doi: 10.4103/0975-9476.109548. +18. Cramer H, Lauche R, Hohmann C, Langhorst J, Dobos G. Yoga for chronic neck +pain: a 12-month follow-up. Pain Med. 2013;14:541-8. doi: 10.1111/pme.12053. +19. Cramer H, Lauche R, Hohmann C, Lüdtke R, Haller H, Michalsen A, et al. +Randomized-controlled trial comparing yoga and home-based exercise for chronic +neck pain. Clin J Pain. 2013;29:216-23. doi: 10.1097/AJP.0b013e318251026c. +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +20. Michalsen A, Traitteur H, Lüdtke R, Brunnhuber S, Meier L, Jeitler M, et al. Yoga for +chronic neck pain: a pilot randomized controlled clinical trial. J Pain. 2012;13:1122- +30. doi: 10.1016/j.jpain.2012.08.004. +21. Cramer H, Lauche R, Haller H, Langhorst J, Dobos G, Berger B. "I'm more in +balance": a qualitative study of yoga for patients with chronic neck pain. J Altern +Complement Med. 2013;19:536-42. doi: 10.1089/acm.2011.0885. +22. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, et +al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. +Lancet. 1991;338:899-902. + + +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +TABLES: +Table 1: Detailed daily activities to study group and control group +Time +Schedule +5:30 am +OM meditation +6:00 am +Practice of asana (postures) +7:30 am +Breakfast +8:00 am +Bhagavat Geetha chanting followed by lecture on Yoga +9:00 am +Discussion with the ward doctors and assessment of vitals +10:00 am +Pranayama (breathing exercise) practices +11:00 am +Sukshma Vyayama (loosening exercise) +12:00 pm +Lecture on Yoga philosophy +1:00 pm +Lunch break +3:00 pm +Cyclic meditation +4:00 pm +Loosening exercise followed by asana +5:00 pm +Sesame oil application (for both the groups) followed by hot sand +fomentation (only for study group) +6:00 pm +Bhajan (Singing of sacred scriptures) +6:30 pm +Relaxation techniques +7:30 pm +Dinner +8:30-9:00 pm +Happy Assembly (interactions among the patients) + + +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +Table 2: Demographic variables of the study group (n = 30) and control group (n = 30) +Variable +Study group (n = 30) +Control group (n = 30) +p value +Age (Years) +32.70±6.04 +35.27±8.28 +0.202¶ +Gender +Female 14/Male 16 +Female 13/Male 17 +- +Height (cm) +159.53±3.56 +160.52±4.57 +0.395¶ +Weight (kg) +62.77±6.72 +64.27±8.22 +0.327¶ +BMI (kg/m2) +24.66±2.40 +24.66±2.38 +0.842¶ +Note: BMI = Body mass index. ¶ = Mann-Whitney U Test. + + + +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +19 + +Table 3: Baseline and post-test assessments of study group and control group +Variables Assessment Sample +size (n) +Study group with +within group +analysis +(Wilcoxon signed +ranks test) +Control group +with within +group analysis +(Wilcoxon +signed ranks test) +Between +groups +analysis +(Mann- +Whitney +U +Test) +p value +VAS +Baseline +29 +7.81±1.08 +7.33±0.83 +0.019 +Post test +29 +2.63±0.98 +5.79±1.18 +<0.001 + +p<0.001 +p<0.001 + +NDI +Baseline +30 +34.47±7.31 +34.80±6.34 +0.846 +Post test +30 +11.20±5.37 +23.73±7.10 +<0.001 + +p<0.001 +p<0.001 + +PSQI +Baseline +30 +14.90±7.53 +11.93±6.41 +0.84 +Post test +30 +6.97±3.00 +8.93±5.33 +0.268 + +p<0.001 +p<0.001 + +SF-36 Health Survey +PF +Baseline +30 +45.00±20.97 +54.17±18.29 +0.154 +Post test +30 +71.00±20.02 +66.17±18.08 +0.201 + +p<0.001 +p<0.001 + +PH +Baseline +30 +20.00±27.39 +35.83±31.27 +0.023 +Post test +30 +59.17±41.25 +59.17±34.42 +0.819 + +p<0.001 +p=0.002 + +ACCEPTED MANUSCRIPT +ACCEPTED MANUSCRIPT +20 + +EP +Baseline +30 +27.78±30.43 +27.78±31.66 +0.826 +Post test +30 +64.44±43.71 +51.67 ±35.11 +0.204 + +p=0.001 +p=0.003 + +Energy +Baseline +30 +44.58±10.42 +53.17±10.54 +0.004 +Post test +30 +58.25±12.85 +56.50±11.38 +0.581 + +p<0.001 +p=0.188 + +EW +Baseline +30 +65.33±12.66 +64.53±11.49 +0.840 +Post test +30 +66.33±12.66 +67.87±12.32 +0.800 + +p=0.628 +p=0.091 + +SF +Baseline +30 +42.50±17.47 +40.00±12.88 +0.742 +Post test +30 +64.08±13.20 +55.25±17.58 +0.035 + +p<0.001 +p=0.091 + +Pain +Baseline +30 +40.75±17.47 +39.83±16.58 +0.745 +Post test +30 +69.00±16.95 +49.92±17.09 +<0.001 + +p<0.001 +p=0.011 + +GH +Baseline +30 +48.58±13.39 +43.58±14.35 +0.399 +Post test +30 +62.17 ±12.30 +56.17±12.01 +0.054 + +p<0.001 +p<0.001 + +Note: All the values are in Mean ± Standard deviation. VAS= Visual analogue scale; NDI= +Neck disability index; PSQI= Pittsburgh sleep quality index; SF = Short form; PH= Physical +functioning; PH= Physical Health; EP= Emotional problem; EW= Emotional wellbeing; SF= +Social functioning; GH= General Health + + diff --git a/subfolder_0/Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment_a randomized controlled trial..txt b/subfolder_0/Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment_a randomized controlled trial..txt new file mode 100644 index 0000000000000000000000000000000000000000..60ecd6d47a063ea9e24fd594d5a5bb9daaf2058f --- /dev/null +++ b/subfolder_0/Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment_a randomized controlled trial..txt @@ -0,0 +1,944 @@ +Complementary Therapies in Medicine (2009) 17, 1—8 +available at www.sciencedirect.com +journal homepage: www.elsevierhealth.com/journals/ctim +Anxiolytic effects of a yoga program in early breast +cancer patients undergoing conventional treatment: +A randomized controlled trial +M. Raghavendra Rao a,∗, Nagarathna Raghuram b, H.R. Nagendra b, +K.S. Gopinath a, B.S. Srinath a, Ravi B. Diwakar a, Shekar Patil a, +S. Ramesh Bilimagga a, Nalini Rao a, S. Varambally c +a Departments of CAM, Surgical Oncology, Medical Oncology and Radiation Oncology, +Bangalore Institute of Oncology, Bangalore, India +b Department of Yoga Research, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India +c Department of Psychiatry, NIMHANS, Bangalore, India +Available online 14 October 2008 +KEYWORDS +Yoga; +Anxiety; +Cancer; +STAI; +CAM; +Relaxation +Summary +Objectives: This study compares the anxiolytic effects of a yoga program and supportive therapy +in breast cancer outpatients undergoing conventional treatment at a cancer centre. +Methods: Ninety-eight stage II and III breast cancer outpatients were randomly assigned to +receive yoga (n = 45) or brief supportive therapy (n = 53) prior to their primary treatment i.e., +surgery. Only those subjects who received surgery followed by adjuvant radiotherapy and six +cycles of chemotherapy were chosen for analysis following intervention (yoga, n = 18, control, +n = 20). Intervention consisted of yoga sessions lasting 60 min daily while the control group was +imparted supportive therapy during their hospital visits as a part of routine care. Assessments +included Speilberger’s State Trait Anxiety Inventory and symptom checklist. Assessments were +done at baseline, after surgery, before, during, and after radiotherapy and chemotherapy. +Results: A GLM-repeated measures ANOVA showed overall decrease in both self-reported state +anxiety (p < 0.001) and trait anxiety (p = 0.005) in yoga group as compared to controls. There +was a positive correlation between anxiety states and traits with symptom severity and distress +during conventional treatment intervals. +Conclusion: The results suggest that yoga can be used for managing treatment-related symptoms +and anxiety in breast cancer outpatients. +© 2008 Published by Elsevier Ltd. + Sources of support: Central Council for Research in Yoga and Naturopathy, Ministry of Health and Family Welfare, Govt. of India. +∗Corresponding author at: Departments of CAM, Bangalore Institute of Oncology, No8, P Kalinga Rao Rd, Sampangiramnagar, Bangalore, +India. Tel.: +91 80 40206000; fax: +91 80 22222146. +E-mail address: raghav.hcgrf@gmail.com (M.R. Rao). +0965-2299/$ — see front matter © 2008 Published by Elsevier Ltd. +doi:10.1016/j.ctim.2008.05.005 +2 +M.R. Rao et al. +Background +Anxiety and depression are the commonest psychiatric prob- +lems encountered in cancer patients. Fear and anxiety +associated with diagnosis of cancer, invasive treatment +procedures, sexual dysfunction secondary to surgery and +radiation, and aversive reactions to chemotherapy are +among the common treatment-related side effects observed +in cancer patients. Clinical descriptions have noted can- +cer patient’s fears of the treatment (e.g., being ‘‘burned’’ +or ‘‘equating radiotherapy with electric current’’), causing +sterility, sickness or vomiting and vast individual differences +in their psychological reactions, which usually predisposes to +anxiety.1—5 Apart from treatment-related anxiety the diag- +nosis of cancer itself is anxiety provoking. +Psychiatric disorders in cancer patients are often missed +or untreated.6 Patients with breast cancer undergoing radi- +ation treatment also report anxiety and depression before, +during and after the treatment.7 The prevalence of anxi- +ety and depression in cancer patients undergoing radiation +treatment was 64% and 50%, respectively.1 +Earlier studies have shown that anxiety increases psy- +chological distress and side effects following conventional +treatment.8,9 This treatment-related distress is predictive +of poorer treatment outcome, poor treatment compliance, +greater pain, longer hospital stays, more postoperative +complications and immune suppression.10,11 This has been +attributed in part to subjects increased attentiveness to +their somatic symptoms12 and development of aversive con- +ditioned responses induced by anxiety.13 Therefore, there is +a need to reduce anxiety in these patients. +The literature on psychosocial treatment for breast can- +cer patients provides uniform evidence for an improvement +in mood, coping, adjustment, vigour, and decrease in dis- +tressful symptoms using a variety of behavioural approaches +including alternative medicine approaches such as yoga.14—21 +Yoga as a complementary and mind body therapy is being +practiced increasingly across the world. It is an ancient +Indian science that has been used for therapeutic ben- +efit in numerous health care concerns in which mental +stress was believed to play a role.22 This could be partic- +ularly useful in cancer patients who perceive cancer as a +threat. +Results from earlier studies provide preliminary sup- +port for anxiolytic effects of yoga interventions in cancer +patients. Positive effects have been seen on a variety of out- +comes, including sleep quality, mood, stress, cancer-related +distress, cancer-related symptoms, and overall quality of +life, as well as functional and physiological measures.23 +Further, results from cancer trials are bolstered by stud- +ies conducted with non-cancer populations, which have +demonstrated positive effects on similar outcomes (e.g., +improvements in mood and fatigue). These studies were +typically more methodologically rigorous than those con- +ducted with cancer populations and often included active +control groups (e.g., relaxation,24 exercise,25 and wait listed +controls26) lending further support to the results.27 +An earlier uncontrolled study with cancer patients in +India also reported mood-enhancing effects with yoga +intervention.28 Being diagnosed with cancer is in itself +anxiety-provoking, and we hypothesize that yoga inter- +vention may be effective for reducing general anxiety +associated with the having cancer and those related to can- +cer treatment. +In this study, we compared the effects of a 24-week +‘‘Integrated yoga program’’ with ‘‘Brief supportive ther- +apy’’ control intervention in early operable breast cancer +patients undergoing surgery, radiotherapy, and chemother- +apy. +Methods +This is a single centre randomized controlled trial which +recruited 98 recently diagnosed women with stage II and III +operable breast cancers. The institutional ethics committee +of the recruiting cancer centre approved the study. Patients +were included if they met the following criteria: (i) women +with recently diagnosed operable breast cancer, (ii) age +between 30 and 70 years, (iii) Zubrod’s performance status +0—2 (ambulatory >50% of time), (iv) high school education, +(v) willingness to participate, and (vi) treatment plan with +surgery followed by adjuvant radiotherapy and chemother- +apy. Patients were excluded if they had (i) a concurrent +medical condition likely to interfere with the treatment, (ii) +any major psychiatric, neurological illness or autoimmune +disorders, and (iii) secondary malignancy. The details of the +study were explained to the participants and their informed +consent was obtained in writing. +Assessments were done prior to their surgery, fol- +lowing surgery, during and following radiotherapy and +chemotherapy. +All +participants +in +the +study +received +the same dose of radiation (50 cGy over 6 weeks) and +prescribed standard chemotherapy schedules (cyclophos- +phamide, methotrexate, fluorouracil or fluorouracil, adri- +amycin and cyclophosphamide— +–six cycles). Subjects in both +groups (control 45%, yoga 39%) received anxiolytic med- +ications during their chemotherapy to prevent aversive +responses (alprazolam 0.5 mg once daily for 1 week following +chemotherapy infusion). The subjects received anxiolytics +as a co-medication for only one to two cycles of chemother- +apy. However, co-medication was given only to prevent +aversive responses such as chemotherapy induced nausea +and vomiting following chemotherapy. +Measures +Before randomization demographic information, medical +history, clinical data, intake of medications, investigative +notes and conventional treatment regimen were ascertained +from all consenting participants. Participants completed the +state trait anxiety inventory (STAI) that consists of a sep- +arate self-report scale for measuring two distinct anxiety +concepts: state anxiety and trait anxiety.29 +The A trait scale asks subjects to describe how they +generally feel, an attempt to tap individual differences in +‘‘anxiety proneness’’ where as the A-state scale asks the +subjects to indicate how they feel at a particular moment in +time. Subjects are asked to rate on a 4-point scale (almost +never/not at all to almost always/very much) whether or +not each statement best describes their feelings. Because +the state measure is regarded similar to mood measures that +have expectedly low test—retest reliabilities, comparison of +internal consistencies between the state and trait measure +Anxiolytic effects of a yoga program in early breast cancer patients +3 +is more appropriate. Coefficient alpha values for the state +measure range from 0.86 to 0.92 and those for trait measure +are equally high. +The subjective symptom checklist was developed dur- +ing the pilot phase to assess treatment-related side effects, +problems with sexuality and image, and relevant psycho- +logical and somatic symptoms related to breast cancer. +The checklist consisted of 31 such items each evaluated +on two dimensions; severity graded from no to very severe +(0—4) and distress from not at all to very much (0—4). +These scales measured the total number of symptoms expe- +rienced, total/mean severity and distress scores and were +evaluated previously in a similar breast cancer population.30 +The patients from both groups were briefed together by +investigators on filling the questionnaire. These self-report +questionnaires were filled by patients themselves at assess- +ment intervals. +Randomization +A person who had no part in the trial randomly allocated +consenting participants (n = 98) to either yoga (n = 45) or +supportive therapy groups (n = 53). Participants were ran- +domized at the initial visit before starting any conventional +treatment. Following randomization participants underwent +surgery followed by radiotherapy (RT) and chemotherapy +(CT) or any other treatment schedule as shown in Table 1. +There were 12 dropouts in yoga and 17 dropouts in control +group, respectively following surgery. Another 15 subjects +and 13 subjects in yoga and control arm who did not receive +the above treatment sequence were not considered for anal- +ysis (see Fig. 1: trial profile). +Sample size +Earlier studies have reported very large effect size (>1) for +anxiety scores with yoga intervention.31 We therefore used +a conservative estimate of effect size/standardised differ- +ence = 1 for our study. The sample size needed in our study +based on formula32 is 17 subjects in each arm with p at +0.05 and 80% power. There were 18 subjects in yoga and +20 subjects in control group who contributed data to the +study. +Interventions +The intervention group received an integrated yoga program +and the control group received supportive therapy sessions, +both imparted individually. Yoga practices consisted of a set +of asanas (postures), breathing exercises, pranayama (vol- +untarily regulated nostril breathing), meditation and yogic +relaxation techniques with imagery. The details of these +practices are described elsewhere.33 These practices were +based on principles of attention diversion, awareness and +relaxation to cope with stressful experiences. The subjects +were given booklets, audiotapes with instructions on these +practices for home practice using the instructors voice so +that a familiar voice could be heard on the cassette. +The subjects underwent four in-person sessions during +their pre- and postoperative period and were asked to +undergo three in-person sessions/week for 6 weeks dur- +Figure 1 +Trial profile. +ing their adjuvant radiotherapy treatment in the hospital +with self-practice as homework on the remaining days. Dur- +ing chemotherapy, subjects underwent in person sessions +during their hospital visits for chemotherapy administration +(once in 21 days) and were imparted in-person sessions by +their trainer once in 10 days. The instructor monitored their +homework on a day-to-day basis through telephone calls and +house visits. Participants were also encouraged to maintain a +daily log listing the yoga practices done, use of audiovisual +aids, duration of practice, experience of distressful symp- +toms, intake of medication and diet history. There were two +instructors, one being a physician in naturopathy and yoga +and the other a trained and certified therapist in yoga from +the yoga institute. They together supervised and imparted +the yoga and supportive therapy intervention with help from +trained social workers and counsellors at the hospital. +The control intervention consisted of brief supportive +therapy with education as a component that is routinely +offered to patients as a part of their care in this centre. +We chose to have this as a control intervention mainly to +control for the non-specific effects of the yoga program +that may be associated with factors such as attention, sup- +port and a sense of control. Subjects and their caretakers +underwent counselling by a trained social worker (once in +10 days, 15 min sessions) during their hospital visits for +adjuvant radiotherapy/chemotherapy. Subjects in the sup- +portive therapy group also completed daily logs or dairies +on treatment-related symptoms, medication and diet dur- +ing their chemotherapy cycles. The subjects were also given +homework based on education component and were also +4 +M.R. Rao et al. +Table 1 +Demographic characteristics of the initially randomized sample (n = 98) +All subjects +Yoga group +Control group +n +(%) +n +(%) +n +(%) +Stage of breast cancer +II +47 +47.9 +24 +53.3 +23 +43.4 +III +51 +52.1 +21 +46.7 +30 +Grade of breast cancer +I +1 +1 +1 +2.2 +0 +0 +II +11 +11.2 +6 +13.3 +5 +9.4 +III +86 +87.8 +38 +84.4 +48 +90.6 +Menopausal status +Pre +44 +44.9 +27 +60 +17 +32.1 +Post +50 +51.1 +15 +33.3 +35 +66 +Peri +2 +2 +2 +4.4 +0 +0 +Post-hysterectomy +2 +2 +1 +2.2 +1 +1.9 +Histopathology type +IDC +75 +76.5 +38 +84.4 +37 +69.8 +ILC +14 +14.3 +5 +11.2 +9 +17 +IPC +6 +6.1 +2 +4.4 +4 +7.5 +IDC-P +3 +3.1 +0 +0 +3 +5.6 +Treatment regimen +S + RT + CT6 +49 +50 +22 +48.9 +27 +50.9 +S + CT6 +7 +7.1 +4 +8.9 +3 +5.6 +S + CT3 + RT + CT3 +28 +28.6 +12 +26.7 +16 +30.2 +S + RT +10 +10.2 +5 +11.1 +5 +9.4 +S + CT6 + RT +4 +4.1 +2 +4.4 +2 +3.8 +Stressful life events past 2 years +Yes +27 +28 +10 +22.2 +17 +32.1 +No +71 +72 +35 +77.8 +36 +67.9 +Control group = Supportive Therapy, IDC—Infiltrating Ductal Carcinoma, ILC—Infiltarting Lobular Carcinoma, IPC—Infiltrating Papillary +Carcinoma, IDC-P—Infiltrating Ductal Carcinoma-Papillary type, S—Surgery, RT—Radiotherapy, CT—Chemotherapy. +followed up with telephone calls and house visits. While +the goals of yoga intervention were stress reduction and +appraisal changes, the goals of supportive therapy were edu- +cation, reinforcing social support and coping preparation. +Statistical methods +Data were analyzed using Statistical Package for Social Sci- +ences version 10.0. We used a per protocol analysis in this +study analyzing only those subjects who underwent surgery +followed by radiotherapy and six cycles of chemotherapy +(in this order) for the study as heterogeneity in treat- +ment modalities and sequence could have confounded the +results. A GLM-repeated measures ANOVA was done with +the within-subjects factor being time/assessments at six +levels and between-subjects factor being groups at two +levels (yoga and supportive therapy). Both within-subjects +and between-subjects effect and group by time interac- +tion effects were assessed. Post hoc tests were done using +Bonferroni correction for changes at different time points +between groups. Intention to treat analysis was also done on +the initially randomized sample (n = 98) with baseline mea- +sure and post-measure (post-CT) for all subjects. Baseline +value was carried forward for subjects who did not have +a post-measure (including those who received other treat- +ment schedules and study drop outs). Pearson correlation +analysis was used to study the bivariate relationships of +anxiety state and trait scores with treatment-related symp- +tom severity and distress at various conventional treatment +intervals (post-surgery/mid-RT/mid-CT). +Results +The subjects in our study were recruited and followed-up +between January 1999 and June 2004. The groups were +comparable with respect to socio-demographic and medical +characteristics (see Table 1). Subjects in both groups (con- +trol 45%, yoga 39%) received anxiolytic medications during +their chemotherapy to prevent aversive responses (alprazo- +lam 0.5 mg once daily for 1 week following chemotherapy +infusion). The subjects received anxiolytics as a comedica- +tion for only one to two cycles of chemotherapy. +Anxiety state +A repeated measures analysis of variance was done on +anxiety state scores. Sphericity was assumed with Hyun +Anxiolytic effects of a yoga program in early breast cancer patients +5 +feldt э at 0.6. Though group by time interaction effects +were not significant, the between-subjects effect was sig- +nificant F (1, 35) = 10.8, p = 0.002. Post hoc tests using +Bonferroni correction showed significant decrease in anxiety +states in yoga group as compared to control at post-surgery +(mean change ± S.E., p value, 95% CI), (4.3 ± 1.96, p = 0.04, +0.2—8.3), mid-RT (5.7 ± 2.2, p = 0.01, 1.3—10.2), post-RT +(5.5 ± 2.1, p = 0.01, 1.3—9.7), mid-CT (8.9 ± 2.2, p < 0.001, +4.3—13.3), and post-CT (8.9 ± 2.6, p = 0.002, 3.6—14.2) (see +Table 2). However, intention to treat analysis done on the +initially randomized sample showed a significant change +between groups on state measure following intervention +(4.7 ± 2.1, p = 0.05, 1.1—6.4) (Table 3). +Anxiety trait +A repeated measures analysis of variance was done on anx- +iety trait scores. Sphericity was assumed with Hyun feldt +э at 0.75. Though group by time interaction effects was +not significant, the between-subjects effect was significant +F (1, 35) = 8.2, p = 0.007. Post hoc tests using Bonferroni +correction showed significant decrease in anxiety trait in +the yoga group as compared to controls at post-surgery +(mean change ± S.E., p value, 95% CI), (6.9 ± 2.4, p = 0.007, +2—11.8), post-RT (5.8 ± 2.1, p = 0.01, 1.5—10.1), and post- +CT (8.2 ± 2.8, p = 0.005, 2.6—13.8) (see Table 2). However, +intention to treat analysis done on the initially randomized +sample did not show any significant change between groups +on trait measure following intervention (Table 3). +Symptom distress +A repeated measures analysis of variance was done on +symptom distress scores. Sphericity was assumed with Hyun +feldt э at 1. Group by time interaction effects was sig- +nificant and between subjects effect was significant F (1, +35) = 14.5, p = 0.001. Post hoc tests using Bonferroni cor- +rection showed significant decrease in symptom distress +in yoga group as compared to controls at post-surgery +(mean change ± S.E., p value, 95% CI), (6.4 ± 2.3, p = 0.009, +1.7—11.1), mid-RT (10.1 ± 2.8, p = 0.001, 4.3—15.8), post- +RT (4.8 ± 1.7, p = 0.009, 1.4—8.2), mid-CT (16.3 ± 3.5, +p < 0.001, +9.3—23.3), +and +post-CT +(7.7 ± 2.9, +p = 0.01, +1.6—13.7) (Table 2). +There was a significant bivariate relationship between +anxiety states and traits with severity and distress of +treatment-related symptoms during various stages of con- +ventional treatment (see Table 4). +Discussion +We compared the effects of a 24-week yoga program +with supportive therapy in 38 recently diagnosed breast +cancer outpatients undergoing surgery, radiotherapy, and +chemotherapy. The results suggest an overall decrease in +both anxiety state (reactive anxiety) and trait with time in +both the groups. Yoga intervention reduced anxiety state +scores by 0.5% following surgery, 4.9% and 6% during and fol- +lowing radiotherapy and 8.5% and 11.6% during and following +chemotherapy from their respective baseline means than +Table 2 +Comparison of scores for anxiety state, trait and symptom distress at various stages of conventional treatment using GLM-repeated measures ANOVA +Outcome measures +Pre-surgerya +Post-surgerya +During radiotherapya +Post-RT +During chemotherapya +Post-CT +Pre-RT +Mid-RT +Pre-CT +Mid-CT +STAI-anxiety state +Yoga, mean (S.D.) +43.9 ± 11 +34 ± 3.2* +34 ± 3.2 +29.3 ± 3.6* +29.1 ± 3.6* +29.1 ± 3.6 +29.3 ± 3.3*** +24.1 ± 3.1*** +Control, mean (S.D.) +48.7 ± 11.6 +38.3 ± 7.4 +38.3 ± 7.4 +35.3 ± 8.2 +34.3 ± 8.2 +34.3 ± 7.8 +38.2 ± 8.5 +33.1 ± 10.5 +STAI-anxiety trait +Yoga, mean (S.D.) +42.1 ± 8.8 +33.4 ± 3.9*** +33.4 ± 3.9 +— +30.1 ± 3.9** +35.7 ± 7.8 +— +26.7 ± 3.9*** +Control, mean (S.D.) +46.8 ± 10.9 +40.6 ± 9.2 +40.6 ± 9.2 +— +35.7 ± 7.8 +35.7 ± 7.8 +— +34.9 ± 10.8 +Symptom distress +Yoga, mean (S.D.) +13.9 ± 9.5 +9.2 ± 8.3*** +9.2 ± 8.3 +10.1 ± 6.5*** +5.4 ± 5.6*** +31.8 ± 4.7 +15.3 ± 9.7*** +5.1 ± 6.5* +Control, mean (S.D.) +15.8 ± 8.5 +15.3 ± 5.7 +34.4 ± 8.7 +19.8 ± 10.1 +10.1 ± 4.7 +37.6 ± 7.8 +31.6 ± 11.1 +12.8 ± 10.7 +*p values < 0.05, **p values < 0.01, ***p values < 0.001, for post hoc tests comparing groups at different time points using Bonferroni correction. y = yoga, c = control/supportive therapy +group. +a Y (n = 18), C (n = 20). +6 +M.R. Rao et al. +Table 3 +Comparison of scores between yoga and control +groups at baseline and following intervention on intention +to treat analysis using RMANOVA in the initially randomized +sample (n = 98) +Measures +Baseline +(mean ± S.D.) +Post-intervention +(mean ± S.D.) +Anxiety state +Yoga (n = 45) +47.7 ± 11.1 +37.8 ± 11.6* +Control (n = 53) +51.1 ± 10.9 +45.9 ± 14.2 +Anxiety trait +Yoga (n = 45) +45.7 ± 10.8 +37.9 ± 13.8 +Control (n = 53) +48.5 ± 10.3 +41.5 ± 12.3 +y = yoga, c = control/supportive therapy group. +* p < 0.05 for post hoc tests comparing groups at different time +points using Bonferroni correction. +the control group. There was also a corresponding decrease +in anxiety trait scores by 7% following surgery, 8.1% follow- +ing radiotherapy, and 10.4% following chemotherapy from +their baseline means as compared to controls. However, +the decrease was less on intention to treat analysis. Our +results are bolstered by other studies in non-cancer popula- +tions using yoga intervention that have clearly demonstrated +both change in state and trait anxiety following 10 days to +6 months of intervention.31,34—38 +In all these studies the effect size for reduction in anxiety +by yoga were large (>0.8), where as in our study the effect +size (Cohen’s f) for anxiety state was 0.33 and trait was +0.24. Another randomized controlled trial in cancer patients +using the anxiety subscale of the Profile of Moods Scale +also reported large effect size with MBSR intervention.39,40 +High effect sizes seen with the above intervention could be +due to absence of an effective control intervention. It can +be argued that a modest effect size (<0.5) seen with our +intervention could be due to the fact that we controlled +for education, support and attention in these subjects that +could have reduced the effects of our intervention. Another +reason could also be for the fact that patients were followed +over a long period and repeat measurements could have +reduced the effect size of our intervention. Nevertheless, +our finding that yoga helped reduce treatment-related dis- +Table 4 +Pearson correlation (r values) between anxiety +scores and treatment-related symptoms (severity and dis- +tress) at various conventional treatment intervals +Symptom severity +Symptom distress +r (95% CI) +r (95% CI) +Post-surgery +Anxiety state +0.66 (0.62—1.1) +0.65 (0.34—0.84) +Anxiety trait +0.68 (0.77—1.3) +0.69 (0.66—1.2) +During radiotherapy +Anxiety state +0.73 (0.62—0.98) +0.73 (0.5—0.79) +Anxiety trait +0.60 (0.62—1.15) +0.58 (0.67—1.15) +During chemotherapy +Anxiety state +0.58 (0.27—0.57) +0.64 (0.26—0.70) +Anxiety trait +0.49 (0.31—1.1) +0.50 (0.41—1.1) +tress and severity at various treatment follow-up intervals +support the anxiolytic effects of our intervention. +Overall, the results suggest that anxiolytic effects of +yoga program could be attributed to stress reduction rather +than mere social support and education in conformity with +earlier studies.41,42 Scores on anxiety state and trait corre- +lated directly with symptom severity and distress at various +stages of conventional treatment further supporting the +idea that reductions in anxiety could contribute to decre- +ments in treatment-related distress and outcomes.43 Earlier +studies also show that state and distressful symptoms can +also change an individual’s personality trait44 and hence +trait changes can also be seen with our intervention. Ear- +lier studies have shown that though distressful symptoms +do influence traits, they are independent of each other and +changes could be actually related to test retest issues and +the inadequacy of the trait scale itself and not related to +change in distressful symptoms. However, trait changes were +not significant on intention to treat analysis and the results +must therefore be viewed with caution. We have shown ear- +lier that yoga has been helpful in reducing aversive reactions +to chemotherapy such as nausea and vomiting.33 A reduction +in symptom distress and subjective severity is an important +benefit to be gained via stress reduction techniques such as +yoga. +We chose to have individual yoga therapy and supportive +counselling sessions as compared to group therapy as being +in a group could have confounded the benefits conferred +by our interventions.45 Moreover, these individual sessions +also helped to understand the specific needs and concerns +of participants and monitor individual progress in practice. +Finally, none of the patients in our study reported any mus- +culoskeletal complaints or any other adverse event that may +be related to yoga practice indicating that the yoga module +developed for cancer patients was safe. +We have also demonstrated that this yoga intervention +package could be used in a cancer centre along with the +routine treatment without any need for additional expen- +sive infrastructure. This would be feasible and cost effective +especially in a developing country where supportive services +for cancer patients are rarely available and access to care +is not affordable for the majority of the cancer population. +One of the major limitations in our study is the inequality +in contact duration of interventions. Supportive therapy +interventions were used only with an intention of negating +the confounding variables such as instructor—patient inter- +action, education, and attention.46 However, inequality in +contact duration of this intervention could have affected +its effectiveness as successes of such interventions depend +mainly on contact duration and content. Similar support- +ive sessions have been used successfully as a control +comparison +group +to +evaluate +psychotherapeutic +interventions46,47 +and have been effective in control- +ling chemotherapy related side effects.48 Secondly; it was +not possible to mask the yoga intervention from the study +participants. Blinding in yoga studies is a topic of intense +discussion in yoga research. As yet there has been no perfect +method for blinding yoga therapy from the participants +because of the nature of the therapy itself, which involves +the patients being asked to perform asanas as well as a +spiritual component that includes the knowledge that they +are performing yoga. +Anxiolytic effects of a yoga program in early breast cancer patients +7 +Conclusions +In summary, our yoga-based intervention was effective in +reducing reactive anxiety and trait anxiety in early breast +cancer patients undergoing conventional cancer treatment. +This was probably facilitated through stress reduction and +helping the cancer patients to cope better with their illness +at various stages of their conventional treatment. Future +studies should explore the putative neurophysiologic mech- +anisms underlying the anxiolytic effects conferred by yoga +intervention. +Acknowledgements +We are thankful to Dr Jayashree, Mrs. Anupama for imparting +the yoga intervention. We are thankful to Dr. B.N. 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Effect of psy- +chosocial treatment on survival of patients with metastatic +breast cancer. Lancet 1989;2:888—91. +43. Carey MP +, Burish TG. Anxiety as a predictor of behavioral ther- +apy outcome for cancer chemotherapy patients. J Consult Clin +Psychol 1985;53:860—5. +44. Fishbain DA, Cole B, Cutler RB, Lewis J, Rosomoff HI, Rosomoff +RS. Chronic pain and the measurement of personality: do states +influence traits? Pain Med 2006;7:509—29. +45. Reissman +F +. +The +helper +therapy +principle. +Soc +Work +1965;10:27—32. +46. Telch CF +, Telch MJ. Group coping skills instruction and sup- +portive group therapy for cancer patients: a comparison of +strategies. J Consult Clin Psychol 1986;54:802—8. +47. Greer S, Moorey S, Baruch JD, et al. Adjuvant psychological +therapy for patients with cancer— +–a prospective randomized +trial. Br Med J 1992;304:675—80. +48. Burish TG, Snyder SI, Jenkins RA. Preparing patients for can- +cer chemotherapy: effect of coping preparation and relaxation +interventions. J Consult Clin Psychol 1991;59:518—25. diff --git a/subfolder_0/Application of integrated yoga therapy to increase imitation skills in children with autism.txt b/subfolder_0/Application of integrated yoga therapy to increase imitation skills in children with autism.txt new file mode 100644 index 0000000000000000000000000000000000000000..9d8fa9e28165e53c62b350c86939b9c5dfb00011 --- /dev/null +++ b/subfolder_0/Application of integrated yoga therapy to increase imitation skills in children with autism.txt @@ -0,0 +1,552 @@ +International Journal of Yoga  Vol. 3  Jan-Jun-2010 +26 +Motor imitation is a complex developmental phenomenon +that serves important cognitive and social functions. At +a social level, it represents earliest forms of reciprocal +interactions between infant and the mother. +There is a growing body of literature demonstrating that +children with autism have specific deficits in imitating +action on objects, body movements, vocalization, +gesture, functional objectives and facial expression. Most +researchers recognize imitation as a central deficit in +children with autism[3,4] and a lack of imitative play is one +of the diagnostic criteria for the disability.[5] +Imitation is defined as the reproduction of a model’s +action in topography and function for the new actions +only. Charmil and Baren-Cohen,[6] Dawson and Adams[7] +and De Myer[8] were among the first to investigate +imitation skills in autism. In their experiment, 12 children +with autism and early childhood schizophrenia were +intROductiOn +The ability to understand another person’s action and, if +needed, imitate that action is a core component of human +social behavior. Imitation skills can be observed as early +as infancy. In typical infants, imitation emerges early in +development and plays a crucial role in the development +of cognitive, social, communication and other behaviors +such as language, play and joint attention.[1] +Early imitation is a non-verbal means of information +processing. In normal development, the baby is not taught +imitation as such; only in the second half of the year +parents begin to teach imitation like waving bye-bye, etc. +Typical children with autism spectrum disorder (ASD) fail +to demonstrate these skills. The more social the imitation +is, the harder it is to master. In the order of difficulty, +spontaneous object use is least difficult, motor object +imitation difficult and body imitation most difficult.[2] +Background/Aim: Children with autism exhibit significant deficits in imitation skills, which impede the acquisition of more complex +behavior and socialization. Imitation is often targeted early in intervention plans and continues to be addressed throughout the +child’s treatment. The use of integrated approach to yoga therapy (IAYT) as a complementary therapy for children diagnosed +with autism spectrum disorder (ASD) is rarely reported and little is known on the effectiveness of such therapies. This study +investigated IAYT as a treatment method with children with ASD to increase imitative skills. +Materials and Methods: Parents and six children with ASD participated in a 10-month program of 5-weekly sessions and +regular practice at home. Pre, mid and post treatment assessments included observers and parent ratings of children’s imitation +skills in tasks related to imitation skills such as gross motor actions, vocalization, complex imitation, oral facial movements +and imitating breathing exercises. +Results: Improvement in children’s imitation skills especially pointing to body, postural and oral facial movements. Parents +reported change in the play pattern of these children with toys, peers and objects at home. +Conclusions: This study indicates that IAYT may offer benefits as an effective tool to increase imitation, cognitive skills and +social-communicative behaviors in children with ASD. In addition, children exhibited increased skills in eye contact, sitting +tolerance, non-verbal communication and receptive skills to verbal commands related to spatial relationship. +Key words: Autism, Yoga, Imitation +ABSTRACT +Application of integrated yoga therapy to increase imitation +skills in children with autism spectrum disorder +Shantha Radhakrishna +Sri. Ganapathi Sachchidananda (SGS) Vagdevi Centre for the Rehabilitation of Communication Impaired, Bangalore, Karnataka, India +Address for correspondence: Shantha Radhakrishna, +Sri. Ganapathi Sachchidananda (SGS) Vagdevi Centre for the Rehabilitation of Communication Impaired, + +3rd C Main, 7th Cross, Girinagar II Phase, Bangalore - 560 085, Karnataka, India. +E-mail: vagdevitrust@rediffmail.com +DOI: 10.4103/0973-6131.66775 +Original Article +www.ijoy.org.in +27 +International Journal of Yoga  Vol. 3  Jan-Jun-2010 +compared to a controlled group of children with mental +retardation. The groups were evaluated on a variety of +body movements and object manipulation. Children with +autism exhibited significantly less imitation skill and +had particular difficulty with gestural imitation. Many +studies supported these findings. Heimann, Ullstadius, +Danigren and Gilberg[9] also found that motor tasks were +the least frequently imitated categories in children with +autism. Many more studies confirmed the above findings +of a relative deficit in motor imitation in children with +autism.[10] +Imitation research on children with autism has focused +primarily on the form of imitation (i.e. gestural, object, facial, +vocal). Cognitive developmental research on imitation +in autism generally used Piagetian models of sensory +motor development and compared children with autism +to mental age matched peers on a series of sensory motor +tasks. In behavioral research of imitation in children with +autism, emphasis is often placed on factors influencing skill +acquisition including teaching factors such as presentation +mode and model type. Independent variables evaluated in +behavioral analytic literature typically include response +class generalization and peer modeling. De Myer’s[8] +initial research generated many studies supportive of the +general findings of imitation deficits in autism. Findings +of deficits in imitation skills have significant implications +for the intervention approaches given the critical nature of +imitation to one’s ability to learn from the environment. +Treatment for autism based on either behavioral or +cognitive developmental models emphasizes on developing +imitation skills in young children with autism. The +methods and treatments used remain to be empirically +validated. +Many behavioral treatment approaches focusing on +imitation are in use in treating children with autism. In +discrete trial training (DTT), a target behavior or skill is +broken into component parts and repeatedly practiced +with prompting and fading the prompting until the skills +are mastered. +The applied behavioral analysis (ABA) also includes +teaching imitation skills in a “command/prompt method” +where a teacher provides a prompt or command for the +autistic student to initiate and if the student achieves +the desired behavior, there are rewards and if not, there +are repeats of the command/prompt and a repeat for the +student to produce the expected behavior. The desired +behavior is then reinforced and the student can repeat the +expected behavior in the classroom. +There are many behavioral treatment approaches such as +language training behavior, natural language procedure, +incidental teaching, pivotal learning and errorless +learning. All these basic procedures use ABA principles +such as stimulus control, prompts, modeling, shaping +and reinforcement to teach imitation skills. All these +procedures consider imitation skills to be essential to new +learning. Imitation skills are typically among the first to +be taught in many of these programs because they are +often considered being pre-requisite abilities for learning +other skills, e.g. motor imitation (clapping, running, +walking on toes and jumping). Once basic imitation skills +are established, they can be used as building blocks for +complex tasks. +A pilot study by Radhakrishna[11] suggests that integrated +approach to yoga therapy (IAYT) can specifically increase +imitation skills, an essential pre-requisite for learning. It +also demonstrated changes in non-verbal communication, +self-esteem, emotional bonding, focus, tolerance to touch, +proximity and sharing of attention. +The study reported here started with the premise that as +clinicians, we need to develop intervention approaches that +are derived from a number of theoretical understandings +of autism. +The IAYT approach is based on the philosophy that the +child is perfect and whole, and that the child and therapist +are both unlimited in their abilities to teach. Supporting +these beliefs is empirically sound therapy based on yoga +philosophy and practice to help the child to reach his/her +highest potential for a quality life. +mateRials and methOds +subject selection +This study adopted a case study approach. The IAYT +program was publicized through workshops conducted at +various national institutes and centers and schools for ASD +children. Six children admitted to SGS Vagdevi Integrated +School were matched for age, sex, IQ and socioeconomic/ +educational background of parents. Children who were +already diagnosed with ASD by leading institutions of +Bangalore, India, were selected for the study. Diagnosis +was cross-validated by the author using DSM-IV-TR[5] +criteria. The Childhood Rating Scale[12] was also used to +determine autism severity. All the children demonstrated +mild to moderate range of autism. +Data are given in Table 1. +Table 1: Demographic data +No. +Age +Sex +IQ +SEB +EB +6 +8–14 years +M/F = 5/1 +70 and above +Middle class +Graduates +SEB = Socio-economic background (minimum Rs. 8000); EB = Educational +background (graduate mothers) +ASDIM +International Journal of Yoga  Vol. 3  Jan-Jun-2010 +28 +Written consent to participate in the study was obtained +from the parents. +imitation test battery +The tasks given in Table 2 were developed for this study +based on previous pilot study experience by the researcher +who is a speech-language/yoga therapist by profession. +assessment procedure +Special educators and parents contributed to a range of +data collection procedure through questionnaire and +observers’ comments and interviews. Assessment was +conducted at 3 points. Pre (1–12 sessions), mid (60th, 80th +and 100th sessions) and post (180th, 181st and 182nd +sessions). +child assessment measures +Perceived outcomes of IAYT for the child were measured +at the mid and end points of the program. Parents +completed a short questionnaire to see whether IAYT +has made any change on the five targeted areas of +behavior. A simple 3-point rating scale was used (based +on researcher’s pilot study[11]) to obtain information on +the level of benefit (0 = rarely imitates, 1 = occasionally +imitates, 2 = consistently imitates). Three trained +observers completed the assessment. Responses were +scored on a 3-point scale; a “2” was recorded if the child +produced exact imitation, a “1” was recorded if the child +produced an occasional imitation and a “0” was recorded +if the child rarely imitates or imitation absent. Inter-rater +reliability was established prior to scoring and maintained +throughout the study. +yoga intervention +Yoga therapy was then introduced five times a week 45 +minutes daily for 10 months. Mother accompanied the +child during all these sessions. These sessions took place +in an open green, serene spiritual atmosphere overlooking +an ashram and temple. Children used their own mats and +marked their own boundary of operation. Yoga asanas +(postures) and pranayama (breathing exercises) adopted in +this study were specially selected to address issues related +to imitation difficulties with ASDs. +Exercises adopted during IAYT are listed in Table 3. +The sequence consisted of “warm-up asanas, strengthening +asanas, release of tension asanas, calming asanas and +breathing asanas”. Yogasanas selected initially were +physically less demanding. During warm-up asanas, if +the child did not imitate the therapist, the attending adult +physically guided the child to complete the task. The child +slowly learned that she/he is expected to imitate the model. +It also provided a motor plan to complete more asanas. +Results and discussiOn +First the children’s baseline data are described in +relation to imitation skills. Second, changes in various +parameters at mid and post therapy phase are discussed. +In the third section, changes in the related behavior, +namely communication, social relationships and +behavioral perseveration, are elaborated. The initial +interviews with parents and staff carried out to gain +an insight into the current imitation behavior are +summarized. +Relative absence of imitation was not of immediate +concern to parents as their knowledge of the importance of +imitation and its impact on development was limited. From +the parents’ perceptive, lack of any form of communication, +not playing with other children, hyperactivity was +something they found particularly difficult to cope with. +The baseline, mid and post therapy data are summarized +in Figure 1. +summary of imitation behaviors +At the start of the study, children in this sample +• never imitate gross motor actions (could not imitate +the model’s actions of pointing to body parts) +• rarely imitate vocalization +• never imitate two phase complex movements +• rarely imitate oral facial movements +• never imitate adult breathing in and out model +Table 2: Target imitation skills +Imitating +gross motor +actions +Imitating +vocalization +Complex +imitation +Imitating +oral facial +movements +Breathing +exercises +Running +Walking +Jumping +Walking on +toes +Imitating +sounds (A, E, +U, OM) +Imitating words +Imitating +phrases +Simple +asanas +Imitating +sequence +actions +Lips, tongue +and jaw +exercises +Blowing +exercises +In and out +breathing +Sectional +breathing +Table 3: Yoga intervention +Warm-up +asanas +Strengthening +asanas +Release +of tension +asanas +Calming +asanas +Breathing +asanas +Jogging +Bending +exercises +Twisting +Trikonasana +Parshavakonasana +Veerabhadrasana +Neck +exercises +Back +bending +exercises +Relaxation +exercises +Sukhasana +Shavasana +Blowing +exercises +in and out +breathing +sectional +breathing +Radhakrishna +29 +International Journal of Yoga  Vol. 3  Jan-Jun-2010 +All the six children performed poorly in imitating +breathing exercises. They could not perform even simple +blowing exercises. This may be directly related to their +poor vocalization and expressive speech. They had +difficulty imitating two or more sequence imitations, +initiate vocalization and imitating gross motor actions. +Children were clumsy with their movements, were poorly +coordinated and could not run, jump, hop and walk +on toes. Four out of six children occasionally imitated +oral facial movements like protruding, elevating tongue +and puckering lips. Generally, this supports previous +research findings that children underperformed on various +imitation tasks such as gross motor actions, vocalization, +complex imitation, oral facial imitation and imitating +breathing exercises.[10] Complex motor tasks were the +least frequently imitated category compared to oral facial +movement imitation. Children had more difficulty on +tasks with multiple components than task involving one +action. Attempts by the therapist to involve the child to +sit in vajrasana (folding both legs backward and sitting +on the heel) initially resulted in the child losing interest +in therapy program and running away. No attempts were +made to force the children on the therapy mat, but slowly +they joined the group voluntarily. +During the mid assessment period, there was a significant +change in imitating gross motor actions, oral facial movements +and performing breathing exercises, but little change was seen +in imitating complex imitation and vocalization. +During last few sessions, significant changes in the +imitation skills related to all the five parameters and +also changes in communication, functional object use, +language, play and joint attention were seen. Pattern of +eye contacts steadily improved. Children started focusing +on the yoga therapist as she gave counts with drumbeat. +Initially, mothers manually guided the children to imitate +the movement. Slowly, manual manipulation decreased +and children started imitating complex motor movements +spontaneously. It is possible that a gentle touch or +pressure gave them a different experience and they started +perceiving changing dynamics and became interested in +therapy. Consequently, children started to display early +shared attention behaviors such as looking at the peers, +making eye contact with the therapist and offering no +resistance to the therapist. +In addition to these behaviors, an increase in facial +expression (pain and pleasure), vocalizations and gazing +at peers suggested an emerging understanding that sharing +an activity could be an enjoyable experience. +As the therapy progressed, increase in imitation skills +was noticed in imitating familiar and learnt movement. +Children started looking at peer model, resulting in +higher levels of generalization and maintenance of learnt +imitation behavior. This supports the study by Carr and +Darey[13] using different types of models (peer and adult) +and suggesting that peer model would help in better +generalization and maintenance of the learnt skill. Close +physical proximity of the mother and prompting of a +specific behavior by the mother may be a contributing +factor for higher generalization. +All the six children started to indicate their preferences +for asana, e.g. Shavasana, Parvathasana. They progressed +from the early resistance to passive tolerance to active +participation and enjoying the therapy sessions. Over +the course of yoga therapy, children started to trust, +share, initiate and reciprocate and thus the barrier to +communication of carrying the label of being “autistic” +is broken. By the end of 183rd session, all six children +engaged in 30–45 minutes of yoga therapy. During this +period, they all displayed increased intention to remain +in close proximity with the therapist and participated in +performing most of the asanas and breathing exercises. +ASDIM +Figure 1: Graphic representation of observed improvement in selected imitation behavioral traits +0.18 +0.17 +0.17 +0.5 +0.15 +0.9 +0.7 +0.6 +1 +0.8 +1.8 +1.6 +1.4 +1.9 +1.5 +0 +0.2 +0.4 +0.6 +0.8 +1 +1.2 +1.4 +1.6 +1.8 +2 +Parameter used for Imitation behavioural assessment +Average rating of responsiveness +on a scale 0 to 2 +Imitating gross +motor actions +Imitating +vocalization +Complex imitation +Imitating oral facial +movements +Imitating breathing +exercises +Pre +Post +Mid +International Journal of Yoga  Vol. 3  Jan-Jun-2010 +30 +All the six children showed increased vocal imitation skills +by imitating vowels “a, e, i, o, u” and “OM”. This increased +vocal imitation may be due to the verbal behavior approach +adopted by the yoga therapist who is also a Speech- +Language-Pathologist (SLP). Verbal behavior approach to +teaching language to children with autism emphasizes +teaching language units in its functional components +such as manding (to alter one’s environment), tacting +(to respond to sensory stimuli) and intraverbals (verbal +behavior in response to another person’s verbal behavior). +Imitation was used throughout the teaching of mands, tacts +and intraverbals. Changes in social interaction were seen. +Children started greeting the therapist with “namasthe” +(with folded hands) and verbalized “om shanthi” (let there +be peace) at the end of the therapy session. +Children engaged in increased play interaction during yoga +therapy sessions. Children who display increased imitation +skills during yoga therapy transferred these responses into +play situation whenever they engaged in symbolic play. +Final interviews with parents and staff were carried out +to assess whether the child’s imitation skill has changed +over the course of the study. Parents reported that their +children indicated basic needs using gestures, interacting +with other children during play situation and increased +sitting tolerance for an activity. +To conclude, this is the first scientific study in India +investigating the effect of IAYT to increase imitation skills +and also related language, social and cognitive skills. +This study aimed to investigate IAYT as a family-oriented +treatment alongside any conventional treatment received +by the children. The pilot study provides initial evidence +of the benefits of IAYT in alleviating the behavioral +symptoms of children diagnosed with ASD, confirmed +through parents’ and teachers’ report and children’s own +behavior. Future directions in IAYT research would be +well served by larger studies that involve teachers as well +as parents, followed by follow-up studies. Rigorously +controlled clinical trials on larger and more homogeneous +population would be needed to provide the necessary +rigor to assess the relative effect of IAYT as an alternative +or complementary treatment to increase imitation skills +in children with ASD. However, the indications are that +IAYT may offer families an effective management tool for +family-oriented treatment of childhood ASD. +acknOWledGments +The author gratefully acknowledges the contribution of parents of the +participants of the study and staff of Sri Ganapathi Sachchidananda +(SGS) Vagdevi Centre for the Rehabilitation of Communication +Impaired. The author also thanks Dr. Nagendra and Dr. Nagarathna +of Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA) +for their input on Integrated Yoga Therapy (IYT). +RefeRences +1. +Rogers S, Pennington B. A theoretical approach to the deficits in infantile +autism. Dev Psychol 1991;3:137-62. +2. +Siegel B. The world of the autistic child, Oxford; Oxford University + +Press: 1991. +3. +Smith IM, Bryson SE. Imitation and action in autism: A critical review. +Psychol Bull 1994;116:259-73. +4. +Williams JH, Whiten A, Suddendorf T, Perrett DI. Imitation, mirror neurons +and autism. Neurosci Biobehav Rev 2001;25:287-95. +5. +American Psychiatric Association, Diagnostic and statistical manual of +mental disorders. 4, text revision. Washington, DC: American Psychiatric + +Association 2000. +6. +Charman T, Swettenham J, Baron-Cohen S, Cox A, Baird G, Drew A. Infants +with autism: An investigation of empathy, pretend play, joint attention, and +imitation. Dev Psychol 1994;33:781-9. +7. +Dawson G, Adams A. Imitation and social responsiveness in autistic children. +J Abnorm Child Psychol 1984;12:209-26. +8. +DeMeyer MK, Alpern GD, Barton S, DeMyer WE, Churchill DW, Hingtgen +JN, et al. Imitation in autistic, early schizophrenic, and non-psychotic +subnormal children. J Autism Child Schizophr 1972;2:264-87. +9. +Heimann M, Ullstadius E, Danigren SO, Gilberg C. Imitation in autism. A +preliminary research ote. Behav Neurol 1992;5:219-27. +10. Stone WL, Ousley OY, Littleford CD. Motor imitation in young children with +autism: What’s the object? J Abnorm Child Psychol 1994;25:475-85. +11. +Radhakrishna S. Using Yoga Therapy (YT) to increase communication, +social and cognitive skills in children with autistic spectrum disorders. +Available from: http://www.integralpsychology.in/texts/nsip/nsip-abstracts/ +shantharadhakrishna.html. [Last cited on 2007]. +12. Schopler E, Reichler RJ, DeVellis RF, Daly K. Toward objective classification +of childhood autism: Childhood Autism Rating Scale (CARS). J Autism Dev +Disord 1980;10:91-103. +13. Carr EG, Darcy M. Setting generality of peer modeling in children with +autism. J Autism Dev Disord 1990;20:45-59. +Radhakrishna +Staying in touch with the journal +1) +Table of Contents (TOC) email alert + +Receive an email alert containing the TOC when a new complete issue of the journal is made available online. To register for TOC alerts go to +www.ijoy.org.in/signup.asp. +2) +RSS feeds + +Really Simple Syndication (RSS) helps you to get alerts on new publication right on your desktop without going to the journal’s website. +You need a software (e.g. RSSReader, Feed Demon, FeedReader, My Yahoo!, NewsGator and NewzCrawler) to get advantage of this tool. +RSS feeds can also be read through FireFox or Microsoft Outlook 2007. Once any of these small (and mostly free) software is installed, add +www.ijoy.org.in/rssfeed.asp as one of the feeds. diff --git a/subfolder_0/Association between a guided meditation practice, sleep and psychological well-being in type 2 diabetes mellitus patients.txt b/subfolder_0/Association between a guided meditation practice, sleep and psychological well-being in type 2 diabetes mellitus patients.txt new file mode 100644 index 0000000000000000000000000000000000000000..8c15bf78d2cc33975883859391a719dd28f0edd2 --- /dev/null +++ b/subfolder_0/Association between a guided meditation practice, sleep and psychological well-being in type 2 diabetes mellitus patients.txt @@ -0,0 +1,231 @@ +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Journal of Complementary and Integrative Medicine. 2018; 20150026 +Short Communication +Mathew P Varghese1 / RagavendrasamyBalakrishnan1 / SubramanyaPailoor1,2 +Association between a guided meditation +practice,sleep and psychological well-being in +type2 diabetes mellitus patients +1 S-VYASA University, 19, Gavipuram Circle, K G Nagar, Bangalore, India, E-mail: ragavendrasamy.b@svyasa.org, +pailoors@gmail.com +2 Department of Yoga, Central University of Kerala, Kasaragod, Kerala, India, E-mail: pailoors@gmail.com +Abstract: +Background: Type 2 diabetes mellitus [T2DM] is one of the leading causes for mortality. This study examined +the role of an self-awareness based guided meditation practice, Cyclic Meditation [CM] on perceived stress, +anxiety, depression, sleep and quality of life in T2DM patients. +Design: A single arm pre-post design was used for the study. +Setting: The study was conducted in an auditorium for general public diagnosed with T2DM in Ernakulam, +Kerala, India. +Subjects: Subjects were 30 T2DM patients, both male and female of age 50.12 ± 11.15 years and BMI 25.14 +± 4.37 Kg/m2 and not having a history of hospitalisation were randomly recruited for the study following +advertisements in national dailies. +Intervention: Participants completed a supervised CM programs in the evenings, 5 days a week for 4 weeks, +in addition to their regular medication. +Measures: Perceived stress, anxiety and depression were assessed with Perceived Stress Scale, State Anxiety +Inventory and Beck’s depression inventory, respectively. Sleep and quality of life were assessed with Pittsburgh +Sleep Quality Index and WHO-Quality of Life – BREF respectively. +Analysis: Changes in the outcome measures from baseline to 4 weeks were compared using paired “t” test. +Results: After 4 weeks, the quality of life and sleep scores increased 7.1% [p = 0.001] and 32.7% [p = 0.001], +respectively. The perceived stress, anxiety and depression reduced 26.1% [p = 0.001], 16.01% [p = 0.003] and +37.63% [p = 0.006] as compared to their baseline reports. The CM practice also reduced daytime dysfunction. +Conclusions: A guided self-awareness based meditation program was safe and effective in improving depres- +sion, anxiety, perceived stress and enhance sleep and quality of life in T2DM patients, which could be helpful +in reducing the future complications of T2DM. Mind management is essential along with medical management +to achieve better clinical results. +Keywords: cyclic meditation, depression, quality of life, sleep, type 2 diabetes mellitus +DOI: 10.1515/jcim-2015-0026 +Received: May 7, 2015; Accepted: May 11, 2018 +Introduction +India with a type 2 diabetes mellitus (T2DM) prevalence rate of 7.1% [1], is increasing proportionately to de- +clare it an epidemic [2]. Psychological stress plays a vital role in the incidence and development of T2DM [3]. +Persistent stress causes release of stress hormones leading to loss of immune specificity, and a state of chronic +low grade inflammation resulting in metabolic disorders and aging [4, 5]. T2DM is understood to be a state +of chronic low grade inflammation, which over a period of time causes complications like atherosclerosis [6], +coronary artery disease [7], nephropathy [8] and obesity [9]. It has been noted that complications cause more +mortality than T2DM itself [10], demanding huge financial burden over the individual and also over the nation +[11]. +Recent studies have given immense importance to understand the significance of relaxation. The role of +introspection and self-awareness has been given considerable importance in classical yoga literatures. To facil- +itate this process, a technique called cyclic meditation (CM) was evolved. CM, is a “moving meditation” which +RagavendrasamyBalakrishnan is the corresponding author. +© 2018 Walter de Gruyter GmbH, Berlin/Boston. +1 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 7/20/18 1:14 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Varghese et al. +DE GRUYTER +integrates the yoga practices along with guided meditation technique derived from Mandukya Upanishad [12], +developed by Nagendra HR. The verse on which the CM is based states that “awaken the mind in states of +mental inactivity; calm it when agitated; realise the possibilities of the mind in between these two mental states +and when the mind reaches the state of equilibrium do not disturb it”. The idea of the technique is to achieve +a state of equilibrium/relaxation through combination of alternating phases of stimulation and relaxation [13] +(refer to supplement material 1). Unlike other meditation practices, whose practice involves either focussing +or defocussing [14], CM involves a judicial combination of focussing followed by defocussing encouraging an +individuals’ attention and enhancing autonomic balance [15]. Earlier studies have shown CM to enhance sleep +quality, quality of life, and attention with better heart rate variability [15]. The present study was designed +to understand the role of awareness based meditation practices, CM - in addressing depression, anxiety and +quality of life in T2DM population. +The pilot work was carried out following the approval from the Institutional Ethical Committee. Thirty pa- +tients both male and female, diagnosed with T2DM since 6.97 ± 1.2 years, with mean 50.12 ± 11.15 years of +age, and BMI 25.14 ± 4.37 Kg/m [2] and not having a history of hospitalisation in the past 6 months were re- +cruited following advertisements issued in national dailies. A total of 70 patients were screened, and 33 patients +matching the inclusion criteria were recruited for the study. A written informed consent was obtained from the +recruits following their expression of interest to participate in the study. The study did not attract any financial +binding with the subjects. The practice involved 23 min of pre-recorded cyclic meditation practice every day for +5 days in a week for 1 month practiced under supervision of experts. Recorded tapes containing instructions +were given to avoid the instructor bias. +Observations were made during the start and end of the month long intervention. Paired samples “t” test +was performed following normal distribution of data. Pittsburgh Sleep Quality Index revealed a significant +improvement in the global score (p ≤0.001), subjective sleep quality (p = 0.05), sleep latency (p = 0.001), sleep +duration (p = 0.017), sleep disturbance (p = 0.032), and daytime dysfunction (p = 0.029) suggestive of overall +improvement in quality of sleep. Quality of life as measured through WHO – Quality of Life had shown sig- +nificant improvements (p = 0.001). Also, a significant reduction was observed in state anxiety (p = 0.003), and +depression scores (p = 0.006) as reported by the state trait anxiety inventory and beck’s depression inventory- +II, respectively. Interestingly the subjective perception of stress was observed to be significantly reduced (p = +0.001) as understood from the perceived stress scale [Table 1]. +Table 1: ap ≤0.05, bp ≤0.01, cp ≤0.001, Paired Sample “t” test. Comparing day 30 values with respective day 1 values +(Mean ± SD) following cyclic meditation intervention. +Assessments +Pre +Post +p Value +(Mean ± SD) +(Mean ± SD) +BDI-II +11.96 ± 8.96 +7.46 ± 5.12b +p ≤0.01 +PSS +17.85 ± 6.39 +13.19 ± 5.42c +p ≤0.001 +STAI (state) +40.58 ± 8.84 +34.08 ± 9.04b +p ≤0.01 +WHOQOL domains +Physical health +24.92 ± 3.16 +26.88 ± 3.80c +p ≤0.001 +Psychological +20.08 ± 3.11 +22.12 ± 3.23c +p ≤0.001 +Social & personal +relationships +11.00 ± 1.98 +11.35 ± 2.17 +Environment +27.85 ± 4.65 +29.88 ± 3.09a +p ≤0.05 +Global score +83.85 ± 10.34 +90.23 ± 9.88c +p ≤0.001 +PSQI +Subjective sleep +quality +0.88 ± 0.65 +0.62 ± 0.70a +p ≤0.05 +Sleep latency +0.92 ± 1.05 +0.35 ± 0.75c +p ≤0.001 +Sleep duration +1.92 ± 0.89 +1.58 ± 0.90a +p ≤0.05 +Habitual sleep +efficiency +0.85 ± 1.19 +0.50 ± 0.99 +p = 0.059 +Sleep disturbance +1.08 ± 0.69 +0.81 ± 0.57a +p ≤0.05 +Use of sleep +medication +0.23 ± 0.82 +0.31 ± 0.88 +p = 0.538 +Daytime dysfunction +0.81 ± 0.63 +0.50 ± 0.58a +p ≤0.05 +Global score +6.69 ± 3.83 +4.50 ± 3.23c +p ≤0.001 +Earlier study on CM conducted on healthy volunteers showed a 32.1% reduction in Oxygen consumption +inducing a state of enhanced physiological rest [16]. And, evoked potentials recorded from the cerebral cortex +of healthy volunteers following CM showed prolonged latencies [17]. Whereas, cognitive evoked potentials +2 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 7/20/18 1:14 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Varghese et al. +suggested reduced latency and enhanced amplitude [18] suggesting a possible cortical inhibition following +CM. Hence, we speculate from the study that, CM practice reduces the perception of stress and thereby it +reduces state anxiety; enhances quality of sleep and quality of life in T2DM patients. +The strength of the study is that we have demonstrated that CM improves the quality of sleep, life, and +reduces the risk for depression in patients with T2DM which can be incorporated into clinical setting along +with routine treatments. However, the limitation of this study is that the results needs to be validated with an +identical group of patients who are under conventional treatment. Further studies are warranted to understand +the probable mechanisms towards alleviation of associated complications and determining the effectiveness of +using CM in the prevention of T2DM in the high risk group. +Summarising the findings, CM in general appears to promote vagal predominance, decrease perceived +stress and promotes sleep, mental well-being and quality of life. These findings suggest the necessity for mind +management apart from the medical management in T2DM. +Author contributions: All the authors have accepted responsibility for the entire content of this submitted +manuscript and approved submission. +Research funding: None declared. +Employment or leadership: None declared. +Honorarium: None declared. +Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, +and interpretation of data; in the writing of the report; or in the decision to submit the report for publication. +References +[1] Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14. +[2] Seidell JC. Obesity, insulin resistance and diabetes-a worldwide epidemic. Br J Nutr. 2000;83. +[3] McEwen BS. Protective and damaging effects of stress mediators. New Eng J Med. 1998;338:171–9. +[4] Bauer ME. Chronic stress and immunosenescence: a review. Neuroimmunomodulation. 2008;15:241–50. +[5] Cannizzo ES, Clement CC, Sahu R, Follo C, Santambrogio L. Oxidative stress, inflamm-aging and immunosenescence. J Proteomics. +2011;74:2313–23. +[6] Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A, et al. Low-grade systemic inflammation and the development of +type 2 diabetes the atherosclerosis risk in communities study. Diabetes. 2003;52:1799–805. +[7] Danesh J, Whincup P +, Walker M, Lennon L, Thomson A, Appleby P +, et al. Low grade inflammation and coronary heart disease: prospective +study and updated meta-analyses. Br Med J. 2000;321:199–204. +[8] Sela S, Shurtz-Swirski R, Cohen-Mazor M, Mazor R, Chezar J, Shapiro G, et al. Primed peripheral polymorphonuclear leukocyte: a culprit +underlying chronic low-grade inflammation and systemic oxidative stress in chronic kidney disease. J Am Soc Nephrol. 2005;16:2431–38. +[9] Bastard JP +, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, inflammation, and +insulin resistance. Eur Cytokine Netw. 2006;17:4–12. +[10] Garcia MJ, McNamara PM, Gordon T, Kannell WB. Morbidity and mortality in diabetics in the Framingham population: sixteen year +follow-up study. Diabetes. 1974;23:105–11. +[11] Stratton IM, Amanda IA, Andrew WN, David RM, Susan EM, Carole AC, et al. Association of glycaemia with macrovascular and microvas- +cular complications of type 2 diabetes (UKPDS 35): prospective observational study. Br Med J. 2000;321:405–12. +[12] Chinmayanada S. Mandukya Upanishad. Bombay, India: Sachin Publishers; 1984. +[13] Nagendra HR, Nagarathna R. New perspectives in stress management. Bangalore, India: Swami Vivekananda Yoga Prakashana; 1997. +[14] Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention regulation and monitoring in meditation. Trends Cogn Sci. 2008;12:163–9. +[15] Subramanya P +, Telles S. A review of the scientific studies on cyclic meditation. Int J Yoga. 2009;2:46. +[16] Telles S, Reddy SK, Nagendra HR. Oxygen consumption and respiration following two yoga relaxation techniques. Appl Psychophysiol- +ogy Biofeedback. 2000;25:221–7. +[17] Subramanya P +, Telles S. Changes in midlatency auditory evoked potentials following two yoga-based relaxation techniques. Clin EEG +Neurosci. 2009;40:190–5. +[18] Sarang SP +, Telles S. Changes in P300 following two yoga-based relaxation techniques. Int J Neurosci. 2006;116:1419–30. +3 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 7/20/18 1:14 PM diff --git a/subfolder_0/BASELINE OCCUPATIONAL STRESS LEVELS AND PHYSIOLOGICAL RESPONSES.txt b/subfolder_0/BASELINE OCCUPATIONAL STRESS LEVELS AND PHYSIOLOGICAL RESPONSES.txt new file mode 100644 index 0000000000000000000000000000000000000000..b380c7ab8486279a6d7a95935f04f37b1be4221f --- /dev/null +++ b/subfolder_0/BASELINE OCCUPATIONAL STRESS LEVELS AND PHYSIOLOGICAL RESPONSES.txt @@ -0,0 +1,33 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/BREATHING THROUGH A PARTICULAR NOSTRIL CAN ALTER METABOLISM AND AUTONOMIC.txt b/subfolder_0/BREATHING THROUGH A PARTICULAR NOSTRIL CAN ALTER METABOLISM AND AUTONOMIC.txt new file mode 100644 index 0000000000000000000000000000000000000000..c4c02190eceae5f8432850f5274844e1043a0725 --- /dev/null +++ b/subfolder_0/BREATHING THROUGH A PARTICULAR NOSTRIL CAN ALTER METABOLISM AND AUTONOMIC.txt @@ -0,0 +1,14 @@ + + + + + + + + + + + + + + diff --git a/subfolder_0/Brainstem auditory evoked potentials in two mditative mental states.txt b/subfolder_0/Brainstem auditory evoked potentials in two mditative mental states.txt new file mode 100644 index 0000000000000000000000000000000000000000..7ed26f0cd84602888f621a56ed9cd71faf7cf3fe --- /dev/null +++ b/subfolder_0/Brainstem auditory evoked potentials in two mditative mental states.txt @@ -0,0 +1,473 @@ +37 +International Journal of Yoga  Vol. 3  Jul-Dec-2010 +have been studies of short and midlatency auditory-evoked +potentials during meditation. The studies on midlatency +auditory-evoked potentials have most often shown changes +in a component called the Na-wave, a negative wave +occurring between 14 and 19 msec. The changes have been +in the form of an increase in amplitude,[8] suggesting the +requirement of more neurons. A decrease in latency has +also been reported,[9] suggesting a decrease in time taken +to transmit sensory information. +Studies on short latency auditory-evoked potentials have +not shown such clear changes.[2] In that study, brainstem +auditory evoked potentials (BAEP) were measured in five +advanced practitioners of transcendental meditation (TM) +to determine whether such responses would reflect an +increase in perceptual acuity to auditory stimuli following +meditation. The BAEP provide an objective physiological +index of auditory function at a subcortical level. Repeated +INTRODUCTION +The functions of the brain in meditation have been +studied using different techniques. These include the +electroencephalogram (EEG),[1] evoked potentials,[2] +regional cerebral glucose utilization as well as, more +recently, functional magnetic resonance imaging.[3] Among +these methods, a specific technique is selected for each +experiment as each of them have different spatial and +temporal resolutions.[4] +Evoked potentials are used in meditation studies because a +correlation between different evoked potential components +and underlying neural generators is reasonably well +worked out.[5] Apart from this, it appears that the cerebral +cortex is actively involved in meditation.[6] Hence, one +may expect corticoefferent gating with changes occurring +at the subcortical relay centers.[7] For these reasons, there +Context: Practicing mental repetition of “OM” has been shown to cause significant changes in the middle latency auditory- +evoked potentials, which suggests that it facilitates the neural activity at the mesencephalic or diencephalic levels. +Aims: The aim of the study was to study the brainstem auditory-evoked potentials (BAEP) in two meditation states based on +consciousness, viz. dharana, and dhyana. +Materials and Methods: Thirty subjects were selected, with ages ranging from 20 to 55 years (M=29.1; ±SD=6.5 years) who +had a minimum of 6 months experience in meditating “OM”. Each subject was assessed in four sessions, i.e. two meditation +and two control sessions. The two control sessions were: (i) ekagrata, i.e. single-topic lecture on meditation and (ii) cancalata, +i.e. non-targeted thinking. The two meditation sessions were: (i) dharana, i.e. focusing on the symbol “OM” and (ii) dhyana, +i.e. effortless single-thought state “OM”. All four sessions were recorded on four different days and consisted of three states, +i.e. pre, during and post. +Results: The present results showed that the wave V peak latency significantly increased in cancalata, ekagrata and dharana, +but no change occurred during the dhyana session. +Conclusions: These results suggested that information transmission along the auditory pathway is delayed during cancalata, +ekagrata and dharana, but there is no change during dhyana. It may be said that auditory information transmission was delayed +at the inferior collicular level as the wave V corresponds to the tectum. +Key words: Brainstem auditory-evoked potential; cancalata; dharana; dhyana; ekagrata. +ABSTRACT +Brainstem auditory-evoked potentials in two meditative +mental states +Sanjay Kumar, Nagendra HR, Naveen KV, Manjunath NK, Shirley Telles +Department of Yoga Research, Indian Council of Medical Research Center for Advanced Research in Yoga and Neurophysiology, SVYASA, +Bangalore, India +Address for correspondence: Dr. Shirley Telles, +Patanjali Yogpeeth, Maharishi Dayanand Gram, Bahadrabad, +Haridwar - 249 402, Uttarakhand, India. +E-mail: shirleytelles@gmail.com +DOI: 10.4103/0973-6131.72628 +Original Article +www.ijoy.org.in +[Downloaded from http://www.ijoy.org.in on Friday, March 04, 2011, IP: 117.211.90.10] +International Journal of Yoga  Vol. 3  Jul-Dec-2010 +38 +measures of the BAEP of TM practitioners were taken +before and after a period of meditation and were compared +with those of age-matched controls. Peak latencies as well +as interwave latencies between major BAEP components +were evaluated. No pre–post meditation differences for +experimental subjects were observed at low-stimulus +intensities (0–35 dB). At moderate intensities (40–50 +dB), the latency of the inferior collicular wave (wave +V) increased following meditation. However, at higher +stimulus intensities (55–70 dB), the latency of this wave +was slightly decreased. Comparison of the slopes and +intercepts of stimulus intensity–latency functions indicate +a possible effect of meditation on brainstem activity.[2] +This study on short latency auditory-evoked potentials +in TM meditation practitioners demonstrated that short +latency auditory-evoked potential varies with stimulus +characteristics. +More recently, we have attempted to understand meditation +based on descriptions from an ancient yoga text. This is +Patanjali’s yoga sutras (circa 900 BC).[10] Based on this +description, meditation has been considered as two states, +namely dharana, which is characterized by focusing on +the object of meditation and dhyana, which is a defocused +state of mental expansiveness. With this background, +the present study was undertaken to determine whether +short latency auditory-evoked potentials would change in +normal subjects in meditation considered as both dharana +and dhyana sessions on separate days. +MATERIALS AND METHODS +Subjects +Thirty subjects were selected in the age range between 20 +and 55 years (group mean±SD, 29.1±6.5 years) recruited +from a residential setup, Swami Vivekananda Yoga +Research Foundation, Bangalore, in south India. This age +range was selected as short latency does not vary within +this age range in healthy individuals.[11] Only male subjects +were selected because it has been demonstrated that short +latency auditory-evoked potentials vary with the phases of +the menstrual cycle.[12] All of them had normal health based +on a routine case history and a clinical examination. Also, +all of them had experience of practicing meditation for at +least 30 min per day, 4 days in a week, for a minimum of 1 +year. Their meditation practice was based on self-reporting +of the meditators as well as (where possible) consultations +with the meditation teacher (guru). +To assess the quality of the practice, visual analogue scale +(VAS) was used at the end of each session. +All of them expressed their willingness to participate in the +experiment. The project was approved by the Institution’s +Ethics Committee. The study protocol was explained to the +subjects and their signed informed consent was obtained. +Apart from their prior experience of “OM” meditation, +they had undergone a 2-month orientation program in +“OM” meditation under the guidance of an experienced +meditation teacher. +The condition to exclude subjects were any health disorder, +especially psychiatric or neurological disorders, auditory +deficits assessed by checking the auditory threshold of +each ear separately and any medication that alters the +functions of the nervous system. None of the subjects had +to be excluded for these reasons. +The order of the four sessions (i.e. two meditation sessions +and two non-meditation control sessions) was randomized +for each subject using a standard random number table.[13] +This was done to prevent the influence of being exposed +to the laboratory for the first time for example, from +influencing the results among other reasons. +Design +Each subject was assessed in four sessions, i.e. two +meditation and two control sessions, to record BAEP +. The +two control sessions were: (i) ekagrata, i.e. single-topic +lecture on meditation and (ii) cancalata, i.e. non-targeted +thinking. The two meditation sessions were: (i) dharana, +i.e. focusing on the symbol “OM” and (ii) dhyana, i.e. +effortless single-thought state “OM.” All four sessions +consisted of three states, i.e. “pre” (5 min), “during” (20 +min) and “post” (5 min). +The assessments were made on four different days, not +necessarily on consecutive days, but at the same time of +the day (i.e., the self-as-control design). The allocation of +the subjects to the four sessions was randomized using a +standard random number table.[13] This was done to prevent +the influence of being exposed to the laboratory for the +first time from influencing the results. +Assessments +BAEP were recorded using the Nicolet Bravo system +(Nicolet Biomedicals, Madison, WI, USA). The amplifier +settings were as follows: low-frequency filter 100 Hz, +high-frequency filter 3 KHz, sensitivity 50 µV +, number of +sweeps averaged 1,500, sweep width 10 ms, delay 0 ms. +Binaural click stimuli, of alternating polarity, with 11.1 Hz +frequency and 100 µS duration, were delivered through +acoustically shielded earphones (Amplivox, Oxfordshire, +UK). The stimulus intensity was kept at 80 dB nHL. The +rejection level was expressed as a percentage of the full- +scale range of the analog-to-digital converter. This level +was set at 90%. Silver chloride (Ag/AgCl) disc electrodes +were placed on the scalp using a conductive water-soluble +Kumar, et al. +[Downloaded from http://www.ijoy.org.in on Friday, March 04, 2011, IP: 117.211.90.10] +39 +International Journal of Yoga  Vol. 3  Jul-Dec-2010 +paste. The active electrode was at Cz according to the +International 10–20 system[14] referenced to linked ear +lobes, with the ground electrode on the forehead (FPz). All +electrode impedances were kept below 5 KΩ throughout +the session. +Interventions +Throughout all sessions, the subjects kept their eyes closed +and followed pre-recorded instructions. The instructions +emphasized carrying out the practice slowly, with +awareness and relaxation. The meditators who participated +in the study underwent 1 month of orientation sessions, +where they practiced two phases that formed a continuum +in meditation (dharana and dhyana) as two separate states +and two control states, i.e. cancalata or non-focused +thinking and ekagrata or focusing without meditation and +on more than one thought. +These states are described in the traditional texts, i.e. the +Patanjali’s Yoga Sutras and Bhagavad Gita, stating that +when awake and in the absence of a specific task, the mind +is very distractible (cancalata), and has to be taken through +the stages of “streamlining the thoughts” (concentration +or ekagrata) before moving on to the states of meditation. +These are: one-pointed concentration or dharana and a +defocused, effortless single-thought state or dhyana. +In the cancalata session, the 20-min period consisted of +“non-targeted thinking,” during which the subjects were +asked to allow their thoughts to wander freely as they +listened to a compiled audio CD consisting of brief periods +of conversation and talks on multiple topics recorded from +a local radio station transmission. In the ekagrata session, +the 20-min period consisted of focusing on a single topic, +which was listening to a lecture on meditation, with +multiple, yet associated, thoughts. In the dharana session, +the 20-min period consisted of focusing on the symbol +“OM.” During this session, they were asked to focus on the +meaning of the syllable, OM, which is used as a symbol for +the entire universe because OM is considered to represent +“that which sustains everything.”[15] In the dhyana session, +the 20 min of the practice consisted of meditation with +effortless absorption in the single-thought state of the +object of meditation, i.e. “OM.” +For the two meditation sessions and the two control +sessions, subjects were given guided instructions through +separate recorded instructions for each session. +Data extraction +For the BAEP +, the peak latencies and peak amplitudes of +all seven waves were calculated. Peak latency (msec) is +defined as the time from stimulus onset to the point of +maximum positive amplitude within the latency window. +Peak amplitude (V) is defined as the voltage difference +between a pre-stimulus baseline and the largest positive +going peak within a given latency window. +Data analysis +Statistical analysis was performed using SPSS (Version +10.0). The peak latencies and peak amplitudes of all seven +waves were analyzed using repeated-measures analyses of +variance (ANOVAs) and post hoc analyses with Bonferroni +adjustment were performed to compare “pre” data with +“during” and “post.” +The repeated measures ANOVAs were performed with two +“within–subject” factors, i.e. Factor 1: Sessions; with four +levels, viz. cancalata, ekagrata, dharana and dhyana, and +Factor 2: States; with six levels, viz. pre, during (D1 to D4) +and post. These repeated measures ANOVAs were carried +out for the peak latency and peak amplitude of all levels. +This was followed by a post hoc analysis with Bonferroni +adjustment for multiple comparisons between the mean +values of different states (pre, during 1 to during 4 and post). +RESULTS +The peak latency of wave V showed a significant difference +between Sessions (F=3.894, for df=2.678, 77.651, +P<0.015, Huynh-Feldt epsilon=0.893) and between States +(F=11.713, for df=4.181, 121.256, P<0.001, Huynh-Feldt +epsilon=0.836). +Post hoc analysis with Bonferroni adjustment for each +session (cancalata, ekagrata, dharana and dhyana) +separately showed a significant increase in the latency of +wave V during the cancalata session (pre versus during, i.e. +D2; P=0.042), ekagrata session (pre versus during, i.e. D2; +P=0.009, pre versus during, i.e. D3; P=0.026, pre versus +during, i.e. D4; P=0.005 and pre versus post P=0.001) and +following the dharana session (pre versus post; P=0.018). +The amplitude of wave V also showed a significant +difference between Sessions (F=6.515, for df=2.692, +78.060, P<0.001, Huynh-Feldt epsilon=0.897) and +between States (F=8.574, for df=4.292, 124.456, P<0.001, +Huynh-Feldt epsilon=0.858). +Post hoc analysis with Bonferroni adjustment for each +session (cancalata, ekagrata, dharana and dhyana) +separately showed no significant change in the peak +amplitude of wave V (P>0.05). Also, there were no +significant change in the other waves (P>0.05). +Hence, the changes in wave V peak latency alone are +presented in Table 1. +Evoked potentials in meditation +[Downloaded from http://www.ijoy.org.in on Friday, March 04, 2011, IP: 117.211.90.10] +International Journal of Yoga  Vol. 3  Jul-Dec-2010 +40 +Kumar, et al. +DISCUSSION +In the present study, normal healthy volunteers who +were experienced in practicing meditation on the syllable +“OM” were assessed in two meditation (i.e., dharana +and dhyana) and two control sessions (i.e., cancalata +and ekagrata sessions). BAEP were recorded throughout +all four sessions. There was a significant increase in the +wave V peak latency during the cancalata, ekagrata and +dharana sessions but there was no change during the +dhyana session. +In the literature, there is only one previous study of short +latency auditory-evoked potentials in TM practitioners. +In this study, at moderate stimulus intensities (40–50 dB), +the wave V latency increased following meditation.[2] In +contrast, at higher stimulus intensities, the wave V latency +was slightly decreased by a comparison of the slopes and +intercepts of stimulus intensity–latency functions. The +authors suggested a possible effect of TM on brainstem +activity. In the present study, there was no attempt to +vary the stimulus intensity, which was kept at the 80 dB +normal hearing level. This would fit in the category of a +higher-intensity stimulus based on the categorization in +the study.[2] In contrast to that study, even at this high- +stimulus intensity, the latency of wave V did not decrease +during either of the two meditation sessions (dharana and +dhyana). In contrast, an increase in wave V peak latency +was found in the cancalata, ekagrata and dharana sessions. +No such increase was obtained in the dhyana session. An +increase in the latency of an evoked potential component +is taken to suggest that sensory information processing at +the level of the underlying neural generator is delayed.[16] +This suggests that in the cancalata, ekagrata and dharana +mental states, sensory processing at the midbrain level +was delayed. Another feature of the present study is that +a difference is seen in the nature of the results in the two +meditation sessions. +In the introduction, it was already mentioned that dharana +and dhyana states have been described in an ancient yoga +text, namely Patanjali’s yoga sutras. In this text, dharana +literary means “fixing the mind on a specific object” +(Patanjali’s yoga sutras Chapter 3 verse 1). The mind +could be fixed on any point and. as long as disturbances +from any corner are warded off, this mental state is called +dharana. When dharana becomes effortless, it takes the +form of dhyana, which is defined as the uninterrupted +spontaneous flow of the mind toward the chosen object. +In contrast to this, the two control sessions, i.e. cancalata +and ekagrata are described in another ancient text, the +Bhagavad Gita.[17] The cancalata state is characterized by +constant shifting of thoughts from one object to another. +The ekagrata state is quite different from this and is +similar to concentration. When haphazard thoughts are +streamlined in a single direction, it is called ekagrata. +Hence, irrespective of whether meditators were in a state +of random thinking (cancalata), channelized thought +in concentration (ekagrata) or in a state of channelized +thought as in meditation (dharana), there was a delay in +sensory information processing, as mentioned above at +the mid-brain (possibly the inferior colliculus) level. In +contrast, when the mental state was characterized by a +lack of effort in dhyana, no such change occurred. +Further studies are required to understand whether neural +relay centers further along the auditory pathway would +also change differently in dharana and dhyana states. The +limitations of the present study are: (i) the fact that there +was no attempt to vary stimulus intensities and hence the +earlier findings of McEvoy, Frumkin and Harkins,[2] could +not be examined, (ii) ekagrata, dharana and cancalata +sessions were not different and cannot be ruled out as +the VAS is essentially a subjective measure; no objective +measure was taken. Only those subjects who achieved 75% +of their ideal practice based of their subjective rating were +included in the study. Again, the possibility that the sound +stimulus influences all four practices cannot be ruled out. +This is another limitation of the study. +Despite these limitations, the present study does +demonstrate a difference between the dharana and dhyana +states of meditation based on BAEP +.[15,17,18] +REFERENCES +1. +Banquet JP. Spectral analysis of the EEG in meditation. Electroencephalogr +Clin Neurophysiol 1973;35:143-51. +2. +McEvoy TM, Frumkin LR, Harkins SW. Effects of meditation on brainstem +auditory evoked potentials. Int J Neurosci 1980;10:165-70. +3. +Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, +Table 1: Latency of wave V brainstem auditory-evoked potentials (BAEP) in four sessions +Sessions +States +Pre +During 1 +During 2 +During 3 +During 4 +Post +Cancalata +5.78±0.18 +5.82±0.18 +5.84**±0.17 +5.84±0.20 +5.84±0.18 +5.82±0.17 +Ekagrata +5.76±0.19 +5.83±0.18 +5.83**±0.18 +5.83*±0.17 +5.87±0.19 +5.85***±0.18 +Dharana +5.75±0.20 +5.80±0.19 +5.80±0.19 +5.78±0.21 +5.80±0.21 +5.82**±0.18 +Dhyana +5.79±0.18 +5.81±0.19 +5.82±0.19 +5.81±0.18 +5.81±0.20 +5.82±0.18 +*P<0.05, **P<0.01, ***P<0.001; RM ANOVA with Bonferroni adjustment compared state with pre. +[Downloaded from http://www.ijoy.org.in on Friday, March 04, 2011, IP: 117.211.90.10] +41 +International Journal of Yoga  Vol. 3  Jul-Dec-2010 +et al. Meditation experience is associated with increased cortical thickness. +Neuroreport 2005;28:1893-7. +4. +Mishra UK, Kalita J. Clinical neurophysiology. New Delhi: B.I. Churchill +Livingstore; 2001. +5. +Woods DL, Clayworth CC. Click spatial position influences middle latency +auditory evoked potentials (MAEPs) in humans. Clin Electroencephalogr +1985;60:122-9. +6. +Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, +et al. Meditation experience is associated with increased cortical thickness. +Neuroreport 2005;28:1893-7. +7. +Napadow V, Dhond R, Conti G, Makris N, Brown EN, Barbieri R. Brain +correlates of autonomic modulation: Combining heart rate variability with +fMRI. Neuroimage 2008;42:169-77. +8. +Telles S, Nagarathna R, Nagendra HR. Alterations in auditory middle latency +evoked potentials during meditation on a meaningful symbol–“OM”. Int J +Neurosci 1994;76:87-93. +9. +Telles S, Naveen KV. Changes in middle latency auditory evoked potentials +during meditation. Psychol Rep 2004;94:398-400. +10. Taimini IK. The Science of Yoga. Madras, India: The Theosophical +Publishing House; 1961. +11. +Lauter JL, Oyler RF, Lord-Maes J. Amplitude stability of auditory brainstem +responses in two groups of children compared with adults. Br J Audiol +1993;27:263-71. +12. Yadav A, Tandon OP, Vaney N. Auditory evoked responses during different +phases of menstrual cycle. Indian J Physiol Pharmacol 2002;46:449-56. +13. ZAR JH. Biostatistical analysis. 4th ed. Delhi, India: Person Education +(Singapore) Pvt. Ltd; 2005. +14. Jasper HH. The ten-twenty electrode system of the International federation. +Electroencephalogr Clin Neurophysiol 1958;10:371-5. +15. Chinmayananda S. Mandukya Upanisad. Bombay: Sachin publishers; 1984. +16. Subramanya P, Telles S. Changes in middle latency auditory evoked +potentials following two yoga based relaxation techniques. Clinical +EEG and Neuroscience 2009;40:190-95. +17. Bhakttivedanta Swami Prabhupada AC. Bhagavad Gita: as it is. Mumbai: +The Bhaktivedanta Book Trust; 1998. +18. Telles S, Desiraju T. Recording of auditory middle latency evoked potentials +during the practice of meditation with the syllable ‘OM’. Indian J Med Res +1993;98:237-9. +Evoked potentials in meditation +Author Help: Online submission of the manuscripts +Articles can be submitted online from http://www.journalonweb.com. For online submission, the articles should be prepared in two files (first +page file and article file). Images should be submitted separately. +1) First Page File: + +Prepare the title page, covering letter, acknowledgement etc. using a word processor program. All information related to your identity +should be included here. Use text/rtf/doc/pdf files. Do not zip the files. +2) +Article File: + +The main text of the article, beginning with the Abstract to References (including tables) should be in this file. Do not include any information +(such as acknowledgement, your names in page headers etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size +to 1 MB. Do not incorporate images in the file. If file size is large, graphs can be submitted separately as images, without their being +incorporated in the article file. This will reduce the size of the file. +3) +Images: + +Submit good quality color images. Each image should be less than 4096 kb (4 MB) in size. The size of the image can be reduced by +decreasing the actual height and width of the images (keep up to about 6 inches and up to about 1800 x 1200 pixels). JPEG is the most +suitable file format. The image quality should be good enough to judge the scientific value of the image. For the purpose of printing, always +retain a good quality, high resolution image. This high resolution image should be sent to the editorial office at the time of sending a revised +article. +4) +Legends: + +Legends for the figures/images should be included at the end of the article file. +[Downloaded from http://www.ijoy.org.in on Friday, March 04, 2011, IP: 117.211.90.10] diff --git a/subfolder_0/CLINICAL STUDY OF YOGA TECHNIQUES IN UNIVERSITY STUDENTS WITH ASTHMA A CONTROLLED TRIAL.txt b/subfolder_0/CLINICAL STUDY OF YOGA TECHNIQUES IN UNIVERSITY STUDENTS WITH ASTHMA A CONTROLLED TRIAL.txt new file mode 100644 index 0000000000000000000000000000000000000000..6be30bcbb91a507f0e9b4e319dccd4c360090c99 --- /dev/null +++ b/subfolder_0/CLINICAL STUDY OF YOGA TECHNIQUES IN UNIVERSITY STUDENTS WITH ASTHMA A CONTROLLED TRIAL.txt @@ -0,0 +1,6 @@ + + + + + + diff --git a/subfolder_0/CYCLIC MEDITATION A MOVING MEDITATION REDUCES ENERGY EXPENDITURE MORE THAN SUPINE REST.txt b/subfolder_0/CYCLIC MEDITATION A MOVING MEDITATION REDUCES ENERGY EXPENDITURE MORE THAN SUPINE REST.txt new file mode 100644 index 0000000000000000000000000000000000000000..e8c102be8ee96b9035aeb81b65b5e496aabf363f --- /dev/null +++ b/subfolder_0/CYCLIC MEDITATION A MOVING MEDITATION REDUCES ENERGY EXPENDITURE MORE THAN SUPINE REST.txt @@ -0,0 +1,25 @@ + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/Cancer Prevention and rehabilitation through yoga.txt b/subfolder_0/Cancer Prevention and rehabilitation through yoga.txt new file mode 100644 index 0000000000000000000000000000000000000000..3878e4e82322d1bf3ef93d38c879423ee36065fc --- /dev/null +++ b/subfolder_0/Cancer Prevention and rehabilitation through yoga.txt @@ -0,0 +1,152 @@ +© 2018 International Journal of Yoga | Published by Wolters Kluwer ‑ Medknow +1 +Cancer is one of the leading causes of death worldwide, +with an incidence of 14 million new cases per year, with +about 1 million diagnosed in India. The prevalence of +cancer has increased over the past decade and is expected +to rise by 8% in the next 5  years. Regular screening, +early detection, and improved therapies have increased +the 10‑year survival from 61% to 77% in the past decade. +However, advancements in cancer treatment have not +changed mortality rates. +While cancer prevention is being debated and developed +in many health‑care facilities, there is no doubt a +strong component is in following some basic lifestyle +modifications. +Cancer cells are not powerful invaders as viruses from +outside. They are born in our own bodies, say a thousand +in a billion cells which are created every day in our +bodies. However, our immune system takes care of them +recognizing them as enemies as it does with outside germs. +It is well known that stress is an immune suppression +factor and highly stressed lifestyle can bring confusion in +the immune system to recognize cancer as an enemy. On +the contrary, it thinks that they are good friends and does +not destroy them. This aspect is known as Viparyaya, a +state of mind in which reality is perceived wrongly  (an +example of perceiving a rope as snake or a post as +ghost). Unless this Viparyaya is corrected, the root cause +of cancer will not be vanquished. This is possible by +de‑stressing mind‑body through the practice of relaxation +techniques such as asanas, breath slowing Pranayama, and +mind‑calming meditation methods. Furthermore, proper +diet, exercise, avoiding smoking, use of tobacco in various +forms, psychedelic drug addictions, and uncontrolled +consumption of alcohol surely will help in the prevention +of cancer. This is where the role of Yoga practices take +importance. It is said in the Gita that he who eats sparingly, +who sleeps just adequately and who is skillful in action, for +such a person Yoga becomes a “killer of duhkha  (distress +or misery)”  (Bhagavad Gita 6:17).[1] A positive attitude in +work arena and to act stress‑free is an important factor in +maintaining high level of immunity. We know, for example, +many students report sick during examination time. This is +because of the stress that is experienced by them and their +inappropriate response to stress. +It is presently recommended that overeating and eating +too often in a day could be causes of reduced immunity. +There are a few individuals who eat only twice a day +and skip all solid foods 1  day a month. Cancer cells are +known to proliferate deriving energy from the food we +eat; by skipping solid foods once a month, we could +arrest the proliferation and even eliminate production of +Cancer: Prevention and Rehabilitation through Yoga +Editorial +cancerous cells. More work is needed to substantiate these +statements; however, there is some basic understanding +of cancer cell activity which is important in cancer +prevention. +We at Vivekananda Yoga Anusandhana Samsthana have +developed yoga module for cancer‑based on traditional +Yoga texts and research evidence. We have carried out +collaborative research studies on Breast Cancer with +MD Anderson Cancer Centre in Texas, USA. Consistent +improvements have been reported in anxiety, symptom +severity, distress, nausea and vomiting, and affect and +global QOL14 as well as beneficial effects on natural +killer cell counts and radiation‑induced DNA damage.[2‑5] +However, safety and efficacy of yoga has to considered +carefully in cancer care. Yoga should be practiced under +the guidance of trained yoga therapist. +Addressing the root cause and using holistic healing +methods along with conventional methods would be the +best solution for cancer prevention and management. +Along with yoga, other Indian systems of medicines have +also shown beneficial effects in cancer care. Hence there +is a need for Integrating AYUSH in Palliative Care. Every +alternate year, we conduct an international conference on +Frontiers in Yoga Research and its Applications. This +year we have selected a theme “Integrative Oncology: +Future of Cancer Care.” The 22nd  INCOFYRA  –  2018 +will make an effort to integrate Ayurveda, Naturopathy, +Yoga, Unani, Siddha, Homeopathy, and Modern Medicine +by bringing prominent researchers and doctors from all +these fields under one platform to evolve better cancer +care. +HR Nagendra +Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, +Karnataka, India +E‑mail: hrn@vyasa.org +References +1. +Swarupananda  +S. +Srimad +Bhagavad +Gita. +Kolkatta: +Advitashrama; 2016. +2. +Rao MR, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, +Diwakar  RB, et  al. Anxiolytic effects of a yoga program in +early breast cancer patients undergoing conventional treatment: +A  +randomized +controlled +trial. +Complement +Ther +Med +2009;17:1‑8. +3. +Vadiraja  HS, Raghavendra  RM, Nagarathna  R, Nagendra  HR, +Rekha  M, Vanitha  N, et  al. Effects of a yoga program on +cortisol rhythm and mood states in early breast cancer patients +undergoing adjuvant radiotherapy: A randomized controlled trial. +Integr Cancer Ther 2009;8:37‑46. +4. +Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, +Srinath  BS, Ravi  BD, et  al. Effects of an integrated +yoga +programme +on +chemotherapy‑induced +nausea +and +Nagendra: Yoga and Cancer +2 +International Journal of Yoga | Volume 11 | Issue 1 | January‑April 2018 +emesis in breast cancer patients. Eur J Cancer Care  (Engl) +2007;16:462‑74. +5. +Chandwani  KD, Perkins  G, Nagendra  HR, Raghuram  NV, +Spelman  A, Nagarathna  R, et  al. Randomized, controlled trial +of yoga in women with breast cancer undergoing radiotherapy. +J Clin Oncol 2014;32:1058‑65. +How to cite this article: Nagendra HR. Cancer: Prevention and +rehabilitation through yoga. Int J Yoga 2018;11:1-2. +Received: December, 2017. Accepted: December, 2017. +This is an open access article distributed under the terms of the Creative Commons +Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, +and build upon the work non‑commercially, as long as the author is credited and the new +creations are licensed under the identical terms. +Access this article online +Quick Response Code: +Website: +www.ijoy.org.in +DOI: +10.4103/ijoy.IJOY_71_17 +© 2018. This work is published under +https://creativecommons.org/licenses/by-nc-sa/4.0/ (the “License”). +Notwithstanding the ProQuest Terms and Conditions, you may use this content +in accordance with the terms of the License. diff --git a/subfolder_0/Challenges faced in diabetes risk prediction among an indigenous South Asian population in India using the Indian Diabetes Risk Score.txt b/subfolder_0/Challenges faced in diabetes risk prediction among an indigenous South Asian population in India using the Indian Diabetes Risk Score.txt new file mode 100644 index 0000000000000000000000000000000000000000..ba45cec898be7ef3ebb84fc720ed42413f2f94c9 --- /dev/null +++ b/subfolder_0/Challenges faced in diabetes risk prediction among an indigenous South Asian population in India using the Indian Diabetes Risk Score.txt @@ -0,0 +1,363 @@ +Themed Paper e Original Research +Challenges faced in diabetes risk prediction among +an indigenous South Asian population in India +using the Indian Diabetes Risk Score +V. Vijayakumar*, M. Balakundi, K.G. Metri +Department of Yoga and Lifesciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA University), +Bengaluru, India +a r t i c l e i n f o +Article history: +Received 16 November 2017 +Received in revised form +14 June 2018 +Accepted 7 September 2018 +Available online xxx +Keywords: +Diabetes risk +Diabetes prevalence +IDRS +Indigenous +South Asian ethnicity +a b s t r a c t +Objectives: Indigenous populations around the world have a higher health disparity and an +increased risk of diabetes. Scientific literature on the prevalence of diabetes in India is not +available, and the current work is a pilot study to explore the risk of diabetes in one such +indigenous population in India. +Study design: This is a cross-sectional survey and screening study. +Methods: The study took place in a remote tribal hamlet of Machuru in South India. A door- +to-door survey was conducted in the hamlet with a population of 555. The Indian Diabetes +Risk Score (IDRS) questionnaire was completed by 160 individuals older than 25 years. +Capillary blood glucose levels were measured to compare the glycaemic status with the +predicted IDRS. +Results: Of 160 adults who completed the questionnaire, 37 were at high risk (23.13%) as per +the IDRS, 52 at medium risk (32.5%) and 71 at low risk (44.38%). None of the respondents +knew their family history of diabetes owing to the lack of awareness about the condition. +Interestingly, the villagers had a sedentary lifestyle owing to their unique family dynamics +but a healthy diet. Five participants were diagnosed with diabetes, and 18 were diagnosed +with impaired fasting glucose or prediabetes. +Conclusions: The IDRS might not be an accurate measure to understand the risk of diabetes +in this particular population owing to their unique family dynamics and a lack of aware- +ness about diabetes. The best possible way to assess the diabetes risk might be through +blood examination. +© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. +* Corresponding author. +E-mail address: dr.venu@yahoo.com (V. Vijayakumar). +Available online at www.sciencedirect.com +Public Health +journal homepage: www.elsevier.com/puhe +p u b l i c h e a l t h x x x ( 2 0 1 8 ) 1 e4 +https://doi.org/10.1016/j.puhe.2018.09.012 +0033-3506/© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. +Please cite this article in press as: Vijayakumar V, et al., Challenges faced in diabetes risk prediction among an indigenous South Asian +population in India using the Indian Diabetes Risk Score, Public Health (2018), https://doi.org/10.1016/j.puhe.2018.09.012 +Introduction +The prevalence of diabetes is increasing worldwide, especially +in the South Asian ethnic population.1 An increase in the +prevalence of diabetes is observed both in rural and urban +India.2 Indigenous populations are the natives of a country, +with ‘defined territory and ethnic distinctiveness’ as the two +distinguishing features.3 In India, indigenous groups are +classified by the government as ‘scheduled tribes’.4 Health +disparities between indigenous and non-indigenous pop- +ulations are universal.5 In the case of diabetes, the prevalence +and related mortality are 3e4 times higher in indigenous +populations than in non-indigenous populations, and this has +been extensively studied in various countries.6 Most of the +accessible information, such as the scientific articles or pub- +lished reports, on indigenous populations is from Western +countries, particularly the US, Canada, New Zealand, the UK +and Australia.6,7 With more than 705 individual ethnic groups +and an indigenous population of more than 104 million in +India,8 such structured published scientific literature on the +tribal or indigenous population is very limited;7 in particular, +there are no available scientific literature on the prevalence of +diabetes. +Diabetes risk assessment questionnaires are cost-effective +tools for assessing the risk of diabetes. Several risk assess- +ment tools have been developed using a combination of de- +mographic, clinical and biochemical information.9 Every +country has tailor-made questionnaires constructed based on +the sociocultural factors and risk factors associated with the +particular population. The Indian Diabetes Risk Score (IDRS) is +one such tool to assess the risk of diabetes in the Indian +population.10 IDRS consists of four questions, namely, on age, +family history, physical activity and waist circumference. In +general, indigenous populations are at an increased risk of +diabetes when compared with non-indigenous populations. +The present study aims at assessing the risk of diabetes in a +remote tribal population in a southern state of India, using the +IDRS questionnaire and evaluating the suitability of the IDRS +questionnaire as an appropriate risk assessment tool. +Methods +Study design +The present study is a cross-sectional study, assessing the +current diabetes risk of the given population through survey +and capillary blood screening. The presented data were +collected as part of a health camp. +Door-to-door surveys were conducted in a remote tribal +hamlet of Machuru in South India as part of a health camp. +The team went to every individual house to get the details of +the family members. The total population of the hamlet was +555. The IDRS questionnaire was completed by 160 individuals +who were older than 25 years. The research team included +members who could speak the local language, in addition to a +member of the local community. Capillary blood glucose +levels were measured using a standardised digital glucometer +(Accu-Chek, Roche Diagnostics, Germany) after 8e12 h of +overnight fasting to compare the current glycaemic status +with their IDRS. +Results +The population of the hamlet was 555. In total, 160 adults +older than 25 years were surveyed initially using the IDRS, and +capillary glucose levels were measured in 103 individuals. The +remaining 57 individuals did not give consent for the finger +prick test. +Among 160 adults, 37 were at high risk (23.13%) as per the +IDRS, 52 at medium risk (32.5%) and 71 at low risk (44.38%; see +Table 1). Five participants were diagnosed with diabetes, and +18 were diagnosed with impaired fasting glucose (IFG) or +prediabetes, according to the American Diabetes Association +criteria (see Table 2). There was no significant difference in +mean glucose levels or IDRS between the genders (P > 0.05). +The risk prediction of the IDRS was not substantial in the +current population. Amongst the 18 individuals with IFG, the +IDRS recognised 12 to be at moderate risk and six at low risk of +diabetes. Among the five individuals with diabetes, IDRS recog- +nised four to be at moderate risk and one at high risk of diabetes. +Discussion +Exploring the lifestyle of a remote tribal indigenous popula- +tion was a unique experience for the research team. The +family dynamics of the population are very unique, in that +there is only one earning member of the family (predomi- +nantly a man younger than 30 years) and the rest of the family +members who are older than 30 years become dependants +and subsequently lead sedentary lives. +None of the 160 adults who answered the IDRS question- +naire knew whether their parents had diabetes. And, for the +question on the ‘family history’ of diabetes, every single +participant said that their parents were not diagnosed with +diabetes as they had never checked their blood glucose levels +before. It is noteworthy that the awareness about diabetes as a +health condition is very minimal in the current population, +let alone the previous generations. Family history scored ‘0’ +for all the subjects as none of them knew the diabetic status of +their parents as no blood test was carried out to detect dia- +betes. This indicates that diabetes awareness and screening +programmes should also be conducted in the remote areas of +Table 1 e Indian Diabetes Risk Score (IDRS) across both +genders. +Male (n ¼ 68) +Female (n ¼ 92) +Age in years (mean ± SD) +34 ± 2.83 +46 ± 4.24 +IDRS risk (n) +High risk +10 +27 +Medium risk +24 +28 +Low risk +34 +37 +IDRS +High risk +55 ± 13 +56 ± 12 +(Mean ± SD) +Medium risk +40 ± 4.7 +38 ± 4.4 +Low risk +29 ± 7.1 +32 ± 12 +SD, standard deviation. +p u b l i c h e a l t h x x x ( 2 0 1 8 ) 1 e4 +2 +Please cite this article in press as: Vijayakumar V, et al., Challenges faced in diabetes risk prediction among an indigenous South Asian +population in India using the Indian Diabetes Risk Score, Public Health (2018), https://doi.org/10.1016/j.puhe.2018.09.012 +the country to curb the increasing prevalence of diabetes in +India. +Age was found to be the major risk factor for diabetes in +this study, followed by the lack of physical activity and +abdominal obesity. In the current indigenous population, +abdominal obesity was not prevalent and contributed only +minimally to the risk score. +The prevalence of diabetes and prediabetes in this particular +indigenous population is much lower at 3.24% and 3.42% when +compared with the national prevalence of 8.7% and 4.6%, +respectively.11 This is contradictory to the findings from the +indigenous populations of other countries, where the preva- +lence of diabetes was 3e4 times higher, on average, than non- +indigenous populations.6 The possible reasons could be that +urbanisation has not reached this particular indigenous com- +munity as much as in the developed countries. Health disparity +in indigenous populations is attributed more to lifestyle factors +than genetic factors.3 Despite a sedentary lifestyle above the +age of 30 years, there are a few factors that are protective +against diabetes in this study population. For example, whole- +grain consumption helps to reduce the risk of diabetes,12,13 and +this particular indigenous population still consumes whole +grains and has not even heard about or used refined products +for cooking. Locally grown vegetables are used in abundance +and become a part of their daily diet which is possibly an added +advantage as fruit and vegetable consumption is inversely +associated with diabetes.14 Basic amenities such as electricity +have still not reached these indigenous community dwellings. +This could be seen as a blessing in disguise as they go to bed +early and get up before sunrise, maintaining an optimal circa- +dian rhythm, possibly keeping them healthy and protected +against a metabolic disorder such as diabetes.15,16 Similar to +most diabetes risk assessment questionnaires around the +world, lifestyle risk factors such as diet and sleep are not +included in the IDRS. The Finnish Diabetes Risk Score ques- +tionnaire, which includes a question on diet, is found to be +better than theIDRS in diagnostic accuracy and clinicalutility.17 +The addition of questions on diet and sleep in the diabetes risk +assessment +questionnaire +might, +thus, +be +beneficial +in +increasing the diagnostic accuracy of type 2 diabetes. +The main strength of the study is that it has been con- +ducted on a remote indigenous tribal population whose dia- +betic status is not widely studied in India, as even accessibility +by road is still limited in these areas. +Limitations +Diagnosis of type 2 diabetes was performed using capillary +glucose levels and not venous blood glucose levels. Owing to +the funding constraints and lack of resources at the remote +tribal location, it was not possible to measure the plasma +glucose levels, and the capillary blood glucose tests were +performed using a glucometer. Screened individuals were +older than 25 years, and there are higher chances that other +types of diabetes such as type 1 diabetes or latent autoim- +mune diabetes of adulthood might have gone unnoticed. The +data reported were from a remote indigenous community in a +southern state of India. The data might not be considered as a +representative sample to explain the diabetic status of all the +indigenous populations across the country. +Conclusions +The best way to assess the diabetes risk in this population +might be through blood glucose measurements, rather than +analysing the diabetes risk scores. The IDRS might not be an +appropriate measure to detect the risk of diabetes in the given +tribal population. The IDRS has definitely been of great benefit +in the early type 2 diabetes risk prediction in a developing +country such as India, similar to all other risk prediction +questionnaires. Adding a few key lifestyle risk factors to the +current available risk prediction tools could make them more +precise. It might not be appropriate to generalise the findings +obtained from this particular population to all the indigenous +tribes in India, and further large-scale studies including other +parameters such as glycated haemoglobin A1c and the oral +glucose tolerance test would give a much better understand- +ing about the diabetes prevalence in the indigenous pop- +ulations of India. +Author statements +Ethical approval +Ethical approval was not applied for the study as the data +presented here are a part of a health camp, and this was not +performed exclusively as a research study. +Funding +This research is funded by the JagMohan Maheswari trust, a +not-for-profit organisation working on the welfare of indige- +nous tribal populations. However, they did not have any in- +fluence on the outcome of the study or designing the +methodology. +Competing interests +The authors declare no conflict of interest. +r e f e r e n c e s +1. Vijayakumar V, Mavathur R, Sharma MN. Ethnic disparity and +increased prevalence of type 2 diabetes among South Asians: +aetiology and future implications for diabetes prevention and +management. Curr Diabetes Rev 2017;14(6):518e22. +Table 2 e Fasting capillary blood glucose measurement +(n ¼ 103). +Range +Fasting glucose (mg/dL) +[mean ± SD] +Male +Female +Normal range +88.79 ± 16.82 +87.69 ± 19.29 +Prediabetes range +107.17 ± 12.58 +110 ± 14.96 +Diabetes range +275 ± 19.52 +225.33 ± 18.31 +SD, standard deviation. +p u b l i c h e a l t h x x x ( 2 0 1 8 ) 1 e4 +3 +Please cite this article in press as: Vijayakumar V, et al., Challenges faced in diabetes risk prediction among an indigenous South Asian +population in India using the Indian Diabetes Risk Score, Public Health (2018), https://doi.org/10.1016/j.puhe.2018.09.012 +2. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, +Unnikrishnan R, et al. Prevalence of diabetes and prediabetes +(impaired fasting glucose and/or impaired glucose tolerance) +in urban and rural India: phase I results of the Indian Council +of Medical ResearcheIndia DIABetes (ICMReINDIAB) study. +Diabetologia 2011;54(12):3022e7. +3. Durie MH. The health of Indigenous peoples: depends on +genetics, politics, and socioeconomic factors. BMJ Br Med J +2003;326(7388):510. +4. Subramanian SV, Smith GD, Subramanyam M. Indigenous +health and socioeconomic status in India. PLoS Med +2006;3(10):e421. +5. Stephens C, Nettleton C, Porter J, Willis R, Clark S. Indigenous +peoples' healthdwhy are they behind everyone, everywhere? +Lancet 2005;366(9479):10e3. +6. Si D, Bailie R, Wang Z, Weeramanthri T. Comparison of +diabetes management in five countries for general and +indigenous populations: an internet-based review. BMC Health +Serv Res 2010;10(1):169. +7. Valeggia CR, Snodgrass JJ. Health of indigenous peoples. Annu +Rev Anthropol 2015;44:117e35. +8. Ministry of Tribal Affairs. Scheduled tribes in India as revealed in +census 2011 (RGI report). New Delhi: India Ministry of Tribal +Affairs; 2017. Available: https://tribal.nic.in/writereaddata/ +AnnualReport/ +ScheduledTribesinIndiaasRevealedinCensus2011.pdf. +9. Glu +¨ mer C, Vistisen D, Borch-Johnsen K, Colagiuri S. Risk +scores for type 2 diabetes can be applied in some populations +but not all. Diabetes Care 2006;29(2):410e4. +10. Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A +simplified Indian Diabetes Risk Score for screening for +undiagnosed diabetic subjects. J Assoc Phys India +2005;53:759e63. +11. Ogurtsova K, da Rocha Fernandes JD, Huang Y, +Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes +Atlas: global estimates for the prevalence of diabetes for 2015 +and 2040. Diabetes Res Clin Pract 2017;128:40e50. +12. Aune D, Norat T, Romundstad P, Vatten LJ. Whole grain and +refined grain consumption and the risk of type 2 diabetes: a +systematic review and doseeresponse meta-analysis of +cohort studies. Eur J Epidemiol 2013;28(11):845e58. +13. Cho SS, Qi L, Fahey GC, Klurfeld DM. Consumption of cereal +fiber, mixtures of whole grains and bran, and whole grains +and risk reduction in type 2 diabetes, obesity, and +cardiovascular disease. Am J Clin Nutr 2013. ajcn-067629. +14. Jannasch F, Kr€ +oger J, Schulze MB. Dietary patterns and type 2 +diabetes: a systematic literature review and meta-analysis of +prospective studies. J Nutr 2017;147(6):1174e82. +15. Sridhar GR, Gumpeny L. Sleep, obesity and diabetes: the +circadian rhythm. Adv Diabetes Nov Insights 2016:197. +16. Tan E, Scott EM. Circadian rhythms, insulin action, and +glucose homeostasis. Curr Opin Clin Nutr Metab Care +2014;17(4):343e8. +17. Pawar SD, Naik JD, Prabhu P, Jatti GM, Jadhav SB, Radhe BK. +Comparative evaluation of Indian Diabetes Risk Score and +Finnish Diabetes Risk Score for predicting risk of diabetes +mellitus type II: a teaching hospital-based survey in +Maharashtra. J Fam Med Prim Care 2017;6(1):120. +p u b l i c h e a l t h x x x ( 2 0 1 8 ) 1 e4 +4 +Please cite this article in press as: Vijayakumar V, et al., Challenges faced in diabetes risk prediction among an indigenous South Asian +population in India using the Indian Diabetes Risk Score, Public Health (2018), https://doi.org/10.1016/j.puhe.2018.09.012 diff --git a/subfolder_0/Changes in Heart Rate Variability Following Yogic Visual Concentration (Trataka)_unlocked.txt b/subfolder_0/Changes in Heart Rate Variability Following Yogic Visual Concentration (Trataka)_unlocked.txt new file mode 100644 index 0000000000000000000000000000000000000000..f2db8aa53f8fb567b591946a315c27f2930fe68a --- /dev/null +++ b/subfolder_0/Changes in Heart Rate Variability Following Yogic Visual Concentration (Trataka)_unlocked.txt @@ -0,0 +1,335 @@ +15 +Heart India, Vol 2 / Issue 1 / Jan-Mar 2014 +Changes in Heart Rate Variability Following Yogic Visual +Concentration (Trataka) +B R Raghavendra, V Ramamurthy +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India +The literal meaning of the Sanskrit word trataka is “to gaze steadily.” +Looking intently with an unwavering gaze at a small point until tears +are shed is known as trataka (Hatha Yoga Pradipika, Ch:2, V:31). +Hatha Yoga Pradipika mentions that, practice of trataka eradicates +all the eye diseases, fatigue and lethargy (Hatha Yoga Pradipika, Ch:2, +V:32). Though trataka is considered as cleansing technique, the final +stage of trataka leads to meditative mental state.[3] +Recently, a study has been conducted to assess the immediate effect +of trataka on critical flicker fusion (CFF).[4] The CFF is defined as the +frequency at which a flickering stimulus is perceived to be continuous. +There was a significant increase in CFF following trataka suggesting +changes at the cortical level in the processes that mediate fusion. +Meditation and autonomic changes are researched extensively and +shown a shift toward vagal tone during meditation.[5-7] However, +there was no study evaluating autonomic changes during trataka +which is similar to meditation. Hence, in the present study, we +used heart rate variability (HRV) which is a well-known and +extensively used method to evaluate autonomic modulation. +MATERIALS AND METHODS +Participants +A total of 30 male volunteers with ages ranging from 20 to 33 +years (group mean age ± SD, 23.8 ± 3.5) were recruited for this +A b s t ra ct +Background: The yogic visual concentration technique, trataka is similar to meditation. Research studies have shown +a shift toward the vagal tone during meditation. However, autonomic changes in trataka were not studied. Objectives: +The present study was planned to assess the changes in heart rate variability (HRV) following trataka. Materials and +Methods: HRV and breath rate were assessed in thirty healthy male volunteers with ages ranging from 20 to 33 years +(group mean age ± SD, 23.8 ± 3.5) before and after yogic visual concentration (trataka) and control session on 2 separate +days. Repeated measures analysis of variance (ANOVA) were performed with two “within subjects” factors, i.e., Factor 1: +Sessions; trataka and control and Factor 2: States; “Pre”, and “Post”. This was followed by post-hoc analyses with Bonferroni +adjustment comparing “Post” with “Pre” values. Results: There was a significant decrease in LF (RM ANOVA with +Bonferroni adjustment P < 0.01) and increase in high frequency (P < 0.01) after trataka. Breath rate (P < 0.001) and heart rate +(P < 0.01) were significantly reduced after trataka compared to before. Control session showed no change. Conclusions: The +practice of trataka leads to increased vagal tone and reduced sympathetic arousal. Though trataka is known as cleansing +technique, it could induce calm state of mind which is similar to a mental state reached by the practice of meditation. +Key words: Heart rate variability, high frequency, low frequency, trataka +Address for correspondence: +Dr. B R Raghavendra, +Swami Vivekananda Yoga Anusandhana Samsthana, +# 19, Eknath Bhavan, Gavipuram Circle, K G Nagar, +Bengaluru - 560 019, Karnataka, India. +INTRODUCTION +Yoga is an ancient Indian science and the way of life. Sage +Patanjali (circa 900 B.C) explains the theoretical aspects yoga in +196 aphorisms called Yoga Sutras.[1] Patanjali evolved Astanga +yoga (eight limbed) to reach the ultimate reality. Later around 10th +Century CE Sage Svatmarama wrote a text called Hatha Yoga +Pradipika in which he explains the method of yoga techniques. +He prescribes six cleansing techniques (kriyas) viz., dauti, basti, +neti, trataka, nauli and kapalabhati to purify the body. The goal of +Hatha Yoga is to prepare the body and mind for the practice of +Raja yoga or Astanga yoga.[2] +O riginal Article +Access this article online +Quick Response Code: +Website: +www.heartindia.net +DOI: +10.4103/2321-449x.127975 +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +16 +Raghavendra and Ramamurthy: Trataka and HRV +Heart India, Vol 2 / Issue 1 / Jan-Mar 2014 +study. They were all students of a yoga university in Southern +India. Their health status was evaluated by a routine clinical +examination and case history. They had normal health and +were not on any medication. The predetermined conditions to +exclude participants from the trial were any chronic illness. Male +volunteers alone were selected as autonomic and respiratory +variables are known to vary with the phases of the menstrual +cycle.[8] The project was approved by the institution’s ethics +committee. The study protocol was explained to the participants +and their signed consent was obtained. +Design +Self as control design was used. Each participant was assessed in +two sessions (trataka and control session) on 2 separate days. Half +the subjects practiced trataka on 1st day and control session on 2nd +day. The other half was having the order of the session reversed. +Duration of both the sessions were of 25 min. Participants were +assessed before and immediately after the sessions. +Assessment +Electrocardiogram (ECG) and respiration were recorded using +a four channel polygraph (Biopac MP 100, USA). +HRV and heart rate +The ECG was recorded using a standard bipolar limb lead II +configuration and an AC amplifier with 100 Hz high cut filter +and 1.5 Hz low cut filter settings. The EKG was digitized using +a 12-bit analog-to-digital converter at a sampling rate of 1024 Hz +and was analyzed off-line to obtain the HRV spectrum. +Breath rate +Respiration was be recorded using a volumetric pressure +transducer fixed around the trunk about 8 cm below the lower +costal margin as the participants sat erect. +Intervention +Trataka (a yogic visual concentration) +Fifteen days orientation program was conducted to train +participants in trataka. Theoretical aspects of trataka was +explained by a senior yoga teacher on day one. The pre-recorded +audio instructions for trataka was played during the session. +Trataka practice consists of two distinct stages. The first stage, +consisted of eye exercises, which is a preparatory practice for +trataka. The eye exercise includes eyeball movements in the +horizontal, vertical and diagonal direction directions and circular +movements. These was performed with eyes open, in a well-lit +room. This was followed by the practice of palming to relax the +eyes. Palming consisted of putting slightly cupped palms over +the eyes, so that the eyes perceive complete darkness. First stage +lasted for 10 min. The second stage, trataka, was practiced in a +dark room. Subjects were asked to fix the gaze on the flame of +the candle for about 2 to 3 min, suppressing the urge to blink +as far as possible. Then visualize the candle flame in between +the eyebrows. This process was repeated for 2-3 rounds. Finally, +subjects were asked to defocus and the practice ended with silence +and then prayer. The second stage lasted for 15 min. The duration +of the whole practice was 25 min. +Control session +During control session participants were asked to practice the +first stage (eye exercise) for 10 min and then for next 15 min +they sat quietly with closed eyes without doing any concentration +or meditation. +Data extraction +HRV +Frequency domain analysis of HRV were carried out. The energy +in the HRV spectrum in the following specific frequency bands +were studied. The low frequency (LF) (0.04-0.15 Hz) and high +frequency (HF) band (0.15-0.4 Hz). According to guidelines, +LF and HF band values will be expressed as normalized units.[9] +Herat rate +The heart rate in beats per minute was calculated by counting +the R waves of the QRS complex in the EKG in 60 s epochs, +continuously. +Breath rate +The breath rate in cycles per minute was calculated by counting +the breath cycles in 60 s epochs, continuously. +Data analysis +Statistical analysis was performed using SPSS (version 16.0). +Since the same individuals were assessed in repeat sessions on +separate days (i.e., trataka and control), repeated measures analysis +of variance was used (ANOVA). Repeated measures ANOVA +were performed with two “within subjects” factors, i.e., Factor +1: Sessions; trataka and control and Factor 2: States; “Pre” and +“Post.” This was followed by post-hoc analyses with Bonferroni +adjustment comparing “Post” with “Pre” values. +RESULTS +The group mean values and standard deviation for frequency +domain measures of HRV, heart rate and breath rate are shown +in Table 1. +Repeated measures ANOVA +Repeated measures ANOVA were conducted where subjects +were measured before and after trataka as well as control session. +There was a significant difference between the states for +1. +LF F(1, 29) = 7.58, P < 0.01; +2. +HF F(1, 29) = 7.60, P < 0.01; +3. +Hear rate F(1, 29) = 13.08, P < 0.01; +4. +Breath rate F(1, 29) = 20.52, P < 0.001. +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +17 +Raghavendra and Ramamurthy: Trataka and HRV +Heart India, Vol 2 / Issue 1 / Jan-Mar 2014 +There was a significant difference between the sessions for +1. +Heart rate F(1, 29) = 6.75, P < 0.05; and +2. +Breath rate F(1, 29) = 9.38, P < 0.01. +There was also a significant interaction between Session and +State for +1. +Breath rate F (1, 29) = 14.14, P < 0.001. +Post-hoc analyses with Bonferroni +adjustment +There was a significant decrease in LF (P < 0.01) and significant +increase in HF (P < 0.01) after trataka. Breath rate (P < 0.001) +and heart rate (P < 0.01) were significantly reduced after trataka +compared to before. Control session did not show any change. +DISCUSSION +In the current study, HRV and breath rate were assessed before +and after the practice of trataka and control session in thirty +healthy male volunteers. There was a significant decrease in LF +and increase in HF after trataka compared to before. Breath rate +and heart rate were significantly reduced after trataka compared +to before. Control session showed no change. +HRV refers to beat-to-beat alterations in the heart rate. In general +two type of HRV analysis are used. These are frequency domain +analysis and time domain analysis. In the preset study, we have +used only frequency domain analysis. Earlier it was believed +that the LF (LF, 0.04-0.15 Hz) band of the HRV is an index of +cardiac sympathetic activity and HF (HF, 0.15-0.4 Hz) band is +correlated with parasympathetic activity.[9] However this has been +questioned subsequently. Recent research findings says, neither +the LF band (LF) nor the HF, are considered exclusive markers of +sympathetic and parasympathetic tone respectively.[10] It is found +that, sympathetic activity can also regulate the HF component +of HRV, though to a lesser extent than the parasympathetic +influence on the LF power. The association between HF power +and cardiac parasympathetic activity is stronger. Hence the HRV +provides broad changes in cardiac parasympathetic regulation and +changes in the LF power and LF/HF ratio have to be considered +carefully. The decrease in LF power and increase in HF power +after trataka suggests increased vagal modulation after trataka. +The changes in hear rate are due to several factors. The heart rate +is under the control of sympathetic and parasympathetic nerves +as well as humeral factors.[11] Hence, it is difficult to conclude +that decrease in hear rate is only due to increased vagal tone or +due to sympathetic withdrawal. +Breath rate depends upon numerous factors ranging from the +level of physical activity to psychological stress.[12] In general, +a decrease in breath rate is correlated with relaxation. Though +trataka practice involves intense focusing, it ends with defocusing +and silence. This might induce relaxation after the practice which +can explain the decrease in breath rate. +The findings in the current study are similar to the earlier study on +autonomic change sand two meditative states described in yoga +texts, which showed reduced sympathetic arousal and increased +vagal tone during dhyana.[7] Hence, it is speculated that the practice +of trataka leads mental state which similar to meditation. +One of the main limitations of the study is that, assessments were +not performed during the practice of trataka. Changes in HRV +during trataka might have conveyed much more information. It +will be interesting to have a longer duration of “Post” session (10 +or 15 min) by which we can understand how much time effect +of trataka sustains. In future, along with HRV other autonomic +variables can be studied before during and after trataka. +In summary, considering changes in HRV +, heart rate and breath rate, +the present results show that, practice of trataka leads to increased +vagal tone and reduced sympathetic arousal. Though trataka is known +as cleansing technique, it could induce calm state of mind which is +similar to a mental state reached by the practice of meditation. +REFERENCES +1. +Taimni IK. The Science of YogaMadras: Theosophical Publishing +House; 1999. +2. +Muktibodhananda S. Hatha Yoga Pradipika. Munger: Yoga +Publications Trust; 1993. +3. +Nagaratha R, Nagendra H. Yoga for Promotion of Positive Health. +Bangalore: Swami Vivekananda Yoga Prakashana; 2000. +4. +Mallick T, Kulkarni R. The effect of trataka, a yogic visual concentration +practice, on critical flicker fusion. J Altern Complement Med +2010;16:1265-7. +5. +Orme-Johnson DW. Autonomic stability and transcendental +meditation. Psychosom Med 1973;35:341-9. +Table 1: Changes in heart rate variability and breath rate before and after trataka and control session +Variables +Control +Trataka +Pre +Post +Pre +Post +LF in n.u.(Hz) +64.40±14.92 +62.21±16.17 +63.85±14.25 +53.58±15.41**↓ +HF in n.u.(Hz) +35.60±14.92 +37.79±16.14 +36.15±14.25 +46.42±15.41**↑ +LF/HF ratio +2.79±2.42 +2.54±2.64 +2.41±1.73 +2.24±1.96 +Heart rate (bpm) +72.87±6.61 +70.91±8.11 +71.20±8.83 +67.29±5.84**↓ +Breath rate (cpm) +15.20±1.34 +14.85±1.36 +15.13±0.96 +13.85±1.22***↓ +**P<0.01, ***P<0.001. Repeated measures analysis of variance with Bonferroni adjustment comparing post values with pre values. ↑: Increase, ↓: Decrease, LF: Low +frequency, HF: High frequency +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +18 +Raghavendra and Ramamurthy: Trataka and HRV +Heart India, Vol 2 / Issue 1 / Jan-Mar 2014 +6. +Wallace RK. Physiological effects of transcendental meditation. Science +1970;167:1751-4. +7. +Telles S, Raghavendra BR, Naveen KV, Manjunath NK, Kumar S, +Subramanya P. Changes in autonomic variables following two +meditative states described in yoga texts. J Altern Complement Med +2013;19:35-42. +8. +Yildirir A, Kabakci G, Akgul E, Tokgozoglu L, Oto A. Effects +of menstrual cycle on cardiac autonomic innervation as assessed +by heart rate variability. Ann Noninvasive Electrocardiol +2002;7:60-3. +9. +Heart rate variability. Standards of measurement, physiological +interpretation, and clinical use. Task Force of the European Society +of Cardiology and the North American Society of Pacing and +Electrophysiology. Eur Heart J 1996;17:354-81. +10. +Lombardi F, Stein PK. Origin of heart rate variability and turbulence: +An appraisal of autonomic modulation of cardiovascular function. +Front Physiol 2011;2:95. +11. +Andreassi JL. Psychophysiology: Human Behavior and Physiological +Response. Mahwah, NJ: Lawrence Earl Baum Associates; 2007. +12. +Stevenson I, Ripley HS. Variations in respiration and in respiratory +symptoms during changes in emotion. Psychosom Med 1952;14:476-90. +How to cite this article: Raghavendra BR, Ramamurthy V. Changes +in heart rate variability following yogic visual concentration (Trataka). +Heart India 2014;2:15-8. +Source of Support: Nil Conflict of Interest: Nil. +Announcement +iPhone App +A free application to browse and search the journal’s content is now available for iPhone/iPad. The application +provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. +Internet connection is required to access the back issues and search facility. The application is Compatible +with iPhone, iPod touch, and iPad and Requires iOS 3.1 or later. The application can be downloaded from http:// +itunes.apple.com/us/app/medknow-journals/id458064375?ls=1&mt=8. For suggestions and comments do +write back to us. +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] diff --git a/subfolder_0/Combination of Ayurveda and Yoga therapy reduces pain intensity and improves quality of life in patients with migraine headache.txt b/subfolder_0/Combination of Ayurveda and Yoga therapy reduces pain intensity and improves quality of life in patients with migraine headache.txt new file mode 100644 index 0000000000000000000000000000000000000000..84193dacd8da0a0629da9ee3f3c4c31d1e37fbf3 --- /dev/null +++ b/subfolder_0/Combination of Ayurveda and Yoga therapy reduces pain intensity and improves quality of life in patients with migraine headache.txt @@ -0,0 +1,1390 @@ +Accepted Manuscript +Combination of Ayurveda and Yoga therapy reduces pain intensity and improves +quality of life in patients with migraine headache +Vasudha M. Sharma, N.K. Manjunath, H.R. Nagendra, Csaba Ertsey +PII: +S1744-3881(18)30100-2 +DOI: +10.1016/j.ctcp.2018.05.010 +Reference: +CTCP 876 +To appear in: +Complementary Therapies in Clinical Practice +Received Date: 18 February 2018 +Revised Date: +8 May 2018 +Accepted Date: 25 May 2018 +Please cite this article as: Sharma VM, Manjunath NK, Nagendra HR, Ertsey C, Combination of +Ayurveda and Yoga therapy reduces pain intensity and improves quality of life in patients with migraine +headache, Complementary Therapies in Clinical Practice (2018), doi: 10.1016/j.ctcp.2018.05.010. +This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to +our customers we are providing this early version of the manuscript. The manuscript will undergo +copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please +note that during the production process errors may be discovered which could affect the content, and all +legal disclaimers that apply to the journal pertain. +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Combination of Ayurveda and Yoga therapy reduces pain intensity and +improves Quality of life in patients with Migraine Headache + + + +Vasudha M. Sharma1*., Manjunath N. K1., Nagendra H.R1., and Ertsey +Csaba2 + + +1. Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) A +Deemed to be University, Bengaluru, Karnataka, India +2. Department of Neurology, Faculty of Medicine, Semmelweis +University Budapest, 1083 Hungary + + + + + + +* Address for correspondence: Dr. Vasudha M. Sharma, Division of Yoga +and Life Sciences, S-VYASA University, Prashanthi Kutiram, Jigani +(Hobli), Anekal (Talluk), Bengaluru – 560106, Karnataka, India. E-mail: +vasudhamsharma@gmail.com +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Objectives: To Understand the efficacy of Ayurveda and Yoga in the management of +Migraine Headache. +Methods: 30 subjects recruited to Ayurveda and Yoga (AY) group underwent traditional +Panchakarma (Bio-purificatory process) using therapeutic Purgation followed by Yoga +therapy, while 30 subjects of Control (CT) group continued on symptomatic treatment +(NSAID's) for 90 days. Body constitution questionnaire was administered to both groups. +The outcome measures included Symptom check list, Comprehensive Headache related +Quality of Life Questionnaire and Visual Analogue Scale. +Results: Forty-six (76.6%) out of 60 subjects belonging to both groups had Pitta based body +constitution. Following 90 days of intervention the AY group showed significant reduction in +Migraine symptoms including pain intensity (p<.001) and improvement in Headache related +Quality of Life (p<.001). The CT group showed no significant change (p>.05). +Conclusion: Traditional Ayurveda along with Yoga therapy reduces symptoms, intensity of +pain and improves Quality of life in Migraine patients. +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +1. Introduction +Migraine is a primary headache disorder which is vastly prevalent across the world. It contributes +extensively to the disease-related burden resulting in lowered Quality of life (1). Migraine is the +10th most disabling disorder amongst both genders in the world (2), triggered by psychological and +physiological stressors (3). Stress as a risk factor attributes to the problem in 50% of the mi- +graineurs (4). Studies have shown that the adherence to prophylactic treatment is low and more than +50% of migraineurs discontinue such treatment, regardless of the class of medicine taken (5). Medi- +cation overuse is also an associated issue in Migraine patients owing to use of Non-Steroidal Anti +Inflammatory Drugs (NSAIDS) with or without doctor’s prescription (6). + +The use of Complementary and Alternative medicine in migraine or in patients with severe head- +ache is popular as they feel it is congruent to their beliefs in health and lifestyle and has lesser- +known side effects with less dependency on medication (7). The idea of Integrative medicine is +gaining popularity and its use is increasing in the management of chronic conditions (8). In a study +on the prevalence of CAM use in Migraine patients, among several therapies acupuncture, massage +and chiropractice were found to be the most commonly used methods. 47.7% participants reported +potential improvement in headache (9). + +Ayurveda is an ancient Indian system of medicine, which considers health as a state of wellbeing +resulting from a synergistic balance in Doshas (Principal systems functions - Vata, Pitta, and +Kapha), Agni (Digestive fire), Dhatu (Body tissues) and Mala (Excretory products). It also empha- +sizes on a blissful state of Atma (spirit), Indriya (sense organs) and Manas (mind) (10). Migraine +headache finds its mention as Ardhavabedhaka under the classification of Shiroroga (Diseases re- +lated to the Head region) in Ayurveda treatises (11). Acharya Sushruta, an ancient Indian Ayurveda +Physician opines Ardhavabhedaka to be a Tridoshaja vyadhi (a disease with involvement of Vata +Pitta and Kapha) (11) and Acharya Charaka mentions it as a Vata-kaphaja Vyadhi (Disease involv- +ing Vata and Kapha) (12). There are visible Pitta lakshana’s (signs of Pitta) and involvement of +Rakta (blood) in the pathogenesis of Ardhavabhedaka (13). The line of treatment involves admin- +istration of Samshodhana (Panchakarma-Bio-purificatory techniques) with special mention of Kaya +virechana (Therapeutic Purgation) (12), diet and lifestyle regulation. Scientific literature also shows +that diet, lifestyle and stress can contribute to increased prevalence of Migraine Headache (14). + +A study on five Ayurveda oral medicines administered for 90 days provided a preliminary evidence +for the effectiveness of an Ayurveda based treatment protocol in the management of Migraine +Headache (15). +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +According to Yoga, Migraine is considered as an Adhija Vyadhi (mind-body disorder) where the +disturbances in the mind influence the flow of Prana (the vital force/breath) resulting in physical +problems and affecting the weakest system in the body (16). + +Studies have shown the beneficial effects of Yoga not only in stress and lifestyle-related diseases +but also in the management of pain related conditions (17). In two different studies, Yoga therapy +for three months and the use of transcendental meditation have demonstrated a significant reduction +in frequency and severity of pain in migraine patients (18) (19). Therefore, Yoga therapy compli- +ments Ayurveda by adding physical activity, breath regulation, relaxation, and meditation. + +Identifying the need for generating more scientific evidence for integrative treatment protocols, the +present study was designed to evaluate the use of traditional Ayurveda based Virechana (Therapeu- +tic purgation) followed by Yoga therapy in the management of Migraine in comparison to sympto- +matic conventional treatment. + + + + + + + + + + + + + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +2. Methods +2.1. Setting +The study was conducted as a prospective matched controlled trial comparing an Ayurveda-Yoga +group (AY) with a Control group (CT) on symptomatic conventional treatment. Participants for +both the groups were recruited at a Center for Integrative Medicine in South India. The participants +in both groups had consulted a neurologist or a physician. The study protocol was approved by the +Institutional Ethics Committee of S-VYASA (a Deemed to be University), Bengaluru, India. The +study was conducted between 2015-2017 and registered with the Clinical Trials Registry of India +(CTRI/2017/10/010074). + +2.2 Participants +Eighty-six individuals who were clinically diagnosed with Migraine Headache were screened pro- +spectively based on inclusion and exclusion criteria and sixty participants were selected for the +study. + +The recruitment was based on self-selection by the participants to either Ayurveda and Yoga (AY) +or Control (CT) group. Participants were explained about the study protocol and an informed con- +sent was obtained before recruitment. They were also given the choice to withdraw from the study +at any stage. + +The sample size was calculated using the G Power software with the Mean values and Standard +deviations derived from a previous study (18) with an effect size of 1.31, α = 0.05 and power = +0.95. The required sample size was 19 participants in each group. Considering the compliance- +related issues, and to improvise the statistical impact, a sample size of 30 participants in each group +was considered in the present study. +The diagnostic criteria were based on the International Classification of Headache Disorders (3rd +edition) of the International Headache Society, 2013 (20). + +2.2.1 Inclusion criteria: The participants included in the study were from both genders, between +18-46 years of age with a headache history for more than one year, 5 or more attacks of headache in +3 months and willingness to follow the dietary restrictions and complete the headache diary. The +Participants in Ayurveda and Yoga group had to be willing to take oral Ayurveda medicine for 75 +days. + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +2.2.2 Exclusion criteria: The participants with primary Psychiatric disorders (Depression, Anxiety, +Psychosis), major medical illness (Renal, Hepatic, Neurological and Cardiac diseases), Pregnancy, +pure menstrual migraine, women who have attained Menopause, participants on Ayurveda or Yoga +intervention for the past six months and participants on conventional prophylactic treatment were +excluded from the study. + +2.3 Study Design +The present study was a prospective matched controlled trial, with a pre-post design. Participants +were recruited as and when they approached the physician who referred them to the investigator. +Those willing to undergo Ayurveda and Yoga intervention were allocated to AY group, while the +others who chose to continue with symptomatic treatment were recruited to the Control (CT) group. +The groups were matched for age and gender. Participants of AY group and CT group were as- +sessed on Day 1, Day 30 and Day 90. + +2.4 Assessment +After the participants volunteered for the study, the Sushruta Prakriti Inventory, Comprehensive +Headache-related Quality of life Questionnaire (CHQQ) and Visual analogue scale (VAS) were +administered to both the groups on day 1 and day 90 of the study. The symptom checklist was ad- +ministered on day 1, day 30 and day 90, since it was essential to closely monitor the response to +therapeutic purgation (Virechana) in the AY group. The assessments were carried out in headache- +free states. + +2.4.1 Prakriti Analysis: The Body constitution (Prakriti) was assessed using Sushruta Prakriti In- +ventory (SPI) which has two parts i.e., SPI-Q (Questions) with 90 items and SPI-C (Checklist) with +60 items. Participants were asked to answer all 90 questions of SPI-Q, while an Ayurveda physician +evaluated the SPI-C. The scoring of SPI-Q and SPI-C were added to quantify the Tridosha domi- +nance of respective participants. +Sushrutha Prakriti Inventory (SPI) is a standardized tool for assessing body constitution (Prakriti) +and the combination of dosha of an individual. SPI has been assessed for reliability and validity in +the Indian population with a test-retest reliability for Vata, Pitta, and Kapha items as 0.994, 0.975 +and 0.976 respectively based on Pearson Correlation coefficient. The Content and consensual valid- +ity based on Cronbach’s alpha was between 0.61 and 0.80 respectively (21). +As seen in other Ayurveda studies, the individuals were grouped as Vata-Pitta, Pitta-Kapha, and +Vata-Kapha based on the total score of the questionnaire (22). +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +2.4.2 Symptom Checklist: It was used to understand the influence of Ayurveda and Yoga on num- +ber and severity of symptoms. The symptom checklist had 10 questions based on the number of +attacks, duration of attack, intensity of pain, use of analgesics, associated with nausea and or vomit- +ing. The checklist was completed based on an individual’s experience of the above-mentioned +symptoms over the past three months. The intensity of being moderate or severe was assessed based +on the pointer which was set between 1-10, where 1-3 was considered as mild, 4-6 was considered +as moderate and 7-10 was considered severe. + +2.4.3 Comprehensive headache-related quality of life (CHQQ): CHQQ is a 23 item question- +naire, used to understand the subjective experience of an individual and to note the way in which +migraine headache affected their daily life. The questionnaire has been found to be reliable with +Cronbach’s alpha being 0.913 for the whole instrument when used in Migraine and Tension-Type +Headache patients. The questions have been categorized under physical, mental and social dimen- +sions with a total score of 0-100 (23). An earlier pilot study in an Indian population has demonstrat- +ed the possible correlations between Ayurveda based Prakriti (Body Constitution) on Headache +related Quality of Life (24). + +2.4.4 Visual Analogue Scale (VAS): The scale included a 10 cm long straight line, marked with +‘No Pain’ on one side and ‘extreme pain’ on the other side. The VAS was used to assess the head- +ache intensity on Day 1and Day 90. Participants were asked to mark the pain level on the straight +line by drawing a perpendicular line. A measuring scale was used to identify the self-rated pain +intensity between 0 and 10 (25). + +No Pain + + + + + + + + + + Extreme Pain + + 0 +1 +2 +3 +4 +5 +6 +7 +8 +9 +10 + + + + + + + + + + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +3. Intervention +Ayurveda treatment of Virechana (Therapeutic Purgation) followed by Yoga therapy was given to +the Participants of AY group for 90 days. + +3.1 Ayurveda: Following the assessment, on day 1 for Deepana - Pachana (Stomachic and Diges- +tive) 2.5 grams - 5 grams of Hinguvachadi churna (polyherbal powder) (26) was given twice a day +after food in the morning and evening with warm water for first 3 days. From Day 4, Abhyantara +Snehapana (Internal Oleation) with Kallyanaka Ghrita (polyherbal preparation made with Clarified +butter) (27) was administered on empty stomach between 7 am to 8 am in arohana pramana (in- +creasing dosage from 30-150 ml) for 3-5 days until Samyak Snighdha Lakshanas (adequacy of in- +ternal oleation) were seen (28). Following this, Sarvanga Abhyanga (external oil application) with +Shuddha Tila taila (Pure Sesame oil) and Swedana (steam bath) was administered for 3 days. The +next day (approximately day 9), Virechana (Therapeutic Purgation) was induced by administering +Trivrit lehyam (polyherbal paste) (29) based on their Prakriti (body constitution) and Koshta (na- +ture of the digestive tract). As documented in an earlier study, the process of Virechana was safe +and efficacious with no imbalance in serum electrolyte levels (30). Samsarjana krama (dietary reg- +imen) for 3-5 days (Day 7-9/12) was specified based on the Shuddhi (degrees of cleansing) (31). + +Shamana Oushadhi (oral pacificatory medicines) were started between the Days 10-13 based on +individual response to purgation. The following medicine was used for oral administration for a +span of 75 days: Pathyakshadhatradi Kashaya (polyherbal decoction) (32) – 15 ml, 30 minutes be- +fore breakfast and dinner with 45 ml of warm water. Kachoradi churna (polyherbal powder) (33) +was used for topical application on the forehead, once a day as a paste mixed with milk (at room +temperature). There was special mention of Pathya and Apathya (Do’s and Don’ts regarding diet +and lifestyle). +The composition of each polyherbal formulation is mentioned in Table - 1. + +The Participants were allowed to take an oral analgesic (NSAID) only on need, based on the inten- +sity of pain tolerable to the subject and the same was noted in their diary for medication use. + +3.2 Yoga therapy: The specially designed integrated Yoga therapy module for Migraine included +loosening exercises, breathing exercises, asana (postures), pranayama (regulated breathing), relaxa- +tion techniques and Chanting. This was practiced for a duration of 40 minutes daily. Yoga practices +were introduced on Day 10/11/12 of the treatment for 7 days as personalized sessions under the +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +guidance and supervision of a trained Yoga therapist. The Participants were asked to practice the +same module at home, 5 days in a week till day 90. +The female Participants were advised not to practice yoga during the first three days of menstrual +cycle. The Yoga therapy module is detailed in Table 2. + +3.3 Control Group: The participants who agreed to participate in the trial but preferred to continue +on oral Analgesics (Non-Steroidal Anti Inflammatory Drug's) for symptomatic relief as per the pre- +scription of a general physician or neurologist were included under the control group. They were +asked not to practice Yoga or follow Ayurveda during the study period. They were given an option +to undergo the same therapy protocol as given for AY group after the study period. + +Participants of AY and CT groups were asked to maintain a daily diary to record the regularity of +the practice of Yoga or Physical activity respectively along with medication use. They were moni- +tored once in two weeks over a telephonic call. The Participants were free to withdraw from the +study at any stage if they felt that the conditions weren’t conducive. + + +4. Data Analysis +The data were analyzed using Statistical Package for Social Sciences, SPSS version 23. The nor- +mality and homogeneity were assessed using Kolmogorov-Smirnov test. Since the data were found +to be normally distributed, the CHQQ data and Visual analogue scale data collected on day 1 and +on day 90 in both AY and CT groups respectively were analyzed using paired sample t-test, while +the between-group comparisons were made using a one-way analysis of variance (ANOVA). The +values were considered significant if p<.05. The missing values of participants in AY and CT group +were replaced using intention to treat analysis. + + + + + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +5. Results +The Ayurveda and Yoga (AY) group had 30 participants with 8 male and 22 female participants +with an average age of 33.83 + 6.84 years. The CT Group had an equally matched number of Par- +ticipants (8male and 22 female) with an average age of 31.46 + 7.81years. There was one drop out +in AY group on Day 90 and one from the CT group on Day 30 and Day 90. + +5.1 Sushruta Prakriti Inventory: The Prakriti analysis showed that there were 15 participants +with Vata Pitta Prakriti, 31 with Pitta Kapha Prakriti and 14 with Vata Kapha Prakriti. This indi- +cated that Pitta dosha was predominantly seen (76.6%) in the Prakriti of 46 participants either as +pravara (primary) or madhayama (moderate) dosha. The details of the Prakriti are mentioned in +Table - 3. + +5.2 Comprehensive headache-related quality of life (CHQQ): The headache-related quality of +life included scores from physical, mental, social domains and their total score. The data of Day 1 +compared to Day 90 in AY group showed significant improvement (p<.001, for all comparisons), +while the CT group did not show any change (p>.05). There was a significant difference between +the groups (AY and CT) when compared using a one-way ANOVA (p<.001). The group mean and +SD of AY and CT group is mentioned in Table - 4. +Participants with Pitta Kapha Prakriti had higher CHQQ scores (average score - 84.92) compared +to the Vata Pitta and Vata- Kapha Prakriti. + +5.3 The Symptom Checklist: The number of attacks and the average maximum duration of an at- +tack reduced in the AY group compared to the CT group when assessed on Day 30 and Day 90 +compared to Day 1 of the study. The number of participants with severe headache, nausea and/or +vomiting reduced across Day 30 and day 90 in the AY group compared to the CT group. The anal- +gesic requirement on need basis which was noticed in all 30 participants of the AY group (100%) +on Day 1 reduced to 14 participants (46.6%) by Day 30 and was noticed in 6 participants (20%) on +Day 90 compared to the CT group. Table 5 represents the changes in symptom checklist. + +5.4 Visual Analogue Scale (VAS): The pain intensity as measured by visual analogue scale has +shown a significant reduction in AY group (p<.001) in comparison to CT group (p>.05) which +showed no change. The between-group comparison also showed a significant difference between +AY and CT groups (p<.001). Table 6 represents the changes in VAS. + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +6. Discussion + +An Integrated approach of Ayurveda combined with Yoga therapy administered for 90 days in 30 +patients with Migraine Headache showed a significant reduction in migraine-related symptoms and +improvement in the quality of life in comparison to Control group where there was no change. + Migraine is a disabling headache related disorder due to its impact on quality of life, affecting +14.7% of the world population (34). Conventional line of treatment has focused on symptomatic +pain management and is associated with side effects due to long term use of drugs. Hence, the pre- +sent study was an attempt to understand the influence of an Ayurveda and Yoga-based intervention +in the treatment of Migraine. +Studies on Ayurveda provide scientific understanding to the Tridosha (Principal systems functions) +theory on which Ayurveda system of Medicine is developed. In a previous report, Prasher et al. +introduced Ayurveda based phenotyping with reference to body constitution as a method to under- +stand the predisposition of individuals to certain diseases (35). This supports the traditional descrip- +tion that a person is prone to a disease caused by the same dosha as his Prakriti (36). While at- +tempting to document and correlate body constitution with Migraine related symptoms, the present +study showed a clear involvement of Pitta in the body constitution (76.6 %) of individuals making +them prone to Migraine headache. + +Similar correlations reported earlier, with respect to Rheumatoid Arthritis (37) demonstrated that +the concept of Prakriti specific disease susceptibility mentioned in Ayurveda is important in both +diagnosis and treatment of diseases. + +The association of Pitta with inflammatory processes was speculated (38) and in Pitta individuals, +the genes related to Oxidative stress pathway were up-regulated (37). Oxidative stress is considered +a key for Migraine trigger (39) and the Phospholipase C in the Cerebrospinal fluid is increased in +migraineurs (40). Evidence on Panchakarma (mild virechana and nasya based) have shown a sig- +nificant reduction in certain plasma metabolites (41) +Perhaps, the choice of Virechana (Therapeutic purgation) as part of bio-purificatory treatment given +to AY group was customized based on the predominance of Pitta and the positive results observed +here are in line with the expected outcomes as mentioned in traditional Ayurveda texts (12). + +The changes in symptom scores observed in the present study suggest reduced frequency, lowered +intensity, and the improved ability to recover from an attack. The changes observed can be attribut- +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +ed to modifying pain perception both at physical and mental levels as pain is a complex sensory and +emotional experience that can vary widely between people and even within an individual. A simple +psychological manipulation, such as distraction, can modify perception of pain (42), and a negative +emotional state increases pain, whereas a positive state lowers the same (43). The neuroimaging +studies in chronic pain suggest that the activity in afferent pain pathways can be altered by the at- +tentional state, positive and negative emotions, empathy and administration of a placebo (44). It is +also understood that psychological factors activate intrinsic modulatory systems in the brain, includ- +ing those involved in opioid-related pain relief (45). +Using real-time Functional MRI (rtfMRI), attempts were made in healthy volunteers to modulate +the activation of their own anterior cingulate cortex (ACC) in order to alter their pain experience +(46). Several studies on Yoga and Meditation have demonstrated activation of areas which regulate +attentional process and emotions in the Brain. The association between increased cortical thickness +in pain-related brain regions (including ACC, bilateral parahippocampal gyrus) and lowered pain +sensitivity in Zen meditators compared to non-meditators has added the much needed supporting +evidence for the underlying mechanisms (47). + +John et al, have reported that the practice of Yoga can reduce the levels of stress biomarkers such as +serum cortisol and Superoxide dismutase levels (48). Yoga in Migraineurs can bring in autonomic +modulation by improving vagal tone and also reduction of drug dosage when used along with con- +ventional care (49). + +While there are few studies on Yoga and Migraine, the studies on Ayurveda are limited to poly- +herbal combinations (15). In this study, the emphasis was on the classical line of Ayurveda treat- +ment combined with Yoga for a better clinical outcome (50). + +For the process of Virechana (therapeutic purgation) few poly herbal combinations were used in the +present study. Kallyanaka ghrita is one of the combinations mentioned in Bower manuscript and +traditional Ayurveda texts and its HPTLC has been studied for qualitative analysis (51). + +The orally administered decoction (Pathyakshadhatyradi Kashaya) used in this study for 75 days +has 7 herbs. The herbs in the combination are Triphala (formula with 3 herbs) which has adap- +togenic, antimutagenic, chemoprotective, radioprotective effects (52), Neem which has anti- +inflammatory, apoptotic and antiproliferative properties (53), Turmeric with the active ingredient +Curcumin has potential therapeutic roles against many pro-inflammatory diseases such as cancer, +arthritis etc (54), Tinospora cordifolia has anti-oxidant, immunomodulatory and anti-inflammatory +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +properties (55) and Andrographis paniculata which is studied for Hepatoprotective activity, Im- +munostimulant activity, antioxidant activity and anti-inflammatory activity. (56). + +While Ayurveda believes that Yoga is a part of Swastha Vritha (Preventive medicine), Yoga thera- +py has grown as an independent system of complementary medicine. Ayurveda can primarily work +at a physical level to bring in balance in Dosha (body constituents) and Agni (digestive fire) while +Yoga therapy has contributed extensively to psychological well-being and mental relaxation. +Hence, a combination of Ayurveda and Yoga therapy given for 90 days has shown to complement +and augment the beneficial effects. This study adds much-needed evidence to demonstrate the +promising future of integrative medicine. The process also provides an opportunity to manage the +condition in a holistic perspective than a system-oriented, symptom-based approach. + +However, a larger sample size and long-term follow up for a minimum period of 1 year is needed. +Further studies involving neuroimaging and biochemical measures are warranted for deeper scien- +tific understanding. + +7. 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Proc Natl Acad Sci USA. 2005;102: 18626-18631 +47. + Grant JA, Courtemanche J, Duerden EG, Duncan GH, Rainville P. Cortical thickness and +pain sensitivity in Zen meditators. Emotion. 2010;10: 43-53 +48. + John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treat- +ment of migraine without aura: A randomized controlled trial. Headache. 2007; 47:654-661. +49. + Kisan R, Sujan M, Adoor M et al. Effect of Yoga on migraine: A comprehensive study us- +ing clinical profile and cardiac autonomic functions. Int J Yoga. 2014; 7(2): 126-132 +50. +Wahbeh H, Elsas SM, Oken BS. Mind-body interventions, Applications in neurology. Neu- +rology. 2008; 70 (24): 2321-2328 +51. +Natsume Y, Neeraj K , Tripathi SM, Nose M, Bhutani KK. Kalyanaka ghrita: an example of +intertextuality among the Bower manuscript, Charak Samhita, Susruta Samhita, As- +tangahrdayam Samhita and Ayurvedic Formulary of India (AFI). Ind J Trad Knowl. +2015;14(4): 519-524 +52. + Peterson CT, Denniston K, Chopra D. Therapeutic Uses of Triphala in Ayurvedic Medi- +cine. J Altern Complement Med. 2017; 23(8): 607–614 +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +53. +Marc S, Claudia C, Simon R, Mario D and Marc D. Anti-inflammatory, pro-apoptotic, and +anti-proliferative effects of a methanolic neem (Azadirachta indica) leaf extract are mediated +via modulation of the nuclear factor-κB pathway. Genes Nutr. 2011; 6(2): 149-160 +54. + Gupta SC, Patchva S, and Aggarwal B. Therapeutic Roles of Curcumin: Lessons Learned +from Clinical Trials. AAPS J. 2013; 15(1): 195-218 +55. + Subramanian M, Chintalwar GJ, Chattopadhyay S. Antioxidant properties of a Tinospora +cordifolia polysaccharide against iron-mediated lipid damage and gamma-ray induced pro- +tein damage. Redox Rep. 2002; 7:137-143 +56. +Chua LS. Review on liver inflammation and anti-inflammatory activity of Androgra- +phis paniculata for hepatoprotection. Phytother Res. 2014;28(11):1589-1598 + + + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +Table1: List of polyherbal preparations (with their botanical names) used across Ayurveda +treatment period and their prescribed quantity in the formulation. + +1a-Hinguvachadi Churna (26) +It is prepared with one part of each of the ingredients mentioned below. They are powdered +separately and mixed together. +Dosage: 2.5grams - 5 grams, 30 minutes before food with warm water. + + +Sanskrit name +Botanical name +Shuddha +Hingu +(Processed with Ghee) +Ferula asafetida +Vacha +Acorus calamus +Vijaya +Terminalia chebula +Pashugandha +Cleome gynandra +Dadima +Punica granatum +Dipyaja(Ajwain) +Trachyspermum ammi +Dhanya +Coriandrum sativum +Pata +Cyclea peltata +Pushkaramoola +Inula racemosa +Shati +Hedychium spicatum +Hapusha +Sphaeranthus indicus +Agni +Plumbago zeylanica +Yavakshar +Alkali preparation made of +Hordeum vulgare +Svarjika kshara +Sarjika kshara +Saindava lavana +Rock salt +Sauvarchala lavana +Black salt +Vida lavana +Type of black salt +Shunti +Zingiber officinalis +Maricha +Piper nigrum +Pippali +Piper longum +Ajaji +Cuminum cyminum +Chavya +Piper chaba +Tintidika +Rhus parviflora +Vetasamla(Amlavetasa) Garcinia morella + +Manufacturer -Arya Vaidya Pharmacy, GMP certified company + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + + +Table 1b- Kallyanaka Ghrita (27) +12g each of the below mentioned ingredients are used to make a medicated ghee (clarified butter) + +Sanskrit name +Botanical name +Haritaki +Terminalia chebula +Vibhitaki +Terminalia bellirica +Amalaki +Emblica officinalis +Vishala +Citrulus cholocynthis +Bhadra ela +Amomum subulatum +Devadaru +Cedrus deodara +Elavaluka +Prunus avium +Sariva +Hemidesmus indicus +Haridra +Turmeric +Daruharidra +Berberis aristata +Shalaparni +Desmodium gangeticum +Prishnaparni +Uraria picta +Phalini +Callicarpa macrophylla +Nata +Valeriana wallichi +Brihati +Solanum indicum +Kushta +Saussurea lappa +Manjishta +Rubia cordifolia +Nagakeshara +Mesua ferrea +Dadimaphalatwak +Punica granatum +Vella +Embelia ribes +Talisapatra +Abbies webbiana +Ela +Elettaria cardamomum +Malati +Jasminum sambac +Utpala +Nymphea stellata +Danti +Baliospermum montanum +Padmaka +Prunus poddum +Hima +Sandalwood -Santalum album +Sarpi +ghee – 768 g + +Manufacturer- Arya Vaidya Pharmacy, Coimbatore, India. + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Table 1c- Trivrit Lehyam (29) +Trivrit – Operculina turpethum +Preparation- 25 grams of the powder is added with 400 ml of water, boiled and reduced to 100 ml, +filtered. To this Trivrit Kashaya, 25 grams of Trivrit powder is again added, along with 50 grams of +sugar and mixed well. 25 ml of honey and 5 grams of each of cinnamon, cardamom and cinnamon +leaves fine powder is added to obtain the sweet paste. +Sl. No. +Ingredients +Quantity +1 +Trivrit Kashaya +100 ml +2 +Trivrit Churna +25 grams +3 +Sugar +50 grams +4 +Honey +25 ml +5 +Cinnamon +5 grams +6 +Cardamom +5 grams +7 +Cinnamon leaves powder +5 grams + +Manufacturer- Arya Vaidya Pharmacy, Coimbatore, India + + + + +Table 1d-Pathyakshadhatradi Kashaya (32) +Herbal decoction is prepared from 10 grams each of the following herbs + +Sanskrit name +Botanical name +Pathya +Terminalia chebula +Aksha +Terminalia bellirica +Dhatri (Amla) +Emblica officinalis +Bhunimba +Andrographis paniculata +Nisha (Turmeric) +Curcuma longa +Nimba (Neem) +Azadirachta indica +Amruta +Tinospora cordifolia + +Dosage-15 ml twice daily before breakfast and dinner mixed with 45 ml of warm water. +Manufacturer- Arya Vaidya Pharmacy + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Table 1e-Kachoradi churna (33). +Equal quantities of herbal powders mentioned below are used to make the powder. + +Sanskrit name +Botanical name +Kachora +Curcuma zedoaria +Dhatri +Emblica officinalis +Manjishta +Rubia cordifolia +Yashti +Glycyrrhiza glabra +Daru +Cedrus deodara +Silajitu +Asphaltum +Vedhi +Ferula foetida +Rohini +Andrographis paniculata +Tintrinisira +Tamarindus indicus +Kumkuma +Crocus sativus +Indu +Camphor +Varivaha +Cyperus rotundus +Rochanam +Mallotus phillippenensis +Bala +Sida cordifolia +Laja +Oryza sativa +Jala +Coleus zeylanicus +Usira +Vetiveria zizanioides +Pushkaramoola +Innula racemosa + +Dosage- ½ tsp to be mixed with milk and applied on the forehead. +Manufacturer- Arya Vaidya Pharmacy, Coimbatore, India + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Table 2: Details of Yoga program specially designed for the Migraine patients are listed below. +The description includes the category of practices, duration of each practice, number of repetitions, +and the sequence of practices. + +Sl.No + +Practices +Number +of +rounds +Duration +1. +Loosening practices (Shithilikarana vyayama) +5 rounds +5 minutes + +Neck up and down movement +Neck side to side movement +Shoulder rotation- Clockwise and Anti clockwise +Shoulder cuff rotation -Clockwise and Anti +clockwise +Head rolling - Clockwise and Anti clockwise, Up +and Down movement + + +2. +Instant Relaxation Technique + +1 Round +1 minute +3. +Breathing Practices +5 rounds each +5 minutes + +Ankle stretch breathing +Shashankasana breathing +Tiger stretch breathing +Uttanapadasana breathing- Single leg + + +4. +Quick Relaxation Technique +1 round +3 minutes +5. +Postures (Asanas) +1 round each +12 minutes +5a +Standing: +Padahasthasana +Ardha Chakrasana +Ardhakati Chakrasana +Trikonasana +30 seconds each +approximately +2.5 minutes + +Relaxation in standing posture +30 seconds +30 seconds +5b +Sitting: +Janushirasana +Vajrasana +Ushtrasana +Shashankasana +Suptavajrasana +Vakrasana +30 seconds each +approximately +4 minutes + +Relaxation in sitting posture +30 seconds +30 seconds +5c +Supine: +Viparita karani/ Sarvangasana +Matsyasana +Pavanamukthasana +Naukasana +Setubandhasana +30 seconds each +2.5 minutes + +Relaxation in supine position +30 seconds +30 seconds +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +5d +Prone: +Bhujangasana +Shalabhasana +Dhanurasana +30 seconds each +1.5 minutes +6. +Deep relaxation technique + +7 minutes +7. +Kriyas +Kapalabhati + +1 minute +8. +Regulated breathing practices (Pranayama) +1 minute each +3 minutes + +Nadishodhana Pranayama +Bhramari Pranayama +Ujjayi Pranayama +1 minute each +3 minutes +9. +Nadanusandhana ( chanting ) + +3 minutes + + + + + +Table 3: The combination of the Prakriti seen in all 60 subjects + +Prakriti +Ayurveda and Yoga group +Control group +Total +Vata- Pitta +3 +5 +8 +Pitta- Vata +4 +3 +7 +Pitta-Kapha +9 +12 +21 +Kapha-Pitta +6 +4 +10 +Vata-Kapha +4 +4 +8 +Kapha-Vata +4 +2 +6 + +Vata-Pitta Prakriti- 15 +Pitta-Kapha Prakriti- 31 +Vata –Kapha Prakriti- 14 + + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Table 4: Comprehensive headache related quality of life questionnaire measuring quality of life at +physical, mental and social domains recorded on Day 1 and Day 90 in Both AY as well as CT +Groups. Values are Group mean ± SD. + +Sl. No. +Domains +Ayurveda and Yoga group +Control group + + +Day 1 +Day 90 +Day 1 +Day 90 +1 +Physical +50.93 +86.63*** +55.72 +55.81 + + +±13.41 +±10.66 +± 17.77 +± 16.75 +2 +Mental +50.06 +80.04*** +55.91 +51.98 + + +±15.18 +±9.49 +± 16.88 +± 13.49 +3 +Social +55.16 +85.68*** +59.00 +59.31 + + +±14.35 +±10.06 +±20.14 +±17.60 +4 +Total +51.47 +83.56***$ +56.52 +54.91 + + +±13.24 +±9.12 +±17.05 +±14.19 + +*** p <.001, Paired Sample t-test comparing the Mean values of the groups on Day 90 compared to +Day 1 values respectively. $ p<.001, Oneway ANOVA comparing the between group differences + + +Table 5: Symptom checklist measuring the change in subjective symptoms recorded on Day 1 and +Day 90 in Both AY Group as well as Control Group. Values are Number of subjects reporting a +particular symptom for items 1,3,4 and 5, while values for item number 2 are group mean in hours. + +Sl. +No. +Symptoms +Ayurveda and Yoga group + +Control group + + +Day 1 +Day 30 +Day 90 +Day 1 +Day 30 +Day 90 +1. +Number of subjects +with 5 or more +migraine attacks in +last 3 months +30 +8 +5 +30 +29 +26 +(100%) +(26.6%) +(16.66%) (100%) +(96.6%) +(86.66%) +2. +Average score of +maximum duration +of attack in hours +27.8 +8.86 +5.62 +43.6 +29.8 +45 +3. +Number of subjects +with severe +headache +21 +10 +4 +18 +20 +21 +(70%) +(33.3%) +(13.33%) +(60%) +(66.66%) +(70%) +4. +Number of subjects +with nausea and/ or +vomiting +30 +17 +4 +30 +27 +28 +(100%) +(56.6%) +(13.33%) (100%) +(90%) +(93.33%) +5. +Number of subjects +with analgesic +requirement on need +30 +14 +6 +30 +27 +26 +(100%) +(46.66%) +(20%) +(100%) +(90%) +(86.66%) + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Table 6: Visual Analogue Scale (VAS) measuring pain intensity recorded on Day 1 and Day 90 in +Both AY Group as well as Control Group. Values are Group mean ± SD. + +Sl. No. +Ayurveda and Yoga +Control + +Day 1 +Day 90 +Day 1 +Day 90 +VAS +7.30 +2.20***$ +7.13 +7.37 + +± 1.53 +± 1.24 +± 1.35 +± 1.06 + + *** p <.001, Paired Sample t-test comparing the Mean values of both groups on Day 90 compared +to Day 1 values respectively. +$ p <.001, One-way ANOVA comparing the Mean values of both groups on Day 90 compared to +Day 1 values respectively. + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT +Highlights +• The present study is the first attempt to evaluate the influence of Ayurveda and Yoga +on symptoms and quality of life in patients with Migraine Headache as a prospective +matched controlled trial. +• The AY group underwent Virechana (Therapeutic Purgation) for the first 15 days +followed by Shamanaushadha (pacificatory oral medicines) and Yoga therapy for 75 +days. The CT group continued on symptomatic treatment using conventional +medicine for 90 days. +• Prakriti questionnaire (SPI-Q and SPI-C) was administered to both groups on Day 1 +to understand their body constitution. The outcome measures included Symptom +checklist (recorded on Day 1, Day 30 and Day 90), Comprehensive Headache related +Quality of Life Questionnaire (CHQQ) and Visual Analogue Scale (VAS) (both +recorded on Day 1 and Day 90). +• Out of the 60 subjects belonging to both groups, 46 (76.6%) had Pitta based Prakriti +(either as pravara (primary) or as madhyama (secondary)). +• The AY group showed a significant reduction in the Migraine related symptoms viz., +number of attacks, duration of each attack, associated with nausea and vomiting, +severity of headache and analgesic requirements. +• There was a significant improvement in the total score of Headache related Quality of +Life along with a reduction in pain intensity. +• The CT group showed no significant change. +• An Integrated Ayurveda and Yoga-based intervention reduced symptoms, the intensity +of pain and improved Quality of life in Migraine patients. + + diff --git a/subfolder_0/Comments to Health realizationInnate health Can a quiet mind and a positive feeling state be accessible over the lifespan wit.txt b/subfolder_0/Comments to Health realizationInnate health Can a quiet mind and a positive feeling state be accessible over the lifespan wit.txt new file mode 100644 index 0000000000000000000000000000000000000000..35e060abbf08d7861b108623d1225c1ca3f8deea --- /dev/null +++ b/subfolder_0/Comments to Health realizationInnate health Can a quiet mind and a positive feeling state be accessible over the lifespan wit.txt @@ -0,0 +1,734 @@ +Health Realization/Innate Health: Can a quiet mind +and a positive feeling state be accessible over the +lifespan without stress-relief techniques? +Judith A. Sedgeman +Department of Community Medicine, West Virginia Initiative for Innate Health, West Virginia University, +Morgantown, WV, U.S.A. +Source of support: Departmental sources +Summary + + +Health Realization/Innate Health (HR/IH) questions long-held assumptions about chronic stress, +and challenges current defi + nitions of both stress and resiliency. HR/IH sets forth principles that +explain why the experience of psychological stress is not an effect of causal factors beyond peo- +ple’s control, but is an artifact of the energetic potential of the mind. HR/IH describes the “cog- +nitive factor” in stress not as the content of people’s thinking in response to stressors, but rather as +a quality of the way people hold and use their thinking, referred to as state of mind. + + +HR/IH hypothesizes that understanding principles that explain the nature and origin of thinking +and experience offers a means to access innate protective processes that are healing and antibi- +osenescent reliably and consistently, without techniques. HR/IH suggests that the primary effort +of mental health care could be to initiate life-long prevention of the state of chronic stress. In ad- +dition, HR/IH suggests that addressing mental well-being would have a broad impact on the inci- +dence and course of the many physical illnesses that are known to be stress-related. + + +The brief therapeutic interactions of HR/IH draw upon people’s innate wisdom and recognition +of the healthy perspective available to everyone. Anecdotal results suggest that people who gain +insight into the principles that explain the nature of thought and experience and who realize how +to re-access a natural, positive state of mind can and do experience sustained day-to-day peace of +mind, wisdom and well-being, regardless of circumstances. HR/IH deserves rigorous scientifi + c eval- +uation. + +key words: +resiliency theory • resiliency application • stress • coping • health • innate • +Health Realization • Innate Health + +Full-text PDF: +http://www.medscimonit.com/fulltxt.php?IDMAN=8224 + +Word count: +3436 + +Tables: +— + +Figures: +— + +References: +66 + Author’s address: +Judith A. Sedgeman, Assistant Professor, Department of Community Medicine, West Virginia University Health +Sciences Center, P.O. Box 9147, Morgantown, WV 26506, U.S.A., e-mail: jsedgeman@hsc.wvu.edu +Received: +2005.09.28 +Accepted: 2005.11.02 +Published: 2005.12.01 +HY47 +Hypothesis +WWW.MEDSCIMONIT.COM +© Med Sci Monit, 2005; 11(12): HY47-52 +PMID: 16319796 +HY +Current Contents/Clinical Medicine • SCI Expanded • ISI Alerting System • Index Medicus/MEDLINE • EMBASE/Excerpta Medica • Chemical Abstracts • Index Copernicus +BACKGROUND +The state of chronic stress underlies many disease states that +diminish quality of life and reduce life expectancy [1–5]. +And the state of chronic stress is a major contributor to the +infl + ation of national health care costs [6]. +Evidence has coalesced around the idea that the ultimate +answer to stress may not lie in addressing external stressors +but in exploring and enhancing internal human capacities. +The intent to develop means to comprehend, build and but- +tress human resiliency is predominant in both behavioral +[7–10] and biological [1,11–20] investigations. +This dual shift towards recognizing the experience of chron- +ic stress itself as an underlying contributor to many disease +states and towards seeing intrinsic human capacity as a heal- +ing mechanism has led to investigation of the biochemis- +try of a psychological immune system that addresses chron- +ic stress systemically. +Research has established the positive physiological and psy- +chological effects of resilience, as well as the extensive nega- +tive physiological and psychological effects of chronic stress +[1,8]. The persistent assumption that stress is a consequence +of factors outside of the control of the individual, howev- +er, has kept research attention on the relationship between +stressors and the individuals who are subject to them. As a +result, studies focus on how best to protect people from +stressors or equip them to respond to stressors as success- +fully as possible. A question for further study is how peo- +ple access their internal resiliency. What allows some peo- +ple to draw upon their internal strengths when they most +need them, while others are easily overwhelmed? What ex- +plains the power of the psychological immune system, and +why is it not consistently engaged or functioning? +The mechanisms of acute stress are readily apparent, and +have been for a century, since they were fi + rst described by +Walter Cannon [21]. But the mechanisms of chronic stress +are less clear. Hans Selye described the fi + nal, chronic stage +in his general adaptation response to stress as “exhaustion” +[22]. That remains a potent metaphor, although an inaccu- +rate scientifi + c description, of the effect of the state of stress +unrelieved over time, which has been shown to redirect the +body’s resources and thus leave the person vulnerable to dis- +ease [2]. But as Sapolsky points out [3], chronic stress does +not actually deplete hormonal resources, but keeps the body +in a constant, unrelieved state of hormonal imbalance, which +creates a “hormonal milieu” that fosters disease states [5]. +But why are people vulnerable to chronic stress? Why doesn’t +the body return to homeostasis after every encounter with +“stressors”? Why are some people in good circumstances un- +able to keep their bearings, while others in the worst of cir- +cumstances are able to remain stable? What is the common +underlying explanation for the varied responses to the same +stressors among different individuals? Why does each person +respond differently to the same stressors at different times? +Assumptions of current research +Current investigations of chronic stress are governed by un- +challenged assumptions. From the outset, stress has been +studied as an inevitable result of pressures beyond the con- +trol of those experiencing the stress. Cannon and Selye, both +using animal studies, established the scientifi + c basis for the +study of stress. Their work focused on physiologic responses +of animals to stressful external pressures, such as heat and +cold, prolonged restraint, surgical procedures. Ideas about +psychological stress in human beings were extrapolated from +the study of physiological stress responses in animals. Then, +early studies of human stress by Richard Rahe and others +[23–26] established the prevailing view that there are distinct, +measurable life stressors that cause stress, and even that those +life stressors can be ranked according to their level of infl + u- +ence on the degree of stress people experience. The stres- +sors were ranked by median responses to various situations. +Thus the question was never raised why one person might +call “going to the dentist” a 20 on the stress scale, while an- +other called it an 85. The broad variations in responses to +the same stressors have never been addressed. +Psychologists now refer to “toxic” circumstances, relation- +ships, emotions and events when describing stress-related syn- +dromes. Stress-coping presentations address “noxious” events +or “insults” to the psyche. Psychiatrists document “allostatic +load,” the weight of stressful and negative circumstances in +a person’s life history [27]. It is assumed that some degree +of stress is inevitable for all people, given the life demands +and challenges everyone must face. It is assumed that “re- +lief” from stress is a desirable, if temporary, departure from +that normal expectation. Techniques and methods that pro- +vide a respite from stress are seen as the appropriate focus +of stress remediation. The premise is that people who prac- +tice such techniques or methods still must cope with a re- +lentlessly stress-inducing milieu but are better equipped to +withstand and recover from stress [28–36]. +THE HEALTH REALIZATION/INNATE HEALTH CONCEPTUAL MODEL +Since the late 1970’s, a completely different way of under- +standing and addressing stress has been quietly spreading +through the helping professions. Known primarily as Health +Realization, or Innate Health, this work emerged from the +insights of Sydney Banks, a man who had spent much of his +life until the early 1970’s in a state of extreme stress and in- +security. The insights that set him free to transcend a life- +time of limitations came out of the blue, unsought, in a pro- +found experience. When he realized how much these simple, +but extraordinary, insights had changed him, he began to +share his knowledge with others, offering free public talks. +After a few psychologists and psychiatrists were exposed to +his insights and began to see and experience life different- +ly for themselves [37–40], they changed their minds about +what is possible in mental health and well-being, and de- +veloped a new approach to clients. The work ultimately be- +came a psychoeducational approach that is based on the +assumptions that (1) people have an innate wellspring of +psychological well-being from which to draw, and (2) any- +one can realize that and live from a healthy, wise, balanced +state of mind, regardless of the “stressors” and external cir- +cumstances encountered over time [38,40–42]. +Principles underlying HR/IH +Health Realization/Innate Health (HR/IH) suggests that +the prevailing fundamental assumptions about chronic +Hypothesis +Med Sci Monit, 2005; 11(12): HY47-52 +HY48 +stress are inherently fl + awed [43–46]. It proposes to replace +the theories of how and why stressors induce and sustain +stress from the outside-in with principles that explain how +and why the experience of stress is created from the inside- +out, regardless of circumstances. HR/IH describes univer- +sal principles that explain how people arrive at so many dif- +ferent ideas about the world and so many strategies about +how to cope with it [43–47]. Current therapeutic methods +concern themselves with what people think and how peo- +ple deal with what they think, and what has caused them to +think the way they think, all of which exist in the realm of +already-created experience. HR/IH addresses the fact that +people think, which represents the fundamental source of +experience, experience inchoate [38,43,47–49]. +The principles underlying HR/IH are Mind, Thought and +Consciousness [43,47]. The principle of Mind describes +the formless, infi + nite energy of all things. The principle of +Thought describes the capacity for the personal mind to +use that energy to form an infi + nitely variable personal real- +ity to express unique life. The principle of Consciousness +describes the capacity to be aware of the reality being cre- +ated, i.e. to perceive, recognize and experience ever-chang- +ing life [43,47]. These three principles combined refer to +a universal dynamic of creation that is constant. Each per- +son’s moment-to-moment thinking is variable, representing +the boundless array of potential forms energy can take. The +essential meaning of the principles is that thoughts are no +different from any other “forms” of life, always in motion, +ever-changing through an infi + nitude of possibilities, origi- +nating from the one formless, energetic source. +HR/IH operates at the emergent impetus for human in- +quiry and self-expression. There are ideas that point to it in +the current literature regarding the mind and the brain, for +example the defi + nition of the mind proposed by Stefano, +Fricchione, Slingsby & Benson [4, p6]: +“…in order for cognitive ability to develop and succeed, however, +there must fi + rst be a unifying consciousness to control or regulate +the many individual neural processes that potentially summate a +decision-making process. …That is, the brain represents only neu- +ral tissues organized into various neural patterns that can work +together or separately. Without a unifying component being able +to cope with a focus, the signifi + cance and uniqueness of this cop- +ing strategy would be lost. … Moreover, a unifi + ed entity, a ‘mind’, +would only be involved with experience-related phenomena (both +exteroceptive and interoceptive) since this is the realm in which cop- +ing strategies are designed.” +But HR/IH is a unique perspective because of its neutral +and non-specifi + c treatment of the creative power of thought +as evidence of the universal energy of Mind, rather than as +evidence of the strength of discrete external situations with +which the personal mind must interact. Most therapeutic +work focuses on the specifi + c content of people’s thinking as +though it were absolute, with no acknowledgement of the +subtle variations in thinking that arise from an ever-chang- +ing state of mind or feeling state. Once the process of think- +ing is realized, once people understand how their thinking +works to create reality and how powerful the transitory and +illusory images of thinking appear to be, they are set free +from living at the mercy of any thoughts they think. They +can see that the experience of stress and distress is actually +their own thought-consciousness manifesting negative, wor- +risome, distressing thoughts in the form of negative, worri- +some, distressing experience, and that those thoughts have +no life beyond the moment they are created and held in +their minds. They see the illusory, kaleidoscopic nature of +all formed thoughts. +THE HEALTH REALIZATION/INNATE HEALTH THERAPEUTIC +MODEL +HR/IH assumes that the state of stress is an occasional brief +and temporary interruption of life lived naturally in a heal- +ing, positive, antibiosenescent state. Moments of stress, reg- +istered as recognizable physical and psychological changes, +are regarded as valuable information about the temporari- +ly deteriorating quality of one’s state of mind (feeling state +and quality of thinking), rather than as upsetting informa- +tion about the negative reality of life circumstances. One +might say that the feeling of stress is a measure of the bar- +ometric pressure of the human mind, not the baromet- +ric pressure of life. If these assumptions hold under scruti- +ny, the need to develop and teach stress coping and stress +management strategies would be drastically reduced, if not +eliminated. People could recognize and access their own +natural resiliency to address life situations. By using their +feeling state as a guide to the quality of their thinking, with +the understanding that all thinking is illusory and fl + eeting +and will pass, they would naturally default to a quiet mind +and a positive feeling state. +HR/IH is innovative because it demands a departure from +prevailing assumptions. But because prevailing assumptions +are so strong, HR/IH is often linked with recognized ther- +apeutic models by people who try to explain it. For exam- +ple, it is often confused with, but is not related to, many +theories that draw on human spirituality and the ability +people consistently show to attain positive feeling states +and quietude under controlled or induced circumstanc- +es [9,12,34,50–54]. It is important to note that even spirit- +ually advanced and profound therapeutic approaches do +not depart from the notion that “stressors” are real and in- +evitable and must be dealt with by marshalling human re- +sources. Even when psychoneuroimmunology suggests that +“innate processes” are at work, it is taken for granted that +these arise from “remembered wellness” or primal learned +responses to external stressors [4,55]. The word “innate” +in that context appears to mean “internal to processes that +naturally occur within the body and brain.” But the word +“innate” in the context of HR/IH means the common, uni- +versal, infi + nite, intrinsic energy before the formation of the +body and the brain. +Comparison with current therapy models +Prevailing therapeutic assumptions, even those that are at the +leading edge of the discoveries of psychoneuroimmunology, +consistently seek to analyze, treat or stave off stressors that +are presumed to exist as factors separate from, and threat- +ening to, the people who must deal with them [1]. HR/IH +proposes that “stressors” are the moment-to-moment per- +ceptions of a mind innocently caught up in negative, up- +setting thinking without recognition and understanding of +the process that is driving the experience. HR/IH does not +question the existence of external life circumstances that +Med Sci Monit, 2005; 11(12): HY47-52 +Sedgeman JA – Innate health theory +HY49 +HY +affect people – physical discomfort or limitations, the up- +heavals of war and weather, unforeseen tragedies, etc. It +explains that there is an internal mediating factor between +such external factors and each individual’s experience of +them; the factors do not have the power to determine a per- +son’s reaction to them, the person has the power to deter- +mine how factors will affect him or her. +Because the principles of Mind, Consciousness and Thought +are linked to the idea of empowerment, they are often at- +tached by observers to familiar concepts of “reframing think- +ing” or “assertiveness” or “locus of control”. Yet the empow- +erment that arises from the principles in action is a much +different quality. It is not an experience of effort or willpow- +er. It is an experience of freedom before the thought of any +particular activity or frame of reference. +The power of the principles in action is seen as the very +ability to have and hold such ideas, i.e. the natural, intrin- +sic capacity of individual minds continually to make things +up and see them as real. Willpower, exercising personal +control, is thus a byproduct of that power, not an aspect of +it. It is a use of the personal mind – just as apathy is a use of +the mind, negativity is a use of the mind, positivity is a use +of the mind, anger is a use of the mind, good will is a use +of the mind, quietude is a use of the mind. +The principles distinguish Health Realization/Innate Health +from theories, such as cognitive-behavioral theory, or rational- +emotive theory, or behavior modifi + cation, or positive psychol- +ogy – or other conceptual frameworks – as means of “improv- +ing” thought or experience [38,44]. All theoretical teachings +are derived from the power of thought; they are thoughts or +thought systems made up by people using their own power +to see the world and make sense of what they see. +Therapeutic impact of HR/IH +The strength of HR/IH is that it opens hope and possibil- +ity even to those who have been caught in a certain way of +thinking for years because it allows them to pull back the +curtain and recognize themselves at the controls before the +thoughts they create. HR/IH practitioners do not try to talk +clients out of negative thoughts, or ask them to replace them +with other, more encouraging, thoughts or teach them how +to empty their mind of certain thoughts. HR/IH practition- +ers explain to clients that fundamental and powerful prin- +ciples are at work, and that they are experiencing the fact +of those principles as surely as a glass of water experiences +gravity when it slips out of someone’s hand and drops to the +fl + oor. As long as they have not yet realized their own ability to +create experience via thinking, they’re bound to get caught +in little whirlwinds of upsetting experiences. They may fi + ght +the content of the thoughts that create them and thus keep +them spinning in their minds, rather than allowing them to +pass as new thoughts come to mind. When they begin to see +the nature of thought, they are able to use distress as a warn- +ing sign to stop ruminating. Then their natural, resilient fl + ow +of thinking can resume. Upsetting thoughts lose their power; +they are no more real, and just as real, as any other thoughts. +The person becomes an artist holding the paintbrush, able +to create a constantly changing reality, rather than a victim +painted into a frightening scenario by thoughts that seem +out of his control and seem to be coming from life. +People realize they can navigate life using their feeling state +as a reliable guide to the moment-to-moment quality of their +thinking, knowing that the thinking process naturally self- +corrects. Unattended thoughts pass, the mind clears, con- +sciousness lifts, and from a quieter mind and positive feeling +state, people get increasingly functional ideas. The natural +tendency of the human mind at peace is towards wisdom +and insight [8,43,46,47], which might be called psycholog- +ical homeostasis. Chronic stress is not an actual enemy of +human well-being with which one must do battle; chron- +ic stress is an artifact of the human imagination in a nega- +tive state of mind. +IMPLICATIONS FOR RESEARCH +For more than 20 years, psychiatrists, psychologists, coun- +selors and social workers who have shared the principles +underlying Health Realization with clients from all walks +of life and across all diagnoses have consistently reported +common results [40,45,46]. Clients come to see life from +a perspective that allows them to operate from wisdom, +peace of mind, insight and strength and to accept negative +states of mind as an indicator of the quality of their think- +ing. Common sense tells them to allow their thinking to +pass in such cases until more constructive thinking comes +to mind [46,56–59]. +The logic of Health Realization indicates that research now +providing increasing evidence that a quiet mind, such as the +state of meditation, is a healing state that not only prevents +the effects of chronic stress [9,15,32,60–63] but may even re- +verse them [8,18,19,64,65] should be directed towards the +study of the unique and growing population [40,42,45,59] +of HR/IH clients. In that population are people who have +realized how to live day to day in a serene state of mind +regardless of past experiences, external challenges in the +present, or uncertainty about the future. +A study population could readily be identifi + ed. Over the +years, HR/IH has been a grassroots movement, spread +through demand from clients who saw others come to a +peace and sense of well-being they did not think possible, +and through word of mouth by practitioners and colleagues +who found hopefulness in working with clients that had elud- +ed them previously. There are thousands of practitioners +and many thousands of clients across the U.S. and in oth- +er countries. Many practitioners have gathered an exten- +sive array of qualitative and anecdotal results that fall out- +side current parameters for expected outcomes in mental +health [40,45,59]. Health Realization is now beginning to +be recognized by and incorporated into university programs +(e.g., San Jose State in California, UBC in British Columbia, +University of Minnesota, Portland State University in Oregon, +State University of West Georgia, West Virginia University) +and is appearing in curricula and textbooks in counseling, +education and prevention [66]. +CONCLUSIONS +Health Realization/Innate Health represents a paradigm +shift in the understanding and study of chronic stress. It ex- +plains the experience of stress as an inside-out process, orig- +inating within the mind. It suggests that people can recog- +nize how to access their own innate health and resiliency +Hypothesis +Med Sci Monit, 2005; 11(12): HY47-52 +HY50 +to live in a quiet mind and a positive feeling state. It sug- +gests that the experience of stress can be temporary, regard- +less of circumstances, and should be seen as a warning sig- +nal to allow the mind to quiet, rather than to focus on the +content of the thinking that is creating the negative feel- +ing state. HR/IH sees the research demonstrating that qui- +etude fosters psychological and physiological benefi + ts that +can ameliorate, or even reverse, the effects of chronic stress +as evidence for the pressing need to investigate its effects. +HR/IH is a new prevention strategy in mental health which +may hold promise for a signifi + cant reduction in the problem +of chronic stress. Evidence to date is anecdotal but compel- +ling and warrants carefully designed clinical studies. +Acknowledgements +William F. Pettit, MD, Medical Director of the West Virginia +Initiative for Innate Health, and a long-time practitioner of +Innate Health, provided guidance and useful commentary. +Sarah S. Quesen, MPH, Statistics Lecturer at West Virginia +University, provided editing suggestions regarding organi- +zation and clarity of material. Robert M. D’Alessandri, MD, +Vice President for Health Sciences, West Virginia University, +provided input and has consistently provided support and +mentorship to the evolution of Innate Health in theory and +practice. Sydney Banks, author, philosopher and friend, con- +tinues to inspire all those who pursue the dream of higher +levels of well-being for all people. +REFERENCES: + 1. Stefano GB et al: The Stress Response: Always Good and When +It Is Bad. New York: Medical Science International Co., 2005, 152 + 2. Charney DS: Psychobiological mechanisms of resilience and vul- +nerability: implications for successful adaptation to extreme stress. Am +J Psychiatry, 2004. 161(2): 195–216 + 3. Sapolsky RM: Why Zebras Don’t Get Ulcers. Henry Holt & Co., +LLC, 2004; 539 + 4. 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California School of Professional Psychology: +Los Angeles, CA, 1997 + 60. Benson H et al: Decreased blood-pressure in pharmacologically treat- +ed hypertensive patients who regularly elicited the relaxation response. +Lancet, 1974; 1(7852): 289–91 + 61. Benson H, Alexander S, Feldman CL: Decreased premature ventricu- +lar contractions through use of the relaxation response in patients with +stable ischaemic heart-disease. Lancet, 1975; 2(7931): 380–82 + 62. Ray O: How the Mind Hurts and Heals the Body. American Psychologist, +2004; 59(1): 29–40 + 63. Sapolsky RM, Krey LC, McEwen BS: The neuroendocrinology of stress +and aging: the glucocorticoid cascade hypothesis. Endocr Rev, 1986; +7(3): 284–301 + 64. Niess JH et al: Review on the infl + uence of stress on immune mediators, +neuropeptides and hormones with relevance for infl + ammatory bowel +disease. Digestion, 2002; 65(3): 131–40 + 65. 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Mooventhan2 / NK. Manjunath3 +Comparativestudyon effect of neutral spinal +bathand neutralspinal spray on blood pressure, +heart rateand heart rate variability in healthy +volunteers +1 Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), A Deemed to be Univer- +sity, #19, Eknath Bhavan, Gavipuram Circle, Kepegowda Nagar, Bengaluru, Karnataka, India +2 Division of Yoga and Life Sciences, Department of Research and Development, Swami Vivekananda Yoga Anusandhana Sam- +sthana (S-VYASA), A Deemed to be University, #19, Eknath Bhavan, Gavipuram Circle, Kepegowda Nagar, Bengaluru, Kar- +nataka, India, E-mail: dr.mooventhan@gmail.com +3 Division of Yoga and Life Sciences & Head, Department of Research and Development, Swami Vivekananda Yoga Anusand- +hana Samsthana (S-VYASA), A Deemed to be University, #19, Eknath Bhavan, Gavipuram Circle, Kepegowda Nagar, Ben- +galuru, Karnataka, India +Abstract: +Background: Hydrotherapeutic applications to the head and spine have shown to improve cardiovascular and +autonomic functions. There is lack of study reporting the effect of either neutral spinal bath (NSB) or neutral +spinal spray (NSS). Hence, the present study was conducted to evaluate and compare the effects of both NSB +and NSS in healthy volunteers. +Methods: Thirty healthy subjects were recruited and randomized into either neutral spinal bath group (NSBG) +or neutral spinal spray group (NSSG). A single session of NSB, NSS was given for 15 min to the NSBG and +NSSG, respectively. Assessments were taken before and after the interventions. +Results: Results of this study showed a significant reduction in low-frequency (LF) to high-frequency (HF) +(LF/HF) ratio of heart rate variability (HRV) spectrum in NSBG compared with NSSG (p=0.026). Within-group +analysis of both NSBG and NSSG showed a significant increase in the mean of the intervals between adjacent +QRS complexes or the instantaneous heart rate (HR) (RRI) (p=0.002; p=0.009, respectively), along with a signif- +icant reduction in HR (p=0.002; p=0.004, respectively). But, a significant reduction in systolic blood pressure +(SBP) (p=0.037) and pulse pressure (PP) (p=0.017) was observed in NSSG, while a significant reduction in dias- +tolic blood pressure (DBP) (p=0.008), mean arterial blood pressure (MAP) (p=0.008) and LF/HF ratio (p=0.041) +was observed in NSBG. +Conclusion: Results of the study suggest that 15 min of both NSB and NSS might be effective in reducing HR +and improving HRV. However, NSS is particularly effective in reducing SBP and PP, while NSB is particularly +effective in reducing DBP and MAP along with improving sympathovagal balance in healthy volunteers. +Keywords: autonomic functions, blood pressure, heart rate, hydrotherapy, naturopathy, spine +DOI: 10.1515/jcim-2018-0118 +Received: July 31, 2018; Accepted: September 4, 2018 +Introduction +Hydrotherapy uses water in its various forms (water, ice and steam) at various temperatures for health promo- +tion and disease prevention and management [1]. Spinal bath is a local, non-pressurized hydratic measure in +which the pre-spinal and para-spinal area is immersed in water of required temperature for a specific duration +to get the desired effects [2]. Spinal spray is a local, slightly pressurized hydratic measure in which the spinal +area is exposed to water of certain temperature for a specific duration to get the desired effects [3]. Cardiovas- +cular diseases (CVDs) are the main cause of mortality worldwide. CVD is associated with lifestyle, especially +physical inactivity, the use of tobacco, unhealthy diet habits, and psychosocial stress. The World Health Organi- +zation has stated that over three-quarters of CVD deaths could be prevented with lifestyle changes. Immersion +in thermo-neutral water and spa bathing were used to treat cardiovascular risk factors. Evidence suggests that +A. Mooventhan is the corresponding author. +© 2018 Walter de Gruyter GmbH, Berlin/Boston. +1 +Brought to you by | Université de Strasbourg +Authenticated +Download Date | 10/20/18 12:18 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Goley et al. +DE GRUYTER +the thermo-neutral water has antihypertensive effect, which is essential for the prevention as well as the man- +agement of lifestyle diseases like CVD [4]. +Heart rate variability (HRV) is one of the most commonly used non-invasive tools that measures cardiac au- +tonomic nervous system and helps to distinguish sympathetic from the parasympathetic activity [5]. There are +various studies reporting the effect of either cold water [6, 7] or hot water applications [8–11] on cardiovascu- +lar variables. But, though neutral water is being widely used in many of the naturopathic hospitals in India for +general health promotion and treatment of various diseases including CVDs, there is a lack of studies reporting +its effect on cardiovascular [12] and autonomic functions [13]. Hydrotherapeutic applications to the head and +spine have shown to improve cardiovascular [14] and autonomic functions [1], However, there is lack of study +reporting the effect of either neutral spinal bath (NSB) or neutral spinal spray (NSS). Hence, the present study +was conducted with the objective to evaluate and compare the effects of NSB and NSS on BP, heart rate (HR) +and HRV in healthy volunteers. +Materials and methods +Study design +This is a parallel-group pilot randomized comparative trial. Recruited subjects were randomly (1:1 ratio) allo- +cated to either a neutral spinal bath group (NSBG) or a neutral spinal spray group (NSSG). The NSBG subjects +received one session of NSB, while the NSSG received one session of NSS for the duration of 15 min. Assess- +ments were taken prior to and after the respective intervention. +Subjects +Thirty healthy subjects of both the genders were recruited from a residential university located in South India. +Both male and female genders aged 18 years and above who are willing to participate in the study were included +in the study. Subjects with the history of any systemic and/or mental illness, chronic smoking and alcoholism +and females during menstruations were excluded from the study. The study protocol was approved by the +institutional ethics committee and informed consents were obtained from all the subjects. +Interventions +Neutralspinal bath group +Spinal bath tubs are made up of fibre material and are water proof and non-allergic. The water level in the tub +was one and half inches to two inches. The subjects were asked to lie down in a spinal bath tub [filled with water +(32–33 °C)] with minimum dress for 15 min, with the head on the side that was most slanted, while the buttock +was at the opposite side end. Upper and lower limbs were kept outside the tub and adjusted in such manner +that water should immerse the entire length of the spine, from the nape of the neck to the lowest portion of the +spine [2]. +Neutral spinal spraygroup +A spinal spray tub consists of a fiber perforated tube at the center of the tub. This tube is connected with a pipe +to a 0.5 H.P. motor adjusted below the tub which is connected to water supply. The subjects were asked to be +in minimum dress and made to lie down in supine posture resting the entire back in a spinal spray tub filled +with water (32–33 °C) in such manner that the pores present in tub were occupied by the subject’s spine and +keeping the head and limbs outside the tub for the duration of 15 min [3]. +Temperature of the water was measured using hydratic thermometer (water thermometer). +Assessments +The primary (BP) and secondary (HR and HRV) outcome measures were taken before and after the intervention +by one of the authors who was blind to NSBG and NSSG. +2 +Brought to you by | Université de Strasbourg +Authenticated +Download Date | 10/20/18 12:18 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Goley et al. +Blood pressure (BP): Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before +and after the intervention using sphygmomanometer. +HR and HRV: HR and HRV were assessed (5 min at baseline and 5 min after intervention) using a four- +channel polygraph (Polyrite D, Recorders and Medicare Systems, Chandigarh, India). The Ag/AgCl pre-gelled +electrodes were placed according to the standard limb lead II configuration to record electrocardiogram. Data +were acquired at the sampling rate of 1,024 Hz [1]. +Data extraction +Time domain and frequency domain analysis of baseline and post-intervention HRV data were performed +using HRV analysis software (Kubios-HRV version 2.0) developed by the Biomedical Signal Analysis Group +(University of Kuopio, Finland) [15]. The time domain HRV variables such as (1) the mean of the intervals +between adjacent QRS complexes or the instantaneous HR (RRI), (2) standard deviation of RR intervals (SDNN), +(3) HR, (4) the square root of the mean of the sum of the squares of differences between adjacent NN intervals +(RMSSD), (5) the number of interval differences of successive NN intervals greater than 50 ms (NN50) and +(6) the proportion derived by dividing NN50 by the total number of NN intervals (pNN50) were analysed [1]. +Similarly, the frequency domain of HRV such as low-frequency (LF) band (0.04–0.15 Hz) and high-frequency +(HF) band (0.15–0.4 Hz) in normalized units and LF/HF ratio were also analysed [16]. Assessments such as +pulse pressure (PP) and mean arterial pressure (MAP) were derived using the following formulas. PP was +calculated by using (SBP −DBP) and MAP by using (DBP + ￿PP) [14] +Sample size +Thirty healthy subjects of both the genders with the age varying from 18 to 25 years were recruited from a +residential university located in South India. Sample size was not calculated based on any previous study. +Randomization +All the subjects were randomly allocated to either a NSBG or a NSSG using computerized randomization. A +simple randomization procedure with 1:1 ratio was done for 30 subjects to get a sample size of (n=15) in each +group. Until interventions were assigned, the random allocation of the intervention was kept in opaque sealed +envelopes. An author who did not involve in assessments performed the randomization. +Blinding +Subjects were not blinded to their intervention. However, the investigator was kept blind to the NSBG and +NSSG. +Data analysis +Data were checked for normality using Kolmogorov–Smirnov test. Statistical analysis of within group was +performed using Student’s paired samples t-test (data that assumed normal distribution) and Wilcoxon signed +ranks test (data that did not assume normal distribution) and between group was performed using independent +samples t-test (data that assumed normal distribution) and Mann–Whitney U test (data that did not assume +normal distribution) using Statistical Package for the Social Sciences (SPSS) for Windows, Version 16.0. Chicago, +SPSS Inc. p-value<0.05 was kept as significant. +Results +Recruited 30 subjects were randomly allocated to either a NSBG or a NSSG. The details of the demographic +variables of both NSBG and NSSG are given in Table 1. There were no significant differences in the baseline of +all the variables between NSBG and NSSG except PP. Results of this study showed a significant reduction in +3 +Brought to you by | Université de Strasbourg +Authenticated +Download Date | 10/20/18 12:18 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Goley et al. +DE GRUYTER +LF/HF ratio in NSBG compared with NSSG. Within-group analysis showed a significant increase in RRI and +insignificant increase in SDNN, RMSSD, NN50, pNN50 and HF spectrum of HRV with a significant reduction +in HR and insignificant reduction in LF spectrum of HRV both in NSBG and in NSSG. However, a significant +reduction in SBP and PP was observed in NSSG, while a significant reduction in DBP, MAP and LF/HF ratio +was observed in NSBG (Table 2). +Table 1: Demographic variables of the neutral spinal bath and neutral spinal spray groups. +Variables +Neutral spinal bath group (n=15) +Neutral spinal spray group (n=15) +Age, years +20.53 ± 1.77 +21.27 ± 2.09 +Gender +Males (n=4), females (n=11) +Males (n=6), females (n=9) +Height, m +1.60 ± 0.07 +1.632 ± 0.07 +Weight, kg +52.33 ± 6.42 +54 ± 5.67 +Body mass index, kg/m2 +20.35 ± 1.73 +20.32 ± 2.18 +Table 2: Baseline and post-test assessments of neutral spinal bath group (n=15) and neutral spinal spray group (n=15). +Variables +Assessment +Neutral spinal bath group (n=15) with +within-group analysis +Neutral spinal spray +group (n=15) with within- +group analysis +Between-group +analysis +t/z +value +p-value +SBP, +mmHg +Baseline +109.87 ± 10.10 +113.73 ± 11.41 +0.983 +0.334! +Post-test +108.00 ± 10.14 +108.53 ± 11.70 +0.133 +0.895! +t=0.969 +p=0.349* +t=2.312 +p=0.037* +DBP, +mmHg +Baseline +71.07 ± 9.47 +66.67 ± 11.18 +1.346 +0.178ˆ +Post-test +63.60 ± 6.56 +68.80 ± 8.94 +1.817 +0.080! +z=2.661 +p=0.008 +z=0.911 +p=0.362 +PP, +mmHg +Baseline +38.80 ± 11.00 +47.07 ± 9.88 +2.165 +0.039! +Post-test +44.40 ± 10.37 +39.73 ± 12.98 +1.088 +0.286! +t=1.844 +p=0.087* +t=2.700 +p=0.017* +MAP, +mmHg +Baseline +84.00 ± 8.18 +82.36 ± 10.25 +0.486 +0.631! +Post-test +78.40 ± 6.25 +82.04 ± 7.84 +1.408 +0.170! +t=3.076 +p=0.008* +t=0.139 +p=0.891* +RRI, ms +Baseline +745.40 ± 74.99 +745.47 ± 133.24 +0.002 +0.999! +Post-test +789.65 ± 67.63 +791.39 ± 133.79 +0.768 +0.443ˆ +t=3.889 +p=0.002* +z=2.613 +p=0.009 +SDNN, +ms +Baseline +53.67 ± 14.41 +52.46 ± 15.92 +0.436 +0.663ˆ +Post-test +54.12 ± 12.15 +60.64 ± 21.29 +1.030 +0.312! +t=−0.159 +p=0.876* +z=1.108 +p=0.268 +HR, +beat- +s/mint +Baseline +81.79 ± 8.88 +82.85 ± 11.91 +0.276 +0.784! +Post-test +76.90 ± 6.86 +77.89 ± 10.16* +0.312 +0.757! +t=3.838 +p=0.002* +t=3.482 +p=0.004* +RMSSD, +ms +Baseline +34.92 ± 8.65 +38.17 ± 17.24 +0.652 +0.520! +Post-test +42.82 ± 16.15 +47.70 ± 29.24 +0.394 +0.693ˆ +z=1.534 +p=0.125 +z=1.563 +p=0.118 +NN50, +count +Baseline +60.53 ± 36.33 +55.87 ± 45.87 +0.312 +0.755ˆ +Post-test +64.00 ± 32.02 +77.13 ± 59.91 +0.749 +0.460! +t=0.898 +p=0.384* +z=1.449 +p=0.147 +pNN50, +% +Baseline +15.57 ± 10.21 +15.49 ± 14.89 +1.038 +0.299ˆ +Post-test +16.97 ± 8.63 +21.67 ± 19.18 +0.866 +0.394! +t=0.145 +p=0.887* +z=1.761 +p=0.078 +4 +Brought to you by | Université de Strasbourg +Authenticated +Download Date | 10/20/18 12:18 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Goley et al. +LF, n.u. +Baseline +57.54 ± 14.44 +60.29 ± 16.73 +1.329 +0.184ˆ +Post-test +49.99 ± 11.69 +59.91 ± 16.95 +1.867 +0.072! +t=1.973 +p=0.069* +z=0.454 +p=0.649 +HF, n.u. +Baseline +42.46 ± 14.44 +39.78 ± 16.71 +1.329 +0.184ˆ +Post-test +50.04 ± 11.71 +40.09 ± 16.95 +1.871 +0.072! +t=1.980 +p=0.068* +z=0.454 +p=0.649 +LF/HF +ratio +Baseline +1.88 ± 2.03 +1.75 ± 1.73 +1.246 +0.213ˆ +Post-test +1.18 ± 0.91 +2.05 ± 1.58 +2.220 +0.026ˆ +z=2.045 +p=0.041 +z=−0.114 +p=0.910 +Note: All values are in mean  ±  standard deviation. Values in bold=p-value <0.05. *=Paired samples t-test; ¶=Wilcoxon signed ranks test; +!=Independent samples t-test; ˆ=Mann-Whitney U test. SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; +MAP, mean arterial pressure; RRI, the intervals between adjacent QRS complexes or the instantaneous heart rate; standard deviation of +RR intervals (SDNN); HR, heart rate; the square root of the mean of the sum of the squares of differences between adjacent NN intervals +(RMSSD); NN50=the number of interval differences of successive NN intervals greater than 50 ms; pNN50=proportion derived by +dividing NN50 by the total number of NN intervals; LF, low frequency; HF, high frequency; n.u.=Normalized units; LF/HF ratio, ratio of +low frequency to high frequency. +Discussion +SBP, DBP, PP and MAP are the commonest and most important indicator of CVD risks [17]. Physical, mental, +cognitive and emotional activities modulate the HR. A beat-to-beat modulation in HR following physiologi- +cal variation is called HRV. Evidence suggests that HR and HRV are the most sensitive and easily accessible +indicators of parasympathetic and sympathetic activity and autonomic regulation [16]. +Results of this study showed a significant reduction in DBP, MAP in NSBG and a significant reduction in +SBP and PP in NSSG. It suggests that application of 15 min of NSB was effective in reducing DBP and MAP, +while the application of 15 min of NSS was effective in reducing the SBP and PP in healthy volunteers. +The hydrostatic pressure created by the head-out water immersion shifts peripheral blood into the thoracic +vasculature, thereby increasing central blood volume, stroke volume, cardiac output (CO) and central venous +pressure. This increase in central venous pressure is likely to stimulate arterial pressure and lower cardiopul- +monary pressure. This process is known to augment parasympathetic activity and inhibit sympathetic activity, +leading to bradycardia [2]. Thus, in the present study, reduction in the blood pressure (BP) variables might +possibly attributed primarily to the effects on reduction of HR. Because BP is the outcome of both CO and +peripheral resistance, wherein CO is the outcome of HR and stroke volume and thus HR forms one of the de- +terminants of BP; hence the reduction of HR in this study might reduce the BP indices by decreasing CO [14]. +Other possible reason for the reduction of BP might be due to humoral control mechanisms, because in a previ- +ous study on immersion at 32 °C it has shown to produce a significant reduction in HR, SBP and DBP along with +a significant reduction in plasma renin activity, plasma cortisol and aldosterone concentrations, and thus the +physiological changes induced by water immersion were reported to mediate by humoral control mechanisms +[12]. However, the reduction in DBP and MAP only in NSBG and a reduction in SBP and PP only in NSSG is +not clear and needs to be explored in future studies. +The time domain analysis of HRV mainly reflects parasympathetic activity, while the frequency domain +analysis reflects overall autonomic balance. Results of this study showed a significant reduction in HR and +a significant increase in RRI along with insignificant increase in all the other time domain variables such as +SDNN, RMSSD, NN50 and pNN50 both in NSBG and in NSSG compared to its respective baseline. Likewise, +there was a trend towards reduction (insignificant) in LF spectrum of HRV and increase (insignificant) in HF +spectrum of HRV both in NSBG and in NSSG. It suggests that 15 min of both NSB and NSS might have ef- +fect in reducing HR and in improving HRV towards parasympathetic dominance or sympathetic withdrawal. +Because the time domain measures of the HRV, i. e. mean RRI, HR, RMSSD and NN50, have been recognized +as stronger predictors of vagal modulation [1]. However, a significant reduction in LF/HF ratio in NSBG in +within- and between-group analysis, unlike NSSG, revealed the presence of better sympathovagal balance in +NSBG compared to NSSG. Previous studies on thermo-neutral water immersion [13] and NSS [3] also reported +the enhanced parasympathetic activity [3, 13], which is supporting the results of the present study. +Strength of the study: To the best of our knowledge, this is the first ever study evaluating the effect of NSB +and comparing the effect of NSB with NSS on HRV and BP in healthy subjects. None of the subjects reported +any adverse effect during intervention. +Limitations of the study: 1) Study was conducted in the healthy subjects that limit the scope of this study in +pathological conditions, 2) Small sample size and sample size calculation was not performed using any previ- +ous/pilot study, 3) Lack of control group to differentiate the effect of NSB and NSS from a simple supine lying, +5 +Brought to you by | Université de Strasbourg +Authenticated +Download Date | 10/20/18 12:18 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Goley et al. +DE GRUYTER +and 4) Long-term effect of NSB and NSS on HRV and BP was not assessed. Hence, further studies with a control +group are required in a large sample size for a better understanding of its precise cardiovascular effects. +Conclusions +Results of the study suggest that 15 min of both NSB and NSS might be effective in reducing HR and in improv- +ing HRV. However, NSS is particularly effective in reducing SBP and PP while NSB is particularly effective in +reducing DBP and MAP along with improving sympathovagal balance in healthy volunteers. +Author contributions: All the authors have accepted responsibility for the entire content of this submitted +manuscript and approved submission. +Research funding: None declared. +Employment or leadership: None declared. +Honorarium: None declared. +Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis +and interpretation of data; in the writing of the report or in the decision to submit the report for publication. +References +[1] Mooventhan A, Nivethitha L. Effects of ice massage of the head and spine on heart rate variability in healthy volunteers. J Integr Med. +2016;14:306–10. +[2] Shetty GB, Shetty P +, Shetty B. Immediate effect of cold spinal bath on autonomic and respiratory variables in hypertensives. World J +Pharm Med Res. 2016;2:236–40. +[3] Avanthika G, Sujatha KJ, Shetty P +. Immediate effect of cold and neutral spinal spray on autonomic functions in healthy volunteers – A +comparative study. IOSR J Dental Med Sci. 2017;16:18–24. +[4] Naumann J, Sadaghiani C, Bureau N, Schmidt S, Huber R. Outcomes from a three-arm randomized controlled trial of frequent immersion +in thermoneutral water on cardiovascular risk factors. BMC Complem Altern Med. 2016;16:250. +[5] Muralikrishnan K, Balakrishnan B, Balasubramanian K, Visnegarawla F. Measurement of the effect of Isha Yoga on cardiac autonomic +nervous system using short-term heart rate variability. J Ayurveda Integr Med. 2012;3:91–6. +[6] Roberts LA, Muthalib M, Stanley J, Lichtwark G, Nosaka K, Coombes JS, et al. Effects of cold water immersion and active recovery on +hemodynamics and recovery of muscle strength following resistance exercise. 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J Physiol. 2016;594:5329–42. +[11] Findikoglu G, Cetin EN, Sarsan A, Senol H, Yildirim C, Ardic F. Arterial and intraocular pressure changes after a single-session hot-water +immersion. Undersea Hyperb Med. 2015;42:65–73. +[12] Srámek P +, Simecková M, Janský L, Savlíková J, Vybíral S. Human physiological responses to immersion into water of different tempera- +tures. Eur J Appl Physiol. 2000;81:436–42. +[13] Florian JP +, Simmons EE, Chon KH, Faes L, Shykoff BE. Cardiovascular and autonomic responses to physiological stressors before and after +six hours of water immersion. J Appl Physiol (1985). 2013;115:1275–89. +[14] Mooventhan A. Immediate effect of ice bag application to head and spine on cardiovascular changes in healthy volunteers. Int J Health +Allied Sci. 2016;5:53–6. +[15] Tarvainen MP +, Niskanen JP +, Lipponen JA, Ranta-Aho PO, Karjalainen PA. Kubios HRV-heart rate variability analysis software. Comput +Methods Prog Biomed. 2014;113:210–20. +[16] Tyagi A, Cohen M. Yoga and heart rate variability: A comprehensive review of the literature. Int J Yoga. 2016;9:97–113. +[17] Nivethitha L, Mooventhan A, Manjunath NK. A pilot study on evaluating cardiovascular functions during the practice of Bahir Kumbhaka +(external breath retention). Adv Integr Med. 2017;4:7–9. +6 +Brought to you by | Université de Strasbourg +Authenticated +Download Date | 10/20/18 12:18 PM diff --git "a/subfolder_0/Coping Strategy, Life Style and Health Status During Phase 3 of Indian National Lockdown for COVID-19 Pandemic\342\200\224A Pan-India Survey.txt" "b/subfolder_0/Coping Strategy, Life Style and Health Status During Phase 3 of Indian National Lockdown for COVID-19 Pandemic\342\200\224A Pan-India Survey.txt" new file mode 100644 index 0000000000000000000000000000000000000000..19e83cc809442d7d20d87f35354060ca439984b7 --- /dev/null +++ "b/subfolder_0/Coping Strategy, Life Style and Health Status During Phase 3 of Indian National Lockdown for COVID-19 Pandemic\342\200\224A Pan-India Survey.txt" @@ -0,0 +1,2005 @@ +ORIGINAL RESEARCH +published: 18 May 2022 +doi: 10.3389/fpubh.2022.814328 +Frontiers in Public Health | www.frontiersin.org +1 +May 2022 | Volume 10 | Article 814328 +Edited by: +Larry K. Olsen, +Logan University, United States +Reviewed by: +Parmeshwar Satpathy, +Indian Institute of Technology +Kharagpur, India +Mujeeb Zafar Banday, +Government Medical College +(GMC), India +*Correspondence: +Raghuram Nagarathna +rnagaratna@gmail.com; +rnagaratna@svyasa.edu.in +Akshay Anand +akshay1anand@rediffmail.com +Specialty section: +This article was submitted to +Public Health Education and +Promotion, +a section of the journal +Frontiers in Public Health +Received: 13 November 2021 +Accepted: 06 April 2022 +Published: 18 May 2022 +Citation: +Nagarathna R, Sharma MNK, +Ilavarasu J, Kulkarni R, Anand A, +Majumdar V, Singh A, Ram J, Rain M +and Nagendra HR (2022) Coping +Strategy, Life Style and Health Status +During Phase 3 of Indian National +Lockdown for COVID-19 +Pandemic—A Pan-India Survey. +Front. Public Health 10:814328. +doi: 10.3389/fpubh.2022.814328 +Coping Strategy, Life Style and +Health Status During Phase 3 of +Indian National Lockdown for +COVID-19 Pandemic—A Pan-India +Survey +Raghuram Nagarathna 1*, Manjunath N. K. Sharma 1, Judu Ilavarasu 1, Ravi Kulkarni 1, +Akshay Anand 2,3,4*, Vijaya Majumdar 1, Amit Singh 1, Jagat Ram 5, Manjari Rain 2 and +Hongasandra R. Nagendra 1 +1 Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India, 2 Neuroscience Research Lab, Department of +Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 3 CCYRN – Collaborative Centre for +Mind Body Intervention Through Yoga, Post Graduate Institute of Medical Education and Research, Chandigarh, India, +4 Centre of Phenomenology and Cognitive Sciences, Panjab University, Chandigarh, India, 5 Department of Ophthalmology, +Postgraduate Institute of Medical Education and Research, Chandigarh, India +The implementation of timely COVID-19 pan-India lockdown posed challenges to the +lifestyle. We looked at the impact of lifestyle on health status during the lockdown in +India. A self-rated scale, COVID Health Assessment Scale (CHAS) was circulated to +evaluate the physical health or endurance, mental health i.e. anxiety and stress, and +coping ability of the individuals under lockdown. This is a pan-India cross-sectional +survey study. CHAS was designed by 11 experts in 3 Delphi rounds (CVR = 0.85) +and was circulated through various social media platforms, from 9th May to 31st May +2020, across India by snowball circulation method. CHAS forms of 23,760 respondents +were downloaded from the Google forms. Logistic regression using R software was +used to compare vulnerable (>60 years and with chronic diseases) with non-vulnerable +groups. There were 23,317 viable respondents. Majority of respondents included males +(58·8%). Graduates/Postgraduates (72·5%), employed (33·0%), businessmen (6·0%), +and professionals (9·7%). The vulnerable group had significantly (OR 1.31, p < 0.001) +higher representation of overweight individuals as compared to non-vulnerable group. +Regular use of tobacco (OR 1.62, p = 0.006) and other addictive substances (OR +1.80, p = 0.039) showed increased vulnerability. Respondents who consume junk food +(OR 2.19, p < 0.001) and frequently snack (OR 1.16, p < 0.001) were more likely to +be vulnerable. Respondents involved in fitness training (OR 0.57, p < 0.001) or did +physical works other than exercise, yoga, walk or household activity (OR 0.88, p = +0.004) before lockdown were less likely to be vulnerable. Majority had a very good +lifestyle, 94.4% never smoked or used tobacco, 92.1% were non-alcoholic, 97.5% never +used addictive substances, 84.7% had good eating habits, 75.4% were vegetarians, +Nagarathna et al. +Lifestyle During Lockdown in India +82.8% had “good” sleep, 71.7% did physical activities. Only 24.7% reported “poor” +coping ability. Depression with somewhat low feeling were more likely to be vulnerable +(OR 1.26, p < 0.001). A healthy lifestyle that includes healthy eating, proper sleep, +physical activeness and non-addictive habits supports better coping ability with lesser +psychological distress among Indian population during lockdown. +Keywords: COVID-19, public health, stress, coping strategy, lockdown +INTRODUCTION +The past two decades have witnessed three highly pathogenic, +novel zoonotic CoVs, first SARS-CoV-1 was recognized in 2002, +followed by MERS-CoV in 2012 and now as a more virulent +strain, the SARS-CoV-2 causing COVID-19 (1). Based on the +estimated report of the instantaneous reproduction number +(Rt) on the severity in China, several countries implemented +social distancing, hygiene etiquettes, contact tracing, wearing face +masks, temperature checks, and avoided premature relaxation of +the lockdown (2). The largest timely lockdown was enforced in +India after its first case on 30th Jan 2020 (3). +The +present +COVID-19 +pandemic +affected +global +mental +health, +as +evidenced +initially +by +panic-buying, +worldwide. +Following +any +natural +disaster, +survivors +are +prone to develop post-traumatic stress disorder (PTSD). +For instance, survivors of the August 2008 floods in India +(Bihar) had shown higher scores for PTSD (4). Similarly, +studies in China showed high level of depression with low +health-related +quality +of +life +(HRQoL) +and +high +scores +on PTSD symptoms with no significant changes during +COVID-19 (5, 6). +The first large-scale community-based cohort study on +387,109 adults in UK concluded that an unhealthy lifestyle +(smoking, physical inactivity, obesity, and excessive alcohol +intake) is a risk factor for hospital admission for COVID- +19 (7). A study on Italian children observed increased screen +time and sleep time, increased consumption of potato chips, +red meat, and sugary drink and decrease in time spent in +sports activities, which may have lasting impact on adiposity +(8). The incidence, progression and death rate during this +pandemic in India seems to be much lesser than other +countries [COVID-19 Worldwide Dashboard | WHO Live +World Statistics]. The reasons being India’s relatively younger +population, early biggest national lockdown (9), and a unique +mutation in the spike surface glycoprotein [A930V (24351C +> T)] in the Indian SARS-CoV-2 (10). A recent survey in +Indian cohort showed that the level of psychological distress +was lesser than the Chinese population on IES-R (11). There +are unpublished observations that the traditional life style of +the Indian families may also be a contributory factor. As +there were no nationwide studies looking at the impact of +life style on vulnerability during first wave and lockdown, we +executed this pan-India on-line survey. The objective of the study +was to investigate physical and mental health, lifestyle and to +examine activities adapted by people to cope with COVID-19 +and lockdown. +MATERIALS AND METHODS +CHAS Survey and Study Subjects +This was a nationwide survey on general Indian population +during the 3rd phase of lockdown for COVID-19 pandemic that +had respondents from all States/Union Territories except Ladakh +and Lakshadweep. COVID Health Assessment Scale (CHAS), +prepared in 10 languages by a committee of 11 experts through +3 Delphi rounds [Content Valid Ratio (CVR) was 0.85], had +questions related to life style behavior (exercise, diet, additive +substances, and sleep), physical health (BMI, chronic diseases, +and endurance), mental health (fear, anxiety, depression, stress), +and coping ability [refer to CHAS questionnaire from reference +(12)]. Endurance under physical health signifies durability or +ability to perform physical work for longer duration of time +without feeling breathlessness. Further, coping ability is defined +as conscious and unconscious efforts and strategies acquired +by respondents such as reading, cooking and others to reduce +emotional impact of challenging situation created by pandemic +and lockdown. +Phone calls and special requests were sent to different +sections of the society (∼200 universities, corporate companies, +healthcare institutions, government organizations, wellness +centers, and their networks) to acquire data by snowball method. +Participants filled the online forms, if they were willing to answer +the subjected questions. Hence, there were no exclusion and +inclusion criteria for participants. +The responses were collected from May 9, 2020 to May 31, +2020. Responses from non-Indians and aged <18 years were not +considered for analysis. After quality control, the participants +were divided into vulnerable and non-vulnerable groups based +on presence of co-morbidities and age >60 years. Respondents +were considered vulnerable when their age was above 60 years +and/or they have any chronic disease as these two conditions +increases the risk of getting infected with COVID-19 and risk of +severe outcome. For zone wise analyses, the 34 states/UTs were +divided into 3 zones based on the number of positive cases in +the state as on 31st May 2020 (source: Ministry of health and +Family Welfare, Government of India). The groups were red +zone (>10,000 cases including Maharashtra, Tamil Nadu, Delhi, +Gujarat), orange zone (5,000 to 10,000 cases including Rajasthan, +Madhya Pradesh, Uttar Pradesh), and green zone (<5,000 cases +including remaining states and UTs). +Statistical Analysis +The CHAS data received from the Google drive in ten +languages were combined into one dataset. R Statistical software, +Frontiers in Public Health | www.frontiersin.org +2 +May 2022 | Volume 10 | Article 814328 +Nagarathna et al. +Lifestyle During Lockdown in India +version 4.0.0, was used for data cleaning, extraction, and +analyses. Incomplete and unreliable responses were excluded. +Logistic regression was used to compare respondents under two +categories viz. vulnerable and non-vulnerable. Arsenal package +was used to test significance on cross tabulations on categorical +variables. Reference for Odd’s ratio (OR) calculation was set to +sequential contrast for all ordinal variables and first row and first +column for nominal variables. +RESULTS +Of the 23,760 respondents, participants from other countries +(n = 401) and marked as other genders (n = 42) were excluded. +Data was analyzed for 23,317 respondents. Logistic regression +to compare 4,416 vulnerable participants with 18,901 non- +vulnerable participants showed that graduates (OR 0.77, p < +0.001) were less likely to and postgraduates (OR 1.11, p = +0.027) were more likely to be associated with vulnerability +than non-graduates (Table 1). Students were less likely to be +associated with vulnerability than agriculturists (OR 0.26, p < +0.001). Businessmen (OR 1.87, p < 0.001), homemakers (OR +2.91, p < 0.001), professionals (OR 1.72, p < 0.001) and those +in other occupations (OR 1.40, p = 0.005) were more likely +to be vulnerable as compared to agriculturists (Table 1). Of +note, only 3.2% were agriculturists and 48.7% were actively +working professionals (6.0% business, 9.7% professionals, 33.0% +employees) among the total respondents. +During the lockdown, those who were not working were more +vulnerable than who worked from home (OR 1.22, p < 0.001). +Those who had stayed away from home (OR 0.41, p < 0.001) +or with friends (OR 0.62, p = 0.017) or colleagues (OR 0.41, p +< 0.001) were less likely to be in the vulnerable group as they +were younger and did not have illnesses. Individuals experiencing +symptoms like cough (OR 2.08, p < 0.001), breathing difficulty +(OR 7.52, p < 0.001) and others (OR 1.74, p < 0.001), except +fever, were more likely to be vulnerable (Table 1). +Life Style +Table 2 summarizes the life style variables. Good eating habits +was reported by 84.7% and strict vegetarian diet was reported +by 75.4% of the total respondents. Vulnerable group had better +eating habit (0.89, p = 0.032) and more strict vegetarians (OR +0.49, p < 0.001). However, consumption of junk food (OR 2.19, +p < 0.001) and frequent snacking (OR 1.16, p < 0.001) was +positively associated with vulnerability. +Substance users were minimal in this cohort as majority said +they “never” used tobacco (94.4%), or alcohol (92.1%) or other +substances (97.5%) before lockdown; only 1.1% “agreed” they +had increased the use of alcohol and tobacco during lockdown. +Regular consumers of tobacco (OR 1.62, p = 0.006) and other +substance users (very few in this cohort; OR 1.80, p = 0.039) were +more likely to be vulnerable. +Looking at the quality of sleep, 82.8% and 79.1% said +they had “good” sleep quality before and during lockdown, +respectively in total respondents. Those who had average +sleep before (OR 1.31, p < 0.001) or during (OR 1.22, p +< 0.001) lockdown were more likely to be vulnerable than +those who had good sleep. Individuals having bad sleep quality +had increased from 2.4% to 4.2% during lockdown among +total respondents. +Logistic regression further showed that those who went for +fitness training (OR 0.57, p < 0.001) or did works other than +exercise, yoga, walk or household activity (OR 0.88, p = 0.004) +before lockdown were less likely to be vulnerable. Walking before +lockdown did not reduce the risk of vulnerability (OR 1.28, p < +0.001). Individual practicing fitness training during the lockdown +were less likely to be vulnerable (OR 0.56, p < 0.001). Very +few individuals never did any physical activity during lockdown. +Those who were involved in physical activity for <30 min (OR +0.79, p = 0.004) or for 30 to 60 min (OR 1.15, p = 0.004) +were more in non-vulnerable group. Individuals involved in +physical activity for more than an hour were more in vulnerable +group (OR 1.12, p = 0.004). It is to be noted that 54.0% did +yoga during lockdown while 46.6% were already practicing yoga +(before lockdown). +Physical Health +Majority had “good/average” endurance as marked on a 3 point +scale (good, average, and bad). Respondents with average (OR +1.72, p < 0.001) and bad (OR 1.55, p = 0.014) endurance were +more likely to be vulnerable than respondents who had good +endurance. BMI was high in vulnerable group at 25·49 ± 4·34 +kg/m2 than non-vulnerable at 24·05 ± 4·31 kg/m2 group (p < +0.001). The BMI between 23 and 24.9 kg/m2 (OR 1.63, p < 0.001) +and above 25 kg/m2 (OR 1.31, p < 0·001) were more likely to be +vulnerable (Table 3). +Mental Health +Majority did not feel depressed (low feeling) in vulnerable +group. Those with depression with somewhat low feeling were +more likely to be vulnerable (OR 1.26, p < 0.001) (Table 3). +Anxiety about implication of COVID-19 on life did not associate +with increased vulnerability. Interestingly, who were “somewhat +anxious” were less likely to be vulnerable (OR 0.83, p < 0.001) +(Table 3). +We enquired on five aspects of fear. Fear of getting infected +with COVID-19 and associated physical suffering was associated +with vulnerability (OR 1.29, p < 0.001). Concerns about financial +implications (OR 0.74, p < 0.001) and fear of infecting near and +dear ones (OR 0.76, p < 0.001 for somewhat; OR 0.79, p = 0.001 +for very much) were not associated with vulnerability (Table 3). +About 21% of the respondents were not sure about stress and +insecurity, which did not associated with vulnerability (OR 0.84, p +< 0.001). Those who agreed that they were stressed and insecure +were less likely to be in vulnerable category (OR 0.83, p = 0.007). +Coping +Coping ability was good in 75.3% and poor in 24.7% of the +total respondents but was non-significant between vulnerable +and non-vulnerable respondents. +Those who did not spend time reading (OR 1.27, p < 0.001) or +cooking activity (OR 1.28, p < 0.001) or spend time on exercise +(OR 1.25, p < 0.001), or did not do Yogasana (OR 1.18, p < 0.001) +were more likely to be vulnerable (Table 3). The respondents who +spend less time on internet were more likely to be vulnerable (OR +1.50, p < 0.001). +Frontiers in Public Health | www.frontiersin.org +3 +May 2022 | Volume 10 | Article 814328 +Nagarathna et al. +Lifestyle During Lockdown in India +TABLE 1 | Comparison of demographic details of vulnerable with non-vulnerable groups. +Variables +Variable +Non- +vulnerable +(n = 18,901) +Vulnerable +(n = 4,416) +Total +(n = 23,317) +Odd’s +Ratio +CI: 2.5% +CI: +97.5% +p-Value +Gender +Female +7,727 (40.9%) +1,883 (42.6%) +9,610 (41.2%) +Ref +Male +11,174 +(59.1%) +2,533 (57.4%) +13,707 +(58.8%) +1.10 +1.00 +1.21 +0.052 +States zones* +Red +6,925 (36.7%) +1,731 (39.2%) +8,656 (37.2%) +Ref +Orange +4,215 (22.3%) +825 (18.7%) +5,040 (21.6%) +0.99 +0.89 +1.10 +0.839 +Green +7,737 (41.0%) +1,857 (42.1%) +9,594 (41.2%) +1.02 +0.93 +1.13 +0.663 +Occupation +Agriculture +647 (3·4%) +101 (2·3%) +748 (3.2%) +Ref +Business +1.070 (5.7%) +321 (7·3%) +1,391 (6.0%) +1.87 +1.47 +2.41 +<0.001 +Employed +6,648 (35.2%) +1,036 (23.5%) +7,684 (33.0%) +1.18 +0.95 +1.48 +0.152 +Homemaker +1,916 (10.1%) +891 (20.2%) +2,807 (12.0%) +2.91 +2.29 +3.73 +<0.001 +Student +4,377 (23.2%) +188 (4.3%) +4,565 (19.6%) +0.26 +0.20 +0.34 +<0.001 +Professional +1,831 (9·7%) +436 (9·9%) +2,267 (9·7%) +1.72 +1.36 +2.20 +<0.001 +Other +2,142 (11.3%) +449 (10.2%) +2,591 (11.1%) +1.40 +1.11 +1.79 +0.005 +Education +Less than +Graduation +5,127 (27.1%) +1,296 (29.3%) +6,423 (27.5%) +Ref +Graduate +7,569 (40.0%) +1,640 (37.1%) +9,209 (39.5%) +0.77 +0.70 +0.84 +<0.001 +Post- +graduate +6,205 (32.8%) +1,480 (33.5%) +7,685 (33.0%) +1.11 +1.01 +1.21 +0.027 +During lockdown staying +with +Family +15.781 +(83.5%) +3,942 (89.3%) +19,723 +(84.6%) +Ref +Friends +278 (1.5%) +32 (0.7%) +310 (1.3%) +0.62 +0.41 +0.90 +0.017 +Colleagues +903 (4.8%) +79 (1.8%) +982 (4.2%) +0.41 +0.31 +0.52 +<0.001 +Alone +1,064 (5.6%) +254 (5.8%) +1,318 (5.7%) +1.01 +0.86 +1.18 +0.947 +Away from +home +875 (4.6%) +109 (2.5%) +984 (4.2%) +0.41 +0.52 +0.81 +<0.001 +During lockdown are +you +Working +from home +7,474 (39.5%) +1,479 (33.5%) +8,953 (38.4%) +Ref +Working +from office +4,185 (22.1%) +604 (13.7%) +4,789 (20.5%) +0.79 +0.70 +0.88 +<0.001 +Not +working +7,242 (38.3%) +2,333 (52.8%) +9,575 (41.1%) +1.22 +1.12 +1.33 +<0.001 +Are you experiencing +any of the following? +No +symptoms +16,866 +(89.2%) +3,791 (85.8%) +20,657 +(88.6%) +Ref +Cough +202 (1.1%) +66 (1.5%) +268 (1.1%) +2.08 +1.52 +2.81 +<0.001 +Fever +27 (0.1%) +5 (0.1%) +32 (0.1%) +1.24 +0.41 +3.06 +0.674 +Breathing +Difficulty +23 (0.1%) +24 (0.5%) +47 (0.2%) +7.52 +3.95 +14.37 +<0.001 +Other +1.783 (9.4%) +530 (12.0%) +2.313 (9.9%) +1.74 +1.55 +1.95 +<0.001 +Have you undertaken +International travel since +January 2020? +Yes +372 (2·0%) +110 (2·5%) +482 (2·1%) +Ref +No +18,529 +(98.0%) +4,306 (97.5%) +22,835 +(97.9%) +1.01 +0.79 +1.30 +0.969 +*States in red zone (>10,000 positive cases in the state)—Maharashtra, Tamil Nadu, Delhi, Gujarat; orange zone (5,000 to 10,000 cases)—Rajasthan, Madhya Pradesh, Uttar Pradesh; +and green zone (<5,000 cases)—All other states and Union Territories. Odds ratio was calculated using sequential contrasts for ordinal variables and odds ratio calculated with first row +and first column as reference for nominal variables. Ref indicates reference group. +DISCUSSION +This first largest pan-India online survey, during the third +phase of nation-wide Indian lockdown, looked at the life style, +physical health, mental health and the coping abilities using +logistic regression. +There is a well-established association between old age and +co-morbidities such as hypertension (30%), diabetes (19%), and +coronary heart disease (8%) with risk of COVID-19 infection +(13–15). UK risk factor estimates had shown a dose-dependent +increase in risk of COVID-19 with 4-fold higher risk in +individuals with most adverse life style (51% of severely infected +Frontiers in Public Health | www.frontiersin.org +4 +May 2022 | Volume 10 | Article 814328 +Nagarathna et al. +Lifestyle During Lockdown in India +TABLE 2 | Lifestyle in vulnerable and non-vulnerable groups. +Domain +Variable +Non- +vulnerable +(n = 18,901) +Vulnerable +(n = 4,416) +Total +Odd’s +Ratio** +CI: 2.5% +CI: +97.5% +p-value +Addictions +Tobacco +Never +17,807 +(94.2%) +4,198 (95.1%) +22,005 +(94.4%) +Ref +Occasionally +837 (4.4%) +146 (3.3%) +983 (4.2%) +1.09 +0.89 +1.33 +0·381 +Regularly +257 (1.4%) +72 (1.6%) +329 (1·4%) +1·62 +1·14 +2·28 +0·006 +Alcohol +Never +17,299 +(91.5%) +4,165 (94.3%) +21,464 +(92.1%) +Ref +Occasionally +1,509 (8.0%) +233 (5.3%) +1,742 (7.5%) +1.00 +0.84 +1.17 +0·959 +Regularly +93 (0.5%) +18 (0.4%) +111 (0.5%) +0.77 +0.40 +1.43 +0·431 +Substance use +Never +18,407 +(97.4%) +4,332 (98.1%) +22,739 +(97.5%) +Ref +Occasionally +378 (2.0%) +55 (1.2%) +433 (1.9%) +0.77 +0.57 +1.02 +0·081 +Regularly +116 (0.6%) +29 (0.7%) +145 (0.6%) +1.80 +1.02 +3.12 +0·039 +Increased substance +abuse during lockdown +Yes +221 (1.2%) +34 (0.8%) +255 (1.1%) +Ref +No +5,273 (27.9%) +990 (22.4%) +6,263 (26.9%) +1.10 +0.76 +1.65 +0·618 +Not +Applicable +13,407 +(70.9%) +3,392 (76.8%) +16,799 +(72.0%) +1.21 +0.83 +1.80 +0·34 +Diet +Eat discipline before +Yes +15,852 +(83.9%) +3,898 (88.3%) +19,750 +(84.7%) +Ref +No +3,049 (16.1%) +518 (11·7%) +3,567 (15.3%) +0·89 +0·80 +0·99 +0·032 +Strict vegetarian/vegan +Yes +13,732 +(72.7%) +3842 (87.0%) +17574 +(75.4%) +Ref +No +5,169 (27.3%) +574 (13.0%) +5,743 (24.6%) +0.49 +0.44 +0.54 +<0·001 +I like eating junk food +Yes +4,684 (24·8%) +454 (10.3%) +5,138 (22.0%) +Ref +No +14,217 +(75.2%) +3,962 (89.7%) +18,179 +(78.0%) +2.19 +1.96 +2.45 +<0·001 +I tend to frequently +snack +Yes +7,273 (38.5%) +1,279 (29.0%) +8,552 (36.7%) +Ref +No +11,628 +(61.5%) +3,137 (71.0%) +14,765 +(63.3%) +1.16 +107 +1.25 +<0·001 +Sleep +Quality of sleep before +lockdown +Good +15,707 +(83.1%) +3,599 (81.5%) +19,306 +(82.8%) +Ref +Ok +2,724 (14.4%) +731 (16.6%) +3,455 (14.8%) +1.31 +1.17 +1.47 +<0·001 +Bad +470 (2.5%) +86 (1.9%) +556 (2.4%) +0.82 +0.63 +1.07 +0·157 +Quality of sleep during +lockdown +Good +14,964 +(79.2%) +3,472 (78.6%) +18,436 +(79.1%) +Ref +Ok +3,093 (16.4%) +799 (18.1%) +3892 (16.7%) +1.22 +1.09 +1.37 +<0·001 +Bad +844 (4.5%) +145 (3.3%) +989 (4.2%) +0.96 +0.77 +1.18 +0·685 +Activity +Physical activity before +lock-down +Did yoga +8,493 (44.9%) +2,377 (53.8%) +10,870 +(46.6%) +Ref +Went +fitness +1,271 (6.7%) +107 (2.4%) +1,378 (5.9%) +0.57 +0.45 +0.71 +<0·001 +Went +walking +3,546 (18.8%) +925 (20.9%) +4,471 (19.2%) +1.28 +1.13 +1.43 +<0·001 +Did +household +2,071 (11.0%) +417 (9.4%) +2,488 (10.7%) +0.88 +0.75 +1.03 +0·102 +Other +3,520 (18.6%) +590 (13.4%) +4,110 (17.6%) +0.81 +0.71 +0.93 +0·004 +Physical activity during +lock-down +Yoga +9,864 (52.2%) +2,721 (61.6%) +12,585 +(54.0%) +Ref +Fitness +893 (4.7%) +74 (1.7%) +967 (4.1%) +0.56 +0.43 +0.73 +<0·001 +(Continued) +Frontiers in Public Health | www.frontiersin.org +5 +May 2022 | Volume 10 | Article 814328 +Nagarathna et al. +Lifestyle During Lockdown in India +TABLE 2 | Continued +Domain +Variable +Non- +vulnerable +(n = 18,901) +Vulnerable +(n = 4,416) +Total +Odd’s +Ratio** +CI: 2.5% +CI: +97.5% +p-value +Walking +2,377 (12.6%) +534 (12.1%) +2,911 (12.5%) +0.96 +0.84 +1.10 +0·591 +Household +work +3,070 (16.2%) +622 (14.1%) +3,692 (15.8%) +0.94 +0.82 +1.07 +0·36 +Other +2,697 (14.3%) +465 (10.5%) +3,162 (13.6%) +0.93 +0.80 +1.08 +0·326 +Duration of the Activity +During Lock-Down +Never +1,239 (6.6%) +256 (5.8%) +1,495 (6.4%) +Ref +< 30 min +4,783 (25.3%) +890 (20.2%) +5,673 (24.3%) +0.79 +0.68 +0.93 +0·004 +30 +min−1 h +7,381 (39.1%) +1,703 (38.6%) +9,084 (39.0%) +1.15 +1.05 +1.26 +0·004** +> 1 h +5,498 (29.1%) +1,567 (35.5%) +7,065 (30.3%) +1.12 +1.04 +1.22 +0·004** +Odds ratio was calculated using sequential contrasts for ordinal variables and odds ratio was calculated with first row and first column as reference for nominal variables. Ref indicates +reference group. +cases) compared to those with optimal lifestyle (7). Although our +survey did not target COVID-19 positive cases, we looked at the +potential associations between life style correlates of respondents, +vulnerable to COVID-19 infection, with the non-vulnerable. +We observed similar gender distribution among vulnerable +and non-vulnerable. However, it is reported that males are more +vulnerable (13). Graduates/post graduates and those who had +employment or business were more likely to be vulnerable than +unemployed persons or agriculturists, who are physically active, +similar to observations in China (16). This observation indicates +that individuals having stressful job in urban regions make +them vulnerable. It is important to state here that individuals +residing in urban regions are at risk of getting infected, where +day to day physical contact with each other is high, such as at +offices, institutes, colleges, airport, markets, due to fast-pace life +style. Good lifestyle before lockdown seems to have contributed +to adopting healthy activities (reading, writing, cooking, yoga, +exercise, and household) with good psychological coping ability +during lockdown. Higher education and good life style seen +in this cohort may not reflect the lifestyle or the behavioral +characteristics of the general Indian population. The limitation +being that response to a call on social media may reflect the +social responsibility of those with good life style by responding +voluntarily to this unstructured survey. +Eating Habits +A healthy diet, rich in fruits and vegetables and low in sugar +and calorie-dense processed foods, is essential to health, which +was observed in majority of our respondents with majority +being strict vegetarians. Diet rich in saturated fat, refined +carbohydrates, and sugars with low levels of fiber that promotes +obesity and type-2 diabetes poses increased risk for severe +COVID-19 pathology and mortality by inhibiting adaptive +immune system (17). +Sleep +In a study, during the present pandemic, the prevalence of +clinical insomnia in France was 19%, close to prevalence reported +in China (20·1%) and Italy (19·8%) but lower than in Greece +(37·6%) (18–21). We observed much lower prevalence with only +2·4% and 4·2% respondents reporting “bad” insomnia before and +during lockdown. This appears to be because of the milder form +of the disease in India and good family support. +Addictions +Studies have observed that past or current smokers (18%) +with COVID-19 had double the risk of progression to severe +disease compared with never-smokers (9%) (22, 23). A small +percentage (1.1%) who agreed that they had increased the +consumption of addictive substances during lockdown did show +increased vulnerability. +Physical Health +Further, obesity is known to be an important contributor for +many non-communicable diseases and also for respiratory and +other infections (17). Pietrobelli et al. reported that children +during social isolation in Italy gained weight which may have +long term implications (8). We observed that the vulnerable +group had higher representation of overweight individuals +as compared to non-vulnerable group. Higher BMI denotes +disturbed metabolism and an overall inflammatory state that +could further increase the likelihood of COVID-19 infection in +the vulnerable individuals (24). +Physical activity maintaining regular exercise with good +physical endurance counteracts the negative effects of the +pandemic stress on immune competency (25). In the present +study, 71.7% did physical activities and those who did not do +exercises and reported poor physical endurance were more likely +to be vulnerable. Yoga, practiced by 54.0% of our respondents +during lockdown, is an unexpected observation of this study +(Table 2). Duggal et al. observed that exercise augments +host immune defenses by catecholamine-mediated preferential +mobilization of lymphocytes primed to recognize and kill virus- +infected cells (26). Exercise also enhances proliferation of virus- +specific memory T-cells and promotes their mobilization to +the site. +Frontiers in Public Health | www.frontiersin.org +6 +May 2022 | Volume 10 | Article 814328 +Nagarathna et al. +Lifestyle During Lockdown in India +TABLE 3 | Comparison of health and coping between vulnerable and non-vulnerable groups. +Domain /Variable +Non- +vulnerable +(n = 18,901) +Vulnerable +(n = 4,416) +Total N (%) +OR +CI: 2.5% +CI: +97.5% +p-value +Physical health +How do you rate your physical +strength and endurance? +Good +16,973 +(89.8%) +3,662 (82.9%) +20,635 +(88.5%) +Ref +Average +1,824 (9.7%) +693 (15.7%) +2,517 (10.8%) +1.72 +1.55 +1.89 +<0.001 +Bad +104 (0.6%) +61 (1.4%) +165 (0.7%) +1.55 +1.09 +2.18 +0.014 +BMI +(N) mean +± SD +(17,666) +24.05 ± 4.31 +(4,139) +25.49 ± 4.34 +< 0.001 +<23 +7,489 (42.4%) +1,140 (27.5%) +8,629 (39.6%) +Ref +23–24·9 +3,703 (21.0%) +903 (21.8%) +4,606 (21.1%) +1.63 +1.48 +1.79 +<0.001 +>25 +6,474 (36.6%) +2,096 (50.6%) +8,570 (39.3%) +1.31 +1.20 +1.43 +<0.001 +Mental health +Depression: Do you feel you are +low in energy and downhearted +during this lock-down period? +Not at all +15,653 +(82.8%) +3,735 (84.6%) +19,388 +(83.1%) +Ref +Somewhat +3,000 (15.9%) +629 (14.2%) +3,629 (15.6%) +1.26 +1.13 +1.40 +<0.001 +Very much +248 (1.3%) +52 (1.2%) +300 (1·3%) +1.06 +0.77 +1.45 +0.718 +Anxiety: How anxious are you +about the implications of +COVID-19 in your life? +Not at all +10,399 +(55.0%) +2,856 (64.7%) +13,255 +(56.8%) +ref +Some what +6,495 (34.4%) +1,256 (28.4%) +7,751 (33.2%) +0.83 +0.76 +0.91 +<0.001 +Very much +2,007 (10.6%) +304 (6·9%) +2,311 (9.9%) +0.89 +0.77 +1.03 +0.113 +Fear: How much do the following issues worry you during this lock-down period? +Fear of getting infected and the +associated physical suffering +Not at all +11,726 +(62.0%) +2,982 (67.5%) +14,708 +(63.1%) +Ref +Somewhat +5,818 (30.8%) +1,239 (28.1%) +7,057 (30.3%) +1.29 +1.17 +1.42 +<0.001 +Very much +1,357 (7.2%) +195 (4.4%) +1,552 (6.7%) +0.97 +0.80 +1.17 +0.741 +Fear of death +Not at all +15,303 +(81.0%) +3,802 (86.1%) +19,105 +(81.9%) +Ref +Somewhat +2,825 (14.9%) +505 (11.4%) +3,330 (14.3%) +1.02 +0.91 +1.15 +0.743 +Very much +773 (4.1%) +109 (2.5%) +882 (3.8%) +1.01 +0.79 +1.28 +0.925 +Fear of a possible financial burden +Not at all +10,359 +(54.8%) +2,939 (66.6%) +13,298 +(57.0%) +Ref +Somewhat +6,299 (33.3%) +1,130 (25.6%) +7,429 (31.9%) +0.74 +0.67 +0.80 +<0.001 +Very much +2,243 (11.9%) +347 (7.9%) +2,590 (11.1%) +1.01 +0.87 +1.16 +0.94 +Fear of unknown related to +COVID 19 +Not at all +11,566 +(61.2%) +3,110 (70.4%) +14,676 +(62.9%) +Ref +Somewhat +5,625 (29.8%) +1,078 (24.4%) +6,703 (28.7%) +0.96 +0.87 +1.06 +0.456 +Very much +1,710 (9.0%) +228 (5.2%) +1,938 (8.3%) +0.90 +0.75 +1.07 +0.231 +Fear of spreading infection to near +and dear ones +Not at all +9,564 (50.6%) +2744 (62.1%) +12,308 +(52.8%) +Ref +Somewhat +6,353 (33.6%) +1260 (28.5%) +7,613 (32.6%) +0.76 +0.70 +0.83 +<0.001 +Very much +2,984 (15.8%) +412 (9.3%) +3,396 (14.6%) +0.79 +0.69 +0.91 +0.001 +Stress: Do you always feel +insecure; stressed and have +mood swings +disagree +12,470 +(66.0%) +3,251 (73·6%) +15,721 +(67.4%) +Ref +Maybe +4,117 (21.8%) +790 (17.9%) +4,907 (21.0%) +0.84 +0.77 +0.92 +<0.001 +Agree +2,314 (12.2%) +375 (8.5%) +2,689 (11.5%) +0.83 +0.72 +0.95 +0.007 +Coping ability +Poor +4,727 (25.0%) +1,036 (23.5%) +5,763 (24.7%) +Ref +Good +14,174 +(75.0%) +3,380 (76.5%) +17,554 +(75.3%) +1.00 +0.92 +1.08 +0.965 +(Continued) +Frontiers in Public Health | www.frontiersin.org +7 +May 2022 | Volume 10 | Article 814328 +Nagarathna et al. +Lifestyle During Lockdown in India +TABLE 3 | Continued +Domain /Variable +Non- +Vulnerable +(n = 18,901) +Vulnerable +(n = 4,416) +Total N (%) +OR +CI: 2.5% +CI: +97.5% +p-value +How do you prefer spending time (apart from your regular, work-related engagements) during this national lock-down period? +TV +Yes +10,018 +(53.0%) +2,188 (49.5%) +12,206 +(52.3%) +Ref +No +8,883 (47.0%) +2,228 (50.5%) +11,111 +(47.7%) +0.92 +0.86 +0.99 +0.022 +Read/Write +Yes +16,199 +(85.7%) +3,676 (83.2%) +19,875 +(85.2%) +Ref +No +2,702 (14.3%) +740 (16.8%) +3,442 (14.8%) +1.27 +1.15 +1.39 +<0.001 +Cook +Yes +13.658 +(72.3%) +2,995 (67.8%) +16,653 +(71.4%) +Ref +No +5,243 (27.7%) +1,421 (32.2%) +6,664 (28.6%) +1.28 +1.19 +1.38 +<0.001 +Exercise +Yes +14,962 +(79.2%) +3,329 (75.4%) +18,291 +(78.4%) +Ref +No +3,939 (20.8%) +1,087 (24.6%) +5,026 (21.6%) +1.25 +1.15 +1.37 +<0.001 +Yoga-asana +Yes +12,671 +(67·0%) +2,903 (65·7%) +15,574 +(66·8%) +Ref +No +6,230 (33.0%) +1,513 (34.3%) +7,743 (33.2%) +1.18 +1.08 +1.28 +<0.001 +Meditation +Yes +14,481 +(76.6%) +3,838 (86.9%) +18,319 +(78.6%) +Ref +No +4,420 (23.4%) +578 (13.1%) +4,998 (21.4%) +0.42 +0.38 +0.47 +<0.001 +Faith practice +Yes +14,095 +(74·6%) +3,374 (76·4%) +17,469 +(74·9%) +Ref +No +4,806 (25.4%) +1,042 (23.6%) +5,848 (25.1%) +0.97 +0.90 +1.06 +0.497 +Internet +Yes +14,353 +(75.9%) +2,929 (66.3%) +17,282 +(74.1%) +Ref +No +4,548 (24.1%) +1,487 (33.7%) +6,035 (25.9%) +1.50 +1.39 +1.62 +<0.001 +Odds ratio was calculated using sequential contrasts for ordinal variables and odds ratio was calculated with first row and first column as reference for nominal variables. Ref indicates +reference group. +Mental Health +Anxiety and Depression +A meta-analysis of 65 studies during severe infections of +SARS had noted that apart from the immediate mental health +effects, PTSD could emerge at a later stage (27). “Somewhat” +depressive low feeling and anxiety was noted in 15.6% and +33.2%, respectively while 1.3% and 9.9% were “very much” +depressed and anxious, respectively. Similar observations have +been reported by studies during this pandemic using different +psychological battery. The first mental health survey in India +during the initial phase of pandemic showed 33.2% had +significant (mild/moderate/severe) psychological impact (11). +Qiu et al. reported 29% had mild to moderate and 5% +had severe psychological distress in China (28). Wang et al. +reported psychological impact in higher percentage (53.8%) of +respondents with higher stress scores that remained high in the +4th week (5). Thus, anxiety (28.8% in Wang et al. vs. 9·9% +in present study) and depression (16·5% in Wang et al. vs. +1·3% in present study) seemed to be higher in China. This +may be attributed to the good lifestyle in our respondents with +higher educational level. In another Indian study, Rehman et al. +observed that people who do not have enough supplies to sustain +the lockdown were most affected and the affluent were negatively +correlated with psychological distress (29). +Fear and Stress +A smaller percentage of respondents in our study were +stressed (11.5%) or expressed “very much” fear of death +(3.8%) or getting infected (6.7%) or financial burden (11.1%) +as compared to Chinese respondents with high level of +education (75%) similar to our cohort (72.5%), who experienced +higher levels of stress (52.1% felt horrified and apprehensive) +(15). Milder form of the disease, stricter lockdown and +higher family support in Indian community may explain +this difference. +The growing stress highlights the importance of funding +translational and alternative medicine research (30) over +fundamental research in vitro (31), in vivo (32–36) and +biomarker +studies +(37–41), +which +is +often +restricted +to +publications. Translating this knowledge into practice may +accelerate the pace of discovery and practice of integrative +medicine. Several online surveys were conducted in India +during this period; however, these surveys reported data +on a small sample size (42–44), specific cohort (43, 45, 46), +selective +parameters +such +as +psychological +or +life +style +or coping strategy (41, 44, 45, 47–49) as compared to +our study. Another uniqueness of this study is that we +used Delphi protocol to develop CHAS questionnaire for +the survey. +Frontiers in Public Health | www.frontiersin.org +8 +May 2022 | Volume 10 | Article 814328 +Nagarathna et al. +Lifestyle During Lockdown in India +Limitations +Although, this survey was aimed at general population, the +responses were received by only those with high level of +education which prevents us from drawing any conclusion +related to Indian race in general. +CHAS was prepared to suit the research question as we did not +find a scale that had all the components we planned to assess. As +the scale was self-reported, social desirability factor influencing +the answers may be a limitation. +CONCLUSION +This is the first nationwide large scale health survey, covering +34 states of India during the 3rd phase of lockdown of COVID- +19 pandemic that shows that those with a good lifestyle +including good eating, sleeping, and non-addictive habits with +good physical activities adopt good coping abilities during +the challenging times of life, irrespective of gender. Increased +weight, unhealthy food, addictions and history of international +travel increase the risk of getting infected with COVID-19 in +vulnerable individuals. This study provides evidence for the +media, policy makers and general population to include good life +style recommendations for prevention. +DATA AVAILABILITY STATEMENT +The raw data supporting the conclusions of this article will be +made available by the authors, without undue reservation. +ETHICS STATEMENT +The studies involving human participants were reviewed +and approved by Swami Vivekananda Yoga Anusandhana +Samsthana, Bengaluru, India. Written informed consent for +participation was not required for this study in accordance with +the national legislation and the institutional requirements. +AUTHOR CONTRIBUTIONS +RN: concept, design, definition of intellectual content, literature +search, manuscript preparation, manuscript editing, manuscript +review, and guarantor. MS: concept, design, definition of +intellectual content, manuscript preparation, manuscript editing, +and manuscript review. RK: concept, design, definition of +intellectual content, data acquisition, data analysis, statistical +analysis, manuscript preparation, manuscript editing, and +manuscript review. JI: concept, design, definition of intellectual +content, data acquisition, data analysis, statistical analysis, +manuscript editing, and manuscript review. AA: concept. VM: +design, definition of intellectual content, literature search, data +acquisition, manuscript editing, and manuscript review. AS: +concept, design, definition of intellectual content, literature +search, data acquisition, manuscript editing, and manuscript +review. JR and MR: manuscript editing and manuscript +review. HN: concept, design, definition of intellectual content, +data acquisition, manuscript editing, and manuscript review. +All authors contributed to the article and approved the +submitted version. +REFERENCES +1. 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Any product that may be evaluated in +this article, or claim that may be made by its manufacturer, is not guaranteed or +endorsed by the publisher. +Copyright © 2022 Nagarathna, Sharma, Ilavarasu, Kulkarni, Anand, Majumdar, +Singh, Ram, Rain and Nagendra. This is an open-access article distributed under the +terms of the Creative Commons Attribution License (CC BY). The use, distribution +or reproduction in other forums is permitted, provided the original author(s) and +the copyright owner(s) are credited and that the original publication in this journal +is cited, in accordance with accepted academic practice. No use, distribution or +reproduction is permitted which does not comply with these terms. +Frontiers in Public Health | www.frontiersin.org +10 +May 2022 | Volume 10 | Article 814328 diff --git a/subfolder_0/Correlation between Excessive Smartphone usage, Basic Psychological Needs, and Mental Health of University Students.txt b/subfolder_0/Correlation between Excessive Smartphone usage, Basic Psychological Needs, and Mental Health of University Students.txt new file mode 100644 index 0000000000000000000000000000000000000000..197a1cad2c0f3e5b3e4c7d192067c52820fb48df --- /dev/null +++ b/subfolder_0/Correlation between Excessive Smartphone usage, Basic Psychological Needs, and Mental Health of University Students.txt @@ -0,0 +1,736 @@ +© 2023 Journal of Mental Health and Human Behaviour | Published by Wolters Kluwer - Medknow +65 +Abstract +Original Article +Introduction +Smartphones have become indispensable in the current mode +of communication and in doing our daily life activities. Among +many technology‑related addictions, smartphone addiction +is newer and emerged as a more serious menace than other +addictions. Recent statistics show a significant rise in the +usage of smartphones every year. The estimated prevalence of +smartphone addiction is in the range of 10%–30%.[1] Studies +have reported the prevalence of problematic smartphone use +among children and adolescents is as high as 10% in the +United Kingdom,[2] 16.7% in Taiwan,[3] 16.9% in Switzerland,[4] +30.9% in Korea,[5] and 31% in India.[6] Further, a survey among +the six Asian countries showed the highest prevalence of +internet addiction through smartphone ownership is 62%.[7] +Although addiction was previously defined as “a pathologic +condition that one cannot tolerate without continuous +administration of substances,” it is now applied to behavioral +addictions, such as gaming and internet use.[8] These symptoms +have a negative influence on the psychophysiological +problems[9] with low psychological well‑being,[10] depression, +loneliness,[11] social anxiety,[12] cognitive disorders,[13] +and distressed interpersonal relationships. A high level of +gamma‑aminobutyric acid has been found in the brains of +those who use smartphones excessively, causing impaired +attention and control, as well as being more easily distracted.[14] +Because of the ease of access to information, adolescents’ +Objectives: The primary aim of the current study was to examine the unique contribution of psychological need frustration and need +satisfaction in the prediction of excessive usage of smartphones and its relation to psychological distress and mindfulness. Methods: We +conducted a correlational study using the smartphone addiction scale – shorter version, basic psychological needs satisfaction and frustration +scale, psychological distress, and mindfulness among 423 graduate and postgraduate engineering students from Bengaluru, South India. +Results: The results showed that excessive usage of smartphones is positively correlated with the time spent on the phone r = 0.19, P ≤ 0.05; +and basic psychological needs frustration r = 0.18, P ≤ 0.05; and negatively correlated with basic psychological needs satisfaction r = −0.19, +P ≤ 0.05 and mindfulness r = −0.39, P ≤ 0.001. However, among the optimal users of the smartphone group, time spent is positively correlated +with satisfaction at r = 0.13, P ≤ 0.05, and further, basic psychological needs satisfaction is negatively correlated with frustration at r = 0.30, +P ≤ 0.001 and also found a positive correlation between mindfulness and basic psychological needs satisfaction at r = 0.31, P ≤ 0.001. +Conclusion: The results suggest that excessive usage of smartphones is associated with frustration, psychological distress, and time spent on +the mobile. However, there is a positive trend in the time spent on the phone among the optimal users of smartphones suggests that smartphones +are used as a coping mechanism to gain momentary satisfaction. +Keywords: Basic psychological needs, excessive usage of smartphone, mindfulness, psychological distress, smartphone addiction, time +spent on the phone +Address for correspondence: Dr. Singh Deepeshwar, +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana +Samsthana (S‑VYASA, Deemed to be University), Bengaluru, Karnataka, +India. +E‑mail: deepeshwar.singh@svyasa.edu.in +Access this article online +Quick Response Code: +Website: +https://journals.lww.com/mhhb +DOI: +10.4103/jmhhb.jmhhb_158_22 +How to cite this article: Putchavayala KC, Sasidharan KR, Krishna D, +Deepeshwar S. Correlation between excessive smartphone usage, basic +psychological needs, and mental health of university students. J Mental +Health Hum Behav 2023;28:65-71. +Correlation between Excessive Smartphone usage, Basic +Psychological Needs, and Mental Health of University Students +Krishna Chaitanya Putchavayala, K. Rajesh Sasidharan, Dwivedi Krishna1, Singh Deepeshwar1 +Division of Yoga and Physical Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S‑VYASA, Deemed to be University), 1Division of Yoga and Life +Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S‑VYASA, Deemed to be University), Bengaluru, Karnataka, India + This is an open access journal, and articles are distributed under the terms of the Creative +Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to +remix, tweak, and build upon the work non‑commercially, as long as appropriate credit +is given and the new creations are licensed under the identical terms. +For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com +Submitted: 01‑Jul‑2022 +Accepted: 20‑Aug‑2022 +Revised: 10‑Aug‑2022 +Published: 21-Jul-2023 +Downloaded from http://journals.lww.com/mhhb by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW +nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/20/2023 +Putchavayala, et al.: Relation between smartphone addiction and psychological health +66 +Journal of Mental Health and Human Behaviour  ¦  Volume 28  ¦  Issue 1  ¦  January-June 2023 +smartphones can lead to reduced attention spans as well.[15] As +adolescents are neurologically immature, they tend to become +reliant on instant rewards provided by smartphones rather +than those derived from interactions with friends or family +members, or their hobbies.[16] Excessive smartphone use may +affect the connectivity in brain regions that control emotions, +decision‑making, inhibition, and impulsive control.[17] +Excessive usage of smartphones and distress +Research has indicated that a maladaptive use of smartphones +can lead to psychological distress. In a systematic review of +11 studies measuring depressive symptoms in children and +adolescents, there was a small but statistically significant +association between social media use and depression.[18] A +meta‑analysis of 23 studies reported problematic use of Facebook +is associated with psychological distress in adolescents and +young adults.[19] When adolescents become overly reliant on +smartphones, especially to connect with others, they lose the +opportunity to practice nonverbal skills like understanding +facial expressions or emotional reactions. Furthermore, they +are inflexible in their communication and less sensitive to their +behaviors.[20] It has been found that checking new messages +and notifications obsessively can lead to personal stress and a +high frequency of texting is reported to be associated with a +reduced level of emotional connection with others.[21] +Compulsive smartphone users struggle to refrain from using the +devices for a short time, owing to how much of their lives revolve +around the device.[22] As a result, their performance at school or +during other activities can suffer when they do not have access +to these devices. In some adolescents, smartphones serve as a +coping mechanism to alleviate depression and boredom.[21,22] As +a result of using devices, they feel less distressed and can divert +their attention away from more important problems in their lives. +In the short term, such behavior may provide adolescents with +relief and as a means of escaping from their problems, but it is +not beneficial in the long run as the issues remain unresolved. As +a result, more people will become dependent on smartphones to +cope with psychological problems.[23] In addition, those seeking +out companionship in a safe virtual environment may develop +depression or being more depressed as they become more +socially isolated, but just focused on their phone.[24] +Basic psychological needs and frustration +Self‑determination theory (SDT) is postulated by Deci and +Ryan for human motivation developed through empirical +evidence. It is a framework of mini‑theories that taps into +multiple facets of human motivation. It has been widely used +in sports, education, health, and employment sectors.[25] Basic +psychological needs form the core of SDT. It is understood +that every human has to satisfy their set of basic psychological +needs for their growth and wellbeing. The primary focus is +on fulfilling three basic needs: autonomy, relatedness, and +competence.[26] Basic psychological needs theory (BPNT) +encompasses both the satisfaction of these thr three needs, +as well as their frustration, with frustration being a stronger +and more threatening experience than a purely lacking need. +Autonomy describes the capacity for free will and willingness +to act. Satisfaction generates a feeling of integrity that +permeates our actions, thoughts, and feelings. Feelings of +frustration can often manifest as pressure and conflict, such +as feeling pushed in an undesirable direction. Relatedness +includes the desire to feel connected, be a part of, and +feel significant to others, as well as a feeling of warmth. +Relatedness frustration is associated with feelings of social +exclusion, loneliness, and alienation. We relate competence +to mastery and effectiveness. It becomes satisfied as one +capably engages in activities and experiences opportunities +for using and extending skills and expertise. The frustrated +often feel ineffective, or outright helpless. A growing number +of researchers have drawn attention to the concept of need +frustration, where they demonstrate adverse effects when +the basic psychological needs for autonomy, competence, +and relatedness are interfered with.[27,28] Further, the need +frustration is viewed as a separate process rather than being +at the other end of a continuum of need satisfaction.[29,30] Need +frustration is more common when the social context actively +undermines the basic psychological needs.[31] Performing a +particular role when one is forced to, being told they are not +capable, or being discouraged or rejected result in a loss of +autonomy, competence, or relatedness. Consequently, need +frustration can be distinguished from lack of need satisfaction, +which is more passively inhibited psychological needs. Need +satisfaction and frustration be in an asymmetrical relationship, +in which the absence of need satisfaction does not necessarily +indicate the presence of need frustration, but the existence of +need frustration is implied the absence of need satisfaction.[32] +In addition, research has shown that need frustrations result in +adverse outcomes as a direct threat to psychological needs.[33] +Mindfulness +Mindfulness can be defined as “an openhearted, +moment‑to‑moment, nonjudgmental awareness” or +maintenance of the attention to the present moment.[34] By +practicing mindfulness, one can pay attention to one’s self +and surroundings nonjudgmentally and with purpose, leading +to happiness, self‑awareness, inner calm, and self‑respect.[35] +Many researchers have applied mindfulness as a treatment +modality for behavioral addictions, such as pathological +gambling, workaholics, and Internet addiction.[36‑38] Students +with excessive usage of smartphones have reported that +mindfulness‑based interventions resulted in a decline in phone +usage time and self‑reported scores.[39] +Van Gordon proposed that the mindfulness approach may +be suitable for behavioral addictions for several reasons: (a) +substitution of addictive behaviors with meditation can +reduce relapse and withdrawal symptoms; (b) cultivation of +compassion helps with addiction‑related negative emotions; (c) +shift of focus to the intrinsic value of life and life priorities from +the instant reward from addictive activities; (d) reduce salience; +and (e) improve on patience.[36] Mindfulness was also found +to have a positive relationship with well‑being[40] including +higher levels of positive emotions, vitality, life satisfaction, +Downloaded from http://journals.lww.com/mhhb by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW +nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/20/2023 +Putchavayala, et al.: Relation between smartphone addiction and psychological health +67 +Journal of Mental Health and Human Behaviour  ¦  Volume 28  ¦  Issue 1  ¦  January-June 2023 +and adaptive emotion regulation and lower levels of negative +emotions and psychopathological symptoms.[41] +In the present study, we intend to investigate the relation +between basic psychological needs satisfaction and frustration, +and mindfulness with psychological distress and excessive +usage of smartphones among college students. +Methods +Participants +A total of 423 graduate and postgraduate students from +an engineering college in Bengaluru, South India were +recruited for the present study. The sample was distributed +as (76% of males; 24% of females) with a mean age = 20.29, +standard deviation (SD) =1.38 years. These participants were +screened by using the smartphone addiction scale – shorter +version (SAS‑SV) and 164 participants reported to be having +excessive usage with cutoff scores ≥31 for males and ≥33 for +females and 259 students are found to be optimal users of the +smartphone below the cutoff scores. The average time spent +on the phone by the participants is 3.26 ± 0.86 h/day. Among +them, the excessive users spend 3.91 ± 0.70 h and optimal +users of smartphones spend 2.85 ± 0.67 h/day +Procedure +We have contacted students through their college WhatsApp +groups. Students who are interested in the study took part +by filling up the forms using a pen and pencil. The data +were collected during the 2021–2022 academic year. The +Institutional Ethics Committee of S‑VYASA Yoga University +approved this study with a reference number of IEC (RES/ +IEC‑SVYASA/113/2017). +Measures +The questionnaires include demographic data such as age, +gender, education qualification, time spent on the smartphone +in a day, and how long they are using the smartphones. The +following questionnaires were included: the SAS‑SV,[42] Basic +psychological needs Satisfaction and Frustration Scale,[28] +Psychological Distress Scale (K‑10),[43] and Mindful Attention +Awareness Scale (MAAS).[44] +Smartphone addiction scale shorter version +The SAS is a 10‑item questionnaire. The sores on this scale are +measured on a 6‑point Likert scale. The six factors analyzed +by this questionnaire were daily‑life disturbance, positive +anticipation, withdrawal, cyberspace‑oriented relationship, +overuse, and tolerance. The cutoff levels to be considered as +addicted were 31 for males and 33 for females. The SAS‑SV +showed good reliability and validity for the assessment of +smartphone addiction. +Basic psychological needs satisfaction and frustration +scale +Basic Psychological Need Theory, the satisfaction of the +psychological needs for Autonomy, competence, and +relatedness are said to represent essential nutrients of growth, +and their psychological well‑being and health should be +enhanced. The Basic Psychological Need Satisfaction +and Frustration Scale were developed, which includes a +balanced combination of satisfaction and frustration items. +The scale consists of 24 items, four items for each of the six +subscales (i.e. autonomy satisfaction, autonomy frustration, +relatedness satisfaction, relatedness frustration, competence +satisfaction, and competence frustration). Respondents +answered the questions concerning their feelings about their +jobs during the previous 4 weeks, on a 7‑point response scale +ranging from 1 (strongly disagree) to 7 (strongly agree). +Kessler psychological distress scale (K‑10) +The Kessler psychological distress scale (K‑10) is a widely +used, simple self‑report measure of psychological distress +which can be used to identify those in need of further +assessment for anxiety and depression. This measure was +designed for use in the general population; however, it may also +serve as a useful clinical tool. The scale comprises 10 questions +that are answered using a five‑point scale (where 5 = all of the +time, and 1 = none of the time). For all questions, the client +circles the answer truest for them in the past 4 weeks. Scores +are then summed with a maximum score of 50 indicating severe +distress, and a minimum score of 10 indicating no distress. +Mindful attention awareness scale +The MAAS was used to measure dispositional mindfulness. +This instrument consists of 15 items, all of which indicate a +lack of mindfulness. These items are rated on a 6‑point Likert +scale ranging from 1 (almost always) to 6 (almost never); +higher scores indicate more mindfulness, and the total score +can range from 15 to 90. The measures assess the quality of +attention and awareness that individuals apply to their daily +lives. The MAAS has good convergent and discriminant +validity, as well as good psychometric properties. +Data collection and statistical analysis +Data were collected by using paper and pencil for all the +questionnaires. The data were statistically analyzed using the +Statistical Package for the Social Sciences (SPSS) (version +21, IBM Corp., Armonk, NY, USA). The mean and SD were +calculated for the participant’s age and time spent on the phone. +Data were checked for the normality using Shapiro test. Data +were not normally distributed hence Mann–Whitney U‑test +was used for between‑groups analysis. Spearman correlation +was used to predict the correlation between the variables. The +results were considered statistically significant if the P ≤ 0.05. +Results +The Mann–Whitney U‑test showed significant differences +in excessive usage of the smartphone compared to optimal +users of the smartphone. The excessive usage of smartphone +group reported significant differences in the variables +including time spent (U = 6134.5, P < 0.001, r = 0.711), +SAS (U = 5.5, P < 0.001, r = 1), frustration (U = 18824, +P  <  0.05, r  =  0.114), K‑10  (U  =  16426.5, P  <  0.001, +Downloaded from http://journals.lww.com/mhhb by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW +nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/20/2023 +Putchavayala, et al.: Relation between smartphone addiction and psychological health +68 +Journal of Mental Health and Human Behaviour  ¦  Volume 28  ¦  Issue 1  ¦  January-June 2023 +r = 0.227), satisfaction (U = 17767.5, P < 0.01, r = 0.163), +and MAAS (U = 18804, P < 0.05, r = 0.115). These results +are illustrated in Table 1. +Mann–Whitney U‑test  (To compare the differences of +Variables) between excessive usage and optimal usage +participants. +The results of correlation analyses were reported as: among +the excessive usage of smartphones group, excessive usage +of smartphones is positively correlated with time spent on +the mobile at r = 0.19, P ≤ 0.05; basic psychological needs +frustration at r = 0.18, P ≤ 0.05; and negatively correlated with +basic psychological needs satisfaction at r = −0.19, P ≤ 0.05; +and mindfulness at r = −0.39, P ≤ 0.001. Further, time spent +on the smartphone is positively correlated with psychological +distress at r = 0.18, P ≤ 0.05; and basic psychological needs +frustration at r = 0.19, P ≤ 0.05; and negatively correlated with +basic psychological needs satisfaction at r = 0.24, P ≤ 0.01; and +mindfulness at r = −0.20, P ≤ 0.01. Furthermore, mindfulness +is negatively correlated with frustration at r = −0.16, P ≤ 0.05. +The correlation analysis among the optimal usage group +reported as time spent is positively correlated with satisfaction +at r = 0.13, P ≤ 0.05; and mindfulness is positively correlated +with basic psychological needs satisfaction at r  =  0.31, +P ≤ 0.001 and negatively correlated with basic psychological +needs frustration at r = −0.17, P ≤ 0.05; and further, basic +psychological needs satisfaction is negatively correlated with +frustration at r = 0.30, P ≤ 0.001. The correlation analysis +results are reported in Table 2. +Discussion +Smartphone usage has been on a drastic rise among +college‑going students. The research fraternity has extensively +discussed the implications of excessive usage. However, +this study intends to understand the intricacies of excessive +usage of smartphones and its relationship with the theory of +basic psychological needs satisfaction and frustration with +psychological distress and mindfulness. +The prevalence of excessive usage of smartphones in this +study is reported at 39%. This shows an ongoing trend +of an upsurge in excessive usage of smartphones among +college students.[45] It is reported that the excessive usage of +smartphones ratio in this study is higher among males. The +results from the current study suggest that the correlations are +significant but, relatively weak. Among them, time spent on the +smartphone is positively correlated with basic psychological +needs frustration, excessive usage of smartphone scores, and +psychological distress implying low emotion regulation and +psychological well‑being. However, smartphone excessive +usage is significantly and negatively associated with +mindfulness and also, the mindfulness is negatively correlated +with basic psychological needs and frustration among the +excessive usage of smartphone group. +The results from the optimal users of smartphone group reflect +that time spent on the smartphone is also positively associated +with basic psychological need satisfaction suggesting that the +smartphone is used as a coping mechanism to negate boredom +and loneliness.[11] Furthermore, basic psychological need +satisfaction has a strong correlation with mindfulness. This +could imply that basic psychological need satisfaction has +a major role in defining the symptoms of excessive usage of +the smartphone. In the absence, it may lead to psychological +distress and frustration and low levels of mindfulness +suggesting low psychosocial well‑being. +Excessive usage of smartphones and psychological +distress +The present study found that psychological distress is +positively correlated with excessive usage of smartphone. +It is understood that psychological distress, which includes +anxiety and depression are key symptoms of excessive usage of +smartphones. We found that distress levels are more prominent +in the excessive usage of the smartphone group when compared +to the optimal users of the smartphone group. Similarly, a study +on university students found that psychological distress and +neuroticism are positively correlated with excessive usage of +smartphones[46] which were similar to our research findings. +Excessive usage of smartphones and basic psychological +needs, satisfaction, and frustration +According to Ryan, the satisfaction of the basic psychological +needs are essential for an individual’s growth, health, and +psychological well‑being. Looking at the recent studies, it +is increasingly clear that the absence of basic psychological +needs satisfaction does not by definition imply it is frustration. +Psychological needs frustration involves more than a mere +Table 1: Mean and standard deviation of excessive usage of smartphone and optimal usage participants +Variables +Excessive usage +Optimal usage +U +P +Effect size (r) +Time spent +3.91±0.7 +2.85±0.67 +6134.5 +<0.001 +0.711 +SAS +37.28±5.04 +22.83±4.33 +5.50 +<0.001 +1.000 +Need frustration +27.34±7.86 +25.64±6.75 +18824 +<0.05 +0.114 +K‑10 +20.71±3.46 +19.27±3.79 +16426.5 +<0.001 +0.227 +Need satisfaction +22.62±6.53 +24.21±6.53 +17767.5 +<0.01 +0.163 +MAAS +46.52±8.03 +48.21±9.42 +18804 +<0.05 +0.115 +Mann–Whitney U‑test (to compare the differences of variables) between excessive usage and optimal usage participants. SAS: Smartphone addiction +scale – shorter version, K‑10: Psychological distress scale, MAAS: Mindfulness attention awareness scale, Satisfaction, and Frustration: Basic +psychological needs satisfaction and frustration scale, Time spent: Time spent on the smartphone in a day +Downloaded from http://journals.lww.com/mhhb by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW +nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/20/2023 +Putchavayala, et al.: Relation between smartphone addiction and psychological health +69 +Journal of Mental Health and Human Behaviour  ¦  Volume 28  ¦  Issue 1  ¦  January-June 2023 +deficit of one’s needs. Given this asymmetrical relation +between need satisfaction and need frustration, a moderate +negative relationship between both can be theoretically +expected. Our findings reflect the theoretical presumptions +being excessive usage of the smartphone has a significant +negative relation with satisfaction and a positive correlation +with frustration and the time spent on the mobile phone. +Between‑group analyses showed that students with excessive +usage of the smartphone have a significant negative correlation +with satisfaction and vice versa with frustration and time +spent on their mobile phones. These results were similar to +the earlier studies on need frustration with the smartphone +over‑usage.[47] However, it is also reported that there is a +positive relationship between the time spent on the mobile and +satisfaction among the optimal usage as well. We can interpret +this result by drawing a comparison with the earlier reports, +that smartphones can be used as a coping mechanism to give +temporary satisfaction and happiness to negate the proneness +to boredom and loneliness. +Time spent on the smartphones +According to a survey, the average time spent on smartphones +is 5 h a day.[48] This has become a key predictor in defining +excessive usage of the smartphone. The current study shows +an average time spent is around 3 h excluding their academic +activity on smartphones due to the COVID situation. This is +less than the predicted values. However, we found that the time +spent on the mobile has a positive relationship with excessive +usage of smartphone scores, psychological distress, and need +frustration;[49] and is negatively correlated with mindfulness. +Excessive usage of smartphones and mindfulness +Based on the empirical evidence, higher mindfulness +levels were significantly associated with lower levels of +proneness to boredom, impulsivity, and problematic usage +of smartphones.[50] Our study findings suggest that higher +mindfulness is associated with higher satisfaction levels and +negatively associated with frustration and psychological +distress scores among smartphone the optimal usage group. +As per the previous studies, lower mindfulness levels may lead +to lower attention levels and academic performance.[51] This +report suggests that the practice of mindfulness may lead to +minimizing the symptoms of excessive usage of smartphones. +Limitations and future scope +This is a basic study constrained to only engineering graduate +students and one particular geographical location. Hence, +future studies should focus on finding the results with +multi‑ethnic populations to generalize the results. The data are +a selfreported which can be further explored with objective +variables. This study tried to establish the primary relation +between the BPNT and excessive usage of smartphones. +Further, doing randomized controlled trial with mindfulness as +an adjunct modality can be studied to understand the intricacies +of the relation between the BPNT and excessive usage of +smartphone symptoms. +Conclusion +Results suggest that there is a positive association between +excessive usage of smartphones, psychological distress, time +spent on the mobile, and need frustration. These results linked +to the smartphone as a coping mechanism to gain momentary +satisfaction. However, prolonged time spent on the phone +may lead to frustration and maladaptive behavior in the +future. Moreover, the negative association between the need +satisfaction and frustration in the optimal users of smartphone +group suggests that fulfillment of need satisfaction plays a key +role in controlling the symptomatic nature of excessive usage +of the smartphone. +Acknowledgments +We acknowledge the management of Jain University, +Bengaluru for giving permission to conduct the study on +students of engineering on their campus. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +References +1. Sohn  SY, Rees  P, Wildridge  B, Kalk  NJ, Carter  B. Prevalence of +problematic smartphone usage and associated mental health outcomes +amongst children and young people: A systematic review, meta‑analysis +and GRADE of the evidence. BMC Psychiatry 2019;19:356. +2. Lopez‑Fernandez  O, Honrubia‑Serrano  L, Freixa‑Blanxart  M, +Gibson  W. Prevalence of problematic mobile phone use in British +adolescents. Cyberpsychol Behav Soc Netw 2014;17:91‑8. +Table 2: Spearman’s correlation between variables in +excessive usage of smartphones and optimal usages’ +participants +Variables +Spearman’s, r +Excessive users +Optimal usage +Time spent +SA +0.19* +‑ +K‑10 +0.18* +‑ +Need frustration +0.19* +‑ +Need satisfaction +−0.24** +0.13* +MAAS +−0.20** +‑ +SAS +MAAS +−0.39*** +‑ +Need frustration +0.18* +‑ +Need satisfaction +−0.19* +‑ +MAAS +Need satisfaction +‑ +0.31*** +Need frustration +−0.16* +−0.17* +Satisfaction +Need frustration +‑ +−0.30*** +*P<0.05, **P<0.01, and **P<0.001. 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Psychol Rep +2021;124:459‑78. +Downloaded from http://journals.lww.com/mhhb by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW +nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/20/2023 diff --git a/subfolder_0/DEVELOPMENT AND STANDARDIZATION OF JATARAGNI IMPAIRMENT CHECKLIST (JIC).txt b/subfolder_0/DEVELOPMENT AND STANDARDIZATION OF JATARAGNI IMPAIRMENT CHECKLIST (JIC).txt new file mode 100644 index 0000000000000000000000000000000000000000..ce91545fd886f2212b0c932f50344baadfd00315 --- /dev/null +++ b/subfolder_0/DEVELOPMENT AND STANDARDIZATION OF JATARAGNI IMPAIRMENT CHECKLIST (JIC).txt @@ -0,0 +1,983 @@ +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +DEVELOPMENT AND STANDARDIZATION OF JATARAGNI +IMPAIRMENT CHECKLIST (JIC) +PKL Nandini1, Raghavendra Rao M2, Malur R Usharani2 +Naik Radheshyam2, Nagarathna R1, Shubha H3 +Dr. Mariyamma philip4 Shekhar G Patil2, Diwakar B Ravi2 + H P Shashidhara2, C T Satheesh2, Basavalinga S Ajaikumar2 +1. Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru +2. Health Care Global Enterprises Ltd., Bengaluru +3. Sri Kalabhireshwara Ayurvedic Medical College, Bengaluru +4. Department of Biostatistics, National Institute of Mental Health and Neurosciences, +Bangalore, + +Introduction +Cancer treatment cause both physical & psychological distress (Haes +et al, 1990). Multiple physical distress symptoms are observed in +majority of patients during chemotherapy, either alone or cluster of +symptoms like nausea & vomiting, loss of appetite, taste alteration etc. +(Barsevick et al, 2006). Their intensity varies with type, stage and +treatment of the disease. (Rebecca Siegel, et al, 2012) It is observed +that, nausea does not occur as a single symptom, but a conglomeration +of symptoms like feeling sick, retching, loss of appetite and other +abdominal discomfort (GI disturbances) (Dodd et al, 2001, 2004). +Also, nausea has been relatively compared to vomiting as an ‘urge to +vomit’(Trikamji, 1935 Chap 20 Verse 6)Though vomiting is fairly +controlled with new antiemetic therapies, delayed nausea still remains +the most distressing concern experienced by seventy per cent of the +patients undergoing moderately emetogenic chemotherapy. As a result, +this subjective symptom is less understood and more so less treated. +Although Antiemetic’s are used to ease temporary nausea and +vomiting, some are known to cause side effects despite their clinical +benefits. (Osoba et al, 1997), (Feyer & Jordan, 2011) & (Roila et al, +2005) But use of antiemetic is necessary in CCINV. +1 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +Another significant problem is that, substantial gap remains between +antiemetic guidelines and practice (Angelis et al, 2003)with majority +of patients poorly controlled for Cancer Chemotherapy induced nausea +and vomiting –CCINV in developing countries. Conventional +antiemetic questionnaires (Functional living Index Emesis and +Morrow Assessment of Nausea and Emesis) only measure nausea and +emesis and their impact on quality of life(Martin et al, 2003), whereas +other +accompanying +symptoms +such +as +anorexia, +abdominal +discomfort etc. causing patients’ distress are not elicited. Health in +Ayurveda is defined in individuals as equilibrium of dosha (three vital +Bio energy), Agni (Bio energy),dhatu (Tissue),mala (Waste products), +kriya (Physiology) with sound soul, sense and mind (Trikamji, 1935 +Chap 1 Verse 53 & 1981 Chap 15 Verse 44) •. +In order to address the problem in holistic way, we used concept of +“Agni” from Ayurveda scriptures to address this cluster of symptoms as +a manifestation of “Agni impairment” and that there are thirteen types +of Agni governing all cellular metabolic processes such as anabolism +and catabolism in all organ systems to bring about a change. (Haridasa +Samskritha Granthamala 106 Chap 11 Verse 34) & (Trikamji, 1935 +Chap 15 Verse 3)Jataragni is the bio energy present in the GI tract. +Epicentred in duodenum and regulates the complete digestion and +assimilation process including gastric emptying phase of digestion and +regulates transit of food through the GI tract facilitating digestion +(Akash Kumar et al 2010) The discomforts caused due to +chemotherapy are related to formation of “ama” because of sluggish +digestion +or +impaired +jataragni +(Haridasa +Samskritha +Granthamala 106 Chap 13 Verse 25 & 27) resulting in Vata +Pittajachardilakshanas, taken in the present study as CCINV (Trikamji, +1935 Chap 20 Verse 7 & 20)Ayurveda texts prescribe correction of +dosha imbalance and Agni ultimately through VayuNiyantrana +(directing the energy channels) (Trikamji, 1935 Chap 28 Verse 3 & 4). +2 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +So, improving Agni and gastric motility play a vital role in management +of CCINV. In this study we attempted to measure the impairment of +Jataragni using a checklist that measures symptomatic manifestation +of Agni impairment. This was done by collectively using all available +information from Ayurveda texts on impairment of Jataragni. +Aim and objective +To develop a comprehensive checklist to evaluate impaired Jataragni +level among the CCINV patients, test the measurability of the items in +the checklist and examine the reliability and validity of Checklist-JIC +Methods +Checklist development procedure +Comprehensive description of methods and steps are as follows: +(Vranda-2009) & (Kiran Rao et al, 1989,) +Phase-1 Pooling of items. Item reduction, Scale construction, +consensual validation. +Pooling of items +As a first step identification of the universe of item pool for the +checklist (Nunnaly, 1978; Messick1980), the researcher contacted +thirty different Ayurveda experts, explained the rationale of the study +and documented their views on Agni with respect to its various +functionalities and manifestations. In short, experts suggested that the +checklist should be based on symptoms of jataragni impairment, as the +study covers the role of jataragni in CCINV. A total of about 30 +Jataragni impaired symptoms were listed as per the experts’ suggestion +with +references +from +Charakasamhitha, +Sushrutha +samhitha +Madhavanidana, Ashtangahrudaya, Ashtangahsangraha and text book- +concept of Jataragni in Ayurveda with special reference to Jataragni +bala pariksha by Vd. Bhagwan Dash. Common Chemotherapy side +3 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +effects and cancer symptoms were also referred as per CTCAE criteria. +The original Sanskrit phrases, their meanings in English were compiled +as a checklist. Thus, thirty original sanskrit symptoms on jataragni +impairment formed the initial item pool of JIC. +Item reduction +Focus Group Discussion (FGD) I- In order to minimize the number of +symptoms in JIC, researcher conducted a group discussion programme- +FGD I at Bangalore where a team of 10 Ayurveda experts were present +in the focus group discussion for corrections and inclusions based on +appropriateness. The researcher posed each of the symptoms to the +group of experts. Those items which were completely agreed and voted +by five or more judges were retained in the checklist. Overlapping, +repeated, irrelevant ambiguous or vague items were eliminated. Thus a +total of nineteen symptoms formed the checklist and eleven were +eliminated. +Scale construction: +The scale was constructed keeping in mind the criteria for uniformity +in scoring using a Likert scale - none, mild, moderate and severe +(Likert-Zyzanski et al, 1974). After considering different bias of scale +construction, the experts also confirmed that the items of the checklist +were linguistically equivalent (Sanskrit terms were translated to +English). +FGD II- the researcher posed each of the 19 symptoms to the group +comprising five oncologists to conform the appropriateness of items. +Those items that received three or more votes were retained in the +checklist. They suggested that the symptom checklist be modelled on +Common Terminology Criteria for Adverse Events (CTCAE) Version +3.0. Field testing for confirming the measurability of the checklist was +carried out among both non cancer patients taking Ayurveda treatment +4 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +and those with cancer on chemotherapy. The provisional checklist was +customised and prepared accordingly. Field testing 1-was conducted at +Ayurveda collage Bangalore on ten patients. Outcome: checklist was +able to show the difference in the level of Agni impairment before and +after panchakarma treatment. Field testing 2-was conducted on cancer +patients at HCG who were undergoing first cycle of chemotherapy. It +was observed that the majority of patients had zero score for nausea +and vomiting items at baseline before chemotherapy. Verbal consent +was first obtained from all subjects prior to their study activities and +confidentiality was maintained regarding the information collected for +the research. No invasive procedures were used in the study. +Consensual and content validity +FGD III-Consensual and content validation of the JIC was done by +convening a expert group of 17 members from Ayurveda, oncology, yoga +and clinical psychology. The experts were asked to validate each of the +items for, cultural relevance, clarity and ease with comprehension, +readability and suitability for a 4-point rating format. Those items +which were completely agreed and voted by nine or more judges +confirmed validity and were retained in the checklist. The experts +accepted the items subject to following conditions: +1. To change the rating of scale from none, mild, moderate and severe +to none, asymptomatic but present occasionally or evident on clinical +examination, symptomatic and frequent but does not interfere with +GI function, Symptomatic but interferes with GI function in lines of +CTCAE criteria version 3 for a clear definition of the grade severity +(See JIC checklist). +2. To capture symptoms other than Nausea and Vomiting to prove +divergent validity. +3. To retain only thirteen symptoms for the checklist (Annexsure-1) +5 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +4. The patients simultaneously were to complete Visual analogue Scale +(Objective assessment).for 2 symptoms- Time interval between each +meal and Quantity taken at each meal. The provisional checklist was +customised and prepared accordingly Final JIC comprised of 13 +symptoms (Annexsure-1). +Phase-2 Pilot Study +Patients for pilot study were chosen from a randomised controlled +study conducted at Health Care Global (HCG) Bangalore i.e. from first +sixty randomized patients, 15 patients were randomly chosen +representing all the 3 groups equally- Random 5 from each group. Pilot +study was carried out with 13 items of checklist. Sampling procedure +was similar to main study. (Usharani et al, 2014) +The aim was to assess the feasibility and comprehensibility of checklist. +This +self-reported +checklist +was +found +to +be +readable +and +comprehendible. The checklist was able to capture the difference in the +jataragni impairment level before and after chemotherapy. The mean +time taken to complete the checklist was found to be 10minutes. +Phase-3 +The final 13 items of JIC were tested to examine the measurability of +the checklist, to establish the norms for final interpretation of scores +and Standardization of Final 13-Items- for Validity and Reliability. +Sampling Procedure: +Study subjects: The study was carried out at Health Care Global +(HCG) Bangalore over 16 months period. (Usharani RM, et al) +Sample Size: The sample size was based on the three arm original +study to evaluate the effects of yoga intervention to manage CCINV +(Usharani et al, 2014). +6 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +This study included patients with solid malignancies except those with +brain metastasises/ brain tumours and GI malignancies. +Ethical issues: The study was approved by institutional ethics +committee and written informed consent was taken from all +participants prior to their participation in the study. +JIC was administered prior to chemotherapy and post 6 days for 1st, +2nd, 3rd cycles of chemotherapy. Here simultaneously patient +completed the Jataragni checklist on par with FLIE quality-of-life (Qol) +questionnaire. +Results +The mean age of study sample was 49.3 ± 11.3 years. Data was not +normally distributed. +Reliability and validity: +Reliability: The reliability of 13 item JIC was good with Cronbachs +alpha=0.74 and inter rater reliability between three raters varied +between 0.68 to 0.80 +Validity: Good divergent validity of JIC with FLIE indicating that it +captured items that were not captured in the FLIE. The kappa values, +ranges between 0.01 to 0.09 across four cycles of chemotherapy in the +overall study sample, indicating divergent validity. Values within each +group also showed similar divergent validity compared to overall study +sample indicating that intervention did not influence validity of the +scale. This strong validity demonstrates the robustness of the scale to +capture Jataragni symptoms independent of FLIE (See table 1&2). The +evidence of content validity has already been established in the initial +phase. + + +7 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +Table 1: Divergent validity of Jataragni checklist with FLIE +TIME +Agni & +FLIE +similar +Agni & FLIE +dissimilar + +Kappa + +p-value +No (%) +D0 (n=120) +45 (37.5) +75 (62.5) +- +- +D7 (n=112) +57 (50.9) +55 (49.2) +0.064 +0.318 +C2 (n=104) +45 (43.3) +59 (56.7) +0.019 +0.769 +C3 (n=94) +48 (51.1) +46 (48.9) +0.097 +0.097 +- couldn’t calculate Kappa, as FLIE @ D0 was 0 for all + +Symptom severity Symptoms were graded based on their presence +(subjective/clinical) and interference with GI function. Anorexia, taste +alteration and dry mouth were some of the major symptoms that +interfered with GI function. Though most of these symptoms were +reported by patients many of them did not interfere with GI function +(See Table 2 &3). + +Table 2: Severity of symptoms related to agni in Jataragni +checklist +Cycle +Mild (1) +No (%) +Moderate (2) +No (%) +Severe (3) + No (%) +D0 (n=120) +45 (37.5) +38 (31.7) +37(30.7) +D7 (n=120) +43(35.9) +38 (31.6) +39 (32.5) +C2 (n=109) + 41 (37.6) +46 (42.2) +22 (20) +C3 (n=102) + 39 (38.2) +32 (31.3) +31 (30.4) + + +8 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +Table 3: Severity of individual symptoms in Jataragni checklist +Symptoms +None 0 +No (%) +Mild 1 +No (%) +Moderate +2 +No (%) +Severe +3 +No (%) +Anorexia D5/7 +41 (37) +45(40) +22(20) +3 (3) +C2 +74 (69.2) +21 (19.6) +10 (9.3) +2 (1.9) +C4 +61 (61.0) +25 (25.0) +11 (11.0) +3(3.0) +ConstipationD5/7 +75 (68) +28 (25) +7 (6) +1(1) +C2 +91 (85.0) +14 (13.1) +2 (1.9) + +- +C4 +81 (81.0) +16 (16.0) +2 (2.0) +1 (1.0) +Diarrhea D5/7 +87(78.4) +19 (17.1) +4 (3.6) +1 (0.9) +C2 +100 +(93.5) +6 (5.6) +1 (0.9) +- +C4 +90 (90.0) +9 (9.0) +1 (1.0) +- +Distention D5/7 +75 (67.6) +29 (26.1) +5 (4.5) +2 (1.8) +C2 +96 (89.7) +9 (8.4) +2 (1.9) +- +C4 +80 (80.8) +14 (14.1) +4 (4.0) +1 (1.0) +Drymouth D5/7 +48 (43.2) +51(45.9) +11(9.9) +1(0.9) +C2 +63 (58.9) +31 (29.0) +12 (11.2) +1 (0.9) +C4 +56 (56.0) +38 (38.0) +5 (5.0) +1 (1.0) +Flatulence D5/7 +79 (71.2) +23 (20.7) +8 (7.2) +1 (0.9) +C2 +89 (84.0) +11 (10.4) +6 (5.7) +- +C4 +72 (72.0) +24 (24.0) +4 (4.0) +- +Heartburn D5/7 +71 (64.0) +31 (27.9) +7 (6.3) +2((1.8) +C2 +93 (86.9) +10 (9.3) +4 (3.7) +- +C4 +78 (78.8) +17 (17.2) +4 (4.0) + +Taste alteration +D5/7 +40 (36.0) +46 (41.4) +24 (21.6) +1 (0.9) +C2 +55 (51.4) +39 (36.4) +13 (12.1) +- +C4 +37 (37.0) +37 (37.0) +25 (25.0) +1 (1.0) +Heaviness D5/7 +75 (67.6) +28 (25.2) +8 (7.2) +- +C2 +93 (86.9) +10 (9.3) +3 (2.8) +1 (0.9) +C4 +80 (80.0) +17 (17.0) +3 (3.0) +- +Gurgling D5/7 +81 (73.0) +28 (25.2) +2 (1.8) +- +C2 +96 (90.6) +9 (8.5) +1 (0.9) +- +C4 +81 (81.0) +17 (17.0) +2 (2.0) +- +Eructation D5/7 +74 (66.7) +31 (27.9) +5 (4.5) +1 (0.9) +9 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +C2 +88 (83.0) +17 (16.0) +1 (0.9 +- +C4 +82 (82.0) +14 14.0) +4 (4.0) +- +Excess salivation +D5/7 +92 (82.9) +16 (14.4) +2 (1.8) +1 (0.9) +C2 +101 +(94.4) +5 (4.7) +1 (0.9) +- +C4 +84 (84.0) +13 (13.0) +3 (3.0) +- +Quantity at each +meal D5/7 +35 (31.5) +37 (33.3) +23 (20.7) +16 (14.4) +C2 +51 (47.7) +36 (33.6) +16 (15.0) +4 (3.7) +C4 +39 (39.0) +38 (38.0) +15 (15.0) +8 (8.0) + +Cut off scores +The 33rd percentile cut off scores was 2 (mean across all chemo cycles) +and 66th percentile cut off was 6 (mean across all chemo cycles) in this +study for Jataragni impairment checklist. +Convergent Validity +Quantity of meal is an extrapolation of Agni quality as per ancient +texts (Trikamji, 1935 Chap 12 Verse 11). We compared the convergent +validity of all items on JIC with quantity of meal at chemotherapy +cycle. There was a strong correlation on Spearmans rank correlation +at different chemotherapy cycles of total Agni of JIC with quantity of +each meal (All p’s=0.001). + + + + + + +10 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +4: Spearmans rank correlation between total agni with +quantity of each meal at different chemotherapy cycles. + +Quantity of each meal at +various chemotherapy +cycles + +TOTALA +GNI C1 +TOTALAG +NID5/7 +TOTALA +GNIC2 +TOTALAG +NIC4 +Quantity At Each +Meal{C1}, N=116 +.619** +Quantity At Each +Meal{D5/D7}, N=111 +.674** +Quantity At Each +meal{C2}, N=107 +.673** +Quantity At Each +Meal{C4}, N=100 +.641** +**p<0.01, using Sperman’s rank correlation +Findings: +There was strong reliability for JIC to measure impairment in Agni. +There was a poor agreement between FLIE and Agni scores indicating +strong discriminant validity and suggesting that JIC measures a +construct different from that of FLIE. However this Checklist measures +only impairment of Agni and is more suited to chemotherapy setting as +it’s known to measure some acute effects. The results suggest that this +questionnaire captures subtleties of symptoms that need not +individually impair GI function but can collectively increase distress. +These symptoms so mentioned are subjective and similar to concept of +symptom clusters proposed by Dodd et al, 2001and 2004. +Secondly, this did show divergent validity with FLIE, but does not +mean that these symptoms had no impact on quality of life as FLIE +11 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +measured only the impact of nausea or emesis on their respective +quality of life domains and not a collective or global quality of life. +Third, being subjective checklist the ensuing psychologic distress could +have increased the symptomatology in these patients confounding the +effects. However despite these limitations these subjective symptoms +still elucidate impairment in jataragni. Ayurvedic texts also describe +that psychological distress is known to affect Agni imbalance, therefore +the presence of these symptoms and distress give more credence to +studying agni in this current context. +As per ancient texts Jataragni is a physiological entity which converts +the substance from biological level to physiological level. It is subtle and +its presence can only be felt and observed but not seen. JIC assessment +helps in clinical evaluation of the diseased- in predicting severity of the +adverse effects, planning management (dietary and pharmacological,) +and in prognosis. But it is a self-reported measure to capture distress +and not a diagnostic tool. It measures only presence or absence of +symptoms and its severity, if present. Thus a comprehensive tool to +evaluate and asses the whole aspects of GI disturbances in its literal +sense, as Western point of view is not contributing much in +understanding the complex mechanism and subtler aspect of patient’s +problems at a time because Chemotherapy further simulates these +symptoms, leading to hypo or hyper functioning of JatarJataragni +affecting Pachaka Pitta) (Trikamji, 1935 Chap 8 Verse 20) .Vitiated +Jataragni ,situated as pachaka pitta influences and have a cascading +effect on other Jataragnis, and further aggravates pranadivayus +resulting in Nausea and Vomiting. +Suggestions: +There is a need to validate if this checklist can be used in other chronic +illnesses as well. Future studies should look at a larger population and +to develop ideal subscales using factor analysis. +12 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +References: +1. Akash Kumar Agrawal, C. R. Yadav and M. S. Meena .(2010) . +Physiological +aspectsof +Agni.Ayu. +Jul-Sep; +31(3):395–398.doi: +10.4103/0974-8520.77159PMCID: PMC3221079. +2. Andrea M. Barsevick, , Kyra Whitmer,, Lillian M. Nail, Susan L. and +William N. Dudley.(2006). Symptom Cluster Research: Conceptual, +Design, Measurement, and Analysis Issues. Journal of Pain and +Symptom Management Vol.31. +3. De Angelis V, Roila F, Sabbatini R. (Eds.). (2003) Cancer +chemotherapy-induced delayed emesis: antiemetic prescriptions in +clinical practice. +4. Dodd M, Miaskowski C & Paul SM. (2001). Symptom clusters and +their effect on the functional status of patients with cancer. Oncol +Nurs Forum; 28:465--470. +5. Dodd MJ, Miaskowski C & Lee KA. (2004). Occurrence of symptom +clusters. J Natl Cancer Inst Monogr 32:76--78. . +6. Feyer P and Jordan K. (2011). Update and new trends in antiemetic +therapy: the continuing need for novel therapies. Annals of +Oncology. 22(1):30-8. +7. Haridasa Samskritha Granthamala 106. Ashtanga Hrudaya of +Vagbhata, Sootra Sthana; Doshadivijnaneedi: Chapter 11, Verse 34 +.Chowkamba Press. +8. Haridasa Samskritha Granthamala 106. Ashtanga Hrudaya of +Vagbhata, Sootra Sthana; Doshopakramaniyam: Chapter 13, Verse +25. Chowkamba Press. +9. Haridasa Samskritha Granthamala 106. Ashtanga Hrudaya of +Vagbhata, Sootra Sthana; Doshopakramaniyam: Chapter 13, Verse +27 Chowkamba Press +13 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +10. J.C.J.M de Haes', F.C.E. van Knippenberg and J.P. Neijt3. (1990). +Measuring psychological and physical distress in cancer patients: +structure and application of the Rotterdam Symptom Checklist. Br. +J. Cancer, 62, 1034-1038. +11. Kiran Rao,1 D.K. Subbakrishna,2 and G.G. Prabhu3. (1989) +development of a coping checklist—a preminary report, Indian J +Psychiatry Apr-Jun; 31(2): 128–133. PMCID: PMC2991673. +12. Martin AR, Pearson JD and Cai. B. (2003). Assessing the impact of +chemotherapy-induced nausea and vomiting on patients' daily lives: +a modified version of the Functional Living Index-Emesis (FLIE) +with 5-day recall. Support Care Cancer. 11:522-7 +13. Messick, S. (1980) Test validity and the ethics of assessment. +14. Nunnally, J.C. (1978) The psychological theory. New York: +MaGraw- Hill Company +15. Osoba D, Zee B, Pater J, Warr D, Latreille J and Kaizer L. +(1997).Determinants of postchemotherapy nausea and vomiting in +patients with cancer. Quality of Life and Symptom. Journal of +clinical oncology. 15(1):116-23. +16. Rebecca Siegel, Carol DeSantis, Katherine Virgo, Kevin Stein, +Angela Mariotto, Tenbroeck Smith, Dexter Cooper, Ted Gansler, +Catherine Lerro, Stacey Fedewa, Chunchieh Lin, Corinne Leach, +Rachel Spillers Cannady, Hyunsoon Cho, Steve Scoppa, Mark +Hachey, Rebecca Kirch, Ahmedin Jemal, and Elizabeth Ward.(2012) +Cancer Treatment and Survivorship Statistics +17. Roila F, Warr D, Clark-Snow RA, Tonato M, Gralla RJ ,Einhorn LH +et al. (2005). Delayed emesis: moderately emetogenic chemotherapy. +Supportive care in cancer.;13(2):104-8. +14 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +18. Usharani RM, PKL Nandini, Raghavendra Rao M, Mahesh Kavya, S +Aishvarrya, et al. (2014) Comparison of Yoga vs. Relaxation on +Chemotherapy Induced Nausea and Vomiting Outcomes: A +Randomized +Controlled +Trial. +J +Integr +Oncol +3:116. +doi: +10.4172/2329-6771.1000116 +19. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Sootra Sthana; 1I +ed. Chapter1 Verse 53. Nirnaya Sagar Press. +20. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Vimana Sthana;; 1I +ed. Chapter8 Verse 20 Nirnaya Sagar Press. +21. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Sootra Sthana; 1I +ed. Chapter12 Verse 11 Nirnaya Sagar Press. +22. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Sootra Sthana; 1I +ed. Chapter15 Verse 3. Nirnaya Sagar Press. +23. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Chikitsa Sthana; 1I +ed. Chapter20 Verse 6 Nirnaya Sagar Press. +24. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Chikitsa Sthana; 1I +ed. Chapter20 Verse 7 Nirnaya Sagar Press. +25. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Chikitsa Sthana; 1I +ed. Chapter20 Verse 20 Nirnaya Sagar Press. +15 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +26. Vaidya Jadavji Trikamji Acharya. (Ed.). (1935). Charaka Samhita of +Agnivesha revised by Charaka and Dridahabala. Chikitsa Sthana; 1I +ed. Chapter28 Verse 3&4 Nirnaya Sagar Press. +27. Vaidya Jadavji Trikamji Acharya. (Ed.). (1981). Sushrutha Samhita +of Sushrutacharya, Sootra Sthana; 1 ed, Chapter 15 Verse 44. +Nirnaya Sagar Press. +28. M.N Vranda. (2009).Development and standardization of life skills +scale, Indian Journal of Social Psychiatry. 25(1-2), 17 - 28. +29. Zyzanski, S.J., Hulka, B.S., Cassel. J.C. (1974) Scale for +measurement of satisfaction with medical care: Modification of +content format scoring. Medical Care, 3, 294-323. American +Psychologist, 35, 1012-1027. +16 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +CHECKLIST FOR EVALUATING STATE OF AGNI WITH SPECIAL REFERENCE TO +JATARAGNI - JIC +Symptom +0 +1 +2 +3 +1. Anorexia +none +Loss of appetite without +alteration in eating +habits +Oral intake altered +without significant +weight loss or +malnutrition, oral +nutritional +supplements +indicated +Associated with significant +weight loss or malnutrition, IV +fluids, tube feeding or TPN +indicated + 2. Constipation +none +Occasional or +intermittent symptoms, +occasional use of stool +softeners, laxatives, +dietary modification or +enema +Persistent +symptoms with +regular use of +laxatives or enema +indicated +Symptoms interfering with +ADL, obstipation with manual +evacuation indicated +3. Diarrhea +none +Increase of <4stools +/day over baseline, +Increase of 4-6 +stools/day over +baseline, IV fluids +indicated <24hrs, +Increase of _> 7 stools/day over +baseline, incontinence, IV +fluids _>24hrs hospitalization, +4. Distension/ +bloating, +none +Asymptomatic but +evident on clinical +Symptomatic but +not interfering with +Symptomatic, interfering with +GI function +17 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +abdominal +examination +GI function +5. Dry mouth +none +Symptomatic(dry or +thick saliva) without +significant dietary +alteration, +Symptomatic and +significant oral +intake alteration, +Symptoms leading to inability +to adequately aliment orally, IV +fluids, tube feedings or TPN +indicated, +6. Flatulence +none +Asymptomatic but +evident on clinical +examination +Symptomatic but +not interfering with +GI function +Symptomatic, interfering with +GI function ---- +7. Heart +burn/Dyspepsia +none +Asymptomatic but +evident on clinical +examination +Symptomatic but +not interfering with +GI function +Symptomatic, interfering with +GI function +8. Taste +alteration +none +Altered taste but no +change in diet +Altered taste with +change in diet, +noxious or +unpleasant taste, +loss of taste. +---- +9. Gastro- +intestinal-others +a) Heaviness of +abdomen +none +Asymptomatic but +evident on clinical +examination +Symptomatic but +not interfering with +GI function +Symptomatic, interfering with +GI function +18 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +b) Gurgling +sound in the +intestine +none +Asymptomatic but +evident on clinical +examination +Symptomatic but +not interfering with +GI function +Symptomatic, interfering with +GI function +c) Eructations +none +Asymptomatic or very +occasional +Symptomatic and +frequent but not +interfering with GI +function +Symptomatic, interfering with +GI function +d) Excessive +salivation +none +Asymptomatic or very +occasional +Symptomatic and +frequent but not +interfering with GI +function +Symptomatic, interfering with +GI function + + Note: The symptoms mentioned as 9a, b, c, d categorized under gastrointestinal-others is graded +depending on the patient’s response (Subjective response) +19 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.735; IC VALUE:5.16 +VOLUME 3, ISSUE 8(4), AUGUST 2014 + + +Reference: The grading of symptoms mentioned in the above checklist +is customized for this study based on Common Terminology Criteria for +Adverse Events (CTCAE) Version 3.0 published by U.S. Department of +health and human services, National Institutes of Health and National +Cancer Institute +20 diff --git a/subfolder_0/Design and validation of integrated yoga therapy module for antarctic expeditioners.txt b/subfolder_0/Design and validation of integrated yoga therapy module for antarctic expeditioners.txt new file mode 100644 index 0000000000000000000000000000000000000000..a26c0528c3585222706e7281e01d3e322a007d05 --- /dev/null +++ b/subfolder_0/Design and validation of integrated yoga therapy module for antarctic expeditioners.txt @@ -0,0 +1,406 @@ +Original Research Article +Design and validation of Integrated Yoga Therapy module for Antarctic +expeditioners +Ragavendrasamy Balakrishnan a, Ramesh Mavathur Nanjundaiah a, *, Mohit Nirwan b, +Manjunath Krishnamurthy Sharma c, Lilly Ganju b, Mantu Saha b, Shashi Bala Singh d, +Nagendra Hongasandra Ramarao e +a Molecular Biosciences Laboratory, Anvesana Research Laboratories, S-VYASA University, Bangalore, India +b Defence Institute of Physiology and Allied Sciences, New Delhi, India +c Anvesana Research Laboratories, S-VYASA University, Bangalore, India +d Life Sciences Research Board, Defence Research and Development Organisation, New Delhi, India +e S-VYASA University, Bangalore, India +a r t i c l e i n f o +Article history: +Received 20 July 2017 +Received in revised form +27 October 2017 +Accepted 18 November 2017 +Available online xxx +Keywords: +Yoga module +Antarctica +Stress +IAYT +a b s t r a c t +Background: Extreme environments are inherently stressful and are characterized by a variety of physical +and psychosocial stressors, including, but not limited to, isolation, confinement, social tensions, minimal +possibility of medical evacuation, boredom, monotony, and danger. Previous research studies recom- +mend adaptation to the environment to maintain optimal function and remain healthy. Different in- +terventions have been tried in the past for effective management of stress. Yoga practices have been +shown to be beneficial for coping with stress and enhance quality of life, sleep and immune status. +Objective: The current article describes preparation of a Yoga module for better management of stressors +in extreme environmental condition of Antarctica. +Materials and methods: A Yoga module was designed based on the traditional and contemporary yoga +literature as well as published studies. The Yoga module was sent for validation to forty experts of which +thirty responded. +Results: Experts (n ¼ 30) gave their opinion on the usefulness of the yoga module. In total 29 out of 30 +practices were retained. The average content validity ratio and intra class correlation of the entire +module was 0.89 & 0.78 respectively. +Conclusion: A specific yoga module for coping and facilitating adaptation in Antarctica was designed and +validated. This module was used in the 35th Indian Scientific expedition to Antarctica, and experiments +are underway to understand the efficacy and utility of Yoga on psychological stress, sleep, serum bio- +markers and gene expression. Further outcomes shall provide the efficacy and utility of this module in +Antarctic environments. +© 2018 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciences +and Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-ND +license (http://creativecommons.org/licenses/by-nc-nd/4.0/). +1. Introduction +Characteristics +and +determinants +of +human +response +to +extreme environmental conditions prevailing in the Antarctic +continent has interested psychologists and physiologists. Extreme +environments are inherently stressful and are characterised by a +variety of physical and psychosocial stressors including but not +limiting +to +capsule +environment, +isolation, +social +tensions, +boredom, monotony and danger [1]. The international commit- +tees, COMNAP (The Council of Managers for National Antarctic +Program) and SCAR (Scientific Committee of Antarctic Research), +in addition to the organisers of the expedition from individual +countries, are primarily concerned to enhance the overall well- +ness of the members sent to the Antarctic stations. Even though +scientific research is the primary goal of Antarctic expedition, +equal importance is given to take care of the physical and psy- +chological health of the expeditioners starting from selection of +expeditioners to emergency evacuation to involving behavioural +* Corresponding author. +E-mail: ramesh.mavathur@svyasa.org (R.M. Nanjundaiah). +Peer review under responsibility of Transdisciplinary University, Bangalore. +Contents lists available at ScienceDirect +Journal of Ayurveda and Integrative Medicine +journal homepage: http://elsevier.com/locate/jaim +https://doi.org/10.1016/j.jaim.2017.11.005 +0975-9476/© 2018 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciences and Technology and World Ayurveda Foundation. This is +an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). +Journal of Ayurveda and Integrative Medicine xxx (2018) 1e4 +Please cite this article in press as: Balakrishnan R, et al., Design and validation of Integrated Yoga Therapy module for Antarctic expeditioners, +J Ayurveda Integr Med (2018), https://doi.org/10.1016/j.jaim.2017.11.005 +scientist and psychologists to offering periodic support through +online group or individual psychological counselling sessions for +helping expeditioners deal with the stress [2]. +Several psychological and physiological changes are observed in +Antarctic expeditioners. Psychological changes range from behav- +ioural changes like aggression, mood swings to psychiatric prob- +lems like depression [3]. Isolation seems to have a considerable +effect. Isolation and inherent danger associated in Antarctic envi- +ronment might enhance the extent of repetitive negative thinking +based on the personality of the individual. Reports suggest an in- +crease in smoking, loneliness, homesickness and a reduction in +rapport during the isolated dark winter months [4]. Physiologically, +decreased immune responsiveness accompanied with variations in +circulating insulin, thyroid stimulating hormones, testosterone, +cortisol, melatonin, pro-inflammatory Cytokines, 25-OH-vitamin D +and a significant increase in total cholesterol have been recorded +[5e8]. Some studies also suggest that such challenging environ- +ments also turn to be salutogenic in certain individuals. With +limited access to health care in the Antarctic environment, strate- +gies are required to be adopted to promote overall psycho-physical +wellness of an individual and also the group. Interestingly, Yoga +practices have been known to be beneficial and promote psycho- +physiological wellbeing across human cultures. +Physical postures (asana), voluntarily regulated breathing (pra- +nayama), and meditation (dhyana) are the three main components +of Yoga practiced in India over thousands of years. In the past +decade, Yoga has gained popularity as a fitness strategy and as well +as an adjunct therapeutic tool in the management of obesity [9], +diabetes [10], hypertension [11] and even auto-immune disorders +[12]. Yoga practices have been shown to alleviate anxiety, fear +[13,14], negative thinking [15], and enhance cardio-pulmonary +fitness [16], immune status [17,18], and also telomere length [19] +in regular practitioners. Yoga practices improve the overall sleep +efficiency and total sleep time [20]. Yoga practice in high altitudes +showed a lower reduction in oral temperature and lower increase +in Oxygen consumption and energy expenditure compared to +physical therapy [21]. Meta-analysis of data on Yoga recommend +Yoga to be considered as an ancillary treatment option in the +management of depressive disorders [22]. +A study was conducted on the summer and wintering over +members of the 35th Indian Scientific Expedition Members to +Antarctica to understand the role of Yoga practices on facilitating +human adaptation to extreme climatic conditions. Even though +Yoga practices are known to be beneficial for individuals irre- +spective of their health and disease states, it is essential to structure +specific Yoga practices that are intended to provide most benefits. +Yoga practices for Antarctica were designed with the following +objectives: +i. To regulate mood and alleviate psychological stress caused +due to isolation +ii. To enhance physical wellness, overcome fatigue and regulate +metabolism +iii. To enable better thermoregulation +iv. To +enhance +better +sleep +and +promote +interpersonal +relationship +The objectives were listed based on the earlier reports on the +psychological and physiological changes in Antarctic expeditioners. +Practices identified were compiled together to promote calmness of +mind and sleep, overcome stress and fatigue, promote overall +endurance of the body, regulate digestion, metabolism and enable +better pulmonary functions (supplementary material 1). The cur- +rent study present the data on the designing and validation of the +Yoga module that was implemented in the expedition members. +2. Materials and methods +The classical and contemporary yoga texts were reviewed to +develop the content of the Yoga module. Texts on Yoga Sutras of +Patanjali, Hatha Yoga Pradipika, Shiva Samhitha, Gheranda Samhita, +Hatharathnavali, Bhagavad Gita, Upanishads, Yoga Vashishta and +Yogic Sukshma Vyayama were reviewed [23e31]. Practices that +might be difficult for the expeditioners to practice and those that +are contra-indicated in common disorders such as hypertension +and cardiovascular disorders were not included. Similarly, those +practices that were difficult to objectively verify and certain +Sükshma vy€ +ay€ +ama (loosening exercise) practices that might not be +feasible to practice in group inside the Antarctic stations like +Jangha Shakti vikasaka [31] were not included. The Yoga module +that was designed consisted of postures with slow movements +and breath +awareness, loosening exercises, suryanamaskara, +asana, pra€ +eayama, relaxation and nadanusandhana. The duration +of the entire practice is 1 h. +The Yoga module was sent along with the objectives to forty +yoga experts out of whom thirty responded with their scores and +comments. Members with allopathic & AYUSH streams of med- +icine with post graduate medical degree in Yoga therapy, re- +searchers with doctoral degree in yoga, and yoga & naturopathic +physicians with over 7 years of clinical experience were consid- +ered to be included in the expert panel for validating the Yoga +module. The experts rated the usefulness of the module on a +scale of 1e5 (1 not at all useful, 2 a little useful, 3 moderately +useful, 4 very useful, 5 extremely useful). Content Validity Ratio +(CVR) for suitability of items was calculated following Lawshe's +method [32]. Dichotomous (yes/no) responses were obtained to +determine the duration of the individual practice and the entire +yoga session. +2.1. Statistical analysis +Lawshe's CVR ratio was calculated [32] for each item in the +module. Items with a CVR of 0.6 and above were considered beyond +change agreement (p < 0.05, one tailed) for 30 experts. Intra class +correlation was calculated for inter-rater reliability [33]. +3. Results +Thirty experts in Yoga therapy and research consented to +contribute to the content validation of the Yoga module for +extreme Antarctic environmental conditions. These Yoga experts +had experience in various traditions of Yoga. The experts age +ranged from 32 to 50 years (mean 36.3 ± 4.17 years). The average +experience following formal yoga training was 12.3 years +ranging between 8 and 26 years. The scores obtained for the +individual practices and the calculated CVR are shown in the +supplementary material 2. One practice viparitakarani with CVR +<0.6 was excluded. The average CVR for the entire Yoga module +was 0.89. Good agreement is noted for most practices listed in +the yoga module. Intra Class Correlation [33] for the entire +module was 0.78. +All +the experts opined on the need +for practicing +Sur- +yanamaskara (sun salutation), relaxation and breath awareness +based practices and pranayama. Most experts agreed on the dura- +tion of 1 h for the Yoga practices (Table 1). In addition to the +practices that were asked to be scored by experts, seven experts +recommended to include vaman dhauti kriya (voluntarily induced +vomiting after drinking saline water in empty stomach). But, was +not considered in module due to challenges in water treatment and +discharge at Antarctica. +R. Balakrishnan et al. / Journal of Ayurveda and Integrative Medicine xxx (2018) 1e4 +2 +Please cite this article in press as: Balakrishnan R, et al., Design and validation of Integrated Yoga Therapy module for Antarctic expeditioners, +J Ayurveda Integr Med (2018), https://doi.org/10.1016/j.jaim.2017.11.005 +4. Discussion +The Yoga module for application in the extreme Antarctic con- +ditions appears to be acceptable for most of the experts. Similar +strategy was used in earlier studies for validating yoga modules for +various pathological conditions [34,35]. +The experts from different schools of yoga were in agreement +with the contents of the module. Only viparitakarani was not fav- +oured to be included in the final module as indicated by the CVR +score (<0.6). Seven experts suggested including vaman dhauti kriya. +However, with concerns over processing the waste water and +maintenance in the Antarctic stations and the decision of experts +not being unanimous, the recommendation was not taken further +into validation. +Several interventions like psychiatric counselling, group ther- +apy, medications and diet are tried on the expeditioners to reduce +their psycho-physiological stress. Yoga, a widely accepted reliever +of stress [36], has never been tried in Antarctica until now. Also, the +strengths of this module is that it consists of simple postures that +are easy to follow and as the practices are derived from traditional +yoga texts, yoga instructor following any school of Yoga should be +able to teach the module. The classical Yoga texts does not describe +specific symptom based guidelines for their practice e as the pri- +mary objective of Yoga practices is to gain mastery over mind [26] +and the observed physical and mental benefits might be actual by- +product of yoga practice. Therefore, the practices have been +selected from the texts based on the approximating descriptions of +mental and physical health benefits of specific Yoga practices and +that are feasible to be practiced at the Indian Antarctic station. This +is the first attempt made to administer structured Yoga practices +with an objective to understand its mechanisms of action in iso- +lated, stressful and extreme Antarctic conditions. The effect of the +Yoga intervention will be known when the study on the summer +[Voyage team] and wintering over [Bharati, Larsemann hills, +(692402800S 761101400E)] members of the 35th Indian Scientific +Expedition to Antarctica will be analysed for changes in their psy- +chological stress, sleep, serum biomarkers, and gene expression +regulations. +5. Conclusion +A comprehensive and traditional text based Yoga module was +developed as an intervention to facilitate coping up with the psy- +chological and physiological stressors in the Antarctica. The Yoga +module was validated by 30 experts who agreed to most of the +practices. The final module was used as an intervention in the 35th +Indian Scientific Expedition to Antarctica. Testing of efficacy of the +intervention on alleviating psycho-physiological stress at genetic +and molecular level is underway and might prove to be an efficient +way to deal the stressors associated with the extreme Antarctic +environments. +Funding +This project was funded by Defence Institute of Physiology and +Allied Sciences, New Delhi (TC/DIP-265/CARS-05/DIPAS/2-15). +Acknowledgements +The authors acknowledge all the experts for offering their +comments and inputs to develop this module. +Appendix A. Supplementary data +Supplementary data to this article can be found online at +https://doi.org/10.1016/j.jaim.2017.11.005. +References +[1] Suedfeld P. Applying positive psychology in the study of extreme environ- +ments. Hum Perform Extreme Environ 2001;6. p 21e5. +[2] Suedfeld P, Steel GD. The environmental psychology of capsule habitats. Annu +Rev Psychol 2000;51. p 227e53. +[3] Gunderson EKE. Emotional symptoms in extremely isolated groups. 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Balakrishnan et al. / Journal of Ayurveda and Integrative Medicine xxx (2018) 1e4 +4 +Please cite this article in press as: Balakrishnan R, et al., Design and validation of Integrated Yoga Therapy module for Antarctic expeditioners, +J Ayurveda Integr Med (2018), https://doi.org/10.1016/j.jaim.2017.11.005 diff --git a/subfolder_0/Development of a Trans-disciplinary Intervention Module for Adolescent Girls on Self-awareness.txt b/subfolder_0/Development of a Trans-disciplinary Intervention Module for Adolescent Girls on Self-awareness.txt new file mode 100644 index 0000000000000000000000000000000000000000..af71eff3be0cc23cf23ced6715b66798a92dc728 --- /dev/null +++ b/subfolder_0/Development of a Trans-disciplinary Intervention Module for Adolescent Girls on Self-awareness.txt @@ -0,0 +1,643 @@ +Journal of Clinical and Diagnostic Research. 2017 Aug, Vol-11(8): VC07-VC10 +7 +DOI: 10.7860/JCDR/2017/25765.10462 +Original Article +Psychiatry/Mental +Health Section +Development of a Trans-disciplinary +Intervention Module for Adolescent +Girls on Self-awareness +Jasmine Mary John1, Janardhan Navneetham2, H R Nagendra3 +Keywords: Adolescence, Females, Mental health promotion +ABSTRACT +Introduction: Mental health promotion among adolescents +has been a key area of intervention for professionals working +with children and adolescents. The opinions of experts in the +field of mental health have taken to frame a trans-disciplinary +intervention for adolescent girls on self awareness. +Aim: To discuss the development and validation of a structured +intervention by combining the knowledge from different +disciplines in helping adolescents enhancing self awareness. +Materials and Methods: Both qualitative and quantitative +methodologies were followed for the development and validation +of the module. First phase of the development of intervention +module was the framing of intervention module after conducting +in-depth interviews with experts in both mental health and yoga +fields. Six experts each from mental health and yoga field were +chosen for interview through convenient sampling. Validated +interview guides were used for the process. The framed +intervention module was given to six mental health experts +and six yoga experts for content validation. The experts rated +the usefulness of the intervention on a scale 0-4 (4=extremely +helpful). +Results: The themes derived in the interviews were importance +of self awareness, autonomy of self, physical level of self +understanding, self regulation of emotions and self monitoring. +The interviews were consolidated to frame the intervention +module consisting of eight sessions having two parts in each +session. Part one of each session is activities and interactions +on mental health and part two is guided instructions for body +focused meditation. Sessions were finalized with rating and +suggestions from the experts. The final version of the module +was pilot tested and had found to have enhanced self awareness +among adolescent girls. +Conclusion: Integration of multiple disciplines brought in novel +perspectives in intervention. +INTRODUCTION +Adolescence is a developmental period with many major internal and +external changes. Developmental challenges during adolescence +includes increased need for independence, evolving sexuality, +consolidating advanced cognitive abilities, negotiating changing +relationships in family, peers and broader social connections [1]. +This paper discusses the development of a structured intervention +in combining the knowledge from different disciplines in helping +adolescents enhancing self awareness. The opinions of experts in +the field of mental health and yoga were sought to frame a trans- +disciplinary intervention for adolescent girls on self awareness. +Interventions aimed at adolescent population in Indian context +majorly include adolescent health education, sexual and +reproductive health, sexuality and sexual abstinence etc., [2]. Life +skills education programmes and resilient training have brought in +significant changes in the self-esteem, motivation and self-efficacy +of adolescents [3]. +The concept of self awareness has higher meanings in transcendental +terms but for an adolescent who is going through the developmental +stage; it is about knowing about the physical changes in oneself +and understanding where their thoughts and emotions take them. +Studies on awareness in adolescents had majorly looked into their +knowledge about the physical changes [4,5]. Self as a construct +in an individual is developed in relation with their interaction with +others in the society. Recent understanding of self could be seen +as the accumulation of experiences one gains by the continuous +interaction with the environment [6]. +Children could safely practice meditation and simple breathing +exercises as long as the breath is never held. Children trained in +these techniques are better able to manage emotional upsets and +cope with stressful events [7]. A study recommended carefully +constructed research to enhance understanding of sitting meditation +and its future use as an effective treatment modality among younger +population [8]. Body focused techniques help in understanding the +subtle changes of physical body frame [9] and subjective features of +internal body responses [10]. Although self awareness and physical +changes of adolescence has been addressed in many of these +studies, we couldn’t find any intervention modules with combined +modalities like knowledge, awareness relaxation, breathing exercises +or meditation. +The current research was carried out between the months of +February, 2015 to October, 2015 in Bengaluru, Karnataka, India, +with the aim of developing a trans-disciplinary intervention module +for adolescent girls on self awareness. +MATERIALS AND METHODS +The development of the module was carried out in two phases. +The Phase 1 was the consolidation of ideas and techniques into +framing the intervention module through literature reviews and in- +depth interviews with experts in the field. Interview guides were +prepared through literature review [10-12]. Separate probes were +framed for mental health experts and yoga professionals and +validated. In-depth interviews were conducted among six mental +health experts and six yoga practitioners to know the preferences +of the professionals in aspects of designing the intervention like the +structure and content of intervention module. Mental health experts +included psychiatric social workers, clinical psychologists and +psychiatrists who had knowledge and experience in child mental +health. All of the experts were professors in the respective fields. Six +mental health experts from three different institutions were chosen +for the in-depth interview. Yoga professionals were those experts in +Jasmine Mary John et al., Development of a Trans-Disciplinary Intervention Module for Adolescent Girls on Self-Awareness +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2017 Aug, Vol-11(8): VC07-VC10 +8 +yoga and meditation who were professors and practitioners in yoga +education. Experts for the interview were selected by convenient +sampling method. Researcher personally contacted the experts +and interviews were conducted at their offices. The interviews were +later transcribed and themes were identified. Thematic analysis +was carried out to categorize the commonly accepted themes from +the interview. Intervention module was prepared from the topics +discussed and themes derived. +Phase 2 was a quantitative phase wherein the validation of the +framed module was done quantitatively. Six experts from each field +who were not part of the interview were contacted personally by +researcher for validation. Out of the six experts in mental health field, +two were psychiatric social workers, two were clinical psychologists +and two were psychiatrists; all working as professors and assistant +professors. All the six experts in yoga were having Doctoral degree +in yoga. +Ethical consideration: Prior permission was taken from each of the +experts for in-depth interviews and validation. Interviews were done +by researcher by visiting their offices with prior appointment. The +objectives of the interview were explained and informed consent +was taken from each of them. Consent for audio recording was +sought for and done for all who agreed for. Confidentiality maintained +while transcribing the interviews. The research had received ethical +clearance from Institute Ethical Committee, National Institute of +Mental Health and Neuro Sciences, Bengaluru, Karnataka, India. +RESULTS +Phase 1 +In-depth Interview +The main theme derived was the importance of self awareness. +There were four sub themes emerged from the interview. Some +of the voices corresponding to the theme and sub themes are +discussed below. +Main theme: Importance of self-awareness +Most of the experts had given their opinion on the importance of +self awareness. +“Awareness of what they are good at; what they are not good at; +what their strengths are; weaknesses are; those things.”(MH 4) +“A holistic approach is needed to enhance awareness in the girl. +(MH 5) +With better awareness of oneself, they would gain confidence to +face and deal with day to day issues in a better way. The yoga +practitioners opined the need of clearly demarcating the self +awareness in adolescent period from that of older people. +Sub themes +1. Autonomy of self: Experts viewed that seeking autonomy is a +prime factor during adolescence, and intervention on self awareness +helps in the achievement of autonomy. +“..so as part of the development itself during that phase, their style +of functioning was of seeking freedom and also they do not want to +get dependant on the parents.” (MH 1) +Experts shared that though dependence on peers is seen in +adolescents, they want to experience their freedom and hence the +responsibility of understanding about self can be given to a growing +individual. +2. Physical level of self understanding: The need for physical +level of understanding for adolescent was enquired into. +Mental Health +intervention +sessions +Scoring (0-4) (Number of +experts) +n (%) of +experts rat­ +ing ≥2 +Content +Validity +Ratio +MH session 1 +0 (0) +1 (1) +2 (1) +3 (4) +4 (0) +5 (83.33) +0.6 +MH session 2 +0 (0) +1 (0) +2 (1) +3 (3) +4 (2) +6 (100) +1.0 +MH session 3 +0 (0) +1 (0) +2 (0) +3 (4) +4 (2) +6 (100) +1.0 +MH session 4 +0 (0) +1 (0) +2 (0) +3 (3) +4 (3) +6 (100) +1.0 +MH session 5 +0 (0) +1 (0) +2 (1) +3 (3) +4 (2) +6 (100) +1.0 +MH session 6 +0 (0) +1 (0) +2 (0) +3 (2) +4 (4) +6 (100) +1.0 +MH session 7 +0 (0) +1 (0) +2 (0) +3 (3) +4 (3) +6 (100) +1.0 +MH session 8 +0 (0) +1 (0) +2 (0) +3 (4) +4 (2) +6 (100) +1.0 +[Table/Fig-2]: Content validity ratio of mental health intervention sessions. +[Table/Fig-1]: Session wise details of the module: Each session has introduction +and conclusion activities ranging from 10 to 15 minutes. +Part 1: +Part 2: +Session 1 +Mental Health Intervention +Introductory session: +Ice breaking and knowing +oneself. +Duration: 25 minutes +Body Focused Meditation +Sitting +posture +was +described; +Breathing awareness and conclusion +with wareness of outer space +Duration of part 2: 5 minutes +Session 2 +Self; “I, me and myself”. +Session on knowing about +oneself. +Duration: 30 minutes +Berating awareness and concluding +with awareness of outer space +Duration was 5 minutes +Session 3 +Multiple selves, one’s +functioning in different +social roles. +Duration: 28 minutes +Detailing of breathing-inhaling and +exhaling with awareness of physical +body part, subtle movement of body +while breathing etc. Closure with +awareness of outer space +Duration was 7 minutes +Session 4 +Session on physical +body awareness. Body +mapping. +Duration: 25 minutes +Sitting descriptions and brief outer +awareness, detailing of breath with +physical awareness, awareness of +body part on a bottom to top manner +and closure with awareness of outer +space. +From this session onwards, duration +of instructions was 10 minutes +Session 5 +Emotions- identification +and regulation. +Duration: 25 minutes +Brief sitting description with more +autonomy for them to get settle. +Awareness on body parts; to do on +their own with freedom given to choose +between top to bottom or bottom +to top approach, reminding of any +incident where emotions experienced +with increased awareness about body +parts feelings in its memory. +Long and slow breathing instructions. +(to help them come out of the changes +in body created by memory); Brief +positive suggestions and closure with +outer awareness. +Duration was 10 minutes +Session 6 +Identifying emotional +responses during +interpersonal situations +and an activity to letting +of oneself (guided +instructions) +Duration: 25 minutes +Awareness on body parts; to do +on their own with freedom given to +choose between top to bottom or +bottom to top approach with focus on +specific sensations which they would +be aware of and positive suggestions +on +confidence +and +experiencing +relaxation. +Duration was 10 minutes +Session 7 +3 R’s: Reacting, +responding and +Responsible. +Duration: 25 minutes +Awareness on body parts; to do +on their own with freedom given to +choose between top to bottom or +bottom to top approach with focus on +specific sensations which they would +be aware of, positive suggestions +and confidence and future life and +experiencing relaxation. +Duration was 10 minutes +Session 8 +Introducing the concept +of monitoring device and +conclusion. +Duration: 25 minutes +Sitting descriptions and brief outer +awareness Awareness on body parts; +to do on their own with freedom given +to choose between top to bottom or +bottom to top approach with focus on +specific sensations which they would +be aware of and positive suggestions +on +confidence +and +experiencing +relaxation. +Duration was 10 minutes +www.jcdr.net + Jasmine Mary John et al., Development of a Trans-Disciplinary Intervention Module for Adolescent Girls on Self-Awareness +Journal of Clinical and Diagnostic Research. 2017 Aug, Vol-11(8): VC07-VC10 +9 +“they can be given guided instruction to focus on big to smaller +things..by starting with awareness of external reality, like listening to +the sounds..breath and then each part of the body..”(YP 4) +The use of physical body as a frame for focusing also was opined +by experts. The process helps one in reconstruction of one’s idea +about one’s physique. +3. Self regulation of emotions: Majority of experts stated that the +emotional regulation can be a significant part in self awareness. +“ immediate emotional reactivity is something that they need to +examine in and learn to tone it down and delay it..” (MH 6) +They can cognitively understand the world, but the understanding +their own emotions and those with whom they interact with, +becomes difficult due to their age. +4. Self-monitoring: Experts suggested encouraging self monitoring +of adolescent even after the intervention. +“..They can write it and discuss with someone if required. Recording +it and even discussing with peers under supervision helps them to +understand them better.” (YP 3) +Both mental health experts and yoga practitioners shared the view +of having self monitoring frameworks for continued understanding +of oneself. +The Module: After analysing the interviews and conducting further +discussions among the authors, the intervention module was framed +focusing on three aspects: +1. +Knowledge of physical changes during adolescent period; +2. +Knowledge about emotional fluctuations during adolescence; +3. +A technique to enable them to understand and accepts these +changes. +The part I of the intervention addressed the first two aspects and +part II of the intervention addresses the third aspect. Thus the +intervention module had eight sessions with two parts in each +session. The methodology used in Part I was interaction, activity +and group based activities. Part II was activity based on body +focused meditation, in which, guided instructions were given to the +participants of the intervention. +[Table/Fig-1] detailed the intervention module which was +consolidated from the responses discussed and topics derived. The +intervention module has got eight sessions with two parts in each +session. Each session had an introductory discussion, followed +by the main section of intervention (which had two parts-Mental +Health Intervention and Body Focused Meditation) and a conclusion +discussion. Each session of the intervention module was timed for +45-50 minutes. The introductory discussion was for less than ten +minutes of duration. The methodology used in Part I of the main +section was that of interaction, individual activity and group based +activities. Part II had activity based on body focused meditation, in +which, guided instructions are given and it has to be followed by the +students. It is prepared in such a way that the beginning sessions, +is of shorter duration, and the time increases for the later sessions. +The concluding interaction stretches up to ten minutes wherein +participants share about their experiences while in the session. +Phase 2 +Validation of the intervention module: Part 1 of each session +which had mental health interventions were validated by the +mental health experts and Part 2 which has guided instructions +for body focused meditation were validated by the yoga experts. +Experts were requested to rate the usefulness of the activities in +each session in a five point scale ranging from 0 to 4 wherein, ‘0’ +signifies the activities in that session ‘not helpful’ and ‘4’ signifies +extremely helpful. Activities that were rated with a score (based on +their knowledge and experience in the field) of two and above by +majority of experts were retained for final module. +[Table/Fig-2] gives the validation score for Part 1 of the intervention +module, that is, the Mental Health Intervention Session. Practices +that received a score of 2 or more from 80% of the experts were +retained in the final module. Content validity ratio for majority of the +sessions was 1.0 which indicated high validity and hence used for +the main intervention. [Table/Fig-3] showed the validation score +for Part 2 of the intervention module, that is, the Body Focused +Meditation part. Practices that received a score of 2 or more from +80% of the experts were retained in the final module. All sessions +had a content validity ratio of 1.0 which indicated high validity of the +intervention as rated by the experts. +Pilot study was done among 18 adolescent girls by providing the +intervention and assessing their self awareness before and after the +intervention. The intervention was provided by the researcher for +eight days (weekly two sessions) for a period of four weeks during +September 2016. The scale used was the Life Skills Assessment +Scale (Vranda, 2007), the subsection of self awareness. The data +was normally distributed and ANOVA was conducted to find out the +changes. The score at baseline was 31.39 (SD=4.975) and at the +post intervention was 39.85 (SD=4.590) which indicated significant +change at 0.05 level in the perception of self awareness among +adolescent girls. +DISCUSSION +In this study, we attempted to develop an intervention module for +adolescent girls with trans-disciplinary approach by combining +mental health intervention for adolescents with body focused +meditation techniques. The module was developed after in-depth +interviews with experts from both the fields and further validated +by another set of experts in both fields. The topics derived out of +interviews were importance of self awareness, autonomy of self, +physical level of understanding, self regulation of emotions and self- +monitoring. Experts viewed the need for understanding of physical +level is crucial for healthy development and that can happen in the +beginning of puberty itself. Mental health experts suggested the +inclusion of the concept of brain changes and the related changes +in behaviour and emotional aspects in adolescent girls for the +intervention. Knowing about self in different situations also was +stressed on. Aspects of autonomy were given importance by all in +the mental health field. +The CVR scores show that majority of the experts rated each +session as extremely helpful and hence suggested to retain sessions +with minor changes. Earlier studies have used similar methodology +in validating yoga interventions for persons with different mental +illnesses and the content validity scores correspond to the current +study [11,12]. Future directions include the testing of the module +among adolescent population and assessing the efficacy of this +module in enhancing self awareness. The module could be used in +the community for promotional mental health interventions among +adolescent girls. +The pilot study conducted was able to demonstrate change in the +variable of self awareness due to the intervention. This marked +the need of optimizing the intervention and providing it for a larger +population. +[Table/Fig-3]: Content validity ratio of body focused meditation sessions. +Body Focused +Meditation ses­ +sions +Scoring (0-4) (Number of +experts) +n (%) of +experts +rating ≥2 +Content +Validity +Ratio +BFM session 1 +0 (0) +1 (0) +2 (0) +3 (2) +4 (4) +6 (100) +1.0 +BFM session 2 +0 (0) +1 (0) +2 (0) +3 (2) +4 (4) +6 (100) +1.0 +BFM session 3 +0 (0) +1 (0) +2 (0) +3 (2) +4 (4) +6 (100) +1.0 +BFM session 4 +0 (0) +1 (0) +2 (0) +3 (1) +4 (5) +6 (100) +1.0 +BFM session 5 +0 (0) +1 (0) +2 (0) +3 (2) +4 (4) +6 (100) +1.0 +BFM session 6 +0 (0) +1 (0) +2 (0) +3 (3) +4 (3) +6 (100) +1.0 +BFM session 7 +0 (0) +1 (0) +2 (0) +3 (2) +4 (4) +6 (100) +1.0 +BFM session 8 +0 (0) +1 (0) +2 (0) +3 (2) +4 (4) +6 (100) +1.0 +Jasmine Mary John et al., Development of a Trans-Disciplinary Intervention Module for Adolescent Girls on Self-Awareness +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2017 Aug, Vol-11(8): VC07-VC10 +10 +10 +LIMITATION +Experts were contacted only once for the validation of the +intervention module. They were not revisited for further opinion after +incorporating the suggestions given. Pilot testing was done with +single variable; other related variables were to be studied for further +evidence. +CONCLUSION +The intervention module provided evidence multiple disciplinary +approaches for the promotion of mental health among adolescent +girls. Mental health professionals working with children could be +trained for implementing this intervention among adolescent girls. +Acknowledgements +The research was carried out by the funding from Indian Council +of Medical Research (ICMR) as Junior Research Fellowship (JRF) +2011 batch. +REFERENCES + Cameron G, Karabanow J. The nature and effectiveness of program models for +[1] +adolescents at risk of entering the formal child protection system. 2003. pp. 443-74. + Jejeebhoy SJ. Adolescent sexual and reproductive behaviour: a review of the +[2] +evidence from India. Social Science and Medicine (1982). 1998;46(10):1275- +90. + Barry MM, Clarke AM, Jenkins R, Patel V. A systematic review of the effectiveness +[3] +of mental health promotion interventions for young people in low and middle +income countries. BMC Public Health. 2013;13(1):835. + Jain RB, Kumar A, Khanna P +. Assessment of self-awareness among +[4] +rural adolescents: A cross-sectional study. Indian J Endocrinol Metab. +2013;17(Suppl1):S367–S372. + Kumar D, Goel NK, Puri S, Pathak R, Singh Sarpal S, Gupta S, et al. Menstrual +[5] +pattern among unmarried women from Northern India. J Clin Diagn Res. +2013;7(9):1926-29. + Gjersoe NL, Hood B. Changing children's understanding of the brain: A +[6] +longitudinal study of the royal institution christmas lectures as a measure of +public engagement. PLoS ONE. 2013;8(11):e80928. + Kaley-Isley LC, Peterson J, Fischer C, Peterson E. Yoga as a complementary +[7] +therapy for children and adolescents: a guide for clinicians. Psychiatry (Edgmont +(Pa: Township). 2010;7(8):20-32. + +[8] +Black DS, Milam J, Sussman S. Sitting-meditation interventions among youth: a +review of treatment efficacy. Pediatrics. 2009;124(3):e532-41. + Sperduti M, Martinelli P +, Piolino P +. A neurocognitive model of meditation based +[9] +on activation likelihood estimation (ALE) meta-analysis. Consciousness and +Cognition. 2012;21(1):269-76. + Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention regulation and monitoring +[10] +in meditation. Trends Cogn Sci. 2008;12(4):163-69. + Bhat S, Varambally S, Karmani S, Gangadhar BN. International Review of +[11] +Psychiatry Designing and validation of a yoga-based intervention for obsessive +compulsive disorder. Int Rev Psychiatry. 2016;28(3):327-33. + Govindaraj R, Varambally S, Sharma M. International Review of Psychiatry +[12] +Designing and validation of a yoga-based intervention for schizophrenia. +2016;0261(October):2-6. +PARTICULARS OF CONTRIBUTORS: +1. PhD Scholar, Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India. +2. Associate Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India. +3. Chancellor, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India. +NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: +Dr. Jasmine Mary John, +PhD Scholar, Department of Psychiatric Social Work, NIMHANS, Bengaluru-560029, Karnataka, India. +E-mail: jasminemarypsw@gmail.com +Financial OR OTHER COMPETING INTERESTS: None. +Date of Submission: Dec 01, 2016 +Date of Peer Review: Mar 16, 2017 +Date of Acceptance: Jul 13, 2017 +Date of Publishing: Aug 01, 2017 diff --git a/subfolder_0/Diabetic yoga protocol improves glycemic, anthropometric and lipid levels in high risk individuals for diabetes a randomized controlled trial from Northern India..txt b/subfolder_0/Diabetic yoga protocol improves glycemic, anthropometric and lipid levels in high risk individuals for diabetes a randomized controlled trial from Northern India..txt new file mode 100644 index 0000000000000000000000000000000000000000..9cba7e5ee54666ebf685fc77bba6fb2466026fb7 --- /dev/null +++ b/subfolder_0/Diabetic yoga protocol improves glycemic, anthropometric and lipid levels in high risk individuals for diabetes a randomized controlled trial from Northern India..txt @@ -0,0 +1,1072 @@ +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 +https://doi.org/10.1186/s13098-021-00761-1 +SHORT REPORT +Diabetic yoga protocol improves glycemic, +anthropometric and lipid levels in high +risk individuals for diabetes: a randomized +controlled trial from Northern India +Navneet Kaur1,4, Vijaya Majumdar2, Raghuram Nagarathna2*, Neeru Malik3, Akshay Anand4* and +Hongasandra Ramarao Nagendra2  +Abstract  +Purpose:  To study the effectiveness of diabetic yoga protocol (DYP) against management of cardiovascular risk pro- +file in a high-risk community for diabetes, from Chandigarh, India. +Methods:  The study was a randomized controlled trial, conducted as a sub study of the Pan India trial Niyantrita +Madhumeha Bharath (NMB). The cohort was identified through the Indian Diabetes Risk Scoring (IDRS) (≥ 60) and a +total of 184 individuals were randomized into intervention (n = 91) and control groups (n = 93). The DYP group under- +went the specific DYP training whereas the control group followed their daily regimen. The study outcomes included +changes in glycemic and lipid profile. Analysis was done under intent-to-treat principle. +Results:  The 3 months DYP practice showed diverse results showing glycemic and lipid profile of the high risk indi- +viduals. Three months of DYP intervention was found to significantly reduce the levels of post-prandial glucose levels +(p = 0.035) and LDL-c levels (p = 0.014) and waist circumference (P = 0.001). +Conclusion:  The findings indicate that the DYP intervention could improve the metabolic status of the high-dia- +betes-risk individuals with respect to their glucose tolerance and lipid levels, partially explained by the reduction in +abdominal obesity. The study highlights the potential role of yoga intervention in real time improvement of cardio- +vascular profile in a high diabetes risk cohort. +Trial registration: CTRI, CTRI/2018/03/012804. Registered 01 March 2018—Retrospectively registered, http://​ +www.​ +ctri.​ +nic.​ +in/CTRI/2018/03/012804. +Keywords:  Diabetic yoga protocol, Indian diabetes risk score, Glycated hemoglobin, Diabetes, Prediabetes +© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which +permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the +original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or +other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line +to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory +regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this +licence, visit http://​ +creat​ +iveco​ +mmons.​ +org/​ +licen​ +ses/​ +by/4.​ +0/. The Creative Commons Public Domain Dedication waiver (http://​ +creat​ +iveco​ +mmons.​ +org/​ +publi​ +cdoma​ +in/​ +zero/1.​ +0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. +Introduction +The rise of diabetes in the developing world poses a +threat to meager health budgets. Owing to the strong +association between various morbidity and mortality +outcomes as complications of this dreaded disease, early +detection of diabetes risk through non-invasive param- +eters is a primary requisite. Observational studies show +that the risk reduction for diabetes can be decreased by +58% or 63–65% if risk factors could be controlled [1, 2]. +Open Access +Diabetology & +Metabolic Syndrome +*Correspondence: rnagaratna@gmail.com; akshay1anand@rediffmail.com +2 Division of Life Sciences, Swami Vivekananda Yoga Anusandhana +Samsathana, Bengaluru, Karnataka 560106, India +4 Department of Neurology, Neuroscience Research Lab, Postgraduate +Institute of Medical Education and Research, Chandigarh 160012, India +Full list of author information is available at the end of the article +Page 2 of 10 +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 +Many argue that such experimental strategies for the +possible halting of conversion of prediabetes into diabe- +tes must continue to include pharmacological interven- +tions even though the rates have not been compared +[3]. Identification of individuals at increased risk for the +disease with invasive measurements of fasting and post +challenge (postprandial) blood glucose are costly and +time consuming. Hence, it has been advocated that the +realistic prevention of diabetes should identify high-risk +subjects with the use of the non-invasive risk scores [4]. +Such studies should also target subjects with normogly- +cemia and prevent their progression to poor glycemic +status [4]. +Yoga plays a promising role in minimizing the risk of +Diabetes for high-risk individuals with prediabetes [5, 6]. +It reduces body weight, glucose, and lipid levels, though, +most of these studies comply with the guidelines of ran- +domized controlled trials adhered to the CONSORT +statements [7–11] whereas majority of studies have not +reported as per CONSORT statements [12–15]. Several +review of published studies, in people with diabetes and +prediabetes, have concluded that the practice of yoga +may reduce insulin resistance and related cardiovascular +disease (CVD) risk factors and improve clinical outcomes +[16]. Specifically, reports suggest that a yoga-based life- +style intervention reduces body weight, glucose and lipid +levels that should reduce diabetes risk. Keeping in view +the high transition rates of diabetes in India, we selected +a high-risk cohort from Chandigarh, one of the most +affluent Union Territories of India with highest reported +prevalence of diabetes in order to establish the efficacy of +yoga to alleviate the cardiovascular disease. Indian Dia- +betes Risk Score (IDRS), specific for Indian ethnicity a +validated tool was used for identification of the high-risk +population [17]. We developed a national consensus ‘Dia- +betes Yoga protocol’ based on published reports and clas- +sical literature with an aim to stimulate weight reduction +by combination of postures and meditation techniques +[18, 19]. Additionally, cardiometabolic risk reduction has +also been recognized as one of the potential outcomes +of yoga-based interventions [20]. Yoga has been shown +to be regulating the risk parameters of diabetes, waist +circumference (WC), body mass index (BMI), oxida- +tive stress, fasting blood sugar (FBS) and systolic blood +pressure (SBP) respectively [21]. Hence, in this study we +tested the efficacy of diabetic yoga protocol (DYP) on +alleviation of glycemic and lipid imbalances in individu- +als at high risk of diabetes. +Materials and methods +Study population +Under the multi-region survey of Niyantarita Maduh- +meha Bharat (NMB-2017) a door-to-door screening +was carried out for the identification of high risk indi- +viduals among the population of Chandigarh (U.T) and +Panchkula (District in Haryana state) on the basis of +Indian Diabetes Risk Score (IDRS). The data collection +was carried out by well trained yoga volunteers for dia- +betes management (YVDMs). Written informed con- +sents were taken from every subject during door to door +screening as well as at the time of registration. All the +experimental protocol, methods and procedures were +approved by Ethics committee of Indian Yoga Asso- +ciation (IYA) (ID: RES/IEC-IYA/001). All experiments +methods and procedures were carried out in accordance +with relevant guidelines and regulations of ethics com- +mittee. The study was registered at clinical trial registry +of India, CTRI/2018/03/012804 (dated: 01/03/2018). +Study design +The present study is the two-armed randomized con- +trolled trial conducted in the population of Chandigarh +and Panchkula regions of northern India. Indian Dia- +betes Risk Score (IDRS) was used for detection of high +risk (≥ 60 score) individuals from the study. Self-declared +diabetics and low (< 30  score) and moderate [between +30–50 score] risk individuals were excluded from the +study. As evident from the flow of patients presented in +the flowchart, out of 1214 eligible subjects, there was +approximately 50% loss of sample data due to error in the +sampling. Further out of 564, we had to exclude as they +were self-declared patients with diabetes and did not fur- +ther participate in the study. However, this led to final +participation of only 184 subjects in the study and alloca- +tion of these subjects diminishing the random selection +of the study cohort. A cohort of high diabetes-risk cohort +consisting of n = 184 participants was randomized into +the interventional and control groups (n = 91:93). After +excluding the dropouts from the study, based on CON- +SORT guidelines, the remaining subjects in the DYP and +control group were further assessed for selected anthro- +pometric, glycemic and lipid parameters. The interven- +tion group was given the Diabetic Yoga Protocol for three +months and control group continued with their daily rou- +tine activities. The detailed categorization of the samples +is shown in Fig. 1. The control group was waitlisted for +yoga. +Randomization +Simple randomization technique was used to allocate +participants into the intervention and the control groups. +An independent statistician generated a computer-gen- +erated random number sequence and the sequence was +given to an external staff who had no involvement in the +study procedures. The participants were allocated their +consecutive numbers, after baseline measurements. +Page 3 of 10 +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 + +Fig. 1  Flowchart of study design. PCA  principal component analysis, MIPCA multiple imputations with PCA +Page 4 of 10 +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 +Blinding of the participants was not possible due to the +nature of the intervention. However, the outcome asses- +sors were blinded. +Risk assessment +To identify the individuals at high-risk of diabetes, Indian +Diabetes Risk Score (IDRS) was administered as pro- +posed by Mohan et al. [22]. It consisted of two unmodi- +fiable (i.e. age, and family history) and two modifiable +(physical activity and waist circumference) risk factors +for diabetes, which can predict the level of risk for the +development of diabetes in the community. The IDRS +is one of the easily accessible and budget friendly ques- +tionnaire to be administered. The aggregate score of the +unmodifiable and modifiable risk used to probe the level +of risk among the population (i.e. High risk > 60, Moder- +ate risk-30–50, Low risk < 30). +Sample size +Sample size estimation for the main Pan India study +was focused for prediabetes subjects [23]. However, for +the present pilot scale study we calculated sample size +assuming a small effect size 0.3 [5] of DYP vs waitlist con- +trol 0.25, α = 0.80 as 180 (n = 90:90). Further, assuming +an attrition rate of 20%, the final sample size was n = 220. +Study outcomes +Changes in the glycemic and other metabolic variables +(anthropometric and lipid) over 3  months were docu- +mented. The fasting blood sample was withdrawn. For +glucose analysis, fasting samples for 10–12 h were taken +early in the morning for the estimation of FBS and after- +wards 75  g glucose was given to the participants. The +blood sampling was repeated after 2 h. for estimation of +OGTT. +Biochemical analysis +For the estimation of biochemical parameters viz. FBS +(Fasting Blood Sugar, Rxl-Max 500), OGTT (Oral Glu- +cose Tolerance Test), HbA1c (Bio-Rad D-10), Triglycer- +ides, Cholesterol, HDL, LDL, Chol/HDL ratio, HDL/LDL +ratio (Rxl-Max 500) and VLDL about 9 ml of blood was +drawn and analyzed by phlebotomist of Sisco Research +Laboratories (SRL) of Chandigarh. Anthropometric +measurements were also obtained (i.e. height, weight, +waist circumference) by trained researcher. The waist cir- +cumference (WC) was reported in centimeters. The BMI +was obtained by using the formula (weight in kg/height +(meter)2). +Interventions +The study protocol consisted of Diabetic Yoga Protocol +(DYP) approved by the Ministry of AYUSH and Quality +Council of India as shown in Table 1. This is the first pro- +tocol to be made specifically for the prediabetics and dia- +betics. The complete sequence of prayer, yogic postures, +breathing and meditative techniques, along with speci- +fied time, was shown in previously published paper [24]. +The Yogic practices were performed for 3  months for +60 min. Certified yoga instructors took the yoga classes +and they recorded regular attendance. Randomization +was done through a computer-generated list of random +numbers and allocation was concealed to the participants +until the completion of the baseline assessment. +Statistical analysis +For the analysis of data SPSS for Windows (version 22; +IBM  SPSS  Inc., Chicago IL) 0 and R statistical pack- +age were used. The normality of data was analyzed +using Kolmogorov–Smirnov test. The paired t-test was +used to estimate the Baseline and posttest differences +of DYP, and control group and the significant level was +set at ≤ 0.05. The trial outcomes were analyzed accord- +ing to the intention-to-treat principle; hence multiple +imputation was carried for the missing variables account- +ing for the loss to follow up. We used absolute change +(time and treatment interaction), to estimate interven- +tion effects refers to the difference in the outcome of +the intervention and control over different time-points +of assessment. Absolute change was determined as fol- +lows: absolute change = [(intervention group follow- +up) – (intervention group baseline)] – [(control group +follow-up) – (control group baseline)]. The percentage +change, also called the relative change was determined as +relative change = (absolute change / intervention group +baseline) × 100%. To evaluate the influence of miss- +ing data, we applied multiple imputations to the data +using missMDA R package (v1.13) based on the princi- +pal component analysis method [25] from the package, +using 5 components to reconstruct the data and over +1000 imputed datasets. One-way multivariate analysis of +covariance (MANCOVA) was conducted to compare the +effects of the DYP with control group glycemic and meta- +bolic measures, while controlling for the age, gender and +baseline values of the covariates. +Results +Baseline characteristics +The data used in this study was collected in (NMB- +2017) the northern region of India i.e. Chandigarh and +Panchkula. The age range of participants was 3–70 +years; [mean age 48.51 (SD 10.08) years]with base- +line characteristics of the yoga and control groups as +shown in Table 2. Mean HbA1c of the high-risk cohort +was 5.64% (0.38), mean FBS was 97.13 mg/dl (SD +11.10), and mean PPBS were 108.40 mg/dl (SD 28.79). +Page 5 of 10 +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 + +Distributions of age and gender was similar between +the intervention and the control groups. The IDRS and +anthropometric values were also similarly distributed +between the groups. Overall, there was no significant +difference in the distribution of demographic, anthro- +pometric, or biochemical parameters between the DYP +and the control groups at the baseline. +When analyzed by multivariate analysis of covari- +ance (MANCOVA), adjusting for age, gender and status +of diabetes/prediabetes/normoglycemia, and baseline +values of the covariates, yoga intervention was found +to have significant influence on few cardinal param- +eters related to glycemic control (PPBS), and lipid con- +trol (LDL-C) as shown in Table 3. We also observed a +significant influence of DPP on waist circumference +reduction [relative changes, − 1.94%. Compared to the +control, DYP also resulted in significant reductions in +LDL-C and, − 0.16% and − 2.81%, for LDL-Cholesterol +and post-prandial blood glucose levels from baseline +to 3  months [absolute changes, − 0.18% and −  3.08%, +respectively and relative changes, − 0.16% and − 2.81%, +respectively]. +Discussion +We examined the effect of Diabetic Yoga Protocol on +baseline and post (3 months) levels of HbA1c and other +glycemic (OGTT and FBS), Lipid (Total cholesterol, tri- +glycerides, HDL-c, LDL-c, and VLDL-c, CDL/HDL, +LDL/HDL) and anthropometric parameters (BMI). In the +present study, we show the efficacy of DYP in substantial +improvement in the waist circumference in a high-risk +diabetes population from Chandigarh (relative change of +1.94 cm). We could also demonstrate a significant decline +in the worsening of post prandial glucose levels with yoga +intervention as compared to the wait-list control group +(relative change of 2.82  mg/ml). However, for LDL-c +levels, there were clinically significant improvements by +0.16 units. Notably, over 3 months study duration there +was an overall increase in the levels of total cholesterol, +triglyceride and VLDL means in the study cohort, while +Table 1  Diabetic yoga protocol (DYP) +S. No. +Name of practice +Duration +(min) +1 +Starting prayer: Asatoma Sat Gamaya +2 +2 +Preparatory Sukshma Vyayamas and Shithililarna Practices +1. Urdhavahastashvasan(Hand stretching breathing 3 rounds at 90°, 135° and 180o each) +2. Kati-Shakti Vikasaka (3 rounds) +a) Forward and Backward Bending b) Twisting +3. Sarvangapushti (3 rounds clockwise, 3 rounds anticlockwise) +6 +3 +Surya Namaskara (SN) +10 step fast Surya Namaskara 6 rounds +12 step slow Surya Namaskara 1 round +Modified version Chair SN 7 rounds +9 +4 +Asanas (1 min per Asana) +1 Standing Position (1 min per Asana) +Trikonasana, Parvritta Trikonasana, Prasarita Padhastasana +2 Supine Position +Jatara Parivartanasana, Pawanmuktasana, Viparitakarani +3 Prone Position +Bhujangasana, Dharuasana followed by Pawanmuktasana +4 Sitting Position +Mandukasana, Vakrasana/ Ardhamatsayendrasana, Paschimatanasana, Ardha Ushtrasana +At the end, relaxation with abdominal breathing in supine position (vishranti), 10–15 rounds (2 min) +15 +5 +Kriya +a. Agnisara:1 min b. Kapalabhati(@60 breaths per minute for 1 min followed by rest for 1 min) +3 +6 +Pranayama +Nadishuddhi (for 6 min, with antarkumbhak and jalandhar bandh for 2 s) +Bhamari 3 min +9 +7 +Meditation (for Stress, for deep relaxation and silencing of mind) +Cyclic Meditation +15 +8 +Resolve (I am Completely Healthy) +1 +9 +Closing Prayer: Sarvebhavantu Sukhina………… +1 +Total duration +60 +Page 6 of 10 +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 +HDL levels had decreased. In particular TG levels have +gone from normal range to mildly high (> 150 mg/dl) [26] +which draws our attention towards accelerated pace of +metabolic dysfunction in the high risk population. These +findings comply with Chandigarh being an affluent union +territory of India with high per-capita GDP and has +been documented to have highest prevalence of diabe- +tes 13.6%, 12.8–15·2 as compared to other Indian states +[27]. As mentioned above, there was a significant influ- +ence of DYP on the waist circumference, one of the two +important modifiable parameters of Indian Diabetes Risk +Score [17]. The relevance of WC reduction in context of +reduced risk of CVD is well established; a 1 cm increase +in WC has been associated with a 2% increase in the rela- +tive risk of future CVD [28]. The visceral adipose tissue +is a primary source of cytokine production and insu- +lin resistance (IR) [29]. Given the higher susceptibility +towards visceral fat accumulation and insulin resistance +in Asian populations as compared to their Caucasian +counterparts, the observed influence of DYP on WC is +of particular relevance to the metabolically obese pheno- +type of Asian Indians [30]. +In relation to the glucose metabolism, we could also +demonstrate a significant decline in the worsening of +post prandial glucose levels with DYP as compared to +the wait-list control group (relative change = −  2.81%, +P < 0.05); however, no significant influence could be +established for fasting blood glucose concentration. These +findings could be justified by the phenotypic differences +underlying fasting and post-challenge hyperglycemia +that represent distinct natural histories in the evolution +of type 2 diabetes [31]. Postprandial glucose disposal is +the primary pathogenic manifestation in impaired glu- +cose tolerance (IGT), and impaired fasting glucose (IFG) +merely signifies an abnormal glucose set point [31, 32]. +Our relevance of the study findings is further underlined +by the previous results wherein PPG has been reported +to contribute more than FBS to overall hyperglycemia +and its control was found essential either to decrease or +to obtain HbA1c goals of < 7 [33]. Several epidemiological +studies have suggested that increased glycemic exposure, +especially post challenge or postprandial hyperglycemia, +is an independent risk factor for macrovascular disease +with no apparent upper or lower threshold. Our results +indicate a significant influence of yoga on glycemic con- +trol integrating postprandial glycemic alterations in the +high diabetes risk group. Since in the present study the +high-risk cohort was selected through A1c based diag- +nosis, and IGT was not a primary manifestation in the +cohort, hence, the overall improvement in postprandial +glucose should be specifically tested in an IGT cohort. +The findings of the current study with a 3-month inter- +vention of yoga on postprandial measures of glucose at- +risk population deserves clinical attention. Increase in +the glucose concentration even in the prediabetes stage, +manifests as a chronic inflammatory condition and pre- +disposes an individual to the risk of pathogenic infections +[32, 34, 35]. +The simultaneous reduction in waist circumference +observed in the cohort, is also consistent with the obser- +vation of an association between abdominal obesity +and the risk of IGT. Based on a significant association +between IGT and CVD risk [32, 33, 36], we note a signifi- +cant improvement in lipid concentrations [LDL-c] by the +DYP protocol as compared to the control group. These +results are consistent with the previously reported overall +beneficial effect of yoga in the management of hyperlipi- +demia [36]. These results need validation at larger scale +and to ascertain the mechanistic insights into the action +of yoga, the indices of monocyte chemotaxis, endothe- +lial inflammation, oxidation, nitric oxide production, +and thrombosis should also be explored [37], including +animal models, invitro systems and other approaches +[38–44]. +The findings of the present study indicate that identifi- +cation of high-risk group through IDRS and consequent +intervention of Yoga based lifestyle protocol could be an +effective strategy to combat the metabolic perturbations +Table 2  Baseline characteristics of the participants in the +intervention and control group +Continuous variables are represented as mean (SD) and compared using +independent t-test. Categorical variables are represented as number +(percentages) and compared using chi-square test. P value < 0.05 were +considered significant. FBS fasting blood sugar, PPBG postprandial blood +glucose, HbA1c glycated hemoglobin, HDL-c high density lipid-cholesterol, LDL-c +low density lipid-cholesterol, VLDL very low density lipid-cholesterol, IDRS Indian +diabetes risk score +Characteristics +DYP Group +N = 91 +Control group +N = 93 +P value +Gender +Male, n (%) +19 (20.88) +30 (32.26) +0.096 +Age (years) +47.77 (9.59) +49.24 (10.53) +0.323 +Weight, Kg +70.93 (10.90) +70.80 (12.44) +0.936 +Waist circumference, cm +99.34 (9.05) +99.72 (9.05) +0.794 +BMI, Kg/m2 +28.59 (5.75) +28.53 (5.01) +0.949 +IDRS +74.07 (10.43) +75.27 (9.95) +0.425 +Biochemical variables +FBG, mg/dl +96.89 (9.95) +97.36 (12.20) +0.776 +PPBG, mg/dl +102.88 (21.91) +113.78 (33.47) +0.012* +HbA1c (%) +5.61 (0.38) +5.66 (0.38) +0.400 +Total cholesterol mg/dl +186.88 (37.64) +179.98 (34.98) +0.199 +Triglycerides, mg/dl +131.93 (68.59) +138.44 (68.89) +0.522 +HDL-c, mg/dl +47.76 (9.16) +48.33 (17.43) +0.780 +LDL-c, mg/dl +112.75 (31.02) +104.38 (31.70) +0.072 +VLDL, mg/dl +26.39 (13.72) +28.00 (13.50) +0.423 +Page 7 of 10 +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 + +associated with diabetes, whose co-morbidity is also +being reported to be associated with increasing vulner- +ability to the emerging viral pandemic of COVID-19. +Lifestyle interventions are reported to reduce the risk of +Type 2 diabetes in high-risk individuals after mid and +long-term follow-up. Information on determinants of +intervention outcome, adherence and the mechanisms +underlying diabetes progression are valuable for a more +targeted implementation. Weight loss is a major con- +tributor in the prevention and management of type 2 dia- +betes. In many of the earlier lifestyle intervention group +of the DPP, weight loss was the dominant predictor of +reduced diabetes risk, with a 16% reduction observed for +every kilogram of weight loss during the 3.2-year follow- +up [45]. Though we failed to observe a significant weight +loss over 3 months of DYP intervention, the significant +reductions in WC indicate the plausibility of significant +weight loss on longer interventions and follow ups. +Whether Yoga alters the conversion of prediabetics +into healthy status and if it helps in maintenance of glyce- +mic index can be assessed by longitudinal studies. There +was a significant improvement in the glycemic status of +Table 3  Comparative assessment of influence of DYP on biochemical and weight related variables with the control group +Absolute change = [(intervention group follow-up) – (intervention group baseline)] – [(control group follow-up) – (control group baseline)]. Relative +change = (absolute change / intervention group baseline) × 100%; p value for difference between the intervention and the control groups by MANCOVA adjusting for +age, gender, status of diabetes/prediabetes/normoglycemia baseline values of glycemic and lipid variables, length of time having had prior exposure of yoga +Variables +Baseline +mean (SD) +After 3 months +mean (SD) +Absolute +change +Relative change +P value +Partial η2 +Waist circumference (cm) +DYP +99.34 (9.05) +98.14 (6.88) +− 1.93 +− 1.94 +0.032 +0.029 +Control +99.72 (9.05) +100.25 (7.72) +BMI, kg/m2 +DYP +28.59 (5.75) +28.00 (6.84) +− 0.4 +− 1.40 +0.622 +0.002 +Control +28.53 (5.01) +28.34 (4.98) +Weight, Kg +DYP +70.93 (10.90) +69.04 (9.13) +− 1.04 +− 1.47 +0.397 +0.005 +Control +70.80 (12.44) +69.95 (10.44) +Postprandial blood glucose, mg/dl +DYP +102.88 (21.91) +118.32 (29.89) +− 1.51 +− 1.47 +0.006 +0.046 +Control +113.78 (33.47) +130.73 (36.98) +Fasting blood glucose, mg/dl +DYP +96.89 (9.95) +99.82 (9.49) +1.44 +1.49 +0.287 +0.007 +Control +97.36 (12.20) +98.85 (9.26) +HBA1c (%) +DYP +5.61 (0.38) +5.61 (0.39) +− 0.02 +− 0.36 +0.077 +0.020 +Control +5.66 (0.38) +5.68 (0.38) +Total Cholesterol, mg/dl +DYP +186.88(37.64) +189.01 (25.64) +− 0.4 +− 0.21 +0.130 +0.014 +Control +179.98 (34.98) +182.51(20.82) +Triglycerides, TG, mg/dl +DYP +131.93 (68.59) +148.14 (54.92) +− 13.98 +− 10.60 +0.138 +0.014 +Control +138.44 (68.89) +168.63 (75.06) +HDL-C, mg/dl +DYP +47.76 (9.16) +47.01 (9.16) +2.2 +4.61 +0.097 +0.017 +Control +48.33 (17.43) +45.38 (12.57) +LDL-C, mg/dl +DYP +112.75 (31.02) +103.39 (21.44) +− 17.56 +− 15.57 +0.044* +0.025 +Control +104.38 (31.70) +112.58 (21.99) +VLDL, mg/dl +DYP +26.39 (13.72) +28.85 (10.47) +− 1.23 +− 4.66 +0.229 +0.009 +Control +28.00 (13.50) +31.69 (10.57) +Page 8 of 10 +Kaur et al. Diabetology & Metabolic Syndrome (2021) 13:149 +the high risk population at administration of DYP. The +analysis shows the aptness of Diabetic protocol which is +apparently superior to previous studies where no stand- +ardized protocols were used for intervention [46, 47]. The +findings suggest that there is potential of DYP to manage +glucose levels in diabetes patients if public intervention is +planned through forthcoming wellness centers in India. +There are additional studies showing beneficial effects of +Yoga on FBS [48], PPBS [49–51], HbA1c [50, 51], total +cholesterol, LDL [50, 51]. The analysis of the yoga proto- +cols used in above said studies reveal the incorporation +of some common and important postures in DYP, which +seem to be important in managing the disease. It is also +the possible that the beneficial effects of mind body tech- +niques are sensitive to mental disposition of subjects and +has been characterized by various measures like psycho- +metric analysis [52, 53], namely, Tridosha and Triguna +scoring [54, 55]. These were not analyzed in this study. +Briefly, DYP’s promising efficacy on glycemic and met- +abolic parameters requires mechanistic insights. This can +be examined by further studies, and long term follow up +which was not possible in this study. As DYP is a non- +pharmacological, cost-effective method to halt the con- +version of early diabetes into prediabetes and/or healthy +individuals, the success of its integration into public +health policy will depend on its wider acceptability and +perception of benefits by both public as well as health- +care workers [56–59]. Yoga’s benefits in maintaining and +regulation of the glycemic status are supported by sev- +eral other studies [49, 50], which might enable its inclu- +sion in the National Ayushman Bharat scheme or as part +COVID pandemic management protocol in which a large +number of individuals with diabetes and heart disease are +falling prey [60, 61]. This will further encourage molecu- +lar and Ayurgenomic studies which presumably underlie +the stated clinical outcome. +Limitations +Moreover, there are some limitations of our study that we +only studied in two regions of North India and thus the +result of this study cannot be generalized on the remain- +ing population. Further, in this study, the socio economic +status and psychological assessments were not carried +out. We were not able to control for the dietary habits +and psychological status of the study participants. How- +ever, the small sample size and absence of long term eval- +uations limit the strength of the study. +Conclusion +The findings indicate that the DYP intervention could +improve the metabolic status of the high-diabetes- +risk individuals with respect to their glucose tolerance +and lipid levels, partially explained by the reduction in +abdominal obesity. The study highlights the potential role +of yoga intervention in real time improvement of cardio- +vascular profile in a high diabetes risk cohort. +Abbreviations +ADA: American Diabetes Association; BMI: Body mass Index; CVD: Cardiovas- +cular disease; DYP: Diabetic yoga protocol; FBS: Fasting blood sugar; HbA1c: +Glycated hemoglobin; HDL-c: High density lipid-cholesterol; IDRS: Indian +Diabetes Risk Score; IFG: Impaired fasting glucose; IGT: Impaired glucose +tolerance; IYA: Indian Yoga Association; LDL-c: Low density lipid-cholesterol; +NMB: Niyantarita Maduhmeha Bharat; OGTT​ +: Oral glucose tolerance test; PPBG: +Postprandial blood glucose; SBP: Systolic blood pressure; VLDL: Very low +density lipid-cholesterol; WC: Waist circumference; YVDM: Yoga volunteers for +diabetes management. +Acknowledgements +The authors would like to thank Central Council for Research in Yoga & +Naturopathy (CCRYN) for their support for man power, Ministry of Health and +Family Welfare (MOHFW) for support the cost of investigations and Indian +Yoga Association (IYA) for the overall project implementation. The authors also +like to thank to thank Yoga Volunteer for Diabetes Management (YVDMs) for +helping in collection of data and also for training participants for yoga. +Authors’ contributions +NK: writing of manuscript, collection of data. VM: writing of manuscript, +analysis. RN: conceptualization of manuscript, supervision and study design. +NM: co-conceptualization of manuscript. AA: conceptualization of manuscript. +HRN: supervision. All authors read and approved the final manuscript. +Funding +The Project was funded by Ministry of AYUSH, Government of India (grant +number 16-63/2016-17/CCRYN/RES/Y&D/ MCT/). +Availability of data and materials +The datasets used during the present study are available from the correspond- +ing author on reasonable request. +Declarations +Ethics approval and consent to participate +Written informed consents were taken from every subject during door to door +screening as well as at the time of registration. All the experimental protocol, +methods and procedures were approved by Ethics committee of Indian Yoga +Association (IYA) (ID: RES/IEC-IYA/001). All experiments methods and proce- +dures were carried out in accordance with relevant guidelines and regulations +of ethics committee. +Consent for publication +Not applicable. +Competing interests +The authors declare that they have no competing interests. +Author details +1  +Department of Physical Education, Panjab University, Chandigarh 160014, +India. 2  +Division of Life Sciences, Swami Vivekananda Yoga Anusandhana Sam- +sathana, Bengaluru, Karnataka 560106, India. 3  +Dev Samaj College of Education, +Sector 36B, Chandigarh 160036, India. 4  +Department of Neurology, Neurosci- +ence Research Lab, Postgraduate Institute of Medical Education and Research, +Chandigarh 160012, India. +Received: 26 August 2021 Accepted: 17 November 2021 +Page 9 of 10 +Kaur et al. 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Wien Klin Wochenschr. +2020;132(13):356–61. +Publisher’s Note +Springer Nature remains neutral with regard to jurisdictional claims in pub- +lished maps and institutional affiliations. diff --git a/subfolder_0/Differences in Quality of Life Between American and Chinese breast cancer survivors.txt b/subfolder_0/Differences in Quality of Life Between American and Chinese breast cancer survivors.txt new file mode 100644 index 0000000000000000000000000000000000000000..ea92e77d549765a6044d3825831e4dafbb170f18 --- /dev/null +++ b/subfolder_0/Differences in Quality of Life Between American and Chinese breast cancer survivors.txt @@ -0,0 +1,855 @@ +ORIGINAL ARTICLE +Differences in quality of life between American and Chinese +breast cancer survivors +Qian Lu1 & Jin You2 & April Kavanagh3 & Krystal Warmoth1 & Zhiqiang Meng4 & +Zhen Chen4 & Kavita D. Chandwani5 & George H. Perkins6 & Jennifer Leigh McQuade6 & +Nelamangala V. Raghuram7 & Raghuram Nagarathna7 & Zhongxing Liao6 & +Hongasandra Ramarao Nagendra7 & Jiayi Chen4 & Xiaoma Guo4 & Luming Liu4 & +Banu Arun6 & Lorenzo Cohen6,8 +Received: 17 July 2015 /Accepted: 28 March 2016 +# Springer-Verlag Berlin Heidelberg 2016 +Abstract +Objective It has been speculated that cancer survivors in Asia +may have lower quality of life (QOL) compared with their +Western counterparts. However, no studies have made interna- +tional comparisons in QOL using a comprehensive measure. +This study aimed to compare Chinese breast cancer survivors’ +QOL with US counterparts and examine if demographic and +medical factors were associated with QOL across groups. +Method The sample consisted of 159 breast cancer patients +(97 Chinese and 62 American) who completed the Functional +Assessment for Cancer Therapy Breast Cancer (FACT-B) +scale before the start of radiotherapy in Shanghai, China and +Houston, USA. +Results Higher income was associated with higher QOL total +scores in both Chinese and American cancer patients, but +QOL was not significantly associated with other factors in- +cluding age, education, disease stage, mastectomy, and +chemotherapy. Consistent with hypotheses, compared to their +US counterparts, Chinese breast cancer survivors reported +lower QOL and all four subdimensions including functional +well-being (FWB), physical well-being (PWB), emotional +well-being (EWB), and social well-being (SWB); they also +reported more breast cancer-specific concerns (BCS). +Differences were also clinically significant for Functional +Assessment for Cancer Therapy General (FACT-G) scale total +scores and the FWB subscale. After controlling for demo- +graphic and medical covariates, these differences remained +except for the SWB and BCS. Furthermore, Chinese breast +cancer survivors receiving chemotherapy reported significant- +ly lower FACT-G scores than those who did not, but this +difference did not emerge among US breast cancer survivors. +Discussion Chinese breast cancer survivors reported +poorer +QOL on multiple domains compared to US women. Findings +indicate that better strategies are needed to help improve the +The University of Texas School of Public Health, Houston, USA. +Location when analyses were conducted +The University of Texas MD Anderson Cancer Center, Houston, USA. +Location when data was collected +* Qian Lu +qlu3@uh.edu +* Lorenzo Cohen +lcohen@mdanderson.org +1 +Department of Psychology, University of Houston, 126 Heyne +Building, Houston 77204, TX, USA +2 +WuHan University, Wuhan, China +3 +The University of Texas School of Public Health, Houston, USA +4 +Fudan University Shanghai Cancer Center, Shanghai, China +5 +University of Texas Health Science Center, Houston, USA +6 +The University of Texas MD Anderson Cancer Center, +Houston, USA +7 +Swami Vivekananda Yoga Anusandhana Samsthana, +Bengaluru, India +8 +Department of Palliative, Rehabilitation, and Integrative Medicine, +Section of Integrative Medicine, The University of Texas MD +Anderson Cancer Center, Houston, TX 77030, USA +Support Care Cancer +DOI 10.1007/s00520-016-3195-1 +QOL of Chinese breast cancer survivors, especially those who +underwent chemotherapy. +Keywords Quality of life . Breast cancer . Culture . Country +Introduction +Cancer is one of the leading causes of mortality worldwide +[1]. Asia represents 60 % of the world’s population [2]. It is +estimated to experience 45 % of all new cancer cases in the +world and 50 % of all cancer deaths in 2008 [3]. China is +seeing a change in cancer rates [4] and currently observing a +country-wide increase [5]. Breast cancer is among the most +frequent types of cancer and alone accounted for 1,383,000 +new cancer cases and 519,000 cancer-related deaths in 2008 +worldwide [1]. Since 1990, rates of breast cancer in China +have increased 3 to 4 % annually, compared to a global annual +increase of 0.5 % [6]. As the effectiveness of cancer treatments +continues to develop in China, the number of breast cancer +patients and survivors will continue to rise. As patients live +longer, concern for psychological factors and quality of life +(QOL) among this population has grown [7]. Although a +growing number of studies have reported QOL in Asian pop- +ulations, they focus on the validation of measurement and one +population. Cross-country comparison of QOL can help to +understand possible areas of intervention and how to design +culturally sensitive interventions. However, no publications +have compared the QOL between Asian and Western breast +cancer patients. This paper aims to compare differences in +QOL between Chinese and US breast cancer patients. +In 1993, the World Health Organization (WHO) defined +QOL as Bindividuals’ perceptions of their position in life in +the context of the culture and value systems in which they live +and in relation to their goals, expectations, standards and +concerns^ [7]. This broad ranging concept is affected, in a +complex way, by a person’s physical health, psychological +state, level of independence, social relationships, and relation- +ship to their environment [7]. Many methods have been doc- +umented in the literature for the purpose of evaluating the +QOL in cancer patients. Of the 12 existing measures, the +two most commonly used were the European Organization +for Research and Treatment of Cancer’s quality of life ques- +tionnaire (EORTC QLQ-C30) and the Functional Assessment +for Cancer Therapy (FACT) scale [8]. The Functional +Assessment for Cancer Therapy Breast Cancer (FACT-B) +scale was developed as a means to evaluate a spectrum of +QOL components in breast cancer patients specifically. The +FACT-B is validated for Chinese; however, no studies have +directly compared responses on the FACT-B in Chinese pop- +ulations to responses from US populations. +Despite the lack of studies comparing Chinese to US pop- +ulations, there is reason to expect that Chinese cancer +survivors may have lower QOL than Americans. For example, +Asian American breast cancer survivors have reported lower +QOL than their European counterparts [9, 10]; Chinese +American survivors are more likely to experience poorer so- +cioeconomic well-being than non-Hispanic White survivors +[11]. Qualitative evidence has also shown that Chinese survi- +vors describe more distress than Americans [12]. Based on +these findings, we hypothesized that Chinese survivors may +have lower QOL compared with the US population. +QOL has become a consistent index of adjustment and an +end point in clinical trials in the West [8], but little research has +characterized QOL issues in Chinese breast cancer patients. +One study with newly diagnosed Chinese breast cancer pa- +tients found that income, time since diagnosis, marital status, +and education were all independently associated with overall +QOL [13]. Other studies with Chinese and US women have +observed that younger age was associated with worse QOL in +breast cancer patients [14–19]. Chinese breast cancer survi- +vors reported that women who underwent breast conservation +therapy had better body image compared to women who had +mastectomy alone [20], consistent with results from studies +with US women [21]. Patients who undergo chemotherapy +have been found to report lower quality of life [22], and this +may be especially true for Chinese cancer patients. Other fac- +tors, e.g., stage of the disease, were also found to be associated +with Chinese cancer survivors’ QOL [23–25]. The present +study therefore investigated how demographic and disease- +related factors were associated with QOL in both countries. +This study was a secondary analysis of existing data from +two intervention studies [26, 27]. The primary goal of this study +was to compare Chinese breast cancer survivors’ QOL with US +counterparts. The second goal was to examine how demograph- +ic and medical factors were associated with QOL across groups. +We hypothesized that Chinese women would have lower QOL +compared with the US women (i.e., hypothesis 1). Based on the +literature reviewed above, we also hypothesized that lower in- +come and education, younger age, later stage of diagnosis, and +more aggressive treatment would be associated with worse QOL +(i.e., hypothesis 2), independent of ethnicity. We finally explored +whether medical factors differentially influenced QOL depend- +ing on ethnicity (Chinese vs. US). We hypothesized that having +undergone chemotherapy prior to the start of radiotherapy (as- +sessment point) and later stage of diagnosis would have a greater +influence on QOL among Chinese than among US breast cancer +survivors (i.e., hypothesis 3). +Methods +Participants +A total of 159 patients (97 Chinese and 62 American) partic- +ipated in the study. Participants were recruited from two +Support Care Cancer +comparable intervention studies conducted in Shanghai, +China and Houston, USA. All the participants who enrolled +in these studies were included in this study and met all inclu- +sion and exclusion criteria of parent studies, which were the +same criteria for this study. Detailed information on the study +methods has been published previously [26, 27]. Eligible +Chinese patients were identified by physicians and research +nurses at the breast cancer clinic. These patients were sched- +uled for radiotherapy at Fudan University Shanghai Cancer +Center (FUSCC) in Shanghai, China. Eligible US patients +were identified through the Cardiac Arrest Registry to +Enhance Survival (CARES) database, which is an institutional +database that keeps track of patient schedules at MD +Anderson Cancer Center. These patients were undergoing ra- +diotherapy in the Department of Radiology Oncology, at MD +Anderson Cancer Center. Inclusion criteria were (1) women +18 years or older, (2) with stage 0–III breast cancer, and (3) +completed surgery and/or chemotherapy and had not started +radiotherapy. Additional inclusion criteria were reading, writ- +ing, and speaking fluency in Chinese for Chinese women or +English for US women. The study excluded patients with any +major psychiatric diagnoses or metastatic disease. +Procedures +Patients were recruited and provided written informed consent +prior to the start of radiotherapy. All patients had completed +surgery and/or chemotherapy prior to consent. In the Qigong +intervention study, 123 Chinese patients were approached, +100 patients consented and were randomized, and 96 complet- +ed the survey, yielding a response rate of 96 %. In the Yoga +intervention study, 137 of the US patients were approached, +81 consented, 71 were randomized, and 61 completed the +survey, resulting in a response rate of 75.3 %. After patients +consented to the study and before they were randomized to the +experimental or control groups, a 45-min battery of question- +naires was given at baseline to measure QOL and demograph- +ic information, and medical data was extracted from patient +charts and electronic medical record. The MD Anderson +Institutional Review Board approved both studies, and the +Fudan University IRB approved the Chinese study. +Measures +QOL was measured by FACT-B version 4. This measure is +validated for both Chinese and US breast cancer patients [28, +29]. Participants respond on a Likert scale ranging from 0 (not +at all) to 4 (very much). The instrument has a total of 36 +statements asking respondents to rate how true each statement +is for the last 7 days. One of the items in the social well-being +subdimension asked about sexual satisfaction and was largely +skipped by Chinese participants; therefore, this item was ex- +cluded from the analysis in this paper. The FACT-B consists of +the Functional Assessment for Cancer Therapy General +(FACT-G) scale [28], with the addition of breast cancer- +specific questions. The FACT-G has four subscale scores: +physical well-being (e.g., BI have nausea.^), functional well- +being (e.g., BI am able to work, including work at home.^), +emotional well-being (e.g., BI feel nervous.^), and social/ +family well-being (e.g., BI am satisfied with family communi- +cation about my illness.^). Responses are summed for a total +score, with greater scores indicating higher QOL. The BCS +subscale addresses breast cancer-specific concerns (e.g., BOne +or both of my arms are swollen or tender.^), with higher scores +on this dimension indicating fewer concerns and better QOL. +In this current study, for group comparison, we reported the +FACT-G subscale and total scores and BCS subscale separate- +ly so that future studies with non-breast and breast cancer +survivors can compare the FACT-G score with our report. +Prior literature demonstrates that the alpha coefficients of the +whole scale are 0.92 and 0.90 and for each subscale ranges +from 0.82 to 0.88 and from 0.82 to 0.85 in US and Chinese +samples, respectively. +Data analyses +In the preliminary analyses, descriptive statistics were com- +puted within each of the cultural samples and cultural group. +Comparisons of all the variables were conducted with +ANOVAs or chi-squared tests. Correlation coefficients of all +variables were computed with Pearson correlations, Spearman +correlations, or cross-tabulations. For all the analyses below, +we first used the FACT-G total score and the BCS score as the +dependent variable. When group differences emerged in the +FACT-G total score, each subscale of FACT-G was used as a +dependent variable to further illustrate cultural differences in a +particular domain of QOL. +To test hypothesis 1, ANOVAs were performed with cul- +tural groups as an independent variable. To rule out the pos- +sibility that the findings were confounded with demographic +and cancer-related characteristics, ANCOVAs were conducted +controlling for all the demographic and medical variables in- +cluding age, disease stage, surgery type (mastectomy vs. con- +servation breast surgery), chemotherapy (yes vs. no), income, +and education. When statistically controlling for income, we +used the relative income compared with the mean within the +group, rather than the absolute value to adjust for country- +related differences in income. To test hypothesis 2, regression +analyses were used with QOL and subscales as dependent +variables and with all demographic and medical variables +(age, disease stage, surgery type, chemotherapy, income, and +education) entered as independent variables. To test hypothe- +sis 3, ANCOVAs were conducted to examine how disease +stage and chemotherapy would separately interact with cultur- +al groups in predicting QOL when controlling for all demo- +graphic and medical variables. For significant interaction +Support Care Cancer +effects, we conducted simple effect analyses to illustrate how +these variables would be differently associated with QOL +within each of the two cultural samples [30]. +Results +Sample characteristics and country comparisons are shown in +Table 1. Compared with the US sample, the Chinese sample +was younger, poorer, less educated, and had a higher percent- +age of women that had undergone chemotherapy, even though +there were no disease stage differences. ANOVAs for hypoth- +esis 1 showed that Chinese breast cancer survivors reported +lower scores for FACT-G total, all FACT-G subscales, and +BCS than their US counterparts (Table 2). ANCOVA analyses +revealed that after controlling for covariates including age, +disease stage, mastectomy, chemotherapy, income, and +education, the above cultural differences remained significant +except for BCS and the social well-being (SWB) subscale. +Regression analyses for hypothesis 2 for the combined +populations revealed that after controlling for other demo- +graphic and medical variables, income was positively associ- +ated with FACT-G total scores (β = 0.31, p = 0.001) and three +subscales of FACT-G, including physical well-being (PWB; +β = 0.21, p = 0.03), SWB (β = 0.38, p < 0.001), and functional +well-being (FWB; β = 0.29, p = 0.002). FACT-G was not +significantly associated with other factors including age, edu- +cation, disease stage, mastectomy, and chemotherapy. +However, age was positively associated with BCS (β = 0.18, +p = 0.04), and having chemotherapy was negatively associat- +ed with PWB (β = −0.21, p = 0.04), after controlling for the +other demographic and medical variables. +Analyses for hypothesis 3 found significant interactions +between cultural group and chemotherapy predicting FACT- +G total scores, F(1, 138) = 6.63, p = 0.01, ηp +2 = 0.046, even +Table 1 Demographic and +cancer-related characteristics of +the samples +Total N = 159, +n (%) +Chinese +N = 97, n (%) +American +N = 62, n (%) +F/χ2 +df +p +Age +15.53 +2 +<0.001 +25–45 years +54 (34.0) +38 (39.2) +16 (25.8) +46–55 years +61 (38.4) +43 (44.3) +18 (29.0) +56–68 years +44 (27.7) +16 (16.5) +28 (45.2) +Annual personal income +15.66 +2 +<0.001 +Below average +9 (5.7) +6 (6.2) +3 (4.8) +Average +50 (31.4) +43 (44.3) +7 (11.3) +Above average +65 (40.9) +33 (34.0) +32 (51.7) +Missing +35 (22.0) +15 (15.5) +20 (32.3) +Educational attainment +35.11 +2 +<0.001 +High school or lower +51 (32.1) +44 (45.4) +7 (11.3) +College +80 (50.3) +47 (48.4) +33 (51.3) +Graduate degree +25 (15.7) +4 (4.1) +21 (33.9) +Missing +3 (1.9) +2 (2.1) +1 (1.6) +Disease stage +1.11 +3 +0.78 +0–I +47 (29.5) +28 (28.9) +19 (30.7) +II +62 (39.0) +35 (36.1) +27 (43.5) +III +40 (25.2) +24 (24.7) +16 (25.8) +Missing +10 (6.3) +10 (10.3) +0 (0) +Mastectomy +2.16 +1 +0.14 +Yes +79 (49.7) +53 (54.6) +26 (41.9) +No +79 (49.7) +44 (45.4) +35 (56.5) +Missing +1 (.6) +0 (0) +1 (1.6) +Chemotherapy +15.73 +1 +<0.001 +Yes +22 (13.8) +92 (94.8) +45 (72.6) +No +137 (86.2) +5 (5.2) +17 (27.4) +The cutoff points of average and below average income are retrieved from government reports for each cultural +sample, which are $8000 and $1500 (currency rate, 6.34 Yuan = US$1) in the Chinese sample and are $50,000 +and $20,000 in the US sample +Support Care Cancer +after controlling for demographic and other medical covariate +variables. Simple effect analysis demonstrated that Chinese +breast cancer survivors receiving chemotherapy (M = 71.55, +SD = 14.52) reported significantly lower FACT-G than those +who did not (M = 86.20, SD = 12.44), F(1, 138) = 7.73, +p = 0.006, but such difference did not emerge among +American breast cancer survivors, F(1, 138) = 1.94, ns (see +Fig. 1). Subscale analyses revealed that cultural group × che- +motherapy interaction effect were significant on PWB, F(1, +138) = 4.00, p = 0.047, ηp +2 = 0.028, and EWB, F(1, +138) = 5.95, p = 0.016, ηp +2 = 0.041. Chinese breast cancer +survivors who had chemotherapy (MPWB = 19.44, SD = 5.21) +reported significantly lower PWB than those who did not +(MPWB = 25.00, SD = 3.32), F(1, 138) = 11.63, p = 0.001. +However, US breast cancer survivors who had chemotherapy +(M = 20.50, SD = 2.71) reported better EWB than those who +did not (M = 18.50, SD = 3.87), F(1, 138) = 4.87, p = 0.03. +Because the Chinese sample had a significantly higher per- +centage (94.8 %) undergoing chemotherapy compared with +the US sample (72.6 %) and only five Chinese women did +not receive chemotherapy, we also compared QOL among +those with chemotherapy controlling for other covariates. +Chinese breast cancer survivors receiving chemotherapy had +significantly lower FACT-G, F(1, 119) = 11.97, p = 0.001, +ηp +2 = 0.091, PWB, F(1, 119) = 5.81, p = 0.018, ηp +2 = 0.047, +EWB, F(1, 119) = 9.17, p = 0.003, ηp +2 = 0.072, and FWB, +F(1, 119) = 9.53, p = 0.003, ηp +2 = 0.074, than did their US +counterparts, and no group differences emerged for SWB, +F(1, 119) = 3.05, ns, or BCS, F(1, 119) = 1.38, ns. +The cultural group × disease stage interaction was signifi- +cant for FACT-G even after controlling for demographic and +other medical variables, F(2, 136) = 4.32, p = 0.05, ηp +2 = 0.06; +see Fig. 2. Simple effect analysis revealed that Chinese breast +cancer survivors with stage II (M = 66.58, SD = 2.40) had +significantly lower FACT-G than those with stages 0–I +(M = 78.86, SD = 12.30), F(2, 136) = 7.50, p = 0.001, but +such difference did not exist in the US sample, F(2, +136) = 1.73, ns. The Chinese breast cancer survivors scored +lower on FACT-G compared to the US women if they were at +stage II, F(1, 136) = 12.86, p < 0.001, and stage III, F(1, +136) = 5.05, p = 0.03, but not at stages 0–I, F(1, +136) = 0.52, ns. Subscale analyses showed that cultural group +interacted with disease stage on EWB, F(2, 136) = 3.78, +p = 0.03, ηp +2 = 0.05, only. Simple effect analyses demonstrat- +ed that Chinese survivors at stage II (M = 15.97, SD = 4.49) +displayed significantly lower EWB than those at stages 0–I +(M = 19.54, SD = 3.04), F(2, 136) = 7.59, p = 0.001, but such +difference did not exist in the US sample. No significant group +and disease stage interaction merged for BCS. +Table 2 Mean, standard +deviation, and comparison of +quality of life between Chinese +and US breast cancer patients +Chinese (N = 97) +American (N = 62) +F +df +p +ηp +2 +FACT-G (26 items) +72.45 (15.31) +83.30 (12.25) +22.10 +1 +<0.001 +0.123 +PWB (7 items) +19.73 (5.27) +22.52 (4.13) +12.46 +1 +0.001 +0.073 +SWB (6 items) +19.29 (4.07) +21.34 (3.58) +10.54 +1 +0.001 +0.063 +EWB (6 items) +17.68 (4.46) +19.92 (3.27) +11.58 +1 +0.001 +0.069 +FWB (7 items) +15.75 (5.19) +19.53 (5.27) +19.84 +1 +<0.001 +0.112 +BCS (9 items) +22.30 (4.88) +24.13 (4.67) +5.51 +1 +0.020 +0.034 +FWB functional well-being, PWB physical well-being, EWB emotional well-being, SWB social well-being, BCS +breast cancer-specific concerns +** +* +Fig. 1 Interaction effects between chemotherapy and cultural group on +FACT-G. *p < 0.05, **p < 0.01 +** +* +* +* +Fig. 2 Interaction effects between cancer stage and cultural group on +FACT-G. *p < 0.05, **p < 0.01 +Support Care Cancer +Discussion +Although the rates of breast cancer have been rising in Asian +populations [5], there has been a lack of understanding of the +QOL among Asian cancer survivors. Furthermore, previous +studies have not compared Asian breast cancer survivors’ +QOL with Westerners. Studies that have been conducted sep- +arately, either in the USA or China, are difficult to compare as +a result of inconsistencies in the time points assessed, tools +used for assessment, and the population of breast cancer pa- +tients examined. This is the first study that has compared re- +sponses on the FACT-B in Chinese and US women with breast +cancer. Both populations were obtained from a similar group +of patients and examined at the same time point (before the +start of radiotherapy). +This study revealed that Chinese breast cancer survivors +had lower overall FACT-G total scores compared to US wom- +en. Furthermore, Chinese women reported lower levels of +functional, physical, social, and emotional well-being and +more breast cancer concerns than US women. A difference +in FACT-G total scores of 5–7 points is indicative of clinically +significant QOL changes/differences [31]. On average, +Chinese women were 11 points lower on the FACT-G total +score compared to the American, which is considered a clin- +ically significant difference. Moreover, the differences +remained pronounced in multiple domains of QOL including +functional, physical, and emotional well-being even after con- +trolling for age, disease stage, mastectomy, chemotherapy, in- +come, and education. The more salient differences emerged +for the functional well-being subscale (ηp +2 = 0.112), where +differences were also clinically significant (>3). +The Chinese sample was poorer, younger, less educated, +and more likely to have undergone chemotherapy compared +with the US sample. The finding that Chinese women were +younger on average than US women is consistent with prior +research showing that Chinese women are being diagnosed +with breast cancer at a younger age than US women [32]. +Even after statistically controlling for these variables, the +Chinese women still had worse quality of life. This suggests +that perhaps symptom control strategies were not as aggres- +sive for the Chinese as the US women. Nevertheless, it is still +possible that income and greater use of chemotherapy could +be reasons for country differences in QOL. Those who have +undergone chemotherapy have been found to report lower +quality of life [22]. It could be possible that Chinese patients +undergo more aggressive treatment or take drugs that have +more adverse side effects. Yet, symptom control strategies +may also be different, and these data were not collected. +Further investigation is needed. +The interaction effect also provided some possible expla- +nations. Chinese patients who underwent chemotherapy were +at later cancer stages and had a much worse quality of life +compared to their US peers, whereas Chinese patients who +did not receive chemotherapy and were at an early cancer +stage were similar to their US peers. These findings suggest +that more attention needs to be paid to improve QOL among +those with chemotherapy and those at more advanced cancer +stages. We did not find surgery type to be differentially linked +to QOL. Future studies need to investigate symptom control +strategies that may have contributed to the country differences +in QOL. +Higher income was associated with higher QOL total score +in both Chinese and US samples, a finding consistent with +previous studies in Caucasian populations [10, 15, 33]. Past +research also suggests that younger age and less education are +associated with poor QOL [22, 34, 35]. We only found an +association between younger age and worse QOL in the US +breast cancer survivors. This may be a result of the small +sample size, relative homogeneity of the samples, the fact that +the Chinese women were significantly younger and less edu- +cated than the US women, and confounded by other medical +and demographic facts known to be associated with QOL. +Studies in Chinese populations have inconsistently found as- +sociations with stage of disease and some subscales of the +FACT-G [13, 36]. In some studies, FACT total score included +the breast cancer concern subdimension, and others did not +include this subdimension. In order to easily make the com- +parisons between this study and other studies reported FACT +scores, we calculated the FACT-G total separately from the +BCS scale and reported the four subdimensions and breast +cancer concerns separately so that future studies can make +comparisons with our findings. +Comparison of responses on the FACT-B in Asian and US +breast cancer patients has not been previously conducted. The +FACT-B has been used in many studies in US breast cancer +patients, and even with the differences in the time QOL was +assessed across studies [15, 19, 37], scores on the FACT-B +subscale scores were similar to our US sample. A previous +study validated the FACT-B in Chinese breast cancer inpa- +tients at an Oncological Hospital in Yunnan providence [29]. +The women in that study scored lower in all FACT-B scales +compared to Chinese women in our study. The women in our +study were treated in Shanghai at one of the best hospitals in +China. If the women in our study have better QOL than +Chinese women treated in other regions, the differences be- +tween Chinese women from regional hospitals and US women +may even be larger. +Several caveats of the current study are worth mentioning. +The study examined the country difference in QOL with two +convenience samples, which limits the generalizability. +However, the Chinese women in our study reported higher +QOL than Chinese women in two other studies, suggesting +that the major conclusion of the study that Chinese women +had worse QOL could be generalized to Chinese women from +other regions within China. Second, the small sample size +limited our analyses of interactions between covariates and +Support Care Cancer +cultural groups. There were a smaller number of breast cancer +survivors without chemotherapy in the analysis for cultural +group by chemotherapy interaction. In addition, a limited +number of covariates were examined. Other covariates that +have been shown to be associated with QOL in both +Chinese and US populations need to be included as well; these +factors include marital status, time since diagnosis, co- +morbidity factors, and social support [23–25, 36]. Other fac- +tors have also been shown to influence QOL, such as pain, +fatigue, and anxiety [18]. Future studies should examine the +relationship between these factors and QOL in both groups. +We were also not able to extract medical data related to symp- +tom control strategies used for the women, such as medica- +tions for nausea and vomiting, fatigue, and sleep disturbances. +Differences in symptom control strategies may explain some +of the QOL differences. Finally, although the FACT-B is val- +idated in Chinese, it may not be completely comparable across +populations and contain questions that introduce bias into +study results. Future studies using a mixed paradigm with both +qualitative and quantitative data may shed light into the cul- +tural equivalence of the questions. +In sum, this study demonstrated that Chinese breast cancer +survivors had worse QOL compared with US counterparts, +and these differences were clinically significant. Treatment +and cancer stage may have contributed to group differences. +However, extra efforts are needed to help improve QOL of +Chinese breast cancer patients. Future studies are warranted to +further understand what contributed to country differences in +QOL and how to design better behavioral and medical inter- +ventions to improve women’s lives in countries where QOL +needs to be improved. +Acknowledgments +Support was provided in part by the US National +Cancer Institute (NCI) grants CA108084 and CA121503 (principal in- +vestigator, Lorenzo Cohen) and the American Cancer Society MRSGT- +10-011-01-CPPB (principal investigator, Qian Lu). Partial support for +Lorenzo Cohen was provided by the Richard E. Haynes Distinguished +Professorship in Clinical Cancer Prevention. Jennifer McQuade is sup- +ported by an institutional T32 training grant and an ASCO Young +Investigator Award. +Compliance with ethical standards +Financial disclosures +There are no financial disclosures from any +authors. +Conflict of interest +The authors declare that they have no conflict of +interest. +References +1. +Ferlay J et al. (2010) Estimates of worldwide burden of cancer in +2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917 +2. +Population Division of the Department of Economic and Social +Affairs of the United Nations Secretariat, World Population +Prospects: The 2012 Revision, in Total Population - Both Sexes +2012. +3. +Centers of Disease Control and Prevention (2007) Cancer +Survivors—United States. MMWR 2011 60:269–272 +4. +Shin HR et al. 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Breast Cancer Res Treat +102:201–210 +37. +Avis NE, Crawford S, Manuel J (2005) Quality of life among youn- +ger women with breast cancer. J Clin Oncol 23:3322–3330 +Support Care Cancer diff --git a/subfolder_0/Effect of Bhramari Pranayama on response inhibition.txt b/subfolder_0/Effect of Bhramari Pranayama on response inhibition.txt new file mode 100644 index 0000000000000000000000000000000000000000..d0a47f7993973b7de4b647b50a7a2e7c7bb29ea7 --- /dev/null +++ b/subfolder_0/Effect of Bhramari Pranayama on response inhibition.txt @@ -0,0 +1,376 @@ +Volume 7 | Issue 2 | July-December | 2014 +Official +Publication +of +Swami +Vivekananda +Yoga +Anusandhana +Samsthana +University +Online full text at +http://www.ijoy.org.in +IJ Y +O +International Journal of Yoga +Guest Editorial +Original Articles +Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers +Effect of trataka on cognitive functions in the elderly +Effect of Bhramari pranayama and OM chanting on pulmonary function inhealthy individuals: A prospective randomized control trial +Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain +Toward building evidence for yoga +Contents +ISSN +0973-6131 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +138 +Effect of Bhramari Pranayama on response inhibition: +Evidence from the stop signal task +Sasidharan K Rajesh, Judu V Ilavarasu, Thaiyar M Srinivasan1 +Department of Psychology, 1Division of Yoga and Physical Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, +Kempegowda Nagar, Bengaluru, Karnataka, India +Address for correspondence: Mr. Sasidharan K Rajesh, +#19 Eknath Bhavan, No. 19, Gavipuram Circle, Kempgowda Nagar, Bengaluru ‑ 560 019, Karnataka, India. +E‑mail: rajesheskay@svyasa.org +to be a useful tool for the study of response inhibition +in cognitive psychology, cognitive neuroscience, and +psychopathology.[1] In SST, subjects act upon a go reaction +time  (RT) task. On a random selection of the trials +(stop signal trials), a stop signal is presented, instructing +them to withhold their go responses.[4] The ability to +stop ongoing motor responses in a split second is a vital +element of response control and flexibility that relies on +frontal‑subcortical network.[5] The stop paradigm is based +on the race model where response execution races with +the inhibitory process to determine whether a response is +inhibited.[6] Further stop signal paradigm allows a sensitive +estimate of inhibitory control known as the stop signal +RT (SSRT), which reflects the time taken to internally +suppress a response.[7] Furthermore, previous studies have +shown medication for the treatment of attention deficit +hyperactivity disorder (ADHD) enhanced SSRT in healthy +volunteers.[8,9] To our knowledge, there is no study to date +using this paradigm in yoga based research. +INTRODUCTION +Adaptive functioning of behavior on the basis of feedback +from the environmental requirements is an important +characteristic of executive control. Response inhibition is +the hallmark of executive function. It refers to the ability +to inhibit inappropriate or irrelevant responses according +to dynamic change in environment.[1] Response inhibition +deficits have been linked to several psychopathological +disorders.[2,3] The Stop Signal Task  (SST) has proved +Context: Response inhibition is a key executive control processes. An inability to inhibit inappropriate actions has been linked +to a large range of neurologic and neuropsychiatric disorders. +Aims: Examine the effect of Bhramari Pranayama (Bhpr) on response inhibition in healthy individuals. +Settings and Design: Thirty‑one male students age ranged from 19-31 years from a residential Yoga University, Bengaluru, India +were recruited for this study. We used a randomized self as control within‑subjects design. Participants were counterbalanced +randomly into two different experimental conditions (Bhpr and deep breathing (DB)). +Materials and Methods: Response inhibition has been measured using a standard tool Stop Signal Task (SST). Each session +lasted for 50 min with 10 min for the experimental conditions, preceded and followed by 20 min of assessment. The primary +outcome measure was stop signal reaction time (SSRT), an estimate of the subject’s capacity for inhibiting prepotent motor +responses. Additional measures of interest were the probability of responding on stop signal trials, P (r | s) and mean RT to +go stimuli. +Results: The mean probability of responding on stop signal trials (p (r | s)) during Bhpr and DB are close to 50%, indicating +reliable SSRT. Paired sample t‑tests showed a significant decrease (P = 0.024) in SSRT after Bhpr session, while the  DB +group did not show any significant change. Further, t‑tests show that the go RT increased significantly after Bhpr (P = 0.007) +and no other changes/differences were observed. +Conclusions: Bhpr enhanced response inhibition and cognitive control in nonclinical participants. +Key words: Bhramari; response inhibition; stop signal; yoga +ABSTRACT +Access this article online +Website: +www.ijoy.org.in +Quick Response Code +DOI: +10.4103/0973-6131.133896 +Short Communication +Rajesh, et al.: Bhramari pranayama on response inhibition +139 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +Yoga in its original form consisted of a system of +ethical, psychological, and physical practices; +although of ancient origin, it transcends cultures and +languages.[10] Yoga lays emphasis on manipulation of breath +movement (Pranayama), which contributes to a positive +neurophysiologic response.[11] Yogic breathing technique +called Bhramari Pranayama (Bhpr), involves producing +a vibrating constant pitch sound emulating the buzzing +of female bumble bee. The term Bhramari is a Sanskrit +word meaning a female bee. In the Bhramari breathing +technique, a humming sound resembling that of a female +bee is produced. In this Pranayama, one produces a low +pitched humming audible sound resembling the sound +of a female bee as long as possible, during exhalation. +EEG paroxysmal gamma waves were measured during +approximately 20 breathing episode of Bhpr in eight +subjects. The result shows an increased theta range +activity, which is similar to results obtained with other +meditation techniques.[12] Further, Bhpr as a therapy shows +significantly reduced irritability, depression, and anxiety +associated with tinnitus.[13] However, the effect of Bhpr on +cognitive function has not been reported. In this study, +we examine the effect of yogic breathing Bhpr on SST in +healthy individuals. +MATERIALS AND METHODS +Subjects +Thirty‑four undergraduate and graduate male students +from a residential Yoga University, Bengaluru, India were +recruited for this study. The final sample comprised +31 volunteers, because the data for three subjects were +excluded due to failure of software. Participants’ age +ranged from 19 to 31 years with a mean age of 23.90 years +(standard deviation (SD) =3.48). All reported having a +normal or corrected vision and normal hearing. Females +were excluded because of reported varying SST during +phases of the menstrual cycle.[14] Participants were free +from medication, smoking, alcohol consumption, and +cardiorespiratory ailments by self‑report. Since the +handedness effects are not known, all subjects selected were +right handed only. The experience of subjects practicing +breathing techniques ranges from 6  months–5  years. +The approval of the Institutional Ethics Committee was +obtained and informed consent was collected. Participants +received no monetary compensation for their participation. +Design and procedure +This was a randomized self as control within‑subjects +design. Participants were counterbalanced randomly into +two different experimental conditions (Bhpr and deep +breathing (DB)). Each session was on a different day. Half of +the subject’s undergone Bhpr session the first day and DB +on the next day. For remaining half the order of the sessions +reversed. Subjects were counterbalanced to either one of +the conditions, to wash out any possible learning effect. +The time of day was kept constant for both sessions for +an individual (6 am-8 am). Each session lasted for 50 min. +The SST was recorded before and after the trial conditions. +All subjects had undergone orientation in the experimental +conditions (Bhpr and DB) for 15 days before the actual +assessment. All subjects received a practice session 1 day +prior to the experimental sessions in order to familiarize +them with the SST and procedures. During the practice +trails, experimenter shows the task on a laptop screen. +Volunteers then undertook brief practice, until it was +evident to the experimenter that the volunteer was +responding appropriately. The experiment was conducted +individually in a room under normal fluorescent lighting +with a laptop in the research lab. Care was taken that +during the experiment no external distractions or noises +were present. +SST +The stimuli were presented on a laptop using STOP‑IT, +which is a free‑to‑use SST program.[7] Participants were +seated approximately at 50  cm from the screen. The +primary task is to perform a two‑choice RT task in which +subjects had to react as quickly and accurately as possible +to discriminate between a square and a circle stimulus. +The primary task stimulus followed by fixation sign (+) +is presented in the center of the computer screen, in +white, on a black background. The subject responds +with ‘Z’ (for square) and ‘/’  (for circle) on a keyboard +with the left and right index finger, respectively. On +no‑signal trials (go task), only the primary task stimulus +is presented. On stop‑signal trials (Stop Task), an auditory +‘stop signal’ beep is presented at a variable delay (stop +signal delay, SSD) following the go stimulus. Subjects +are instructed to inhibit their responses on the trials with +a stop signal beep. Tasks were presented randomly: Go +task (75%) and stop task (25%). SSD is initially set at +250 ms and is adjusted continuously with dynamically +tracking procedure, dependent upon the performance +of the participant. Successful inhibitions resulted in an +increase of the SSD by 50 ms, whereas failed inhibitions +resulted in a reduction of the SSD by 50 ms. This procedure +ensured that on average each participant in each session +had a probability of successful inhibition approaching +50%.[7] A total of 392 trials were presented, divided over +six blocks of 64 trials, lasting 3 min each. Subjects had +waited for 10 s between blocks before they start the next +block. The primary outcome measure is SSRT, an estimate +of the subject’s capacity for inhibiting prepotent motor +responses. SSRT was calculated by subtracting mean stop +signal delay from mean RT to go stimuli (go RT). Additional +measures of interest are the probability of responding on +stop signal trials, p (r | s) and Go RT. +Rajesh, et al.: Bhramari pranayama on response inhibition +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +140 +Experimental conditions +Subjects sat on a comfortable cushion on the floor of the +experimental room, in a crossed leg posture keeping the +spine erect, with eyes closed condition. On experimental +session  (Bhpr), after a deep inhalation, participant +exhale strictly through the nasal airways, emulating the +buzzing of bumblebees with a constant pitch. On control +session (DB), the subjects assumed the Bhpr position, +but did not produce the humming sound. Instead, they +attempted to manipulate the respiratory rhythm by deep +inhalation and exhalation.[12] Both the sessions were of +10 min in duration. Each subject performed approximately +an average of 20 inhalations and exhalations per session. +RESULTS +Statistical analysis was carried out using Statistical +Package for Social Sciences (SPSS) version 10.0. Table 1 +shows the means of the SSRT and go RT and also the +p (r | s). The mean probability of responding on stop‑signal +trials (p (r | s)) during Bhpr and DB are close to 50%, +indicating that the dynamic tracking algorithm worked +well in both sessions and produced a reliable SSRT. +The data for SSRT and go RT were found to be normally +distributed and difference between the means of the two +PRE sessions was not significant. Paired sample t‑tests +showed a significant decrease (P = 0.024) in SSRT after +Bhpr session, while the DP group did not show any +significant change [Table 1]. The means in the post session +were not significantly different, but the Bhpr group showed +a notable lower value. Further, t‑tests show that the Go RT +increased significantly after Bhpr (P = 0.007) and no other +changes/differences were observed. +DISCUSSION +In the present study, we have evaluated the immediate +effect of Bhpr on SST. There was a significant reduction +in SSRT, suggesting that the practice results in enhanced +response inhibition.[1] Further, subject slow down the go +responses, indicating subject made a proactive response +strategy to achieve a balance between competing goals, +suggesting a flexible cognitive control.[15] +As per our knowledge, there is no previous report +specific to BhPr on cognitive function for comparison. +We found that, enhancement of inhibitory control is +consistent with previous behavioral studies on single dose +administration of atomoxetine[8] and methylphenidate[9] +in healthy volunteers. Atomoxetine and methylphenidate +are widely used stimulant medication for the treatment +of ADHD. The mechanism underlying the enhancement +is not known. Dynamics of electroencephalogram (EEG) +theta activity correspond to executive control demands +across different sources of cognitive interference.[16] Theta +power enhancement relates to the recruitment of cognitive +control. Earlier study has shown resonating and repetitive +effects of humming bee sound in the Bhpr breathing +technique, increased theta activity.[12] We hypothesize +that improvement in response inhibition may be due to +enhanced theta activity. Further, it is possible to use this +breathing technique as an adjunct for the management +of ADHD. More studies are required for the use of this +technique in clinical cases. +The study is limited by the small sample size, and the +lasting effect of intervention was not assessed. Future +studies should incorporate various assessment methods +to capture changes while performing the task and +intervention to understand underlying mechanism. +ACKNOWLEDGEMENT +We are especially grateful to S‑VYASA Yoga University, Bengaluru +for financial support and Prof. Gordon D. Logan for insightful +suggestions on design and assessment. +REFERENCES +1. +Verbruggen F, Logan GD. Response inhibition in the stop‑signal paradigm. +Trends Cogn Sci 2008;12:418‑24. +2. +Enticott PG, Ogloff JR, Bradshaw JL. Response inhibition and impulsivity +in schizophrenia. Psychiatry Res 2008;157:251‑4. +3. +Aron AR, Poldrack RA. The cognitive neuroscience of response inhibition: +Relevance for genetic research in attention‑deficit/hyperactivity disorder. +Biol Psychiatry 2005;57:1285‑92. +4. +Logan GD, Cowan WB, Davis KA. On the ability to inhibit simple and choice +reaction time responses: A model and a method. J Exp Psychol Hum Percept +Perform 1984;10:276‑91. +5. +Aron AR, Behrens TE, Smith S, Frank MJ, Poldrack RA. Triangulating a +cognitive control network using diffusion‑weighted magnetic resonance +imaging (MRI) and functional MRI. J Neurosci 2007;27:3743‑52. +6. +Band GP, van der Molen MW, Logan GD. Horse‑race model simulations of +the stop‑signal procedure. Acta Psychol (Amst) 2003;112:105‑42. +7. +Verbruggen F, Logan GD, Stevens MA. STOP‑IT: Windows executable +software for the stop‑signal paradigm. Behav Res Methods 2008;40:479‑83. +8. +Chamberlain SR, Hampshire A, Muller U, Rubia K, Del Campo N, Craig K, +Table  1: Bhramari and deep breathing: Mean and standard deviations +Deep breathing +Bhramari pranayama +Pre +Post +Pre +Post +p (r|s)(%) +48.58±1.93 +49.68±1.78 +48.96±1.77 +49.47±3.38 +SSRT (ms) +239.44±30.59 +237.35±38.40 +243.75±40.16 +232.67±43.81* +Go RT (ms) +733.88±170.89 +751.81±182.16 +701.67±184.10 +732.24±193.40** +p (r|s) = Mean probability of responding on stop‑signal trials, SSRT = Mean stop‑signal reaction time, Go RT = Mean reaction time on no‑signal trials. *P<0.05, +**P<0.01, t test for paired data comparing “pre” with respective “post” values +Rajesh, et al.: Bhramari pranayama on response inhibition +141 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +et al. Atomoxetine modulates right inferior frontal activation during inhibitory +control: A pharmacological functional magnetic resonance imaging study. +Biol Psychiatry 2009;65:550‑5. +9. +Nandam LS, Hester R, Wagner J, Cummins TD, Garner K, Dean AJ, +et  al. Methylphenidate but not atomoxetine or citalopram modulates +inhibitory control and response time variability. Biol Psychiatry 2011;69: +902‑4. +10. Nagendra HR. Defining yoga. Int J Yoga 2008;1:43‑4. +11. +Jerath R, Edry JW, Barnes VA, Jerath V. Physiology of long pranayamic +breathing: Neural respiratory elements may provide a mechanism that +explains how slow deep breathing shifts the autonomic nervous system. Med +Hypotheses 2006;67:566‑71. +12. Vialatte FB, Bakardjian H, Prasad R, Cichocki A. EEG paroxysmal gamma +waves during Bhramari Pranayama: A yoga breathing technique. Conscious +Cogn 2009;18:977‑88. +13. Sidheshwar  P, Niladri  KM, Ravishankar  N. Role of self‑induced +sound therapy: Bhramari Pranayama in Tinnitus. Audiol Med 2010;8: +137‑41. +14. Colzato LS, Hertsig G, van den Wildenberg WP, Hommel B. Estrogen +modulates inhibitory control in healthy human females: Evidence from the +stop‑signal paradigm. Neuroscience 2010;167:709‑15. +15. Verbruggen F, Logan GD. Proactive adjustments of response strategies in the +stop‑signal paradigm. J Exp Psychol Hum Percept Perform 2009;35:835‑54. +16. Nigbur R, Ivanova G, Sturmer B, Theta power as a marker for cognitive +interference. Clin Neurophysiol 2011;122:2185‑94. +How to cite this article: Rajesh SK, Ilavarasu JV, Srinivasan TM. Effect +of Bhramari Pranayama on response inhibition: Evidence from the stop +signal task. Int J Yoga 2014;7:138-41. +Source of Support: S-VYASA University, Conflict of Interest: +None declared +Author Help: Reference checking facility +The manuscript system (www.journalonweb.com) allows the authors to check and verify the accuracy and style of references. 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Ramarao +Division of Life Sciences, SVYASA, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India +Email: barvevaibhavi@rediffmail.com + +Received November 24, 2012; revised December 26, 2012; accepted January 28, 2013 +ABSTRACT +Objective: Ayurveda and Yoga have emerged as beneficial adjuvant in management of diabetes. This pilot study was +planned to understand the concepts and assess the effect of a combination of Ayurvedic panchakarma and Yoga. Design: +Experimental pilot study with pre post design. Subjects: Twelve patients with type 2 diabetes in age between 40 - 70 +years (mean 56 ± 9.08) with no cardiac, renal or retinal complications. Settings: Residential Holistic Health Centre of +S-VYASA. Intervention: A validated Ayurveda protocol comprising of panchakarma followed by maintenance the- +rapy with a specific module of Integrated Approach of Yoga Therapy for Diabetes that included selected physical pos- +tures (asanas), pranayama, meditation, lifestyle change and yogic counseling for stress management. All subjects un- +derwent a residential program for six weeks followed by therapy at home for 12 weeks. Results were analyzed using +paired “t” test. Results: After 6 weeks, Fasting Blood Glucose reduced (p < 0.05) from 129.31 ± 58.11 to 103.54 ± +40.74 (19.93%), Post Prandial Blood Glucose from 191.69 ± 76.77 to 152.92 ± 62.06 (20.23%, p < 0.05), Total choles- +terol from 209 ± 33.7 to 186.92 ± 23.36 (10.56%, p < 0.05), Triglycerides from 198.25 ± 94.78 to 151.25 ± 43.65 +(23.71%, p < 0.05), HbA1c reduced (p = 0.014) from 8.79 ± 2.12 to 8.07 ± 1.77 (8.19%) in 6th week and further to 7.63 +± 2.12 (13.19%, p = 0.001) after 12th week. Oral Hypoglycemic Agent (OHA) drug score reduced from 2.83 ± 0.93 to 1 +± 1.27 (64.66%, p < 0.001). Symptom score reduced from 2.83 ± 1.02 to 1.66 ± 0.65 (p < 0.001). At baseline guna +questionnaire showed six subjects each with rajas and tamas dominance. On post assessments, two subjects shifted from +tamas to rajas dominance. Conclusion: This first pilot study has indication of a potentially beneficial effect of combin- +ing traditionally recommended Ayurveda panchakarma with maintenance herbs and Yoga, in reducing blood glucose +and lipids. Long term RCT is recommended. + +Keywords: Ayurveda; Yoga; Diabetes +1. Introduction +Diabetes mellitus imposes a sizeable burden globally in +terms of early mortality, morbidity, and health care costs. +The incidence of diabetes worldwide was likely to be +2.8% in 2000 and expected to rise to 4.4% by 2030, and +above three-quarters of people with diabetes would be +living in developing countries [1]. Diabetes mellitus +(madhumeha) was known to ancient Indian physicians +with detailed description of its clinical features and +management protocols [2]. Ayurveda is a comprehensive +system of traditional health care, which originated in +India approximately three thousand years ago. Its unique +holistic approach appears to have become relevant today +due to the increasing prevalence of non communicable +diseases. This science of life deals with body, mind, and +spirit as a single entity with clear understanding of the +techniques of managing them. Ancient Ayurveda classics +by Charaka, Sushruta, and Vagbhata contain ample +literature about Prameha and its treatment. Prameha is a +metabolic disorder and is diagnosed mainly with the help +of signs and symptoms related to “Mutra” (Urine). +Genetic predisposition with sedentary life style, inju- +dicious intake of food, and stress are recognized as some +of the important etiological factors of Prameha, [3]. The +diagnosis and management of diabetes (madhumeha) is +based on tridosa (bodily humor) theory which says that +kapha (phlegm), pitta (bile) and vata (wind) are the basic +pillars of life [4]; balanced functioning of these tridosas +is health and imbalance is disease [5]. A disturbance in +the doshas precedes the genesis of various pathological +states which results to 20 types of Prameha where finally +diabetes (madhumeha) is one of the chronic type of +Prameha. Thus, the primary aim in prevention, diagnosis +and treatment of a disease is to detect the degree of +vitiation in these doshas. +Several studies have shown the beneficial effects of +Ayurveda in T2DM with significant reduction in Glyco- +sylated Haemoglobin (HbA1c), Fasting and Post Prandial +Copyright © 2013 SciRes. OJEMD +B. VAIBHAVI ET AL. +91 +Blood Glucose (FBG, PPBG) levels and lipids [6-8]. A +study by Ahmed et al. that treated diabetic rats with the +fruit juice of Momordia charantia has reported rege- +neration or increase in the number of beta cells [9], +which appears to offer some evidence to the additional +benefits of Ayurveda because none of the conventional +Oral Hypoglycemic Agents (OHA) exhibit this property. +Momordia charantia also has exhibited extra-pancreatic +effects with improved peripheral glucose utilization [10]. +Recent studies [11,12] have described the role of a few +herbs like Trigonella foenum graecum and Tinospora +cordifolia on activities of enzymes involved in carbo- +hydrate and lipid metabolism. In animal based studies, +herbs like Curcuma longa have shown reduction in +dyslipidemia in diabetics [13] through its effect on lipid +peroxidation [14]. +Ayurveda being a holistic science, it has to be pra- +cticed as a whole science including several steps of +management and cannot be given only as one capsule of +a proven herbal preparation. Hence it was necessary to +review the classical texts and compile them to present a +holistic management protocol in the form of flow chart +with different steps, which was finally done and sent for +validation from various Ayurveda experts [15]. +Yoga is also one of the modalities in Complimentary +and Alternative Medicine (CAM) which is an integral +part of Ayurveda (mentioned in classical texts) [16]. +Yoga is found to be very effective as a complimentary +treatment for type 2 diabetes in several studies [17-19]. +Studies have demonstrated significant reduction in FBG, +PPBG [20-22] Glycosylated Haemoglobin (HbA1c) [22], +improvement in nerve functions [22], reduction in oral +glycemic agents [23] and Body Mass Index (BMI) [24] +after the practice of Yoga. +Multiple factors involved in the pathogenesis of +diabetes demands a multi-modal remedial approach [25]. +Although there are many studies that reveal the efficacy +of CAM modalities, there are very few studies which +report the efficacy of these modalities when used +together. Since there are ample evidences that Ayurveda +can be a potential complimentary therapy for diabetes +[6-8], it would be worthwhile to test its efficacy when +combined with Yoga, which is also one of the CAM +modalities having large number evidence based studies +supporting its effect in type 2 diabetes. +Hence this pilot study was planned with an intention of +assessing the feasibility and safety of this residential +Ayurveda and Yoga therapy before launching a con- +trolled study on a larger population. +2. Materials and Methods +2.1. Subjects +Twelve (n = 12) subjects (7 female, 5 male) in age range +of 40 - 70 years (mean 56 ± 9.08) with Type 2 Diabetes +Mellitus (T2DM) were recruited for the study. The +sample size was calculated based on an effect size +(Cohen’s effect size, ε = 2.45) obtained from a previous +study of changes following the practices of Yoga in DM +patients [16]. It was calculated using G*Power software, +Version 3.0.10, where the level was 0.05 and power = +0.95 and the recommended sample size was twelve. Thus, +a sample size of twelve was recruited for the present study. +Subjects who satisfied the American Diabetes Association +(ADA) criteria for T2DM [26], not practicing Yoga for at +least previous three months and willing to participate in +the trial were included. Those with cardiac complications +and nephropathy were excluded after checking ECG, +FBG, blood urea, and creatinin. Those with proliferative +retinopathy (screened by an ophthalmologist) and had +practiced Yoga in the recent past (three months) were +also excluded. Ethical clearance was obtained from +institutional ethical committee. Signed informed consent +was obtained from all subjects. +2.2. Design +This was an experimental pilot study with a pre post +design in a single group. +2.3. Methods +All subjects went through a daily routine (Table 1) that +included Integrated Approach of Yoga Therapy for Diabetes +(IAYTD) along with a progressive plan of panchakarma +(purificatory therapy) and maintenance herbs. +The protocol had the flexibility for changes in medica- +tion or Yoga practices based on their daily response as- +sessments. After admission, first week was planned for +stabilization of the baseline parameters without any in- +tervention. The fasting (12-hr) blood sample was ob- +tained via a veni-puncture in the arm with the individual +in an upright position and after at least 5 min in a resting +state. Supervised intervention with strict adherence to the +schedule was followed from the beginning of second to +end of fifth week. The clinical progress was monitored +daily by one Ayurveda and one allopathic physician; +therapies were carried out by certified therapists and +documentation was done by the research team. The sub- +jects were monitored daily for symptoms scores, medica- +tion scores (number of OHA tablets per day), pulse rate, +blood pressure, respiratory rate and blood glucose (glu- +cometer). Diet was planned based on nutritional and +dosha assessments. Post assessments were done in sixth +week when the patients continued to remain in the cam- +pus attending the same daily routine on their own without +instructions by the therapists. After discharge they were +given the diet chart, personalized Yoga chart with in- +struction DVD, and maintenance medication. Home +Copyright © 2013 SciRes. OJEMD +B. VAIBHAVI ET AL. +92 +Table 1. Ayurveda protocol. +Ayurveda protocol +Treatment plan +Drugs used in treatment plan +with their dosage and time +Appetizer, digestive drugs +(Deepana/Paachan) for 3 - 7 +days +Trikatu churna [27] 2 gms twice +daily before food +Internal oleation for 3 - 7 +days (Snehapaan) +Sarshapa tail [28] +30ml/60ml/90ml in increasing +dose +External oleation with +sudation (Abhyanga/Swedan) +for 3 days +Brihat saindhavadi Taila [29] +(external application) +Purgation (Virechan) 1 day +Trivrit lehyam [30] 30 - 60 gms +Post purgation diet +restrictions +(Samsarjana/Krama ) for 3 - +5 days +- +Palliative therapy (Shamana) +to be continued +Kathakhadiradi kashaya [31] 15 +ml twice daily. Amritmehari +churna [32] 2 gms twice daily. +Shilajatwadi vati [33] 2 tabs +thrice daily + +practice was monitored up to 12 weeks by regular moti- +vating phone calls. HbA1c was assessed at the end of +twelfth week. +2.4. Intervention +A validated Ayurveda protocol developed on the basis of +classical scriptural references was used which included +panchakarma followed by maintenance medication (Ta- +ble 2). Along with Ayurveda protocol, the module of +Integrated Approach of Yoga Therapy (IAYTD) for dia- +betes comprised of Yogasanas, Pranayama, meditation +and lectures as used in our two earlier studies in India +[23,34] and UK [17] (Table 3). +2.5. Outcome Measures +Ama, agni and kostha were assessed at baseline using a +check list prepared for the purpose of this study based on +guidelines in classical texts. Agni was scored on a three +point scale 1 = mandagni (less digestive capacity), 2 = mad- +hyagni (medium digestive capacity) and 3 = pravaragni +(more digestive capacity). The end point of the cleansing +procedure was considered to be when ama score reached +a balanced score of 1. Koshta (colonic sensitivity) was +assessed based on seven questions with three response +choices. A total score of 1 to 7 indicates mrudu koshta +(more colonic sensitivity), 8 to 18 madhyam koshta (me- +dium colonic sensitivity) and 19 to 21 krura koshta (less co- +lonic sensitivity). These assessments were done at baseline +and daily for assessing the effect of panchakarma procedure. +Table 2. Daily schedule of subjects. +Daily schedule of subjects +Time (hours) +Duration +(minutes) +Yoga practice +5.00 - 5.30 +30 +Om meditation +5.30 - 6.30 +60 +Yoga based special technique 1 +(physical practices)/kriyas +6.30 - 7.30 +60 +Bath and wash +7.30 - 8.15 +45 +Lecture on bhagvadgita/chanting +8.15 - 8.45 +30 +Breakfast +8.45 - 10.00 +75 +Rest +10.00 - 11.00 +60 +Lecture (on ayurvedic and yogic +lifestyle) +11.00 - 12.00 +60 +Pranayama (breathing practices) +12.00 - 13.00 +60 +Yoga based special technique 2 +(physical practices) +13.00 - 14.00 +60 +Lunch (vegetarian diabetic diet) +14.00 - 14.30 +30 +Deep Relaxation Technique (DRT) +14.30 - 16.00 +90 +Assessments, psychological and +yogic counseling +16.00 - 17.00 +60 +Cyclic Meditation (CM) +17.00 - 18.00 +60 +Tuning to nature +18.00 - 19.00 +60 +Divine hymns session (Bhajan) +19.00 - 19.45 +45 +Mind sound resonance technique +19.45 - 20.30 +45 +Dinner ( vegetarian diabetic diet) +20.30 - 21.30 +60 +Cleansing technique for eye +(Trataka) +21.30 - 22.00 +30 +Self study +22.00 +- +Lights off +2.5.1. Symptom Score +The average severity of all symptoms documented before +and after the 6 weeks was recorded. Severity was scored +on a 4-point scale of 0 - 3 (0 = nil, 1-mild not disturbing +the daily routine, 2 = moderate-disturbs routine requires +symptomatic medication, 3 = severe-require hospital- +ization or parenteral medication). +2.5.2. Medication Score +Number of tables of Oral Hypoglycemic Agent (OHA)/day; +1 tablet = the standard strength each for adults quoted in +pharmacopeia index e.g. one tablet of Metformin = 500 mg. +2.5.3. Guna Assessment +The G-Inventory [35] (GI) assessed the shift of guna +dominance after the intervention. GI is a measure of the +Copyright © 2013 SciRes. OJEMD +B. VAIBHAVI ET AL. +Copyright © 2013 SciRes. OJEMD +93 + +Table 3 Demographic details of the subject +Sub no. +Name +Age +(years) +Sex +(M/F) +Duration of +DM in years +**Family H/O +DM +Creatinine +(mg/dl) +Urea +(mg/dl) +Agni +Ama +Kostha +1 +SS +69 +M +03 +N +1.3 +30.8 +1 +3 +19 +2 +AS +48 +F +5.5 +N +0.78 +29.4 +3 +3 +9 +3 +MG +55 +M +12 +N +0.90 +30.3 +1 +3 +9 +4 +R +68 +F +08 +N +0.7 +28 +1 +3 +12 +5 +H +56 +F +15 +F +0.86 +34.2 +1 +3 +8 +6 +TC +49 +F +14 +M/B +0.85 +18.6 +3 +2 +9 +7 +BS +50 +F +16 +B/S +0.86 +21.7 +1 +3 +7 +8 +AS +40 +M +04 +B +0.72 +22.8 +1 +3 +18 +9 +Hu +52 +M +07 +N +0.8 +39.5 +2 +3 +19 +10 +A +61 +F +11 +S +1.0 +20.0 +1 +3 +11 +11 +S +63 +F +25 +GF +1.0 +23.0 +2 +2 +13 +12 +D +66 +M +9 +B +1.2 +19.0 +1 +3 +7 +**F—Father, M—Mother, B—Brother, S—Sister, GF—Grandfather, GM—Grandmother, N—Nil history. + +three gunas (sattva, rajas and tamas) and contains ten +questions with three response choices. A total score of +above 28 indicates sattva, 24 to 28 rajas and <24 tamas. +This test has a test retest reliability of 0.60 with a confi- +dence level of 99% and has been validated. Biochemical +parameters: these included Fasting (FBG) and Post Pran- +dial Blood Glucose (PPBG), HbA1c and lipid profile +determined at baseline and at the end of 6th week. HbA1c +was repeated at end of 12th week. A semi-auto analyzer +was used for the biochemical measurements. Blood Glu- +cose was determined by enzymatic oxidation method +using glucose peroxidase [36]. HbA1c was estimated by +glucose oxidase method and cation-exchange resin me- +thod [37]. Cholesterol was determined after enzymatic +hydrolysis and oxidation [38]. Triglycerides were deter- +mined after enzymatic splitting with lipoprotein lipase. +Indicator for the same was generated from 4-aminoanti- +pyrine and 4-chlorophenol by hydrogen peroxide under +the catalytic action of peroxidase. LDL-VLDL Choles- +terol was determined by using Friedewald’s equation +[39]. +3. Statistical Analysis +Data were analyzed using SPSS version 16.0; checked +for normal distribution by Shapiro Wilk’s test. As the +data were normally distributed for all variables student’s +paired samples “t” test was used with a significance +value set at 0.05 for two-sided hypothesis testing. +4. Results +Table 3 gives the demographic characteristics of subjects. +The mean age was 56 ± 9.08 years. None had cardiac, +renal or retinal complications. There were no drop outs in +this study. At baseline, 2 subjects had madhyam ama and +10 had pravara ama, while 10 subjects had manda agni +and 2 had madhyam agni and 3 subjects had mrudu +kostha, 7 had madhyam kostha and 2 had krura kostha. +Table 4 shows the results after the intervention. +After 6 weeks of intervention, the symptom score re- +duced from 2.83 ± 1.02 to 1.66 ± 0.65 (p < 0.001). OHA +score reduced (p < 0.001) from 2.83 ± 0.93 to 1 ± 1.27 +(64.66%). FBG reduced (p < 0.05) from 129.31 ± 58.11 +to 103.54 ± 40.74 (19.93%). PPBG decreased from +191.69 ± 76.77 to 152.92 ± 62.06 (20.23%, p < 0.05). +HbA1c reduced (p = 0.014) from 8.79 ± 2.12 to 8.07± +1.77 (8.19%) in 6th week. It reduced further to 7.63 ± +2.12 (13.19%, p = 0.001) after 12th week. At baseline +guna questionnaire showed 6 subjects each with rajas and +tamas dominance. On post assessments, two subjects +shifted from tamas to rajas dominance. All of them had +balanced functioning of agni, ama and kostha at the end +of 6 weeks. +Lipid profile: Total Cholesterol decreased significantly +(p < 0.05) from 209 ± 33.7 to 186.92 ± 23.36 (10.56%). +Triglycerides reduced (p < 0.05) from 198.25 ± 94.78 to +151.25 ± 43.65 (23.71%). There was non-significant +reduction in the levels of LDL, VLDL and HDL. +5. Discussion +This pilot study on twelve subjects with T2DM has +shown significant reduction in FBG, PPBG, HbA1c, TC +nd TG along with reduction in oral hypoglycemic +a + +B. VAIBHAVI ET AL. +94 + +Table 4. Results after the intervention. +Post intervention changes# +Variables +Pre (1st week) +Mean ± SD +Post (6th week) +Mean ± SD +Post2 (12th week) +Mean ± SD +p-value +Medication scores +2.83 ± 0.93 +1 ±1.27*** +- +0.001 +Symptom score +2.83 ± 1.02 +1.66 ± 0.65*** +- +0.001 +FBG +129.31 ± 58.11 +103.54 ± 40.74* +- +0.017 +PPBG +191.69 ± 76.77 +152.92 ± 62.06* +- +0.013 +HbA1c +8.79 ± 2.12 +- +7.63 ± 2.12*** +0.001 +Total Cholesterol +209 ± 33.7 +186.92 ± 23.36* +- +0.024 +Total Triglycerides +198.25 ± 94.78 +151.25 ± 43.65* +- +0.020 +LDL +129.42 ± 29.63 +115.25 ± 15.63 +- +0.121 +VLDL +39.65 ± 18.96 +38.5 ± 33.5 +- +0.907 +*p < 0.05, **p < 0.01, ***p < 0.001, baseline data compared with the post data using a paired “t” test. Fasting Blood Glucose (FBG), Post Prandial Blood Glu- +cose (PPBG), Glycosylated Hemoglobin (HbA1c), Total Cholesterol (TC), Total Triglycerides (TG), Low Density Lipoprotein (LDL), Very Low Density +Lipoprotein (VLDL). #Note: These significant values stated are based on single group pre comparison to post. There is no control group which is an imita- +tion of this study and that can also effect p-values when compared with control groups in main efficacy study. + +medication and balanced functioning of agni, ama and +kostha after six weeks of residential intervention using +Yoga and Ayurveda. +5.1. Comparisons +To the best of our knowledge, there are no studies which +report the effect of a combination of Yoga and Ayurveda +(panchakarma and maintenance therapy) although there +are studies on these two therapeutic modalities used +independently in comparison to conventional medicine. +Kumari et al. [8]. Assessed the effect of panchakarma +followed by maintenance ayurvedic herbal therapy in +forty two subjects with T2DM, which showed significant +reduction in FBG and PPBG by 10.2% and 6.4% +respectively after one month of intervention. In one of +our earlier Yoga studies we had observed a decrease in +FBG and HbA1c by 6.9% and 15.5% after an integrated +Yoga protocol in a control study on diabetics in London +[17]. Sahay et al. showed that Yoga was effective in +reducing TC (by 0.47%) and TG (by 18.03%) [25]. In +comparison, the present study has shown reduction in +mean values of FBG (19.9%), PPBG (20.2%), HbA1c +(13.2%), TC (10.6%), and TG (23.7%). These values +(except HbA1c) showed higher magnitude of change +than the independent Yoga or Ayurveda studies. There +are other studies on Ayurveda in T2DM that have shown +encouraging results. Elder et al. randomized 60 adults +with newly diagnosed T2DM (baseline HbA1c of 6.0 to +8.0) into experimental and control groups. The Ayurveda +protocol included Ayurvedic diet, meditation and +Ayurvedic herbal supplement (MA 471). The results +showed significant difference between groups (ANCOVA) +in HbA1c, FBG, TC, LDL and body weight in those who +had higher baseline HbA1c [6]. Saxena and Vikram +reviewed the accumulated literature on ten herbs with +antidiabetic activity and reported that momordica +charantia, pterocarpus marsupium and trigonella foenum +greacum have beneficial effects in treating T2DM [40]. +The results of many other studies on Yoga are also +consistent with the outcomes of present study [17]. Yoga +nidra (a form of guided relaxation) resulted in decreased +FBG, PPBG, in patients with T2DM [41]. Looking at +cardiac functions Singh et al. showed that training in +Yoga asanas for forty days in 24 T2DM decreased their +pulse rate, blood pressure, and Corrected QT interval in +addition to decrease in FBG (25.5%), PPBG (27.03%) +and HbA1c (13.3%) [42]. A randomized control study +that used Nadishodhana Pranayama and Sun Salutation +for 5 weeks in twenty T2DM has shown significant +decrease in plasma glucose, serum cortisol and serum +Malone-Di-Aldehyde (MDA) levels and a significant +increase in serum Super Oxide Dismutase (SOD) activity, +more prominently in those who has poor glycemic +control [43]. +5.2. Mechanism +According to the present day molecular biological under- +standing of T2DM, the etiology is traceable to erratic life +style that promotes expression of the diabetes related +genes [44]; this results in a series of imbalances [calorie +intake-out put = obesity, adipoleptin-nectin = IR; [45] +proinflammatory—anti-inflammatory cytokines = tissue +Copyright © 2013 SciRes. OJEMD +B. VAIBHAVI ET AL. +95 +inflammation [46] resulting in insulin resistance which in +turn is responsible for the biochemical changes and the +clinical manifestations. Thus, the benefits may be traced +to reduction in oxidative stress mediators, modified HPA +axis [47], reduction in adipoleptin [48], and pro-inflam- +matory cytokines [49] that are known to induce IR. The +mechanism described by Yoga and Ayurveda offers a +different model of understanding T2DM. Accordingly, +diabetes is the effect of erratic life style that has resulted +from lack of mastery over the mind and wrong notion +about the meaning and purpose of life (prajnaparadha). +The flow chart in Table 5 shows the pathogenesis of +T2DM. Yoga masters proposed that the human system is +made of five levels of subtle bodies [annamaya (physi- +cal), pranamaya (vital energy), manomaya (mental), vij- +nanamaya (intellectual) and anandamaya (bliss) kosas] +[50]. Three gunas (satva, rajas and tamas) that grossify +into three doshas (vata, pitta and kapha) constitute the +physical body (annamaya kosha). Man is in best of health +when there is a balanced functioning of the tridosas +which is possible when the mind is in a state of satva +(freedom from stress) and established in anandamaya +kosha. T2DM, madhumeha [8] is a tridoshaja vyadhi, i.e. +there is vitiation of all three dosas which is preceded by +imbalance of the three gunas [dominance of tamas and/or +rajas]. T2DM, a life style disease (samanya adhija vya- +dhi), begins in manomaya kosha. This is due to lack of +right knowledge (a function of vijnanamaya kosha) that +“I am made of happiness and freedom from all thoughts”. +This leads to craving for happiness from outside objects +(wealth and fame). Long standing stresses (due to unsat- +isfied desires) leads to sleeplessness, irritability, indeci- +siveness, depression, and/or frustration (violent negative +emotions). The long standing suppressed emotions are +characterized by uncontrolled rewinding of thoughts in +the mind (yogic definition of stress).This habituated un- +controlled speed percolates in to the pranamaya kosha +and drains large quantities of prana leading to early aging +(DM is an aging disease). This uncontrolled habituated +speed results in an imbalance that further settles down in +the physical body as structural damage (inflammation = +speed at annamaya kosha). This descent (prasava) from a +balanced state of functioning of the mind-body complex +results in an imbalance of the three doshas. Caraka, the +father of Ayurveda, describes T2DM as a disease char- +acterized by covering (avarana) of excess kapha over +vata that leads to obstruction in the harmonious move- +ment of vata, and this obstructed/restricted movement in +turn leads to stagnation and unavailability of pitta that is +responsible for healthy metabolic processes in tissues. In +addition, the obstructed vata gets aggravated and gets +vitiated further [51]. Thus, T2DM begins with wrong life +style due to adnyana (pragnaparadha) that leads to kapha +dosha or tamo guna pradhanaka vihara and ahara (seden- +tary life- style, day time sleeping, excessive intake of +fermented foods, oily foods, excess sweets and meat). +This domi- nance of kapha results in agnimandya (im- +proper func- tioning of digestive fire). This goes on to +produce excess ama (endotoxins) which blocks the +channels (srotas) thus preventing the balanced flow of +vata. The vitiated kapha circulates throughout the body +resulting in dhatwagni mandya (poor functioning of di- +gestive fire at tissue level). It affects the dushya struc- +tures, the dhatus (tissues). Adipose tissue (medas) is the +first dushya to be affected. Then it goes on to affect all +other structures of the body including muscular tissue +(mansa), intracellular and extra cellular fluids (kleda), +vasa (muscle fat), shukra (semen), rakta (blood), majja +(marrow tissue), rasa (blood plasma), lasika (fluids & +plasma) and ojas (vital substance that maintains immu- +nity). Mutravaha srotas is the main channel to be affected +that leads to madhumeha [52]. +The holistic module of management of T2DM is based +on measurement of the status of guna, the genetic per- +sonality type (prakrti), the present state of imbalance of +the doshas (vikrti), the status of dushya, srotas, agni and +ama at all stages of therapy. +It includes manifold techniques that possess the ability +to reinstate homeostasis (pratiprasava) through increas- +ing the satva guna and balancing the vitiated doshas. The +integrated approach to yoga therapy (IAYT) prescribes +practices at all the five koshas to arrive at complete mas- +tery over the modifications of mind and remain in a state +of inner contentment and joyful existence under all cir- +cumstances of life. The physical practices begin with +cleansing the system of all endotoxins. This is achieved +through satkriyas (Yoga) or panchakarma (Ayurveda). +The stepwise progression of panchakarma starts with +stimulating the excretion of the endotoxins (ama) through +Snehana-Abhyangam (external and internal oleation +through medicated massage) and swedana (induced +sweating) followed by Virechana that helps in dislodging +the vitiated doshas (excess kapha and pitta) [8] through +purgation. This is followed by sanshamana (soothing +relaxation) through herbal therapies for maintenance of +balance. Thus, panchakarma removes ama, reduces +kapha, clears the avarana (covering), cleanses the srotas, +improves agni, promotes normal flow of vata, normalizes +pitta and restores dhatwagni that promotes normal func- +tioning of dhatus. IAYT, a mind body intervention adds +on the component of self corrective processes to restore +balance at all levels through deep rest. In summary, +avoiding the etiological factors (nidan parivarjana) +through lifestyle change [by mind mastery through jnana +Yoga (right knowledge), raja Yoga, karma Yoga and +bhakti Yoga] [55], detoxification through panchakarma, +Copyright © 2013 SciRes. OJEMD +B. VAIBHAVI ET AL. +Copyright © 2013 SciRes. OJEMD +96 + + + + +Table 5. Pathophysiology and management of Type 2 Diabetes Mellitus according to Ayurveda, Yoga and biomedicine. +Pathophysiology according to +Ayurveda and Yoga [53] +Reversing Pathophysiology Ayurveda +and Yoga [54] +Pathophysiology according to +modern [46] +Reversing the +Pathophysiology +modern [46] + + + +correct the dosha imbalance and clear the subtle channels +through medication, asanas and pranayama forms the +basis of this integrated Yoga and Ayurveda model used +in this program. Long term regular monitoring is neces- +sary to prevent return of the imbalance that is genetically +determined in T2DM. This is ensured by lifelong regular +IAYT and medication. +6. Strength of the Study +This is the first attempt to test the efficacy of multi mo- +dalities of CAM in a residential setting using standard +tools of assessment. The development of an integrated +module by an exhaustive search of all available texts of +Ayurveda and Yoga (16 texts) with a sound conceptual +basis for the holistic approach is the major contribution +of this study. Rendering the traditional knowledge in an +acceptable capsule for the present day elite community of +diabetics has been achieved by this pilot study. +7. Limitations of the Study +Sample size was small and no control group was planned. +There is lack of a control group using either of Yoga and +Ayurveda, the comparison with other single method +study is not very valid. As this was a pilot study and not +an efficacy trial the conclusions from the study are only +pointers to a larger study and not a proof of concept. +8. Implications and Suggestions for Future +Work +The Yoga and Ayurveda model of etio-pathogenesis of +T2DM based on the concepts of imbalance of gunas and +doshas offers an opening to subtler dimensions Holistic +way of understanding of this disease and may bring about +a paradigm shift in diabetes research. This pilot study has +prepared the ground for a four armed control study that +has been funded by dept. of AYUSH, ministry of health +and family welfare, Govt. of Karnataka, India. Statisti- +cally acceptable sample sizes, with a battery of assess- +ment of the cognitive functions (subjective and objective), +autonomic functions along with biochemical, molecular, +genetic, immunological variables has been included in +the proposed project. +9. Conclusion +This pilot study has shown the safety, feasibility and in- +dication of a potentially beneficial effect of an integrated +Yoga and Ayurveda module in achieving good glycemic +control and lipid profile with reduced requirement of +B. VAIBHAVI ET AL. +97 +Oral Hypoglycemic Agents in patients with T2DM. This +has prepared the ground for an efficacy trial. +10. Acknowledgements +We thank the faculty of Susruta Ayurveda College, Ban- +galore for their help in preparing the module of Ayurveda +protocol. We thank the therapists of S-VYASA for their +support in carrying out the study. We thank Dr. Pradhan +B. for his support with statistics and Dr. Haldavnekar R. +for her continuous support during the study. +REFERENCES +[1] +S. Wild, G. Roglic, A. Green, R. Sicree and H. King, +“Global Prevalence of Diabetes: Estimates for the Year +2000 and Projections for 2030,” Diabetes Care, Vol. 27, +No. 5, 2004, pp. 1047-1053. +doi:10.2337/diacare.27.5.1047 +[2] +V. P. Upadhyay and P. 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Lokeswarananda, “Taittireya Upanishad,” The Ramak- +rishna Mission Institute of Culture, Kolkatta, 1996. +[51] S. A. Dutta, “Sushruta Samhita,” In: Nidanasthana, Chau- +khamba Bharati Academy, Varanasi, 2007, pp. 251-252. +[52] K. N. Shastri and G. N. Chaturvedi, “Agnivesha’s Cha- +raka Samhita,” In: Chikitsasthana, Chaukhamba Bharati +Academy, Varanasi, 2004, pp. 228-229. +[53] K. N. Shastri and G. N. Chaturvedi, “Agnivesha’s +Charaka Samhita Vidyotini Commentary,” In: Chikitsas- +thana, Chaukhamba Bharati Academy, Varanasi, 2004, p. +243. +[54] K. N. Shastri and G. N. Chaturvedi, “Agnivesha’s Cha- +raka Samhita,” In: Chikitsasthana, Chaukhamba Bharati +Academy, Varanasi, 2004, pp. 234-235 +[55] R. Nagarathna and H. R. Nagendra, “Integrated Approach +of Yoga Therapy for Positive Health,” Swami Vivekan- +anda Yoga Prakashana, Bangalore, 2008. + diff --git a/subfolder_0/Effect of Mind Sound Resonance Technique.txt b/subfolder_0/Effect of Mind Sound Resonance Technique.txt new file mode 100644 index 0000000000000000000000000000000000000000..dfe256490b17d234f80a6befc0199341f78a11c4 --- /dev/null +++ b/subfolder_0/Effect of Mind Sound Resonance Technique.txt @@ -0,0 +1,602 @@ +Complementary Therapies in Medicine 56 (2021) 102606 +Available online 13 November 2020 +0965-2299/© +2020 +The +Author(s). +Published +by +Elsevier +Ltd. +This +is +an +open +access +article +under +the +CC +BY-NC-ND +license +(http://creativecommons.org/licenses/by-nc-nd/4.0/). +Effect of Mind Sound Resonance Technique (MSRT – A yoga-based +relaxation technique) on psychological variables and cognition in school +children: A randomized controlled trial +U.S. Anusuya a, Sriloy Mohanty b, Apar Avinash Saoji c,* +a Annai College of Naturopathy and Yoga Sciences, Anaikudi Road, Kovilachery, Kumbakonam, Tamil Nadu, India +b Center for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India +c Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India +A R T I C L E I N F O +Keywords: +MSRT +Yoga-based relaxation +Children +Cognition +Mind wandering +Mindfulness +A B S T R A C T +Objective: School children undergo stress, which could impact their psychological functions and cognitive abil­ +ities. Yoga practices have been found useful in enhancing psychological functions and performance. The current +study was planned to evaluate a yoga-based relaxation technique’s efficacy as an extracurricular activity on +psychological state and cognitive function. +Design and setting: This study was a parallel-group randomized controlled trial conducted at a government school +in south India. +Participants: Sixty students with age ranging between 14–16 years (mean age ± SD; 15.3 ± 0.71 years) satisfying +the inclusion and exclusion criteria were randomized to experimental and control groups with an allocation ratio +of 1:1. +Intervention: Experimental group received Mind Sound Resonance Technique (MSRT), whereas the control group +performed supine rest (SR) for two-weeks. +Outcome measures: Participants were assessed with State trait anxiety inventory - short form, Mind Wandering +Questionnaire, State Mindfulness Attention Awareness Scale, and Trail making task at baseline and post- +intervention. +Results: Experimental group showed a reduction in state anxiety and mind wandering with improvement in state +mindfulness and performance in the Trail-making task compared to the control group. +Conclusion: Results of the current trial indicate the beneficial role of MSRT in enhancing psychological and +cognitive functions in children. Further, large-scale trials are warranted to ascertain the usefulness of the +technique. +1. Introduction +School children face stress, both physical as well as psycho-social. +They are subjected to high levels of stress, anxiety and depression +arising from peer pressure.1 Studies demonstrate a high level of aca­ +demic stress in high-school students with depressive symptoms.2 Such +stress could lead to declined cognitive abilities, impaired verbal pro­ +cessing, and complex problem-solving abilities and could also lead to +physical health issues, resulting in decreased academic performance. +Studies demonstrate declined cognition and academic performance +associated with anxiety in school children.3,4 Also, physical conditions +such as tension-type headaches5 and chronic fatigue syndrome 6 were +prevalent among students. If not addressed in time, the stress and anx­ +iety among children could lead to a cascade of physical and +psycho-social issues, which may impact cognition among children. +In science, cognition is referred to all sets of mental abilities and +processes related to acquizition and utilization of knowledge. It includes +the processes such as attention, memory and working memory, judg­ +ment and evaluation, reasoning and computation, problem-solving and +decision making, comprehension and production of language, etc.7 +Human cognition is conscious and unconscious, concrete, or abstract, as +well as intuitive. Cognition helps to generate new knowledge through a +* Corresponding author at: Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, 19, Eknath Bhvan, Gavipuram Circle, KG Nagar, +Bengaluru, 560019, India. +E-mail address: aparsaoji@gmail.com (A.A. Saoji). +Contents lists available at ScienceDirect +Complementary Therapies in Medicine +journal homepage: www.elsevier.com/locate/ctim +https://doi.org/10.1016/j.ctim.2020.102606 +Received 14 January 2020; Received in revised form 24 October 2020; Accepted 26 October 2020 +Complementary Therapies in Medicine 56 (2021) 102606 +2 +mental process and helps to use the knowledge people have in daily life. +Several Mind-Body techniques have been used to combat stress and +enhance cognitive abilities. Relaxation techniques have a significant +impact on human physiology and psychology.8 Yoga has emerged as a +popular Mind-body therapy for managing stress and anxiety in the +recent past. A study performed in school children demonstrated a pos­ +itive impact of Yoga for anxiety.9 Several studies show the beneficial +effects of Yoga to reduce stress and enhance well-being among stu­ +dents.10 There is also a positive impact of specific yoga practices such as +yoga breathing on psychological functions in adults.11,31 Yogic practices +are also known to restore autonomic balance12 and help reduce the risk +of complications of long-standing stress. The practice of Yoga is also +found to enhance cognitive abilities in students.13 +Mind Sound Resonance Technique (MSRT) is one of the yoga-based +relaxation techniques that uses mantra to generate resonance, which is +used to induce deep relaxation for mind and body. MSRT can be prac­ +ticed for improving well-being, concentration, willpower, and relaxa­ +tion.14 The practice of MSRT has demonstrated to improve stress, +anxiety, depression, self-esteem, blood pressure, and heart rate in clin­ +ical and non-clinical populations.15,16 It is also found to decrease state +anxiety and improve psychomotor performance.17 A single-session of +MSRT positively impacted cognitive performance in University medical +students.18 Another study demonstrated that a month-long intervention +of MSRT facilitates a reduction in stress, anxiety, fatigue, and psycho­ +logical distress. The relaxation technique also enhanced self-esteem and +quality of sleep among female teachers working in primary schools.16 +Though these studies indicate a positive impact of MSRT, there are no +studies to understand the effect of MSRT on psychological functions and +cognitive abilities in school children. Hence, the present study was +planned to evaluate the impact of a two-week practice of MSRT on +psychological factors and cognition of school students. +2. Materials and methods +2.1. Design and setting +The current trial was a single-center randomized controlled trial with +two assessment points, i.e., baseline and two-weeks. The study consisted +of two groups, i.e., experimental and control, in which the allocation of +subjects was done with a 1:1 ratio. Experimental group received guided +relaxation sessions of MSRT for 30 min/day, six days/week for two +weeks. Beyond the guided sessions at school, subjects were asked not to +perform the practice at home to maintain practice uniformity. The +Control group continued their routine activities, along with supine rest +(SR), for a similar duration of MSRT. The study was executed at a gov­ +ernment school in Tamilnadu, India. The trial was not registered in the +clinical trial registry. +2.2. Participants +The subjects were recruited from a pool of eighth and ninth-grade +students of a government school in Tamilnadu, India, based on the in­ +clusion and exclusion criteria. Sixty healthy school going children with +equal gender distribution were allocated to either of the groups with an +allocation ratio of 1:1. The inclusion criteria were; healthy children +regardless of their gender, aged between 14–16 years with no history of +any illness for at least six months before the study. Unwilling subjects +and the ones could not comprehend and follow the instructions given by +the instructor were excluded. Written informed consent was obtained +from the participant and their guardians after explaining the steps of the +study. They also underwent systemic health checkup by a trained +physician, who otherwise had no role in the study. The sample size was +not calculated a priori. All eligible 60 students satisfying inclusion and +exclusion criteria from grade eighth and ninth were recruited for the +study. +2.3. Randomization +Eligible subjects were identified and were stratified based on their +gender. Then subjects from each stratum were randomly divided into +two groups, i.e., experimental and control groups. A computer-based +program generated the random numbers with an allocation ratio of +1:1 by a statistician who had no role in the study. Further, to maintain +concealment, serial number specific opaque sealed envelopes were made +by the same statistician. Authors enrolled the patients and allotted in +groups to them. The current study was a non-blinded trial. However, the +outcome assessors were blinded to group allocation. +2.4. Ethical considerations +The study’s protocol was reviewed and approved by the Institutional +Ethics Committee of the Swami Vivekananda Yoga Anusandhana +Samsthana, Bengaluru. Written Informed consent was obtained from the +participants and their legal guardians after a briefing about the protocol. +It was ensured that the participants and the guardians understood the +implications of signing the consent form; all the details were explained +to them in their vernacular language. A participant information sheet +(PIS) in the colloquial language was also provided to all the eligible +participants before randomization. PIS document provides detail on the +purpose of this study, assessments and procedures involved, risks, and +benefits of participation in the trial. +2.5. Intervention +2.5.1. Experimental group +The study group received the advanced yogic technique called MSRT +done in a supine position, with closed eyes. MSRT involves experiencing +with closed eyes the internal vibrations and resonance developed while +chanting the syllables A, U, M, Om, and Maha-Mrityunjaya Mantra.14,17 +The intervention was given by an institutionally trained yoga therapist +for 30 min every day for two weeks at school. The participants were +asked to appreciate the resonance all over the body during loud (Ahata: +heard) and mental chanting (Anahata: unheard). This is done alter­ +nately, starting from Ahata (loud) ’A’ followed by Anahata(mental) ’A’ +repeated three times. Similar repetitions of all other chants follow this. +2.5.2. Control group +Participants in the control group practiced SR for the same duration, +i.e., 30 min in Shavasana, as described in the Hatha Yoga Pradipika with +closed eyes and palms facing roof.19 A teacher supervised the sessions. +All subjects, irrespective of their group allocation, were advised to +follow their routine day to day schedule and not practice at home to +maintain homogeneity of intervention. +2.5.3. Environment of the therapy room +A suitable environment for the practice of MSRT was created to avoid +disturbance due to external sound or light. The MSRT sessions were +conducted in a dimly lit yoga hall, which had sufficient space to +accommodate all the participants, and it was made sure that the in­ +structor’s voice was audible to everyone. +2.5.4. Outcome measures +The outcome measures were planned to assess the psychological +function and cognition in children. Since the study was an exploratory +one, no primary endpoint was decided. The four instruments used were +State anxiety inventory-short form (STAI-SF), State mindfulness atten­ +tion awareness scale (SMAAS), Mind wandering questionnaire (MWQ), +and Trail making test (TMT). Data were obtained at baseline and at the +end of two-weeks. The instruments were administered in their original +English versions since all the study participants were comfortable with +English. +STAI-SF is a six-item short version for assessing state anxiety from the +U.S. Anusuya et al. +Complementary Therapies in Medicine 56 (2021) 102606 +3 +original Spielberg’s State-Trait Anxiety inventory. The participants were +asked to respond to each question on a Likert scale ranging from 1 to 4.20 +SMAAS is a reliable and valid tool to assess state mindfulness. The +questionnaire contains five questions to be answered on a scale of 1 (not +at all) to 6 (very much). MWQ is a reliable and validated five-item +self-rated questionnaire, in which subjects filled responses on a scale +of 1 (almost never) to 6 (almost always).21 TMT was used to evaluate +changes in attention and working memory.22 The tool consists of two +parts: TMT "A" involved subjects drawing lines connecting 25 consecu­ +tive circled numbers in a numerical sequence (i.e., 1–2–3, etc.) as rapidly +as possible. In TMT "B," the subjects were directed to draw lines to +connect 12 consecutive circled numbers and 12 following letters in an +alternate numeric and alphabetic sequence (i.e., 1-A-2-B, etc.) as rapidly +as possible. Time (in seconds) taken for completing the tasks was noted +using a stopwatch. The score on each part represents the amount of time +required to complete the task.23 The errors committed during task +completion were scored accurately. +Cronbach’s alphas for the scales were as follows: STAI-SF = 0.82; +SMAAS = 0.92; MWQ = 0.85; and TMT = 0.89. +2.5.5. Data analysis +The data were extracted using the questionnaires/tools’ manuals and +arranged in JASP statistical package version 0.11.1 (JASP Team, 2019). +We performed an analysis of covariance (ANCOVA) using the baseline +values as covariates. +3. Results +A schematic representation of the trial profile is depicted in Fig. 1. +Sixty participants from grades 8 and 9 with a mean age (±SD) of 15.03 ± +0.71 years completed the study with an allocation ratio of 1:1. There +were no dropouts in the current trial. The participants’ socioeconomic +status was assessed using the Kuppuswamy and Udai Pareekh’s scale +adapted by the Govt. of India.24 The demographic data from the whole +study population are presented in Table 1. +A one-way analysis of covariates (ANCOVA) was performed to +determine the significant differences between groups in the post values, +controlling for the baseline values, age, and gender as covariates. Sta­ +tistically significant changes were observed in STAI-SF scores (p = +0.0308) SMAAS scores (p = 0.0017); MWQ scores (p < 0.001) and each +component of TMT scores (p < 0.001). The details of the same are +depicted in Table 2. +We performed within-group analyses using paired samples t-test. +Significant reductions were observed in the STAI-SF and MWQ scores, +with improvements in SMAAS scores and performance in the TMT in the +experimental group. In the control group, however, only two variables +changed significantly. MWQ scores increased significantly (p = 0.049), +indicating increased mind wandering, which increased the time taken in +TMT task B significantly (p = 0.01). Thus, there was deterioration in +performance in the control group. The within-group changes in experi­ +mental and control groups are indicated in Table 3, respectively. +4. Discussion +This study was conducted to assess the effect of a two-week session of +Fig. 1. Trial profile. +Table 1 +Demographic Characteristics of the participants at baseline. +Experimental +Group +Control +Group +Total +Age (years) +15.13 ± 0.63 +14.93 ± 0.78 +15.03 ± 0.71 +Gender +Male: 15 +Male: 15 +Male: 30 +Female: 15 +Female: 15 +Female: 30 +Socioeconomic status +High: 01 +High: 03 +High: 04 +Middle: 19 +Middle: 17 +Middle: 36 +Lower: 09 +Lower: 11 +Lower: 20 +Educational Status +Grade 8th :15 +Grade 8th : 15 +Grade 8th: 30 +Grade 9th:15 +Grade 9th : 15 +Grade 9th: 30 +State of anxiety at +baseline +Normal: 15 +Normal: 12 +Normal: 27 +Anxious: 15 +Anxious: 18 +Anxious: 33 +U.S. Anusuya et al. +Complementary Therapies in Medicine 56 (2021) 102606 +4 +MSRT on psychological functions and cognition in school children. The +study results revealed a reduction in anxiety and mind wandering with +increased state mindfulness, awareness, attention, and working memory +in school children. This is the first study assessing the effect of MSRT in +school children to the best of our knowledge. Our findings indicate +enhanced psychological functions and cognition among children +following a two-week intervention period compared to the control +group, which continued to perform their routine activities and SR for 30 +min. +Our findings concur with previous studies conducted with the MSRT +and other yogic relaxation/meditation techniques. In an earlier study +conducted on effects of MSRT, a single session of MSRT was found to be +beneficial in enhancing the performance in cognitive tasks that demand +sustained attention, concentration, visual scanning, and activation and +inhibition of rapid responses, psychomotor speed, mental flexibility, and +speed of information processing, when compared to SR for the same +duration .18 Ten days of MSRT was applied to patients with generalized +anxiety, in which Bhargav et al. could demonstrate reduced anxiety and +enhanced cognitive abilities.17 An earlier randomized controlled trial +showed a reduction in anxiety in patients with chronic neck pain by the +practice of MSRT for ten days compared to SR.25 The possible mecha­ +nism involved in reducing stress, anxiety and the improvement in the +psychological variables assessed could be attributed to parasympathetic +dominance resulting from om chanting and mantra chanting. An fMRI +study performed on chanting of OM was found to have a similar effect to +that of vagal stimulation,26 which could have led to a state of para­ +sympathetic dominance. Reduction of anxiety through the practice of +MSRT, as seen in an earlier study,17 could also be attributed to enhanced +performance in the TMT, as anxiety can impact cognition negatively.3,4 +A systematic review mentioned that yoga and meditation interven­ +tion nurture mindfulness and may be a feasible and effective building +resilience method in childhood and adolescence.27 +Enhanced +mindfulness was associated with reduced anxiety and mind-wandering +in an earlier study with Yoga breathing.11 Mind-wandering is related +to low mood and depression,28 a reduction of the same may have +contributed to enhanced cognitive abilities. Earlier studies on medita­ +tion practices are shown to have increased mindfulness and reduced +mind-wandering.29,30 In all the trials mentioned above, the common +limitation was the short duration of the intervention (ranging from a +single session to a maximum of one week). In the current experiment, +the length of the intervention was comparatively extended than the +other trials (for two-weeks). +Clinically, the data we gathered in the current study indicate a trend +towards reduced anxiety and mind-wandering and improved mindful­ +ness and performance in the cognitive tasks. Both the trends are sig­ +nificant in the learning abilities, especially in school-children. The +results warrant further inquiry into the impact of MSRT in school- +children. +Since the study was conducted at the school, there were no dropouts +throughout the study. Though we used the robust design of RCT, a +relatively small sample size and lack of objective measures to determine +the possible mechanism of action of MSRT are amongst the limitation of +the study. There was also no follow-up, and so, it is not known whether +improvements in task performance and self-efficacy sustained. Studies +with an extended follow-up period and robust objective assessment tools +to assess the effects of MSRT may be planned to ascertain the impact and +the underlying mechanisms of action. +5. Conclusion +The current study suggests that training in MSRT may enhance +psychological functions and cognitive abilities in school children. +Incorporating MSRT as a regular practice in schools may help enhance +the psychological well-being and cognitive functions of school children. +Research involving human participants +The study was approved by the institutional ethics committee and +have therefore been performed in accordance with the ethical standards +laid down in the 1964 Declaration of Helsinki and its later amendments. +Informed consent +All the participants who participated and their legal guardians pro­ +vided a written informed consent. +CRediT authorship contribution statement +U.S. Anusuya: Data curation, Investigation, Project administration, +Writing - original draft, Writing - review & editing. Sriloy Mohanty: +Conceptualization, Data curation, Formal analysis, Methodology, Vali­ +dation, Writing - original draft, Writing - review & editing. Apar +Table 2 +Changes between the experimental and control groups following two-week +assessment duration. +Outcome +Adj. R2 +F +p +Cohen’s d +MWQ +0.50 +15.93 +< 0.0001 +−1.936 +SMAAS +0.21 +4.99 +0.0017 +0.998 +STAI +0.11 +2.88 +0.0308 +−0.573 +TMT- A +0.80 +61.86 +< 0.0001 +−0.702 +TMT-B +0.87 +105.75 +<0.0001 +−0.801 +TMT- Total Time +0.69 +34.94 +<0.0001 +−1.302 +TMT Executive function +0.72 +38.92 +<0.0001 +−0.571 +MWQ: Mind Wandering Questionnaire, SMAAS: State Mindfulness Attention +Awareness Scale, STAI-SF: State trait anxiety inventory - short form; TMT: Trail +making task. +The results are obtained from fitting ANCOVA model in which post test result +taken as dependent variable & pre-test result, group(experimental and control), +age and gender(male and female) taken as independent variables. +Table 3 +Changes within the experimental and control groups before and following the two-week assessment duration. +Variable +Experimental Group +(n = 30; df = 29) +Control Group +(n = 30; df = 29) +Pre +Post +t +Pre +Post +T +MWQ Score +3.65 ± 9.86 +2.51 ± 0.96*** +5.500 +3.76 ± 0.66 +4.10 ± 0.58* +−2.053 +SMAAS Scores +4.04 ± 1.45 +5.00 ± 0.92** +−2.995 +4.11 ± 0.90 +3.87 ± 1.27 +0.954 +STAI- SF Scores +39.56 ± 9.74 +33.22 ± 7.14*** +3.658 +42.55 ± 10.46 +38.89 ± 10.52 +1.427 +TMT A (Sec) +30.40 ± 4.03 +28.20 ± 3.85*** +4.826 +34.07 ± 5.84 +34.70 ± 5.79 +−1.208 +TMT B (Sec) +65.50 ± 9.77 +61.30 ± 9.11*** +7.290 +73.73 ± 9.70 +76.57 ± 10.50** +−2.746 +TMT Total time +95.90 ± 12.21 +89.50 ± 11.91*** +8.222 +105.43 ± 19.42 +111.27 ± 13.50 +−1.970 +TMT Executive Function +35.10 ± 8.63 +33.10 ± 7.35** +2.906 +39.67 ± 9.24 +41.87 ± 10.27 +−1.677 +Paired samples t-test. * = p < 0.05, **= p < 0.01, *** = p < 0.001. +MWQ: Mind Wandering Questionnaire, SMAAS: State Mindfulness Attention Awareness Scale, STAI-SF: State trait anxiety inventory - short form; TMT: Trail making +task. +U.S. Anusuya et al. +Complementary Therapies in Medicine 56 (2021) 102606 +5 +Avinash Saoji: Conceptualization, Data curation, Formal analysis, +Investigation, Methodology, Project administration, Supervision, Vali­ +dation, Visualization, Writing - original draft, Writing - review & +editing. +Declaration of Competing Interest +The authors report no declarations of interest. +References +1 Oppenheimer CW, Hankin BL, Young J. 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Med. 2019;10 +(1):50–58. https://doi.org/10.1016/j.jaim.2017.07.008. +U.S. Anusuya et al. diff --git a/subfolder_0/Effect of Needling at CV-12 (Zhongwan) on Blood Glucose Levels in Healthy Volunteers_.txt b/subfolder_0/Effect of Needling at CV-12 (Zhongwan) on Blood Glucose Levels in Healthy Volunteers_.txt new file mode 100644 index 0000000000000000000000000000000000000000..900f31cfa9c3d0cb8d7a86ccd34db2a8a9512798 --- /dev/null +++ b/subfolder_0/Effect of Needling at CV-12 (Zhongwan) on Blood Glucose Levels in Healthy Volunteers_.txt @@ -0,0 +1,353 @@ +RESEARCH ARTICLE +Effect of Needling at CV-12 (Zhongwan) on +Blood Glucose Levels in Healthy Volunteers: +A Pilot Randomized Placebo Controlled Trial +Sriloy Mohanty 1, A. Mooventhan 2,*, Nandi Krishnamurthy Manjunath 2 +1 Department of Naturopathy, S-VYASA University, Bangalore, Karnataka, India +2 Department of Research and Development, S-VYASA University, Bangalore, +Karnataka, India +Available online 20 September 2016 +Received: May 30, 2016 +Revised: Aug 20, 2016 +Accepted: Aug 24, 2016 +KEYWORDS +acupuncture; +blood glucose; +Zhongwan +Abstract +Introduction: Acupuncture, a key part of traditional Chinese medicine, is used to relieve symp- +toms of diabetes mellitus. The aim of this study was to evaluate the effect of needling CV-12 +(Zhongwan) on blood glucose levels in healthy volunteers. +Materials and methods: Thirty-six individuals were recruited and randomized into either the +acupuncture group or the placebo control group. The participants in the acupuncture +group were needled at CV-12 (4 cun above the center of the umbilicus), and those in the pla- +cebo control group were needled at a nonexisting “sham” point on the right side of the +abdomen (1 cun beside the CV-12)da nonacupuncture point. For both groups, the needle +was retained for 20 minutes without stimulation. Assessments were performed prior to and af- +ter the intervention. Statistical analysis was performed using the Statistical Package for the +Social Sciences, version 16. +Results: The result of this study showed a mild reduction in random blood glucose (RBG) levels +in the acupuncture group and a mild increase in RBG levels in the placebo control group. +However, these changes were not statistically significant both within and between groups. +This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// +creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any me- +dium, provided the original work is properly cited. +* Corresponding author. Department of Research and Development, S-VYASA University, #19, Eknath Bhavan, Kavipuram Circle, +Kempegowda Nagar, Bengaluru 560019, Karnataka, India. +E-mail: dr.mooventhan@gmail.com (A. Mooventhan). +pISSN 2005-2901 +eISSN 2093-8152 +http://dx.doi.org/10.1016/j.jams.2016.08.002 +Copyright ª 2016, Medical Association of Pharmacopuncture Institute. +Available online at www.sciencedirect.com +Journal of Acupuncture and Meridian Studies +journal homepage: www.jams-kpi.com +J Acupunct Meridian Stud 2016;9(6):307e310 +Conclusion: The result of this study suggests that although 20 minutes of needling at CV-12 +without stimulation produced a mild reduction in RBG levels in healthy volunteers, it did +not produce a statistically significant result. +1. Introduction +Diabetes +is +a +major +public +health +problem +that +is +approaching epidemic proportions globally. The number of +people with diabetes is likely to increase up to 380 million +by 2025. Almost 80% of total adults with diabetes are from +developing countries. India leads the global top 10 coun- +tries in terms of the highest number of people with dia- +betes, and there is a growing incidence of diabetes at a +younger age [1]. +Acupuncture at CV-12 (Zhongwan) has been widely used +in traditional Chinese medicine to relieve symptoms of +diabetes. Previous studies using electroacupuncture on only +CV-12 [2] and combining this with CV-4 (Guanyuan) [3,4], +SP-6 (Sanyinjiao), and ST-36 (Housanli) have produced a +hypoglycemic effect [2e4] with normalized insulin sensi- +tivity, ameliorating both insulin resistance and hyper- +insulinemia [3] in diabetic rats. +In +a +human +study, +CV-12din +combination +with +acupuncture points such as CV-4, CV-6 (Qihai), CV-10 (Xia- +wan), ST-24 (Huaroumen), ST-25 (Tianshu), TE-5 (Wailing), +SP-15 (Daheng), and KI-13 (Qixue)dwas shown to decrease +blood glucose levels and improve insulin resistance with no +adverse effects in obese Type 2 diabetic volunteers [5]. +Other studies have focused on single needling at CV-12 +[2], ST-36 [6], BL20 (Pishu) [7], and GB 26 (Daimai) [8] in a +rat model; however, there is lack of studies on human +volunteers. Hence, the aim of this study aims was to eval- +uate the effect of single point acupuncture at CV-12 on +blood glucose levels in healthy human volunteers. +2. Materials and methods +2.1. Participants +A total of 36 healthy volunteers whose ages ranged from 18 +years to 24 years were recruited from a residential college +based on the following inclusion and exclusion criteria. The +inclusion criteria called for male and female volunteers +who were 18 years and above, and were willing to partici- +pate in the study. The exclusion criteria were as follows: +individuals with a history of any systemic and mental +illness, regular use of medication for any diseases, needle +phobia, chronic smoking, and alcoholism. The study pro- +tocol was approved by the institutional ethics committee, +and a written informed consent was obtained from each +participant. +2.2. Study design +This is a pilot randomized placebo-controlled trial, in which +all participants were randomly assigned into either the +acupuncture group or the placebo control group. The +acupuncture group received needling at CV-12 and the +placebo +control +group +received +needling +at +a +non- +acupuncture point for 20 minutes. Data assessment was +performed prior to and after the intervention. +2.3. Randomization +All participants were allotted with random numbers. The +first volunteer was allocated to a group on the basis of a flip +of a coin, then the next volunteer was assigned to the +opposite group, in a randomization ratio of 1:1. Thus, all +members of the group had an equal chance to be in either +group. This randomization was performed by one of the +authors, who was involved in intervention but was not +involved in any part of the investigation. +2.4. Blinding/masking +All participants were blind to the acupuncture (CV-12) and +the placebo control points. The investigator who assessed +the blood glucose was blind to the acupuncture and placebo +control groups. +2.5. Assessments +2.5.1. Random blood glucose +The random blood glucose (RBG) level was assessed be- +tween 10:30 and 11:30 A.M. using a portable ACCU-CHEK, +Performa Nano machine (Roche Diagnostics India Pvt. Ltd, +Mumbai, India). Assessments were performed prior to and +after the intervention for both groups. +2.6. Intervention +2.6.1. Acupuncture group +The participants received traditional Chinese medicine- +style of acupuncture. Needling was performed at CV-12 (4 +cun above the center of the umbilicus) [9] at a depth of 0.5 +cun. The participants were informed about the procedure, +sensations of needle insertion, and response sought. The +needle was left out without any stimulation. We used 0.5- +cun filiform locally manufactured cupper needle with +0.38 mm diameter and 13 mm length. The participants +received only one session of acupuncture for a duration of +20 minutes. The participants did not receive any treat- +ments other than acupuncture. Needling was administered +by one of the authors who is institutionally qualified with 2 +years’ experience in clinical acupuncture. +2.6.2. Placebo control group +The participants in this group received needling in the right +side of the abdomen 1 cun lateral to CV-12 where there is +no known acupuncture point. +308 +S. Mohanty et al. +2.7. Data analysis +All data were checked for normality using Kolmogor- +oveSmirnov and ShapiroeWilk tests. Statistical analysis was +performed using Student paired t test (within groups) and +analysis of variance (between groups) was carried out using +Statistical Package for the Social Sciences (SPSS) for Win- +dows, Version 16.0, Chicago, SPSS Inc. +3. Results +Of 41 volunteers, five did not meet the inclusion criteria +and were subsequently excluded from the study. All +recruited participants (n Z 36) were randomly divided into +either the acupuncture (n Z 18) or the placebo control +group (n Z 18). Needling was performed at CV-12 and at +the right side of the abdomen 1 cun lateral to CV-12 in the +acupuncture and placebo control groups, respectively. +Baseline and posttest assessments were done prior to and +after the intervention. Demographic (Table 1) and the +baseline blood glucose levels (Fig. 1) were comparable, and +there were no significant changes between the groups. +Even though the result of this present study showed mild +reduction in RBG levels in the acupuncture group and mild +increase in the placebo control group, these changes were +not statistically significant both within and between groups +(Fig. 1). +4. Discussion +CV-12 is known as the stomach control point in Korean +medicine and is located on the abdominal wall associated +with the pancreas. Although it is located on the Conception +Vessel Meridian, it is considered a therapeutic point for +diseases of the digestive organs such as the stomach, +pancreas, and spleen [10]. For example, electric stimula- +tion at the CV-12 was used for treatment of diabetic rats +[2,10]. +The results of this present study showed that a 20- +minute single session needling at CV-12 acupuncture point +without any stimulation (manual or electrical) produced a +mild reduction in RBG levels in healthy volunteers. At the +same time a 20-minutes single session of needling at the +placebo control point produced a mild increase in RBG +levels in healthy individuals. However, these changes were +not statistically significant. +Only one session was administered on CV-12 to check for +the immediate effect on RBG. This may not be sufficient to +produce +significant +changes. +Needling +was +performed +without stimulation, however, including either manual, +electrical, laser, or catgut embedding stimulation, which +might have produced a more significant effect in reducing +RBG. It should be noted that in previous studies on elec- +troacupuncture at CV-12 alone in diabetic rats [2] and in +combination with other acupuncture points in diabetic rats +[3,4] and human studies [5], laser irradiation on CV-12 along +with other points in metabolic syndrome [9], and catgut +embedding in CV-12 along with other acupuncture points in +diabetic rats [11] have been shown to reduce blood glucose +[2e5,11] and fasting insulin [9,11]. +001As healthy individuals have normal physiological +functions and do not have abnormally elevated blood +glucose/reduced insulin levels, CV-12 might have not +influenced the blood glucose levels. In previous studies, the +hypoglycemic effect of CV-12 alone [2] and in combination +with other acupuncture points were reported mainly in +diabetic rats [3,4,11], and in diabetic patients but not in +healthy individuals [5]. Hence, we expect needling at CV-12 +to be effective in participants with high blood glucose +levels; however, this needs to be confirmed in further +studies. +4.1. Strength of the study +This is the first randomized placebo controlled study to +evaluate the effect of CV-12 on RBG levels in healthy vol- +unteers. Both the participants and the investigator were +blind to the acupuncture and placebo control groups. +4.2. Limitations of this study +Sample size was not calculated based on the previous study. +The present study evaluated only the immediate effect +without stimulation and did not evaluate its short-term or +long-term effect with or without stimulation. Assessment of +variables such as fasting blood glucose, postprandial blood +Table 1 +Demographic variables of acupuncture (n Z 18) +and placebo control groups (n Z 18). +Variables +Acupuncture +group +Placebo control +group +Age (y) +19.61  1.975 +19.22  1.517 +Sex +9 males/9 females 9 males/9 females +Height (cm) +161.78  11.855 +164.00  9.628 +Weight (kg) +54.94  8.003 +56.28  8.372 +Body mass index +(kg/m2) +21.40  3.520 +20.90  2.288 +All values are expressed as mean  standard deviation, except +for values of sex. +Figure 1 +Baseline and post-test random blood glucose levels +of acupuncture (n Z 18) and placebo groups (nZ18). +Effect of Needling at CV-12 in RBG Levels +309 +glucose, glycosylated hemoglobin, and insulin levels was +not performed. Hence, long-term studies with either +manual or electric stimulation are required in a larger +sample size, and more variables such as fasting blood +glucose, postprandial blood glucose, HbA1C, and insulin +levels should be measured in order to better understand +the effect of CV-12 on blood glucose levels. +5. Conclusion +The result of this present study suggests that 20 minutes of +needling at CV-12 without stimulation produces a mild +reduction in RBG levels in healthy volunteers; however, it +did not produce a statistically significant result. +Disclosure statement +The authors declare that they have no conflicts of interest +and no financial interests related to the material of this +manuscript. +Acknowledgments +The authors thank Robert Mazure, Integrated Holistic Ther- +apies, London, UK, for his help in editing the manuscript. +References +[1] Tabish SA. Is diabetes becoming the biggest epidemic of the +twenty-first century? Int J Health Sci (Qassim). 2007;1:5e8. +[2] Chang SL, Lin JG, Chi TC, Liu IM, Cheng JT. An insulin- +dependent hypoglycaemia induced by electroacupuncture at +the Zhongwan (CV12) acupoint in diabetic rats. Diabetologia. +1999;42:250e255. +[3] Zheng YH, Ding T, Ye DF, Liu H, Lai MH, Ma HX. Effect of low- +frequency +electroacupuncture +intervention +on +oxidative +stress and glucose metabolism in rats with polycystic ovary +syndrome. Zhen Ci Yan Jiu. 2015;40:125e130. +[4] Peplow PV, McLean GT. Repeated electroacupuncture: an +effective treatment for hyperglycemia in a rat model. J Acu- +punct Meridian Stud. 2015;8:71e76. +[5] Yang Y, Liu Y. BO’s abdominal acupuncture for obese type-2 +diabetes mellitus. Zhongguo Zhen Jiu. 2015;35:330e334. +[6] Lee YC, Li TM, Tzeng CY, Chen YI, Ho WJ, Lin JG, et al. +Electroacupuncture at the zusanli (ST-36) acupoint induces a +hypoglycemic effect by stimulating the cholinergic nerve in a +rat model of streptozotocine-induced insulin-dependent dia- +betes mellitus. Evid Based Complement Alternat Med. 2011. +http://dx.doi.org/10.1093/ecam/neq068. +[7] Cornejo-Garrido J, Becerril-Cha +´vez F, Carlı +´n-Vargas G, Ordo- +n +˜ez-Rodrı +´guez JM, Abrajan-Gonza +´lez Mdel C, de la Cruz- +Ramı +´rez +R, +et +al. +Antihyperglycaemic +effect +of +laser +acupuncture treatment at BL20 in diabetic rats. Acupunct +Med. 2014;32:486e494. +[8] Li YY, Hu H, Liang CM, Wang H. Effects of electroacupuncture +stimulation of “Daimai” (GB 26) on body weight, blood glucose +and blood lipid levels in rats with metabolism syndrome. Zhen +Ci Yan Jiu. 2014;39:202e206. +[9] El-Mekawy HS, ElDeeb AM, Ghareib HO. Effect of laser +acupuncture combined with a dieteexercise intervention on +metabolic syndrome in post-menopausal women. J Adv Res. +2015;6:757e763. +[10] Kim MS, Sung B, Ogay V, Choi CJ, Kim MS, Kang DI, et al. Novel +circulatory connection from the acupoint Zhong Wan (CV12) to +pancreas. J Korean Pharmacopunct Inst. 2008;11:13e19. +[11] Zhang H, Guo H, Zhang YC, Liu M, Ai K, Su YM, et al. Effect of +acupointecatgut-embedding intervention on type II diabetic +rats. Zhen Ci Yan Jiu. 2014;39:358e361, 381. +310 +S. Mohanty et al. diff --git a/subfolder_0/Effect of Trataka on cognitive functions in the elderly.txt b/subfolder_0/Effect of Trataka on cognitive functions in the elderly.txt new file mode 100644 index 0000000000000000000000000000000000000000..5d0f38cd7cdfc3bb99ddc1dd29a64fbde7833215 --- /dev/null +++ b/subfolder_0/Effect of Trataka on cognitive functions in the elderly.txt @@ -0,0 +1,779 @@ +Volume 7 | Issue 2 | July-December | 2014 +Official +Publication +of +Swami +Vivekananda +Yoga +Anusandhana +Samsthana +University +Online full text at +http://www.ijoy.org.in +IJ Y +O +International Journal of Yoga +Guest Editorial +Original Articles +Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers +Effect of trataka on cognitive functions in the elderly +Effect of Bhramari pranayama and OM chanting on pulmonary function inhealthy individuals: A prospective randomized control trial +Effect of yogic colon cleansing (Laghu Sankhaprakshalana Kriya) on pain, spinal flexibility, disability and state anxiety in chronic low back pain +Toward building evidence for yoga +Contents +ISSN +0973-6131 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +96 +Effect of trataka on cognitive functions in the elderly +Shubhada Talwadkar, Aarti Jagannathan, Nagarathna Raghuram +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India +Address for correspondence: Dr. Aarti Jagannathan, +Swami Vivekananda Yoga Anusandhana Samasthana 19, Gavipuuram, + +Kempegowda Nagar ‑ 560 019, Bengaluru, Karnataka, India. + +E‑mail: jaganaarti@gmail.com +Original Article +functions, as well as various other complex cognitive +functions.[5‑7] Varied treatment options have been +propagated for cognitive impairment in the elderly +such as oral medications,[8] cognitive interventions,[9] +diet,[10] etc., Many experts have suggested that mentally +challenging activities (e.g. crossword puzzles and brain +teasers) may be helpful for patients with mild cognitive +impairment.[11] Physical activity (PA), aimed at improving +cardiorespiratory health, has been proposed to be a +good, practical, and powerful candidate to overcome +cerebral and behavioral declines.[12] Yoga practices also +have shown various health benefits including the ability +to improve cognition and thereby preventing cognitive +impairments and dementia.[13] +Many scientific studies have proven that yoga is effective +to improve various cognitive functions such as remote +memory, mental balance, attention and concentration, +attention span, processing speed, attention alternation +ability, delayed and immediate recall, executive functions, +verbal retention, and recognition tests in the healthy young +subjects.[14,15] Very few studies have looked at the effect of +yoga in the elderly population. For example, relaxation +INTRODUCTION +In normal aging, decreased ability to retrieve information +can cause memory lapses that sometimes impair the ability +to perform activities of daily living.[1] These changes are +largely the result of decline in frontal lobe function, +which is measured as executive functions (the ability +to organize, plan, and focus on a topic).[2] Age‑related +decline in cognitive abilities varies considerably +across individuals and across cognitive domains. +Various cognitive domains show different degrees of +susceptibilities to aging.[3] Changes in the brain due to +aging occur earliest in the prefrontal cortex (PFC).[4] The +PFC is associated with memory, attention, executive +Background: Trataka, a type of yoga practice is considered to improve cognitive functions. The aim of this study was to test +the effect of trataka on cognitive functions of the elderly. +Materials and Methods: Elderly subjects were recruited based on inclusion and exclusion criteria (n = 60) and randomly divided +using randomized block design into two groups: Trataka and wait list control group. Trataka (a visual cleansing technique) +was given for a period of 1 month (26 days). The subjects in both groups were assessed on day 1 (pre‑ and postintervention +in trataka group and after quiet sitting in control group) and on day 30 on Digit Span Test, Six Letter Cancellation Test (SLCT), +and Trail Making Test‑B (TMT‑B). +Results: Friedman’s test and Wilcoxon signed‑rank test showed that at the 2nd follow‑up there was significant improvement +in digit span scores (z = −3.35, P < 0.01) in the trataka group. SLCT scores (t = 5.08, P < 0.01) and TMT‑B scores (t = −4.26, +P < 0.01) improved immediately after the practice of trataka (when baseline compared to first follow‑up). At 1 month follow‑up, +trataka group showed significantly better performance in the SLCT test compared to baseline (t = −3.93, P < 0.01) and TMT‑B +scores (t = 7.09, P < 0.01). Repeated measure analysis of variance (RM ANOVA) results also reiterated that there was significant +interaction effect at the end of 1 month of trataka intervention as compared to control group on TMT‑B and SLCT scores. +Conclusions: The results of this study establish that Trataka can be used as a technique to enhance cognition in the elderly. +Key words: Cognitive functions; elderly; trataka. +ABSTRACT +Access this article online +Website: +www.ijoy.org.in +Quick Response Code +DOI: +10.4103/0973-6131.133872 +Talwadkar, et al.: Trataka for cognitive functions +97 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +response training is seen to improve reaction time on +simple attention/psychomotor tasks in older adults.[16] +Another cross‑sectional study comparing the cognitive +performance of 20 meditators (long‑term practitioners of +Vihangam yoga meditation) and 20 non‑meditators in the +geriatric age group showed that Vihangam yogis performed +better on all the tests of attention except for the digit +backward test.[17] +The above review depicts that the number of published +literature in the last decade on effectiveness of yoga on +cognitive functions of the elderly is limited. Although +there are no published scientific studies, authentic +traditional texts of yoga describe the benefits of trataka +on a whole range of physiological and cognitive +functions.[18,19] It is observed to be most effective on the +ajna chakra[20] (the vortice of vital energy in the forehead) +and the brain.[21] Ajna chakra is described as the “eye +of knowledge”, and it is said that with the activation of +this chakra, the intelligence, concentration, and memory +improve and the mind becomes strong and steady.[22] It +is proposed that the practice of Trataka may activate +this chakra,[23] and thus may improve attention, memory, +and concentration.[24,25] In the above context, the aim of +this study was to test the effect of trataka on cognitive +functions of the elderly. Effect of trataka was studied +as against wait list control group; in improving short +term memory, attention, concentration, and executive +functions. +MATERIALS AND METHODS +Participants were recruited from old age homes in Goa and +from individuals staying in and around Ponda and Margao +areas in Goa. The approval from Institutional Ethics +Committee of Swami Vivekananda Yoga Anusandhana +Samasthana (SVYASA) was obtained. +A total of 136 subjects were screened usinginclusion and +exclusion criteria. Those who were 60-80 years of age +and had minimum of fifth grade education were included +in the study. Further those subjects who had  (a) Any +neurological disorder,  (b) any psychiatric disorder, +and (c) had received yoga training in last 3 months were +excluded from the study. The above exclusion criteria +and abnormality in hearing and vision were examined +by a trained and qualified clinician. Based on this +screening procedure, 75 subjects were found suitable +for the study. As 15 of them declined to give consent to +participate, the remaining 60 subjects were considered +for the study and written informed consent was taken +from them. +The sample size calculation estimated that 27 participants +in each group was required to detect a clinically significant +difference equivalent to an effect size of 0.75 (Cohen’s d) +in total memory score between the groups. A sample of +27 had 80% power to detect this difference with an alpha +of 0.05 for a between‑groups analysis. To account for a +dropout of about 10%, a sample of 30 patients in each +group was decided. Hence, it was decided to recruit a +total of 60 healthy elderly sample for the study using +purposive sampling. The CONSORT diagram of the flow +of participants and the sociodemographic data of the +participants has been provided in Figure 1 and Table 1, +respectively. +A randomized block design was used in the study where +subjects were divided into four blocks  (two old ages +homes comprising of one block each and two blocks of +individual elderly participants from Ponda area of Goa), +a sample of approximately 15 subjects comprised of one +block. The lottery method of manual randomization was +conducted due to the small number of blocks (n = 4). Two +blocks were randomized into trataka group (intervention +group) and two blocks were randomized into wait list +control group. +For the intervention group, assessments were conducted +on day 1 before intervention, immediately after trataka +intervention on day 1, and after 1  month of trataka +intervention. In the wait list control group, data was +taken on day 1 before the quite sitting and after 30 min +of quite sitting and at the end of 1 month. The variables +used in this study were:  (a) Working memory  (Digit +Span Forward and Backward Test[26]), (b) attention and +concentration  (Six Letter Cancellation Test, SLCT[27]), +and  (c) executive functions  (Trail Making Test B, +TMT‑B[28]). For SLCT and TMT‑B, the standard procedure +for translation was used; translated and back translated +from Roman to Devnagiri to Roman. The tests were +translated into Devnagiri for the ease of application of the +tests to the local population in Goa. The Digit Span (DS) +is a subtest in Wechsler Adult Intelligence Scale‑third +edition (WAIS‑III)[29] and has been standardized for use +in an Indian population. The SLCT which measures +cognitive functions such as selective and focused +attention, concentration, visual scanning as well as +activation and inhibition of rapid responses has been +employed to assess cognitive impairments in alcoholic +Table  1: Socio‑demographic details of the subjects +(n=55) +Variable +Mean  (SD)/n  (%) +t value/ +chi‑square +P value +Trataka +(n=31) +Control +(n=24) +Age (years) +67.7 (7.4) 71.2 (6.6) +−1.83 +0.07 +Educational status (years) 11.8 (3.6) 11.6 (3.8) +0.15 +0.88 +Gender +Male +8 (25.8) +9 (37.5) +0.87 +0.35 +Female +23 (74.2) +15 (62.5) +SD = Standard deviation +Talwadkar, et al.: Trataka for cognitive functions +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +98 +cirrhotic patients,[30] and to evaluate target detection +deficits in patients who have undergone frontal +lobectomy surgery.[31] This test has also been evaluated +for its reliability and validity based on standard criteria +and has standard norms for the Indian population. TMT‑B +is one of the most popular neuropsychological tests and +is included in most test batteries, is a measure of visual +scanning, complex attention, psychomotor speed mental +flexibility, and executive functions. The TMT is sensitive +to a variety of neurological impairments.[32,33] Adequate +test‑retest reliability has been found for both Part A and +Part B of the TMT in the healthy control group (r = 0.46 +and 0.44, respectively), as calculated using Pearson’s +correlation coefficients.[34] +The intervention of trataka included set of procedures +including eye exercises and gazing at the candle +flame with focused attention followed by defocussing. +Breathing and chanting were also included in the practice +that promotes internal awareness and focusing on the +Figure 1: The CONSORT (consolidated standards of reporting trials, Altman et al., 2001) diagram of flow of participants through each stage of the randomized trial +activity followed by defocusing. Each session was of +30 min duration [Table 2]. Classes were conducted on +everyday basis, except for Sundays and attendance was +also recorded. Data of only those participants who had +completed a minimum of 75% and above class attendance +was analyzed. +The data at baseline was assessed for normality using +Shapiro‑Wilk test. As the data was found to be normal +for TMT‑B (trataka, statistics = 0.931, P = 0.05; control, +statistics = 0.929, P = 0.09) and SLCT (trataka = 0.957, +P = 0.24; control statistics = 0.946, P = 0.22) parametric +tests such as paired sample t‑tests, independent sample +t‑test, and Repeated measure analysis of variance (RM +ANOVA) were used to analyze the data. In case of the +Digit Span Test, the data was not found to be normally +distributed (trataka statistics = 0.845, P = 0.00; control +statistics = 0.931, P = 0.72). There were no outliers in +the data; however the data had distinct two peaks at the +higher and lower range of scores. If we had divided the +Talwadkar, et al.: Trataka for cognitive functions +99 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +digit span scores using the median values into two groups, +we could have possibly got two independent normal +distributions. However, as we did not have any rationale +for dividing the group based on the median values, +nonparametric tests such as Mann‑Whitney, Wilcoxon +signed rank test, and Friedman’s test were used to analyze +the Digit Span Test scores. Bonferroni adjustment was +conducted as there were multiple comparisons to analyze +the time effect. +RESULTS +Out of the 60 subjects, 55 subjects completed the first +follow‑up on day 1  (postintervention). However, only +48 subjects completed the second follow‑up, which was +conducted at the end of 1 month (trataka group n = 26, +wait list control n = 22). +There were no group differences at baseline in all three +outcome variables. Both the groups were comparable at +baseline, on all outcome variables. On Mann‑Whitney +tests, there was no significant difference between trataka +and wait list control group in Digit Span Test scores at +the first follow‑up. When compared to wait list control +group at the second follow‑up a possible trend towards +significance could be observed in the trataka group. When +compared within group (Friedman’s test and Wilcoxon +signed rank test), digit span scores improved at the first +follow‑up in trataka group, but the difference was not +significant. At the second follow‑up, there was significant +improvement in digit span scores (z = −3.35, P < 0.01). +While in control group, scores decreased at the first and +the second follow‑up, but there were no any significant +changes [Figure 2]. +When compared between groups (independent sample +t‑test), there was no significant difference between the +trataka and wait list control group at first and second +follow‑up in SLCT scores. However, with respect to +time effect  (paired sample t‑test), selective as well as +sustained attention and concentration (measured using +SLCT scores) was seen to improve immediately after +the practice of trataka (when baseline compared to first +follow‑up) (t = 5.08, P < 0.01). Wait list control group +also performed better (may be because of retest effect), +but the improvement was not significant. At 1 month +follow‑up, trataka group showed significantly better +performance in the SLCT test compared to baseline +(t = −3.93, P < 0.01). Whereas, scores of wait list control +group came back to the baseline scores at the second +follow‑up. +On the independent sample t‑test, at the first follow‑up, +there was no significant difference in TMT‑B scores +between trataka and wait list control group. However at the +second follow‑up, there was a trend towards significance. +Trataka group performed significantly better at the first +follow‑up (paired sample t‑test) (t = −4.26, P < 0.01) +in TMT B test  (indicative of executive functions). In +contrast, in the wait list control group there was increase +in time taken to complete the task (suggestive of poor +performance) and the change was not significant. At the +second follow‑up, only trataka group showed significantly +improved (statistics = 7.09, P = 0.00) performance when +compared to the baseline scores. +The traditional analysis that is used to detect treatment +outcomes in randomized longitudinal clinical trials was +used; RM ANOVA. RM ANOVA results showed that +the executive functions in both the groups improved +over time  (occasion effect). Though there was no +significant group effect, trataka group showed significant +improvement in TMT‑B scores over a month period +of the study as compared to the wait list control +group (f = 6.67, P < 0.01; interaction effect) [Table 3]. +Table  2: Details of trataka practice +Name of the practice +Duration +Starting prayer +1 min +Preparatory eye exercises +9 mins +Up and down or vertical movements‑10 rounds +30 secs +Simple palming +1 min +Right and left or horizontal movements‑10 rounds +30 secs +Simple palming +1 min +Diagonal movements‑right up‑left down‑10 rounds +30 secs +Press and release palming +1 min +Diagonal movements‑left up‑right down‑10 rounds +30 secs +Press and release palming +1 min +Rotational movements‑clockwise‑10 rounds +30 secs +Constant pressure palming +1 min +Rotational movements‑anticlockwise‑10 rounds +30 secs +Constant pressure palming +1 min +Jyoti trataka +Effortless gazing or focusing +4 mins +‘A’kara chanting +1 min +Intensive focusing +4 mins +‘U’kara chanting +1 min +Break +1 min +De‑focussing +4 mins +Bhramari +1 min +Silence +4 mins +Closing prayer +1 min +Figure 2: Changes in median digit span scores across timeline in trataka and +wait list control group (Friedman’s test) + + + + + +%DVHOLQH +VWIROORZXS +QGIROORZXS +'LJLWVSDQWHVW +7UDWDND*URXS +&RQWURO*URXS +Talwadkar, et al.: Trataka for cognitive functions +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +100 +With respect to SLCT scores, there was a trend towards +better improvement (f = 3.11, P = 0.05) in trataka group as +compared to the wait list control group over the 1 month +period of the study (interaction effect) [Table 3]. +For the convenience of conducting intervention, half +of the subjects in the trataka group were provided the +intervention in the morning and the remaining half +were provided the intervention in the evening. Baseline +analysis showed that there were significant differences +in TMT‑B and SLCT scores between the morning group +and the evening group, with scores higher in the evening +group than morning group. Hence, post hoc test was +conducted to check if there was any significant interaction +effect (group X time) after controlling for baseline scores +using analysis of covariance (ANCOVA). Results show that +there was no significant difference between groups (people +who practiced in the morning as compared to people +who practiced in the evening) over the study period after +controlling for baseline differences. +DISCUSSION +In this study on elderly subjects, trataka intervention +improved cognitive functions  (short‑term memory +and working memory, selective and focused attention, +concentration, visual scanning as well as activation and +inhibition of rapid responses and executive functions) +when compared to wait list control group at the end of +1 month. Trataka practice involves various steps like +preparatory eye exercises, focusing, defocusing, chanting, +and silence during relaxation. Each component or all +of them together could have been responsible for the +improvement in the cognitive functions. Preparatory +eye exercises improve the stamina of the eye muscles +and avoid eye strain. The degree of optical illusion is +observed to reduce post a set of yoga practices that includes +trataka (involving both focusing and defocusing of the +gaze and attention).[35] Dharana or focusing improves +concentrative attention  (“desha‑bandhashchittasya +dharanam”; Patanjali’s Yoga Sutras, Chapter III, Verse 1).[36] +Focused attention (FA) is the attention which is restricted +to a specific focus[37] such as the breath or the candle +flame (trataka). Receptive attention is a kind of attention +which is “objectless” and the goal is simply to keep attention +fully “readied” in the present moment of experience +without orienting, directing, or limiting it in any way. +Research studies have shown that intense FA meditation +effects cortical engagement, as reflected by a concomitant +reduction in event related desynchronization  (ERD) +to target tones in the beta (13-30 Hz) frequency band. +Reductions in beta ERD after practice of external tasks is +due to the decreased cognitive efforts.[38] There is enhanced +processing of task‑related auditory inputs during FA +meditation. FA meditation training is thought to improve +one’s ability to remain vigilant and monitor distractors +without losing focus. It is proposed that these mental +training‑related effects might be produced by a reduction +in cortical noise and/or by an enhancement of the rhythmic +mode of attention. +The second stage of trataka, the phase of defocussing is +akin to the stage of dhyana effortless attention (“tatra +pratyayaikatanata dhyanam”; Patanjali’s Yoga Sutras, +Chapter III, Verse 2).[39] When dharana becomes effortless, +it takes the form of dhyana, which is defined as the +uninterrupted spontaneous flow of the mind toward the +chosen object. Vigilance and attention are not required +during dhyana, which is the actual phase of meditation.[40] +Though there are different forms of meditation all of them +lead to calm yet alert mind.[41] At a more advanced level +of training in FA meditation which could be considered +a state of dhyana, the regulative attention skills are +invoked less frequently, and the ability to sustain focus +thus becomes progressively “effortless”.[38] Dhyana +is associated with reduced sympathetic activity and +increased vagal tone.[42] The defocussed phase of trataka +could be similar to the benefits of dhyana phase of +meditation. Multiple studies show that meditation may +affect multiple pathways that could play a role in brain +aging and mental fitness.[13] For example, meditation may +reduce stress‑induced cortisol secretion and this could +have neuroprotective effects potentially via elevating +levels of brain derived neurotrophic factor  (BDNF). +Meditation processes are linked to gamma‑aminobutyric +acid  (GABA) ergic cortical inhibition, a mechanism +implicated in improved cognitive performance and +enhanced emotional regulation.[43] Further, meditation +may potentially strengthen neuronal circuits and enhance +cognitive reserve capacity. Brain regions associated with +attention, interception, and sensory processing are thicker +in meditation practitioners including the PFC and right +anterior insula.[44] Advanced meditators have higher +melatonin levels (that blocks the build‑up of beta‑amyloid +plaque, a hallmark feature of Alzheimer’s disease)[45] than +nonmeditators.[46] +The results suggest that long‑term practice of trataka and +not just 1 day practice is required to improve short‑term +Table  3: RMANOVA for TMT‑B and SLCT scores +Variable +Mean (SD) +F +P value +Baseline +1st follow up +2nd follow up +TMT B +Trataka 170.58 (92.43) 151.45 (88.0) 111.27 (71.63) 6.67 +0.003 +Control 187.96 (79.77) 191.70 (91.98) 151.76 (80.67) +SLCT +Trataka 23.88 (10.07) +31.48 (14.68) +31.04 (13.31) 3.11 +0.05 +Control 24.96 (12.71) +29.33 (14.61) +26.23 (13.53) +TMT-B = Trail making test‑B; SLCT = Six letter cancellation test; SD = Standard +deviation +Talwadkar, et al.: Trataka for cognitive functions +101 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +memory. Similar study done on elderly subjects showed +that, at the 3  month follow‑up, yoga group improved +in semantic memory, short‑term primary memory, and +short‑term working memory.[47] So, the result of our study +is consistent with the results of earlier study. The only +difference is that our study period was only of 1 month; +still we could show significant improvement in the trataka +group. Thus, we can make a statement from our results +that first time yoga participants, if provided with 1 month +trataka intervention, can improve their executive, memory, +and cognitive functioning. This claim however needs to +be tested in larger samples. +In a study done on the healthy aging adults, it was seen +that performance on a simple attention task improved after +5‑week relaxation response training program; whereas, no +improvement was seen in complex tasks of attention.[16] +In another study, net scores on the six‑letter cancellation +task were significantly higher after a session of Dharana.[48] +These results are in consistence with our results, as we +also observed increased SLCT scores immediately after +Trataka practice. Since Trataka is a type of dharana practice +that involves focused attention on a specified object, this +further strengthens that the results are valid and obtained +correctly. +There could be various other possible reasons for finding +differences over the 1 month period. The group was at a +stage when cognitive decline was a reality. All the aging +individuals  (after the age of 60  years) develop some +degree of decline in cognitive capacity as time progresses. +Studies show that 16.8% of aged people have some form +of cognitive decline without the symptoms of dementia.[49] +If the study was done on healthy young subjects, then we +might not have got the significant difference, because of +‘ceiling effect’. +Another reason for the significant result could be that +majority of the participants of the study had never been +exposed to trataka or any yoga intervention earlier. A few +of the participants, who had earlier learnt yoga, had either +discontinued or had not practiced it for the past 3 months. +In such a case, we believe that the effect of trataka was +pronounced as there was no previous or past effect of any +similar intervention. +The fact that we got significant results to show that trataka +practice for 1 month is effective in improving cognitive +functions shows that the scales used in this study were +sensitive enough to tap the cognitive improvement in the +elderly after the trataka intervention. Three tests used in +this study were Digit Span Test, TMT‑B, and SLCT. Though +not developed specifically to test the effect of trataka, these +widely used tests have shown that they can tap significant +changes post yoga intervention. +Studies have time and again discussed the importance +of the prolonged practice of yoga.[50‑52] We assessed the +cognitive functions immediately after one session of +trataka and after 1 month of continuous daily practice. The +results pronounced that there was no significant difference +between groups at the end of one session (first follow‑up); +however, significant group and time differences including +interaction effects were observed at the end of 1 month +of intervention. Hence, we believe that our study results +validate earlier quoted studies which advocate prolonged +duration (number of days) of practice of yoga/trataka for +desirable effects. +The design of the study, that is, randomized block +design (RBD) was the main strength of the study. RBD +eliminates any bias in treatment assignment, specifically +selection bias and confounding. It maximizes statistical +power, especially in subgroup analyses. Another strength +of the study was that the intervention was provided +to the sample that needed the intervention, aging +individuals (after the age of 60), as they often develop +some degree of decline in cognitive capacity. +In spite of its strong methodology, the results of the +study need to be understood in the context that the +sampling was done only in two old age homes in Goa. +Further the sample size was small. The total sample size +was 60 based on earlier sample size calculations and +post attrition, the sample size for analysis was reduced +to 48. The results of the current study showed that +there was a trend towards significance in the trataka +group in the between group analysis  (group effect) +for some outcome variables. In this context, a larger +sample size could have depicted significant differences +between groups. Also, only three outcome variables +were used in the study. Age‑related cognitive decline +can be seen in different cognitive domains (e.g. speed +of processing, spatial ability, reasoning, etc.) and +varies individually. Further studies can be conducted +to test the effect of trataka on different neurological test +batteries. +CONCLUSION +The results of this study establish that trataka can be +used as a technique to enhance cognition in the elderly. +The trataka intervention is easy to learn, implement, and +adhere. Further trataka, after the initial few sessions, can +be practiced independently by the participant to achieve +desired results. For researchers, this study could provide +a substantial base for conducting future trials to test the +efficacy of trataka in controlled experiments. +REFERENCES +1. +Squire LR. Memory and Brain. 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Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy +as an add‑on treatment in the management of patients with schizophrenia:A +randomized controlled trial. Acta Psychiatr Scand 2007;116:226‑32. +52. Gangadhar BN, Nagendra HR, Thirthalli J, Subbakrishna DK, Muralidhar D, +Varambally S, et al. Efficacy of Yoga as an Add‑on Treatment in Schizophrenia. +Project report submitted under Scheme for Extra Mural Research (EMR) to +Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), +New Delhi; 2010. diff --git a/subfolder_0/Effect of Yoga Based Lifestyle Intervention on Patients with Knee Osteoarthritis A Randomized Controlled Trial.txt b/subfolder_0/Effect of Yoga Based Lifestyle Intervention on Patients with Knee Osteoarthritis A Randomized Controlled Trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..b6fa094cd1bba5c43ee0d187be48dcb2f8e7da9d --- /dev/null +++ b/subfolder_0/Effect of Yoga Based Lifestyle Intervention on Patients with Knee Osteoarthritis A Randomized Controlled Trial.txt @@ -0,0 +1,1082 @@ +ORIGINAL RESEARCH +published: 08 May 2018 +doi: 10.3389/fpsyt.2018.00180 +Frontiers in Psychiatry | www.frontiersin.org +1 +May 2018 | Volume 9 | Article 180 +Edited by: +Mardi A. Crane-Godreau, +Department of Microbiology & +Immunology, Geisel School of +Medicine at Dartmouth, United States +Reviewed by: +Alejandro Magallares, +Universidad Nacional de Educación a +Distancia (UNED), Spain +Karin Meissner, +Ludwig-Maximilians-Universität +München, Germany +*Correspondence: +Singh Deepeshwar +deepeshwar.singh@svyasa.org +Specialty section: +This article was submitted to +Psychosomatic Medicine, +a section of the journal +Frontiers in Psychiatry +Received: 21 February 2018 +Accepted: 18 April 2018 +Published: 08 May 2018 +Citation: +Deepeshwar S, Tanwar M, Kavuri V +and Budhi RB (2018) Effect of Yoga +Based Lifestyle Intervention on +Patients With Knee Osteoarthritis: A +Randomized Controlled Trial. +Front. Psychiatry 9:180. +doi: 10.3389/fpsyt.2018.00180 +Effect of Yoga Based Lifestyle +Intervention on Patients With Knee +Osteoarthritis: A Randomized +Controlled Trial +Singh Deepeshwar*, Monika Tanwar, Vijaya Kavuri and Rana B. Budhi +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India +Objective: +To investigate the effect of integrated approach of yoga therapy (IAYT) +intervention in individual with knee Osteoarthritis. +Design: Randomized controlled clincial trail. +Participants: Sixty-six individual prediagnosed with knee osteoarthritis aged between +30 and 75 years were randomized into two groups, i.e., Yoga (n = 31) and Control (n += 35). Yoga group received IAYT intervention for 1 week at yoga center of S-VYASA +whereas Control group maintained their normal lifestyle. +Outcome measures: The Falls Efficacy Scale (FES), Handgrip Strength test (left hand +LHGS and right hand RHGS), Timed Up and Go Test (TUG), Sit-to-Stand (STS), and right +& left extension and flexion were measured on day 1 and day 7. +Results: There were a significant reduction in TUG (p < 0.001), Right (p < 0.001), and +Left Flexion (p < 0.001) whereas significant improvements in LHGS (p < 0.01), and right +extension (p < 0.05) & left extension (p < 0.001) from baseline in Yoga group. +Conclusion: +IAYT practice showed an improvement in TUG, STS, HGS, and +Goniometer test, which suggest improved muscular strength, flexibility, and functional +mobility. +CTRI +Registration +Number: +http://ctri.nic.in/Clinicaltrials, +identifier +CTRI/2017/10/ +010141. +Keywords: knee osteoarthritis, integrative approach of yoga therapy (IAYT), handgrip strength (HGS), goniometer, +falls efficacy scale (FES) +INTRODUCTION +Osteoarthritis (OA) is the most common form of arthritis and leading cause of disability and loss of +functions in the elderly population. It can affect any joints, but the knee is one of the most affected +parts of the body in humans. There are several risk factors for OA such as obesity, smoking, intra- +articular fractures, chondrocalcinosis, crystals in joint fluid/cartilage, female gender, prolonged +immobilization, joint hypermobility, instability, peripheral neuropathy, prolonged occupational, +or sports stress (1). The prevalence of knee osteoarthritis increases with age (2). Approximately +41.1% of males and 56.5% of females suffer from OA (3). Over 40% of adults between 50 and 75 +years are affected with knee OA worldwide (4). The prevalence of knee OA in India is estimated to +be 28.7% (5). A total of 11 COPCORD (Community Oriented Program for Control of Rheumatic +Disorders) reports of knee OA data showed differences between rural (3.3%) and urban (5.5%) +population of India (6, 7). +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +Symptoms of OA present as pain in and around the joints, +morning stiffness, restricted joint movements associated with +muscle weakness. Knee OA is associated with disrupted sleep, +depression, increased sedentary behavior, less physical activity, +obesity and decreased the quality of life (8). Bilateral knee +osteoarthritis impaired the balance and increased the risk of fall, +particularly in people with moderate knee osteoarthritis (9). +Non-pharmacological +interventions +such +as +exercise, +Yoga, integrated approach of yoga therapy (IAYT), Tai-Chi, +physiotherapy, acupressure, naturopathy, and massage therapy +showed improvements in quality of life along with a reduction +in pain, improved physical functions, psychological balance in +patients with knee OA (10–14). These non-pharmacological +rehabilitation interventions have focused mainly on practices +for Knee OA that produces only small to moderate benefits +with the limited durability of effects on the symptoms of knee +OA (15). These interventions provided substantial benefits, but +are underutilized, and the efficacy and safety remain poorly +defined. In few earlier studies, yoga showed promising changes +in reducing pain, morning stiffness, and increased flexibility, +muscular strength and overall quality of life in knee OA patients +(16–19). +Yoga, a mind-body intervention, originated in India. Different +schools of yoga (such as Iyengar yoga, IAYT, hatha yoga, etc.) +developed a therapeutical intervention for knee OA. A pilot study +was conducted on nine participants, using modified Iyengar +yoga postures (90-min classes once in a week for 8 weeks) as a +treatment modality and showed potential reductions in pain and +disability caused by knee OA (20). Few other studies compared +yoga therapy with different interventions such as traditional +stretching and strengthening exercises or no structured group +exercise for 6 weeks and showed functional changes and +improvement in the quality of life in traditional practice +and yoga-based approach (21). Ebnezar et al. investigated +transcutaneous electrical stimulation and ultrasound treatment +followed by IAYT intervention (40 min) and reported that IAYT +is better than physiotherapy exercises for reducing pain, morning +stiffness, state and trait anxiety, blood pressure and pulse rate in +OA patients (18). This study was limited to numerical pain scale +and state and trait anxiety (STAI 1&2). Meta-analyses of yoga for +musculoskeletal problems suggest that yoga is helpful for chronic +pain and low back problems in older women population (16). +Studies on aerobic exercises including physical activities, yoga, +and Tai Chi, have long been a rehabilitation intervention for +treating patients with OA in decreasing pain, joint tenderness and +improving functional status (22). Most of these studies indicate +the long-term effect of yoga on symptoms of OA. There are +very few studies reporting the immediate impact of yoga on +patients with knee OA and self-efficacy. Also, limited data are +available to support the efficacy of IAYT intervention for OA +management. Few studies have methodological issues related to +their design such as small sample size, wide-ranging age group +due to unavailability of similar age group participants, whereas +other studies have a long-term intervention, high attrition rate, +etc. +Hence, the present study intended to investigate the +immediate effect of 1-week integrated approach of yoga therapy +(IAYT) intervention in older adults with knee OA. We +hypothesized that a brief intervention of yoga practice may have +a positive effect on, (i) Falls Efficacy Scale (FES), (ii) handgrip +strength (HGS), (iii) Timed up and Test (TUG), (iv) Sit to Stand +(STS), and (v) knee extension and flexion. +MATERIALS AND METHODS +Participants +A total of 66 participants (50 female and 16 male) aged 30– +75 years (60.2 ± 8.2 years), were recruited from Arogyadhama, +a home-based health center, S-VYASA, Bangalore and the +nearby area between April 2015–July 2015. The sample size was +calculated with G-Power software by fixing the alpha at 0.05 +powered at 0.8 and an effect size of 0.71 based on the mean and +SD of an earlier study (18). The inclusion criteria were, patients +suffering from knee OA for more than 3 months (diagnosed by +a physician), fully ambulant, literate, and willing to participate +in the study. Patients with rheumatoid arthritis, autoimmune +diseases, malignancies, knee surgery or knee-arthroscopy, and +knee pain caused by congenital dysplasia were excluded. The +flow chart of study participants from enrollment to completion +is given in Figure 1. +Prospective participants were informed about the trial +through media reports and advertisements in local newspapers +and University magazine. The CONSORT Flow diagram of the +trial is given in Figure 1 and the demographic details collected +for all participants (age, gender, duration of OA complaints, BMI, +education, and Occupation) are given in Table 1. +Ethical Consideration +The +research +study +was +approved +by +the +Institutional +Review +Board +(IRB) +of +the +S-VYASA +University +(No. +SVYASA/MSc/IRB/10/21) and conducted under the guidance +of senior doctors and therapists of the University. All subjects +were informed about the trial, and written informed consent was +obtained from the participants of this study. +Design +Recruited participants were randomly divided into two groups, +i.e., Yoga group with the intervention of integrative approach +for yoga therapy (IAYT) and Control group without any form +of yoga intervention. The study set-up was completely a yoga- +based lifestyle where all participants in yoga group followed +intervention of IAYT treatment for 6 days. All assessments +and treatment plans for participants were discussed with senior +doctor and therapist. All participants in both groups continued +their medication as per the requirements. It was not possible +to mask the yoga intervention from the subjects. However, the +investigators who collected primary and secondary outcomes +were blind to the intervention (23). +Intervention +Integrated Approach of Yoga Therapy (IAYT) +IAYT module for arthritis was developed using a holistic +approach to health management at physical, mental, emotional, +and intellectual levels (24). The practices were yoga postures +Frontiers in Psychiatry | www.frontiersin.org +2 +May 2018 | Volume 9 | Article 180 +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +FIGURE 1 | CONSORT Flow diagram of study participants. +(asana), yoga breathing (pranayama), relaxation techniques, +meditation and lectures on yogic lifestyle, devotional sessions, +and stress management through yogic counseling. The yogic +practices for knee OA included simple yogic movements and +postures that provided stretching, flexibility, strengthening weak +muscles and relaxation of body and mind (24). Yogic breathing +helps participants to achieve a slow rhythmic pattern of breathing +with slowing down the breathing pattern, deep inhalation, and +longer exhalation as the foundation (25). Cyclic meditation, +Om meditation and devotional sessions (prayers) are part of +meditation to control the surge of negative emotions. Lectures +and individual yogic counseling for stress management were +effectively focused on knee pain (26). +Cleansing techniques (Kriyäs) were used to help clean and +refresh the optical path, respiratory tract, and gastrointestinal +tract. All participants practiced intense candlelight gazing +Frontiers in Psychiatry | www.frontiersin.org +3 +May 2018 | Volume 9 | Article 180 +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +TABLE 1 | Characteristics of the study participants (n = 66). +Participants +Yoga (n = 31) +Control (n = 35) +Gender—50 Females (75%) +Males +6 (61.83 ± 9.1 years) +10 (60.13 ± 8.6 years) +Females +25 (59.8 ± 8.2 years) +25 (59.4 ± 9.4 years) +Duration of pain, in years; +mean (SD) +2–16 years; 11.52 +(4.01) +2–14 years; 12.31 +(5.36) +BMI (mean; SD) +28.15 (5.80) +30.02 (4.15) +Education: n (%) +(<6 years) +22 (71%) +19 (54%) +(>6 and 12 years) +7 (22%) +12 (34%) +(>12 years) +2 (7%) +4 (11%) +Occupation: n (%) +Housewife +18 (58%) +24 (69%) +Govt. Employee +2 (5%) +1 (3%) +Private Employee +7 (20%) +8 (23%) +Retired +5 (17) +2 (5%) +(Tr¯ +at +.aka), nasal cleansing with water and catheter (Jala and sutra +neti), frontal brain cleansing breath (Kap¯ +alabh¯ +ati), vomiting with +lukewarm saline water (Vamana dhauti), partial colon cleansing +(Laghu´ +sankha Praksh¯ +alana) (27). These techniques were done +everyday twice (morning and evening) during the intervention +period of 7 days. The summarized yoga practices for knee OA are +given in Table 2. +Outcome Measures +All participants were assessed for primary and secondary +outcomes twice, at baseline (day 1) and end of study period, day 7. +Primary Outcomes +(i) Timed up and go Test (TUG)—TUG is an easy and low-cost +test developed to assess the functional mobility of patients during +everyday activities. The test comprises the following sequence of +movements: to stand up from a standard chair, walk 3 m, turn, +walk back to the chair and sit down again. The time taken by +patients to complete the sequence of this movement is recorded +and compared before and after treatment (28). The internal +consistency (Cronbach’s alpha) was 0.74. +(ii) Sit-to-Stand (STS)—Participants were instructed to stand +up five times from a chair without using the support of their +arms, as fast as possible. The test was repeated twice as this +improved the reliability of the test, and the average time will be +calculated in seconds (29). The correlation coefficients of intra- +session reliability and test-retest reliability were 0.95 and 0.99, +respectively. The convergent validity of the five-repetition sit-to- +stand test was supported by significant correlation with a one- +repetition maximum of the loaded sit-to-stand test, isometric +muscle strength, scores of Gross Motor Function Measure, and +gait function (r or rho = 0.40–0.78) (30). +(iii) Goniometer test for flexibility and range of motion— +Participants were seated on a chair with legs stretched in front +called Right and Left Extension. The goniometer was placed on +the knee and was asked to bend the leg at the knee as far as +they could, Right and Left Flexion, and the degree of the bend +was measured with the goniometer. The average range of motion +(ROM) of the knee is 120–150◦(31). The data analysis revealed +that the inter-tester reliability (r = 0.98; ICC = 0.99) and validity +(r = 0.97–0.98; ICC = 0.98–0.99) were high (32). An overall +mean score was calculated for each participant. +Secondary Outcomes +(i) Handgrip Strength Test (HGS)—Handgrip strength of both +hands right handgrip strength (RHGS) and left handgrip strength +(LHGS) were assessed using a handgrip dynamometer. Subjects +were tested in 6 trials, 3 for each hand alternately, with a gap of +10 s between trials (33). +(ii) Falls Efficacy Scale (FES)—FES is an instrument to +measure fear of falling, based on the operational definition of +this fear as “low perceived self-efficacy at avoiding falls during +essential, non-hazardous activities of daily living.” FES is a 10- +item rating scale with test–retest reliability (r = 0.71), used to +assess confidence in performing daily activities without falling +(34). Each item is rated from 1 = extreme confidence, to 10 = +no confidence at all. Participants who reported avoiding activities +because of fear of falling had higher FES scores, representing +lower self-efficacy or confidence than those not reporting fear of +falling. +Procedure +All recruited participants were randomized in two groups, +i.e., Yoga group (n = 31; 59.8 ± 10.21 years) and Control +group (n = 35; 61.07 ± 9.17 years), using systematic +sampling method. The data collected of 66 participants on +Day 1 and Day 7 were extracted with the help of the +therapist from rheumatology department. There were no +dropouts in this study, and all collected data were observed +carefully. The data were tabulated and no missing values were +found. +Data were obtained from participants as per the stipulated +instructions in the manuals of questionnaires and tests. +DATA ANALYSIS +Statistical +analysis +was +carried +out +using +the +Statistical +Package for the Social Science (SPSS version 20.00, IBM +Corp., +USA). +The +scores +were +assessed +for +between- +group +differences +in +the +change +of +outcome +measures, +i.e., Timed up and test (TUG), Sit to stand test (STS), +Handgrip strength test (HGS), Extension and Flexion, and +Falls Efficacy Scale (FES) after the 1-week intervention of +IAYT. +Within +Group +and +Between-Group +comparisons +were +performed for exploratory reasons and are given in Table 3. +Test of normality showed no significant difference in age, +duration of osteoarthritis and socio-economic status between +the +groups. +Repeated +measures +of +Analysis +of +Variance +(ANOVA) were performed for each outcome measures with +two factors: (1) Groups: Yoga and Control; and (2) number +of assessments: Pre and Post. Repeated measures of ANOVA +were carried out separately followed by post-hoc analysis +Frontiers in Psychiatry | www.frontiersin.org +4 +May 2018 | Volume 9 | Article 180 +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +TABLE 2 | Yoga practices module for knee OA. +S. No. +Practices +Practice name (Sanskrit and English) +Duration of practice +1. +Breathing practices +Hands in and out Breathing +5 rounds (2 min) +Hands Stretch Breathing +5 rounds (2 min) +Ankle Stretch Breathing +5 rounds (2 min) +2. +Loosening practices in standing +Twisting +5 rounds (2 min) +Side bending +5 rounds (2 min) on each side +3. +Loosening practices in sitting +Knee Cap Tightening +5 rounds (2 min) each, both legs +Passive Patella Movement (Up and Down, In and Out, Rotation) +10 rounds (4 min) both legs +Knee bending +5 rounds (2 min) each, both legs +4. +Loosening practices in Supine +Folded Leg Lumber Stretch (Left, Right, Both) +5 rounds (2 min) +Cycling +5 rounds (2 min) both legs +Straight Leg Raising (Left, Right and Both) +5 rounds (2 min) +5. +Yoga Posture- Sitting +Paschimottasana (Seated forward bend Pose) +3 rounds (3 min) +Bh¯ +un +. aman¯ +asana (Earth Salutation Pose) +3 rounds (3 min) +6. +Yoga Posture-Prone +Bhuja ˙ +ng¯ +asana (Cobra Pose) +3 rounds (3 min) +Salabh¯ +asana (Locust Pose) +3 rounds (1 min) +Vipareetkarani (Inverted Pose) +2 min +7. +Yoga posture- Supine +Setubandh¯ +asana (Bridge Pose) +2 rounds (1 min) +Markat +. ¯ +asana (Lumbar Stretch Pose) +2 rounds (1 min) +Sav¯ +asana (Corpse Pose) +5 min +8. +Relaxation Techniques +Instant Relaxation Technique +2 min +Quick Relaxation Technique +5 min +Deep Relaxation Technique +10 min +9. +Kriyas (Cleansing techniques) +Jalaneti (Nasal Cleansing with Water) +30 min +Vamanadhouti (Internal Cleansing by Water) +15 min +Tr¯ +at +.aka (Candle Light Gazing) +10 min +Kap¯ +alabh¯ +ati (Frontal Brain Cleansing) +5 min +10. +Pr¯ +an +. ayama (Yoga Breathing) +Vibh¯ +ag¯ +ıyaPr¯ +an +. ayama (Sectional Breathing) +3 rounds (3 min) +N¯ +ad¯ +ı´ +suddh¯ +ı (Alternate Breathing) +9 rounds (3 min) +Brah¯ +amar¯ +ı (Humming Bee Breathing) +9 rounds (3 min) +Bhastrik¯ +a (Bellows Breathing) +9 rounds (3 min) +11. +Cooling Pr¯ +an +. ayama +´ +S¯ +ıtali (Rolling Tongue Breathing) +9 rounds (3 min) +´ +Sitk¯ +ar¯ +ı (Folded Tongue Breathing) +9 rounds (3 min) +Sadant¯ +a (Clenched Teeth Breathing) +9 rounds (3 min) +12. +Meditation +N¯ +ad¯ +anusandh¯ +ana (A,U,M and A-U-M Kara chanting) +10 min +Om Meditation +10 min +Cyclic Meditation +30 min +Mind Sound Resonance Technique +10 min +with Bonferroni correction, for two-time points of all the +outcome measures. All comparisons were made between +pre and post mean values of each outcome measure. If the +p-value was p ≤0.05, the results were considered statistically +significant. +RESULTS +The demographic data of recruited participants are given in +Table 1. The repeated measures of ANOVA were performed for +each outcome measure with two factors, i.e., groups (Yoga and +Frontiers in Psychiatry | www.frontiersin.org +5 +May 2018 | Volume 9 | Article 180 +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +TABLE 3 | Comparison of change in primary and secondary outcomes in IAYT and control groups. +Variables +Within group +Between-Group (p-value) +2-Way repeated measures of ANOVA +Yoga group +Control group +F group (p-value) F time (p-value) F interaction (p-value) +Before +After +Before +After +PRIMARY OUTCOMES +Timed Up and Go Test (TUG) +19.16 ± 5.99 +15.57 ± 5.23*** +18.56 ± 6.41 +19.02 ± 5.19* +0.014 +2.500 +35.413$$$ +8.842$$ +Sit-to-Stand (STS) +18.35 ± 6.25 +14.22 ± 4.65*** +19.28 ± 5.69 +18.06 ± 5.71 +0.004 +4.72$ +30.973$$$ +9.092$$ +Goniometer - +177.58 ± 3.63 +179.36 ± 2.14* +178.17 ± 3.25 +176.21 ± 3.05 +NS +0.912 +6.298$ +1.142 +(i) Right Extension +(ii) Right Flexion +45.52 ± 13.03 +37.23 ± 11.28*** +46.22 ± 13.40 +44.54 ± 14.32 +0.026 +2.38$ +28.910$$$ +12.671$$$ +(iii) Left Extension +176.52 ± 4.49 +179.32 ± 1.90*** +175.84 ± 4.22 +176.20 ± 5.19 +0.035 +0.887 +12.429$$ +7.927$$ +(iv) Left Flexion +46.39 ± 15.47 +39.84 ± 12.55*** +47.89 ± 16.24 +45.43 ± 15.12* +NS +1.96 +31.435$$$ +6.488$ +SECONDARY OUTCOMES +Falls Efficacy Scale (FES) +39.13 ± 10.36 +41.58 ± 11.18 +37.53 ± 11.05 +36.21 ± 13.14 +NS +0.258 +2.180 +2.081 +Hand Grip Strength (HGS)- +(i) Right Hand Grip Strength (RHGS) +22.42 ± 6.28 +23.67 ± 6.05 +24.51 ± 7.35 +24.34 ± 5.75 +NS +0.886 +0.937 +1.779 +(ii) Left Hand Grip Strength (LHGS) +21.11 ± 6.32 +22.55 ± 6.88** +22.11 ± 6.01 +20.2 ± 6.32 +NS +0.821 +7.625$$ +1.082 +*p < 0.05; **p < 0.01; ***p < 0.001 significant difference before and after yoga intervention. +$ < 0.05; $$ < 0.01; $$$ < 0.001 showed main effect or interaction effect in 2-way repeated measures ANOVA. +Frontiers in Psychiatry | www.frontiersin.org +6 +May 2018 | Volume 9 | Article 180 +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +Control) and times of assessment (Pre and Post). The primary +and secondary outcome scores of within-group analysis are +shown in Table 3. The 2-way ANOVA results showed that there +was a significant interaction between “group” and “time” of (i) +TUG (F = 8.84; p < 0.01), (ii) STS (F = 9.09; p < 0.01), and +(iii) Goniometer (a) Right Flexion (F = 12.67; p < 0.001), (b) +Left Extension (F = 7.93; p < 0.01), and (c) Left Flexion (F += 6.49; p < 0.05). Post-hoc analysis with Bonferroni correction +showed significant decrease in TUG (p < 0.001), STS (p < 0.001), +increased Right & Left Flexion (p < 0.001) and Right (p < 0.05) +& Left (p < 0.001) extension in primary outcomes. +Whereas in the secondary outcomes, handgrip strength showed +significant increase in LHGS (p < 0.01) in yoga group after 1 week +IAYT intervention and no changes falls efficacy score. In Control +group, we observed there was no relief of symptoms. After 1 +week, we observed that the Control group had a significant +increase in TUG (p < 0.05) and a decrease in Left Flexion +(p < 0.05) suggesting worsened symptoms after 1 week with +conventional treatment alone. Between group analysis showed +there was significant difference in post assessments of TUG (p +< 0. 05), STS (p < 0.01), Right Flexion (p < 0.05), Left Extension +(p < 0.05) of Yoga and Control group as shown in Figures 2A–C. +DISCUSSION +The results of the present study of the 1-week integrated +approach of yoga therapy (IAYT) demonstrated significant +improvements in TUG and STS tests in the Yoga group and +no changes were observed in Control group. Yoga group +participants reported significantly shorter time taken to perform +different physical tests after 1-week yoga intervention which +suggest better functional performance. The TUG test assesses +multiple components of balance and mobility (35). The STS +movement is one function people frequently use as they change +from a sitting position to a standing position. STS requires +forward movement of the center of mass while still seated +(in preparation to stand), acceleration of the center-of-mass +both in the anterior, posterior, and vertical plane, push offand +stabilization once standing is achieved (36, 37). This movement +is defined as a transitional movement to the upright posture +requiring movement of the center of mass from a stable position +to a less stable position over extended lower extremities (38). +The HGS is a reliable measurement when standardized methods +and calibrated equipment are used, even when there are different +assessors or different brands of dynamometers (39, 40). Grip +strength is related to the predictive of other health conditions. +In the present study, right and left handgrip strength showed +improvement after 1 week IAYT intervention. Previous studies +reported that handgrip strength is positively related to normal +bone mineral density in postmenopausal women (41), and can be +used as a screening tool for women at risk of osteoporosis (42). +Additionally, in the present study, Yoga group patients +showed that there was a significant decrease in knee pain and +stiffness, and significant improvement in mobility, measured +through right and left leg extension and flexion test. These +results are consistent with previous findings of Schilke et al. +were 10 patients with knee pain, have undergone 8 weeks of +the isokinetic muscle-strength-training program and showed +a significant decrease in pain and stiffness. There was also a +significant decline in arthritis activity after intervention and an +increase in all strength measures of right-left flexion and left-leg +extension across the training period (14). +One study on rheumatoid arthritis (RA) patients aged 18 +years and older, underwent 8 weeks of yoga (two 60-min +classes and one home practice/wk) reported higher physical +component summary (PCS), walking capacity, positive affect +and lower center for epidemiologic studies depression scale. +Improvements were also shown in SF-36 health-related quality +of life, role physical (work and daily activity impairment +due to physical health), pain, general health, vitality, and +mental health scale (43). Yoga showed a reduction in pain, +depression and more significant improvement in life satisfaction +after intervention (44). Yoga is mind-body interventions, that +impart stress management with physical activity may be well +suited for osteoarthritis and rheumatoid arthritis. Another +therapeutic intervention of Iyengar yoga in patients with knee +OA, EMG biofeedback showed a significant reduction in pain +and improvement in functional ability (19). This suggests that +yoga along with conventional therapy provides better results +in chronic knee osteoarthritis regarding pain and functional +disability. In a comparison of conventional therapy and add- +on yoga for 56 patients of knee rehabilitation after total knee +arthroplasty showed that there was a significant change for +pain, stiffness and functional subscales of Western Ontario and +McMaster Universities OA Index (WOMAC) Scale in both the +groups (45). This indicates that yoga asana protocol works better +than physiotherapy alone. The practice of yoga is doable, easy to +follow, safe and most important is useful for patients with knee +OA. There is evidence that Tai-Chi and yoga are safe and showed +significant reduction of pain and improvement of physical +function and quality of life in patients (46). The physical posture +(hatha yoga) practice also helps to reduce pain and symptoms +of OA and increase scores of daily activities, sports, spare-time +activities, and quality of life (17). The practice of yoga effects +on knee OA reported positive outcomes on symptoms including +pain, flexibility, functional disability, anxiety, and quality of life +(20). Earlier studies indicated subsided pain intensity in walking +scale and improvement in WOMAC and quality of life after yoga +practice. The resting pain and morning stiffness were studied in a +former study, and the current study is a continuation of the same +intervention (i.e., IAYT). The present study reported reduction +in Time Up and Go test, Sit To Stand test. These results show that +yoga practice improves muscular strength, better movement, and +flexibility. +The possible mechanism of yoga therapy-related changes in +symptoms of OA is not known. The multifactorial approach +of yoga therapy includes physical postures (asanas), breathing +practices (pranayama), meditation (dhyana), spiritual and +emotional cultures discourses may help to the amelioration of +OA symptoms. Yoga therapy intervention may increase cartilage +proteoglycan content and prevent cartilage degeneration (47). +This is helpful for the strengthening of periarticular muscles (i.e., +quads and hamstrings) that normally contract to stabilize the +Frontiers in Psychiatry | www.frontiersin.org +7 +May 2018 | Volume 9 | Article 180 +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +FIGURE 2 | Comparison between yoga and control groups after intervention. (A) Time Up and Go Test(TUG) and Sit To Stand (STS). (B) Right and left extension +assessed with Goniometer. (C) Right and left flexion assessed with Goniometer. *p < 0.05, **p < 0.01. +Frontiers in Psychiatry | www.frontiersin.org +8 +May 2018 | Volume 9 | Article 180 +Deepeshwar et al. +Yoga Based Lifestyle Intervention for Osteoarthritis +knee joint pain. Also, yoga practice may prevent synovial fluid +volume deterioration by stretching and strengthen different parts +of the body, massaging and bringing fresh blood to the internal +organs while rejuvenating the nervous system and lubricating the +joints, muscles, and ligaments. It is purported to have different +effects on the nervous and circulatory systems, coordination and +concentration and calming effect on the body. This also suggests +that yoga practice helps in reducing several psychological factors +such as stress, anxiety, depression, mood disturbances, and +enhance self-esteem and quality of life (43) in individuals with +chronic pain and arthritic conditions (48). It can be concluded +that yoga can be used as a complementary treatment along with +conventional treatment to improve the situation of people with +knee osteoarthritis. +There are several limitations to this study such as very +short duration of yogic intervention, confounding variables +such as diet, controlled environment, small sample size, etc. +Another limitation was no standard self-reported measure of +osteoarthritis symptoms was used. Further, sample was not +balanced by gender, so the outcome of the study cannot be +generalized and future study can be planned with equal number +of both the gender. Additionally, placebo is reported to be +effective for OA, especially for subjective outcomes such as pain, +stiffness, self-reported function, and physician global assessment +and in the current study no placebo group was taken. Hence, +the placebo effect on the outcome cannot be ruled out in +this study and further study can be planned with placebo +group. The strength of the present study is its cost-effectiveness +and use of non-invasive intervention and assessments. This +study comprises intensive lifestyle modification program with +self-corrective practice. The IAYT intervention could be used as +an add-on treatment of alternative and complementary therapy +for osteoarthritis. +CONCLUSION +In summary, the previous evidence and present study suggest that +yoga is an acceptable and safe intervention, which may result in +clinically relevant improvements in pain and functional outcome +associated with a range of musculoskeletal conditions such as +muscular dystrophy, osteoarthritis, rheumatoid arthritis, etc. The +present study would suggest that 1 week of IAYT may be useful +in decreasing pain and increasing functional mobility in these +patients over time. +AUTHOR CONTRIBUTIONS +SD helped in trial design, allocated participants, collected the +data, analysed, interpreted data, and wrote the manuscript; MT +performed the literature search and evaluated the outcomes +(blind assessor); VK data analysis; assisted in manuscript +compilation and RB editing; assisted in manuscript compilation +and correspondence. +ACKNOWLEDGMENTS +The authors would like to thank Yoga therapy center in +Bengaluru for providing participants and support for the conduct +of this study. 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The use, distribution or reproduction in other forums is permitted, provided +the original author(s) and the copyright owner are credited and that the original +publication in this journal is cited, in accordance with accepted academic practice. +No use, distribution or reproduction is permitted which does not comply with these +terms. +Frontiers in Psychiatry | www.frontiersin.org +10 +May 2018 | Volume 9 | Article 180 diff --git a/subfolder_0/Effect of Yoga as an Add-on Therapy in the Modulation of Heart Rate Variability in Children with Duchenne Muscular Dystrophy.txt b/subfolder_0/Effect of Yoga as an Add-on Therapy in the Modulation of Heart Rate Variability in Children with Duchenne Muscular Dystrophy.txt new file mode 100644 index 0000000000000000000000000000000000000000..3177753848e109a7a173da770d9976e7b01c7609 --- /dev/null +++ b/subfolder_0/Effect of Yoga as an Add-on Therapy in the Modulation of Heart Rate Variability in Children with Duchenne Muscular Dystrophy.txt @@ -0,0 +1,308 @@ +Int J Yoga. 2019 Jan-Apr; 12(1): 55–61. +doi: 10.4103/ijoy.IJOY_12_18 +PMCID: PMC6329227 +PMID: 30692784 +Effect of Yoga as an Add-on Therapy in the Modulation of Heart Rate +Variability in Children with Duchenne Muscular Dystrophy +Dhargave Pradnya, Atchayaram Nalini, Raghuram Nagarathna, Trichur R Raju, Ragupathy Sendhilkumar, +Adoor Meghana, and Talakad N Sathyaprabha +Physiotherapy Center, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India +Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India +Vivekananda Yoga Research Foundation, Bengaluru, Karnataka, India +Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, +Karnataka, India +Address for correspondence: Dr. Talakad N. Sathyaprabha, Department of Neurophysiology, National +Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru - 560 029, Karnataka, India. E-mail: +drsathyaprabha@gmail.com +Received 2018 Feb; Accepted 2018 May. +Copyright : © 2018 International Journal of Yoga +This is an open access journal, and articles are distributed under the terms of the Creative Commons +Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the +work non-commercially, as long as appropriate credit is given and the new creations are licensed under the +identical terms. +Abstract +Background: +Duchene muscular dystrophy (DMD) is a progressive muscular disorder. Cardiac disorder is the +second-most common cause of death in children with DMD, with 10%–20% of them dying of cardiac +failure. Heart rate variability (HRV) is shown to be a predictor of cardio-autonomic function. +Physiotherapy (PT) is advised for these children as a regular treatment for maintaining their functional +status. The effect of yogic practices on the cardio-autonomic functions has been demonstrated in +various neurological conditions and may prove beneficial in DMD. +Materials and Methods: +In this study, 124 patients with DMD were randomized to PT alone or PT with yoga intervention. +Home-based PT and yoga were advised. Adherence was serially assessed at a follow-up interval of 3 +months. Error-free, electrocardiogram was recorded in all patients at rest in the supine position. HRV +parameters were computed in time and frequency domains. HRV was recorded at baseline and at an +interval of 3 months up to 1 year. Repeated-measures ANOVA was used to analyze longitudinal +follow-up and least significant difference for post hoc analysis and P < 0.05 was considered +statistically significant. +Results: +In our study, with PT protocol, standard deviation of NN, root of square mean of successive NN, total +power, low frequency, high-frequency normalized units (HFnu), and sympathovagal balance improved +at varying time points and the improvement lasted up for 6–9 months, whereas PT and yoga protocol +1 +2 +3 +4 +1 +4 +4 +1 +2 +3 +4 +showed an improvement in HFnu during the last 3 months of the study period and all the other +parameters were stable up to 1 year. Thus, it is evident that both the groups improved cardiac functions +in DMD. However, no significant difference was noted in the changes observed between the groups. +Conclusion: +The intense PT and PT with yoga, particularly home-based program, is indeed beneficial as a +therapeutic strategy in DMD children to maintain and/or to sustain HRV in DMD. +Keywords: Duchene muscular dystrophy, heart rate variability, physiotherapy, yoga +Introduction +Duchenne muscular dystrophy (DMD) is a steadily progressive primary muscle disease and is the most +common form of neuromuscular disorder with an X-linked recessive pattern of inheritance that +ultimately leads to loss of ambulation and death at a young age.[1,2] The incidence of DMD is +approximately 15.9–19.5/100,000 live births.[3,4] In India, DMD has been found to account for 30% of +all reported forms of muscular dystrophies.[5] Respiratory failure and cardiac involvement are the most +common causes of death in children with DMD,[6] but with advancement in respiratory support +techniques, cardiac disorders remain an important problem in the late stages of the disease. Research in +this field reveals that there is an involvement of myocardium before the onset of clinically apparent +cardiomyopathy in DMD.[7] However, it has been observed that, in a routine management of DMD +children, assessment of cardiac function is not considered until the clinical manifestations are detected. +Nonrecognition of cardiac impairment and treatment at the early stages can lead to poor outcomes. +Hence, recognition and management of the cardiac autonomic dysfunction is an important strategy for +prolonged life expectancy and better quality of life in children with DMD. +Heart rate variability (HRV) assessment is an economical, noninvasive, and sensitive procedure for +investigating autonomic neurocardiac regulation.[8] HRV also provides a novel approach to the clinical +diagnosis and prognostic measures. Several authors have used HRV to assess cardiac neural regulation. +[9,10,11] Short-term HRV analysis is a good tool to investigate DMD children for evidence of cardiac +autonomic dysfunction.[12] Our previous study demonstrated the need for routine assessment of +cardiac functions using HRV measures, and short-term HRV analysis showed significant difference in +the cardio-autonomic parameters among the DMD children than the healthy volunteers.[12] +Apart from medical management, physiotherapy (PT) in the form of physical exercise is considered as +one of the vital rehabilitation strategies for the maintenance of physical function. The role of exercise +has been studied in the modulation of cardiac functions and found that training induces a resting +bradycardia accompanied by increased cardiac vagal modulation in healthy individuals.[13] +Yoga being the adjuvant therapy is considered as a simple practice that can be followed even at home +with prior training. Practicing yoga has shown improvement in cardio-autonomic functions in normal +individuals of different age groups.[14,15,16] Improvement in cardio-autonomic functions in healthy +volunteers using different yoga modules and physical exercise has been documented.[17] However, the +effect of yoga therapy to modulate HRV in DMD children has not been studied. +Materials and Methods +Subjects +This study was conducted at the National Institute of Mental Health and Neurosciences (NIMHANS). +Approval for this study was obtained from the Institutional Ethics Committee. Two hundred children +were screened, and 124 children with genetically confirmed DMD, in the age group of 5–10 years, who +were self-ambulant or required minimal assistance for walking, were recruited after obtaining written +assent and consent. Our cohort were drug naive at the time of evaluation and were recruited for the +study after genetic testing which was available within 3–4 weeks after clinical examination. Children +who had muscular dystrophy other than DMD, nonambulant children, and children/parents not willing +to participate in the study were excluded from the study. +Study design +Age matched randomized controlled repeated measure design. +The patients were paired for age and randomly allocated to Group 1 (PT only) and Group 2 (yoga and +PT [Y and PT]) using a computer-generated random table. +Assessment +HRV was used as the assessment tool in this study. Artifact-free, electrocardiograms were obtained for +all patients in the supine position. Recordings were analyzed for time and frequency domain parameters +according to the Taskforce report on HRV.[8] HRV parameters were computed in time and frequency +domains. Time domain measures include the standard deviation of NN (SDNN) interval and root of +square mean of successive NN (RMSSD) interval. Frequency domain consisted of total power (TP), +low frequency (LF), and high frequency (HF) power values. The ratio of LF/HF power values was +determined using the customized software. HRV assessments were done at the first presentation and +sequentially at intervals of 3, 6, 9, and 12 months. All participants were given a compliance notebook +to maintain exercise performance to make sure that children were practicing yoga and PT at home. Log +books were reviewed on every visit. +Intervention +All children received the standard approved therapy of oral prednisolone at 0.75 mg/kg/day from the +day of diagnosis and this was continued during the entire study period. +Physiotherapy +PT exercise was taught to children and parents in the Physiotherapy Department of NIMHANS. They +were made to practice it under the supervision of physiotherapists initially for a period of 1 week. Once +they learned the exercises, they were advised to carry it out at their homes. PT exercises were +performed twice daily by the participants, morning and evening for 45 min per session, and were +continued during the entire study period. Details of PT exercises are summarized in Table 1. +Table 1 +Physiotherapy exercises +Yoga +Similarly, yoga practice was taught to the children and their parents by a trained, accredited yoga +therapist. They were made to perform the yoga under the supervision of the yoga therapist for 1 week. +Once they learned, they were advised to practice yoga in their homes. Children in this group performed +yoga in the morning and PT exercises in the evening, each session lasting for 45 min, and was +continued during the entire study period. Detail of yoga practices is summarized in Table 2. +Table 2 +Yoga practices +Open in a separate window +Data extraction +All the data were documented in a standardized pro forma and later decoded. +Data analysis +Basic demographic details were analyzed using descriptive statistics. Groups were compared using +independent sample t-test for continuous variables. HRV data were square root transformed to produce +normal distributions. Values are expressed in (mean [standard deviation]). Level of significance was +kept at <0.05. RM ANOVA was used to analyze longitudinal follow-up and least significant difference +for post hoc analysis. +Results +The age of the children participated in this study ranged from 5 to 10 years. The mean age at +presentation was 7.9 ± 1.5 years. Mean height was 118.2 ± 8.4 cm (95–147 cm). Mean weight was 20.6 +± 4.3 kg (11–32 kg). Mean age at onset of DMD was 2.8 ± 0.6 years (1.5–4.0 years). Mean duration of +illness was 5.1 ± 1.5 years (1–8 years). At the end of the study, 45 children completed the scheduled +assessments in PT group and 43 children completed in Y and PT group. Details are explained in +CONSORT diagram [Figure 1]. +Open in a separate window +Figure 1 +CONSORT flow diagram +At baseline, DMD children showed significantly lower mean NN (PT: 606.1 ± 77.1 and Y and PT: +605.7 ± 78.5), higher average heart rate (PT: 100.4 ± 12.0 and Y and PT: 100.8 ± 13.0), and +significantly reduced HF and HF normalized units (HFnu). The sympathovagal balance (SVB) was +tilted toward sympathetic limb in DMD children. The time and frequency domain findings of HRV +were similar in both the two study groups. +After the PT protocol, SDNN, RMSSD, TP, LF, HFnu, and SVB improved at varying time points and +the improvement lasted up for 6–9 months. Whereas the combined protocol of PT and yoga showed an +improvement in HFnu during the last 3 months of the study period and all the other parameters were +stable up to 1 year. When compared age wise with baseline values up to 1 year, in PT group, there was +no significant change in any of the HRV parameters, while, Y and PT group showed a significant +improvement in HFnu in 5–6 years’ group and mean NN and average HR in 7–8 years. However, no +significant difference was observed between PT and Y and PT groups in other parameters. We +observed that PT group demonstrated improvement in HRV parameters, but these effects were not long +lasting, whereas Y and PT combination is more helpful in improving cardiac function between 5–8 +years of age. Detailed data are provided in Tables 3 and 4. +Table 3 +Comparison of serial evaluation of heart rate variability values in the two study groups +Table 4 +Age-wise difference between baseline and 1 year for heart rate variability values in the two +study groups +Open in a separate window +Strengths +Discussion +This study was conducted to know the added effect of yoga in the modulation of HRV among the +children with DMD. The HRV measures were used to assess the sympathetic and parasympathetic +nervous activities. In HRV measures, the HF component of the HRV indicates the vagal activity. In a +given point of time, any rise in the HF power, especially HFnu, indicates a vagal dominance. Similarly, +increased LF power indicates increased sympathetic activity. The LF-HF ratio indicates overall SVB. +High LF-HF ratio denotes increased sympathetic activity and a low LF-HF ratio indicates increased +parasympathetic activity.[18] In this study, the baseline HRV findings were showing predominant +sympathetic overactivity (increased SVB and reduced HF; HFnu) along with decreased mean NN. +Subsequently, the PT intervention showed noteworthy changes in HRV parameters. The +parasympathetic domination was very obvious during the intervention and lasted up to 6–9 months. +However, the added benefit of yoga showed further improvement in parasympathetic regulation +(HFnu). The age-wise improvement toward vagal balance was significant in our study. There was an +additional long-lasting improvement in autonomic modulation in 5–8 years of age of DMD children +with Y and PT group. All these findings confirm that DMD children have autonomic dysfunction and +these can be modulated by the interventions and stringent follow-ups. We also proved that yoga as an +adjuvant therapy has an additional benefit in enhancing the neuro-cardiac autonomic controls. +Studies showed that skeletal muscle training can be beneficial in patients with DMD.[19,20,21] Despite +the lack of studies addressing the use of yoga exercises as a complementary therapy for DMD patients, +there have been several other clinical studies of yoga on healthy volunteers. A study on healthy adults +aimed to find out the effect of yoga practice on HRV and showed increase in certain HRV parameters +such as mean RR interval, SDNN, HF power, and HFnu.[22] There was also reduction in the resting +heart rate, LF power, and LF/HF ratio. Several other studies on the effect of yoga on HRV exhibited an +increase in the parasympathetic tone which is reflected through the HRV measures.[14,23] To our +knowledge, the present study is the first to address and confirm the safety and efficacy of yogic +exercises along with PT in children with DMD. The yogic exercises used in the present study are +distinctive and were aimed at improving the muscular strength. Each school of yoga has various +physical postures (asanas), breathing practices (pranayama), and meditation as their components. In our +study, we used Sakthivikasaka (a practice aimed to improve the overall muscular function), selected +asanas, pranayama, and meditation (guided meditation). Although the effect of Sakthivikas has not +been studied, it can be considered as a practice equivalent to performing moderate-intensity exercise. +Since yoga comprises both physical activity in the form of sakhivikasakas and asanas and pranayama, +it has advantage in the modulation of HRV through mechanisms similar to practicing physical exercises +in addition to practicing pranayama and meditation. +The possible beneficiary effect of interventions on DMD may be due to several mechanisms. It +includes a reduction in the catecholamine, angiotensin II, and an increased bioavailability of nitric +oxide.[24] Complex neurophysiological mechanism, mediated through limbic, hypothalamic medullary +axis and the medullary cardiovascular center, is thought to be the reason for improvements in the HRV +after the practice of slow pranayamas.[18] On the other hand, HF yoga breathing practices such as +Kapalabhathi are found to enhance sympathetic activity by reducing the vagal tone.[25] Overall +relaxation and calming the mind through physical and breathing practices is the primary goal of yogic +practices. Finally, we could see that yoga does have a positive effect on skeleton muscle as well as +neuro-cardiac beneficiary with probable above-discussed mechanisms. +Strengths and limitations of our study +To our knowledge, this is the first study involving DMD children, with follow-up for 1 year, +with large samples, to study the effect of yoga. It was a longitudinal, prospective, age-matched, two- +group randomized study, with controlled RM design. The DMD being a progressive disease, +performing exercise and yoga might have reduced the deleterious effects on such patients. The primary +objective of the study was to show that yoga and exercises can be performed by patients with DMD. +Although there was 30.6% and 27.4% dropout in yoga and exercise groups, this study showed that +yoga exercises are feasible, harmless, and can actually improve HRV in DMD children. +Limitation +This study was not blinded for assessments and interventions. +Conclusion +Since modulation of HRV is an indicator of stable cardiac function and assessment of cardiac function +using HRV measure and therapeutic measures, we advised that combined PT and yoga can be initiated +as one of the rehabilitation strategies in children with DMD. This can also be a home-based PT, and +yoga programs appear to be beneficial and cost-effective in the management of patients with DMD if +started early. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +References +1. Siciliano G, Tessa A, Renna M, Manca ML, Mancuso M, Murri L, et al. Epidemiology of +dystrophinopathies in North-West Tuscany: A molecular genetics-based revisitation. Clin Genet. +1999;56:51–8. [PubMed] [Google Scholar] +2. Parsons EP, Bradley DM, Clarke AJ. Newborn screening for Duchenne muscular dystrophy. Arch +Dis Child. 2003;88:91–2. [PMC free article] [PubMed] [Google Scholar] +3. Mendell JR, Shilling C, Leslie ND, Flanigan KM, al-Dahhak R, Gastier-Foster J, et al. Evidence- +based path to newborn screening for Duchenne muscular dystrophy. Ann Neurol. 2012;71:304–13. +[PubMed] [Google Scholar] +4. Moat SJ, Bradley DM, Salmon R, Clarke A, Hartley L. 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[PMC free article] [PubMed] +[Google Scholar] +Articles from International Journal of Yoga are provided here courtesy of Wolters Kluwer -- Medknow +Publications diff --git a/subfolder_0/Effect of a diet enriched with fresh coconut saturated fats on plasma lipids and erythrocyte fatty acid composition in normal adults.txt b/subfolder_0/Effect of a diet enriched with fresh coconut saturated fats on plasma lipids and erythrocyte fatty acid composition in normal adults.txt new file mode 100644 index 0000000000000000000000000000000000000000..155fc4a4e5cca8f4574763879b73bb1c8838a559 --- /dev/null +++ b/subfolder_0/Effect of a diet enriched with fresh coconut saturated fats on plasma lipids and erythrocyte fatty acid composition in normal adults.txt @@ -0,0 +1,760 @@ +Full Terms & Conditions of access and use can be found at +http://www.tandfonline.com/action/journalInformation?journalCode=uacn20 +Download by: [Cornell University Library] +Date: 18 May 2017, At: 09:36 +Journal of the American College of Nutrition +ISSN: 0731-5724 (Print) 1541-1087 (Online) Journal homepage: http://www.tandfonline.com/loi/uacn20 +Effect of a Diet Enriched with Fresh Coconut +Saturated Fats on Plasma Lipids and Erythrocyte +Fatty Acid Composition in Normal Adults +Rokkam Shankar Nagashree MSc, N. K. Manjunath, M. Indu, M. Ramesh, V. +Venugopal, P. Sreedhar, N. Pavithra & Hongasandra R. Nagendra +To cite this article: Rokkam Shankar Nagashree MSc, N. K. Manjunath, M. Indu, M. Ramesh, V. +Venugopal, P. Sreedhar, N. Pavithra & Hongasandra R. Nagendra (2017): Effect of a Diet Enriched +with Fresh Coconut Saturated Fats on Plasma Lipids and Erythrocyte Fatty Acid Composition in +Normal Adults, Journal of the American College of Nutrition, DOI: 10.1080/07315724.2017.1280713 +To link to this article: http://dx.doi.org/10.1080/07315724.2017.1280713 +Published online: 16 May 2017. +Submit your article to this journal +View related articles +View Crossmark data +Effect of a Diet Enriched with Fresh Coconut Saturated Fats on Plasma Lipids +and Erythrocyte Fatty Acid Composition in Normal Adults +Rokkam Shankar Nagashree, MSca, N. K. Manjunatha, M. Indub, M. Ramesha, V. Venugopala, P. Sreedhara, N. Pavithrab, +and Hongasandra R. Nagendraa +aSwami Vivekananda Yoga Anusandhana Samsthana, Department of Yoga and Life Sciences, Bengaluru, India; bSt. John’s Research Institute, Division of +Nutrition, Bengaluru, India +ARTICLE HISTORY +Received 8 November 2016 +Accepted 5 January 2017 +ABSTRACT +Objective: The objective of this study was to compare the effects of increased saturated fatty acid (SFA) +(provided by fresh coconut) versus monounsaturated fatty acid (MUFA) intake (provided by a combination +of groundnuts and groundnut oil) on plasma lipids and erythrocyte fatty acid (EFA) composition in healthy +adults. +Material and Methods: Fifty-eight healthy volunteers, randomized into 2 groups, were provided +standardized diet along with 100 g fresh coconut or groundnuts and groundnut oil combination for +90 days in a Yoga University. Fasting blood samples were collected before and after the intervention +period for the measurement of plasma lipids and EFA profile. +Results: Coconut diet increased low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels +significantly. In contrast, the groundnut diet decreased total cholesterol (TC), mainly due to a decrease in +HDL levels. There were no differences in the major SFA of erythrocytes in either group. However, coconut +consumption resulted in an increase in C14:0 and C24:0 along with a decrease in levels of C18:1 n9 (oleic +acid). There was a significant increase in levels of C20:3 n6 (dihomo-gamma linolenic acid, DGLA). +Conclusions: Consumption of SFA-rich coconut for 3 months had no significant deleterious effect on +erythrocytes or lipid-related factors compared to groundnut consumption. On the contrary, there was an +increase in the anti-atherogenic HDL levels and anti-inflammatory precursor DGLA in erythrocyte lipids. +This suggests that coconut consumption may not have any deleterious effects on cardiovascular risk in +normal subjects. +Abbreviations: SFA, saturated fatty acid; MCSFA, medium-chain saturated fatty acids; MUFA, monounsaturated fatty +acid; HDL, high-density lipoprotein; TC, total cholesterol; TG , triglycerides; CAD, coronary artery disease; PUFA, poly- +unsaturated fatty acid; DGLA, dihomo-g-linolenic acid; VCO, virgin coconut oil; WHO, World Health Organization; +FAO, Food and Agriculture Organization +KEYWORDS +Coconut; saturated fat; +plasma lipid; erythrocyte +fatty acid; MUFA; gas +chromatography; groundnut +Introduction +Consumption of saturated fat is believed to increase the risk of +coronary artery disease mainly because of its effects on increas- +ing plasma total cholesterol (TC) levels. As early as the 1950s, +Keys et al. [1,2] and later Dietschy [3] and Hegsted et al. [4] +worked out equations that showed how dietary fatty acids influ- +enced plasma cholesterol levels. These equations suggested that +saturated fatty acids (SFAs) increased TC levels, whereas poly- +unsaturated fatty acids (PUFAs) decreased them and monoun- +saturated fats (MUFAs) were largely considered as neutral [5]. +These studies were the basis of dietary recommendations that +advised reduced consumption of all types of SFAs [6]. +Nearly one third of the world’s population depends on coco- +nut to some degree for their food [7]. Indian diets are relatively +low in fat; however, inclusion of fresh/dry coconut in the daily +diet is a common practice in many parts of the country. India +is the third largest producer of coconuts in the world [8] and +more than half of this (52%) is consumed in raw form as either +fresh or dry coconut [9]. Studies on the effect of coconut oil +consumption on plasma lipids are contradictory, with some +studies showing deleterious effects and others showing neutral +effects. However, there are almost no studies conducted on the +health effects of fresh coconut consumption. Fresh coconuts +contain 40%–50% moisture and, in addition to SFAs, they are +rich in fiber and protein and a number of vitamins, minerals, +and electrolytes [10]. Furthermore, the coconut SFA composi- +tion is unique in that it consists of over 50% of medium-chain +SFAs (MCSFAs) [11], whose properties and metabolism appear +to differ from longer chain SFAs commonly found in animal +products [12]. MCSFAs are rapidly oxidized in the liver to Ace- +tyl coenzyme A (acetyl CoA) and do not enter or alter the lipid +pool in the liver, thus remaining neutral with respect to regula- +tion of TC or low-density lipoprotein (LDL) levels [13]. +The current study was therefore undertaken to study the +effects of daily consumption of fresh coconut on plasma lipids +CONTACT Rokkam Shankar Nagashree +gaurirokkam@gmail.com +Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, +Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bengaluru - 560018, Karnataka, India. +© 2017 American College of Nutrition. +JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION +https://doi.org/10.1080/07315724.2017.1280713 +and erythrocyte fatty acid composition in healthy young men +and women. +Materials and methods +The study was carried out on 58 healthy adults who were +recruited following advertisement of the study at Swami Vive- +kananda Yoga Anusandhana Samstha University. Sample size +was calculated using SPSS software, Version 10 (IBM), where +the alpha was 0.05 and the power was 0.95. The effect size was +0.570 and the sample size was 27. Subjects were aged 23.8 § +4.8 years and had no known metabolic, endocrine, or hemato- +logical diseases; were not on any medications; and had high +physical activity levels. Subjects were nonsmokers and tee- +totalers residing on a residential campus of a university. The +study protocol was approved by the institutional ethics com- +mittee. This study has been registered with the Clinical Trial +Registry of India (CTRI/2016/07/007071). Signed informed +consent was obtained from the volunteers. +The subjects were randomized into 2 groups—the coconut +group (C) and the groundnut group (G). Randomization was +done using a computer-generated random number table (www. +randomizer.org). All subjects received a balanced diet based on +yogic principles of food (sativic, rajasic, and tamasic) blended +with modern medical nutrition (calorie requirements, composi- +tion of a balanced meal) and consumed this standard meal plus +intervention for a period of 90 days. Details of the diet are pro- +vided in Table 1. In addition to this standard meal, group C +consumed 100 g (444 kcal) of fresh coconut per day and group +G consumed 45 g (256 kcal) of groundnuts and 22 g (198 kcal) +of groundnut oil per day. A combination of groundnut and oil +was used to make the 2 study interventions isocaloric and to +ensure similar macronutrient compositions. Group C con- +sumed 2689 kcal, 392 g of carbohydrates (58.3%), 77 g of pro- +teins (11.4%), and 90 g (30.3%) of fat and group G consumed +2699 kcal, 384 g of carbohydrates (57%), 89 g protein (13%), +and 90 g fats per day (30%). +Subjects were trained and requested to abstain from con- +suming anything other than the food and snacks provided by +the project kitchen, set up exclusively for the study. +Anthropometry +Subjects’ weight, height, waist and hip measurements, and body +mass index (BMI; weight in kilograms divided by height in +square meters) were determined. Body weight was measured +using a digital scale, height was measured with a stadiometer, +and waist and hip circumferences were assessed using a stan- +dard tape measure, performed by the same person. +Biochemical data and fatty acid analysis +Lipid profile was measured soon after sample collection using a +fully automated biochemistry analyzer (Mindray BS 390 +Shenzhen, China). Blood samples for erythrocyte fatty acid +analysis were collected into EDTA tubes and centrifuged with +HiSep lymphocyte separation media (LSM 1077) at 1550 rpm +for 15 min. Erythrocytes were separated, washed 3 times with +phosphate-buffered saline, and centrifuged at 1400 rpm for +10 min at 4C and stored at ¡80C until analysis. +Fatty acid profile of rbs through gas chromatography +Fatty acids in 300 mL erythrocytes were extracted using a chlo- +roform: methanol (1:2) mixture and transmethylated with 2% +concentrated H2SO4 in methanol. The different fatty acids were +separated using gas chromatography–flame ionization detec- +tion (Varian 3800; Varian, Palo Alto, CA; fused silica column– +fatty acid methyl ester (FAME), Varian 50 m, 0.2 mm capillary +column) with nitrogen as the carrier gas and quantified using +C17 as an internal standard. The total fatty acid content of the +samples was calculated and each identified fatty acid was +expressed as a percentage of total fatty acids. +Fatty acids profile of the meals +The fatty acid profile of coconut and groundnut meal for one +person for a whole day was obtained through gas chromatogra- +phy–flame ionization detection. Coconut meal contained 58% +SFA and 18% MUFA compared to 22% SFA and 41% MUFA +in the groundnut meal (Table 2). +Data analysis +Statistical analysis was done using SPSS Version 10 (IBM). +Each variable was first assessed for normality of distribution +using the Kolmogorov-Smirnov test. When the data were nor- +mally distributed with equal variance, parametric statistical +tests were selected for analysis. Within-group analysis was +done using a paired sample t test comparing the data collected +on day 90 with the respective day 1 values for each variable +Table 1. Diet composition of standard meal. +Food Group +No. of Exchanges Portion (g) Quantity(g) Energy(kcal) +Cereals and millets +12 +30 +360 +1200 +Pulses +3 +30 +90 +300 +Milk and its products +3 +100 +300 +210 +Roots and tubers +1 +100 +100 +80 +Green leafy vegetables +2 +100 +200 +90 +Other vegetables +3 +100 +300 +90 +Fruits +2 +100 +200 +80 +Jaggery/honey +3 +5 +15 +60 +Fat +3 +5 +15 +135 +Total +2245 +Table 2. Macronutrient and fatty acid composition of the 2 diets. +Coconut Group +Groundnut Group +Energy (kcal/day) +2689 +2699 +Carbohydrates (%) +58.3 (392 g/d) +57 (384 g/d) +Protein (%) +11.4 (77 g/d) +13 (89 g/d) +Fat (%) +30.3 (90 g/d) +30 (90 g/d) +Fatty acid composition (%) +MCSFAs +39 (11.8%) +0 +Total SFAs +58 (17.5%) +22 (6.6%) +MUFAs +18 (5.4%) +41 (12.3%) +PUFAs +24 (7.4%) +37 (11.1%) +MCSFA D medium-chain saturated fatty acid, SFA D saturated fatty acid, MUFA D +monounsaturated fatty acid, PUFA D polyunsaturated fatty acid. +2 +R. S. NAGASHREE ET AL. +separately. Chi-square test was performed when the data were +nonparametric in nature. The between-group comparisons +were done to understand the significant differences between +groups C and G at baseline as well as at day 90 using an inde- +pendent sample t test. +Results +Table 2 provides details of the diet composition of the 2 groups. +Both groups consumed similar amounts of macronutrients; +however, the fatty acid compositions of the 2 diets were very +different. Group C consumed 17.5% as SFA, of which 11.8% +came from MCSFA, whereas group G consumed only 6.6% as +SFA, with no MCSFA. The MUFA as well as PUFA intake in +group G was double that of group C. +Physical activity levels of subjects in both groups were com- +parable (x2 +1 +ð Þ D 1:16; p D 0:466Þ. Table 3 shows that the +baseline characteristics of the 2 groups were similar. A significant +decrease in weight was observed in group C; however, no changes +were observed in either BMI or in waist–hip ratio in either group. +The effect of coconut consumption on plasma lipids is pre- +sented in Table 4. It was seen that consumption of coconut for +90 days resulted in an increase in both LDL as well as high-den- +sity lipoprotein (HDL) levels, although TC levels did not +increase significantly. On the other hand, groundnut consump- +tion for the same period resulted in a decrease in TC levels that +was mainly due to a significant decrease in HDL levels. No +changes were observed in any of the other lipids. +Erythrocyte fatty acid composition before and after the inter- +vention is detailed in Table 5. No significant changes were +observed in the major SFA composition in either group, although +significant changes were seen in minor fatty acids in both groups. +In the coconut group, an increase was seen in all of the minor +SFAs—14:0 and 24:0—whereas in the groundnut group, there +was a decrease in 14:0 and a corresponding increase in 22:0 and +24:0. There was also a decrease in total n-3 PUFAs in the ground- +nut group. A significant increase was seen in the levels of 20:3 n-6 +(dihomo-g-linolenic acid, DGLA) accompanied by a decrease in +the main MUFA (18:1 n-9) in the coconut group. +Discussion +In this carefully controlled diet study, we seek to shed light on +the impact of SFAs from fresh coconut (C) in comparison to +MUFAs from a groundnut and groundnut oil combination (G) +on some well-accepted indices of cardiovascular disease (CVD) +risk. The most important finding of the present study was that +despite much higher intakes of SFAs in the coconut group, the +effects on plasma TC and triglycerides were minimal. There +was a significant increase in LDL levels in the coconut group, +which is in line with a number of studies with coconut oil sup- +plementation [14,15]. This has been generally attributed to +either increased LDL synthesis or reduced LDL clearance. On +the other hand, a number of studies have reported beneficial +effects of virgin coconut oil on LDL and have attributed it to +the presence of high levels of polyphenols such as caffeic acid +[16], which play a key role in scavenging free radicals [17]. In +the current study, despite the use of fresh coconut rich in poly- +phenols, we observed an increase in LDL levels. However, it +was also seen that there was no significant increase in TC levels, +suggesting that this increase in LDL was well within physiologic +variability in the current study population of normal men and +women. +Groundnut was used as the control in this study because it is +a rich source of MUFA and is more commonly consumed than +Table 3. Basic characteristics of the 2 groups before and after dietary intervention. +Variables +Coconut Group (n D 27) +Groundnut Group (n D 31) +Age (years) +23 § 4.1 +24.65 § 5.5 +Gender (male/female) +15/12 +16/15 +Day 1 +Day 90 +Day 1 +Day 90 +Mean § SD +Mean § SD +Mean § SD +Mean § SD +Weight (kg) +59.8 § 10.2 +59.1 § 9.6 +56.78 § 7.3 +56.2 § 7.9 +BMI +21.6 § 2.2 +21.4 § 2.1 +21.0 § 2.0 +20.80 § 1.9 +Waist–hip ratio +0.82 § 0.07 +0.79 § 0.12 0.82 § 0.06 +0.81 § 0.06 +BMI D body mass index. +p < 0.05, paired sample t test; day 90 values compared to respective day 1 values. +Table 4. Biochemical measures recorded in both coconut and groundnut groups +on days 1 and 90.a +Coconut Group +Groundnut Group +Variable +Day 1 +Day 90 +Day 1 +Day 90 +TG (mg/dl) +78.1 § 34.2 +79.7 § 25.3 +78.7 § 32.1 +70.1 § 24.8 +LDL (mg/dl) +85.9 § 20.1 97.96 § 23.8 +81.84 § 19.3 79.97 § 21.0 +HDL (mg/dl) +42.9 § 9.6 +46.74 § 11.4 +43.61 § 10.3 41.19 § 10.3 +TC (mg/dl) +150.5 § 22.6 157.6 § 27.9 +144.45 § 20.1 133.8 § 19.3 +TG/HDL +1.9 § 1 +1.8 § 0.8 +1.9 § 1 +1.8 § 0.9 +apo-B/apo-A1 +0.63 § 0.16 +0.63 § 0.17 +0.63 § 0.16 +0.63 § 0.17 +TG D triglycerides, LDL D low density lipoprotein, HDL D high density lipoprotein, +TC D total cholesterol, apo-A D apolipoprotein A, apo-B D apolipoprotein B. +aValues are group mean § standard deviation. +p < 0.05.p < 0.01.p < 0.001. Comparing day 90 values with day 1 values +using paired sample t test. +Table 5. Fatty acid profile of erythrocytes recorded in both coconut and ground- +nut groups on days 1 and 90.a +Coconut Group +Groundnut Group +Fatty Acid +Day 1 +Day 90 +Day 1 +Day 90 +12:0 +0.01 § 0.04 +0.06 § 0.34 +0.09 § 0.31 +0.06 § 0.26 +14:0 +0.09 § 0.26 +0.43 § 0.55 +0.32 § 0.52 +0.11 § 0.33 +16:0 +24.5 § 2.1 +24.0 § 1.2 +24.6 § 1.8 +24.4 § 3.5 +18:0 +18.3 § 1.4 +18.0 § 1.23 +18.1 § 1.8 +18.2 § 1.5 +18:1 +13.4 § 1.5 +12.7 § 1.3 +13.6 § 1.7 +13.7 § 1.6 +18:2 n-6 +13.9 § 1.3 +14.3 § 1.4 +13.6 § 0.94 +13.4 § 1.5 +20:3 n-6 +1.63 § 0.33 +1.79 § 0.43 +1.60 § 0.31 +1.60 § 0.40 +20:4 n-6 +14.4 § 2.1 +14.4 § 1.5 +14.4 § 2.5 +14.1 § 3.1 +22:0 +0.68 § 0.54 +0.92 § 0.85 +0.63 § 0.52 +0.96 § 0.49 +22:04 +4.47 § 1.12 +4.35 § 1.12 +4.7 § 0.93 +4.66 § 1.13 +24:0 +2.8 § 1.1 +3.2 § 0.78 +2.7 § 1.0 +3.5 § 0.82 +22:5 n-6 +2.6 § 1.3 +2.8 § 0.7 +2.5 § 1.1 +2.5 § 0.72 +22:5 n-3 +1.1 § 0.58 +1.0 § 0.38 +1.1 § 0.55 +0.96 § 0.53 +22:6 n-3 +1.7 § 0.66 +1.6 § 0.55 +1.7 § 0.64 +1.6 § 0.72 +Total SFA +46.5 § 3.5 +46.7 § 2.4 +46.5 § 3.5 +47.3 § 5.6 +Total MUFA +13.4 § 1.5 +12.7 § 1.3 +13.6 § 1.8 +13.7 § 1.6 +Total PUFA +40.0 § 4.1 +40.4 § 2.4 +39.8 § 4.2 +38.9 § 6.6 +Total n-6 +37.0 § 3.6 +37.7 § 2.3 +36.9 § 3.5 +36.4 § 5.7 +Total n-3 +2.9 § 1.1 +2.7 § 0.81 +2.8 § 1.1 +2.5 § 1.2 +SFA D saturated fatty acid, MUFA D monounsaturated fatty acid, PUFA D polyun- +saturated fatty acid. +aValues are group mean § standard deviation. +p < 0.05.p < 0.01.p < 0.001. Comparing day 90 values with day 1 values +using paired sample t test. +JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION +3 +olive oil in India. We have enough evidence from several epide- +miologic studies that dietary MUFAs have a positive impact on +CVD risk factors by promoting a healthy blood lipid profile, +improving blood pressure, and decreasing inflammation and +oxidative stress [18,19]. MUFAs are also reported to improve +insulin sensitivity [19]. In the present study, there was a signifi- +cant decrease in TC levels in the groundnut group; however, +this appeared to be mainly due to a decrease in HDL levels +(Table 4). In contrast, the coconut group showed a significant +increase in HDL levels, which could be attributed to the high +MCSFA content of the diet [20]. +Research from the past 30 years has shown that increased +levels of circulating HDL cholesterol are associated with a +reduced risk of coronary heart disease events, and HDL par- +ticles have properties that could provide protection against the +development of atherosclerosis [21–23]. Low levels of HDL +(<40 mg/dl) are not only an independent risk factor for CVD +[21] but are considered a higher risk factor than elevated levels +of LDL, mainly because HDL has important anti-atherogenic +effects like reverse cholesterol transport, inhibition of LDL oxi- +dation, and antiplatelet and anti-inflammatory actions [24]. +Supplementation of as little as 2 g of coconut oil (8 weeks) +increased HDL levels significantly without harmful effects on +LDL or TC [25]. Older studies have shown that lauric and myr- +istic acids increase HDL levels [26,27]. Green and Pittman pro- +posed that a lower rate of Cholesteryl ester transfer protein +(CETP)-mediated transfer of lauric or myristic acid–rich cho- +lesteryl esters from HDL compared to longer chain saturated +fatty acids results in this increase in HDL levels [28]. +However, increased HDL levels do not always ensure protec- +tion against atherosclerosis. It is not the level of HDL that +determines the innate ability for cholesterol efflux from macro- +phages [29]. Therefore, alternative markers have been proposed +to better reflect cardiovascular risk, such as the TC: HDL ratio +or TG: HDL or apolipoprotein ratios [30]. A recent review of +coconut oil studies points to this flaw; that is, in earlier research +the effect of coconut consumption on the ratio of TC or TG to +HDL was often not studied [31]. In the current study, there was +no significant change in the TG: HDL ratio in either group. +Therefore, it appears that daily consumption of 100 g of coco- +nut providing 16% as SFA does not have any deleterious effects +on plasma lipid profile. +The effect of dietary changes in fat intake are reflected well +in erythrocyte membrane fatty acid composition. Long-term fat +quality is best reflected in the fatty acid composition of adipose +tissue [32]. However, a number of studies confirm that erythro- +cytes fatty acid composition can serve as a reliable biomarker of +medium- to long-term dietary changes [33]. The results of the +current study show that daily consumption of coconut for 3 +months had no deleterious effect on erythrocyte fatty acid com- +position compared to consumption of groundnut. Though the +dietary intake of SFAs was 2.6 times higher in the coconut +group compared to the groundnut group (58 g vs 22 g; Table 2), +there was no change in the levels of major SFAs such as pal- +mitic (16:0) and stearic (18:0) acid. This is logical because SFA +composition is more an index of de novo lipogenesis, and it is +likely that increasing intakes of dietary SFAs could result in a +downregulation of de novo fatty acid synthesis [34]. However, +significant changes were seen in minor fatty acids in both +groups. In the coconut group, an increase was seen in minor +saturated fatty acids C14:0 and C24:0. In the groundnut group, +there was a decrease in C14:0 and a corresponding increase in +C22:0 and C24:0. +The differences in the intakes of MUFAs (18 g vs 41 g), +however, appear to be reflected in the erythrocytes because +there was a significant decrease in oleic acid (18:1 n-9) lev- +els at the end of the intervention period in the coconut +group. Although there were no changes in the total PUFA +content in both groups, it was interesting to note that the +levels of DGLA (20:3 n-6) were significantly increased in +the coconut group. DGLA is also a substrate for both cyclo- +oxygenase as well as lipoxygenase, leading to the formation +of the 1-series prostaglandins and the 3-series leukotrienes, +respectively [35]. These molecules have been shown to be +anti-inflammatory in nature and also play a role in reducing +risk of thrombosis [36]. Taken together, it appears that con- +sumption of high SFAs from coconut does not have any +deleterious effects on erythrocyte fatty acids. +Recently, there have been some questions raised about die- +tary recommendations to reduce SFA consumption. A meta- +analysis of prospective epidemiologic studies in 2010 shows +that there is a lack of significant evidence on SFA intake and +CVD/coronary heart disease risk [37]. The 2010 Joint World +Health Organization/Food and Agriculture Organization rec- +ommendations continue to reiterate the previous recommenda- +tion to reduce SFAs to less than 10% of total calories [6]. This +needs to be better understood in regard to coconut saturated +fats. Even long-term coconut oil studies confirm that there is +no change in lipid-related cardiovascular risk factors and events +after 2 years of coconut oil consumption [38]. A recent study +has also suggested that PUFA-rich oils such as soybean oil +might be more deleterious to metabolic health compared to +SFA-rich coconut oil [39]. The current study shows that con- +sumption of fresh coconut, which is commonly consumed as +part of the daily diet in many parts of India, does not have any +deleterious effects on blood lipids or erythrocyte fatty acids but +may have some beneficial effects such as increasing levels of the +anti-atherogenic HDL as well as the anti-inflammatory fatty +acid DGLA. +Recent advances in nutritional science now allow assessment +of critical questions about the health effects of SFAs. Our find- +ings contradict the perspective that dietary saturated fat per se +is harmful and emphasize the importance of considering the +source of dietary SFAs. This is one of the first studies on fresh +coconut that supports the beneficial effects of coconut. +Conclusion +Fresh coconut, though rich in SFAs in comparison to a combi- +nation of groundnut and groundnut oil when used over a +period of 90 days, had no significant deleterious effect on eryth- +rocyte fatty acid composition and did not deleteriously change +lipid-related cardiovascular risk factors. On the whole, this +study suggests that regular consumption of 100 g of coconut, +containing high levels of SFAs, does not have any harmful +effect on plasma lipids and erythrocyte fatty acid composition. +The results of this work have particular relevance in suggesting +that individuals wishing to use fresh coconut in their diets can +4 +R. S. NAGASHREE ET AL. +do so safely, but more studies need to be conducted with larger +sample sizes. +Acknowledgments +The authors thank the SVYASA project kitchen, especially the man- +ager and staff of the kitchen for working together to share the main +kitchen space and endless hours of tasty food preparation. In addition, +we are grateful for the efforts of student volunteers of SVYASA for +working toward study-related tasks. St. John’s Research Institute and +“Anveshana” molecular biology lab at SVYASA is gratefully acknowl- +edged for analyzing all of our samples. Lastly, the authors thank the +research participants for their time and dedication in making this +study possible. +References +1. Keys A, Mickelsen O, Miller E, Chapman C: The relation in man +between cholesterol levels in the diet and in the blood. Science 112 +(2899):79–81, 1950. +2. Keys A, Anderson JT, Grande F: Serum cholesterol response to +changes in the diet. Metabolism 14:776–787, 1965. +3. 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PLoS One 10: +e0132672, 2015. +JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION +5 diff --git a/subfolder_0/Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint A randomized control study.txt b/subfolder_0/Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint A randomized control study.txt new file mode 100644 index 0000000000000000000000000000000000000000..323d3515a9857901915ee2eea14bcff37a6b6253 --- /dev/null +++ b/subfolder_0/Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint A randomized control study.txt @@ -0,0 +1,384 @@ +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +1/9 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A +randomized control study +John Ebnezar, Raghuram Nagarathna, [...], and Hongasandra Ramarao Nagendra +Abstract +Aim: +This study was designed to evaluate the efficacy of addition of integrated yoga therapy to therapeutic exercises in osteoarthritis +(OA) of knee joints. +Materials and Methods: +This was a prospective randomized active control trial. A total of t participants with OA of knee joints between 35 and 80 years +(yoga, 59.56 ± 9.54 and control, 59.42 ± 10.66) from the outpatient department of Dr. John's Orthopedic Center, Bengaluru, +were randomly assigned to receive yoga or physiotherapy exercises after transcutaneous electrical stimulation and ultrasound +treatment of the affected knee joints. Both groups practiced supervised intervention (40 min per day) for 2 weeks (6 days per +week) with followup for 3 months. The module of integrated yoga consisted of shithilikaranavyayama (loosening and +strengthening), asanas, relaxation techniques, pranayama, meditation and didactic lectures on yama, niyama, jnana yoga, +bhakti yoga, and karma yoga for a healthy lifestyle change. The control group also had supervised physiotherapy exercises. A +total of 118 (yoga) and 117 (control) were available for final analysis. +Results: +Significant differences were observed within (P < 0.001, Wilcoxon's) and between groups (P < 0.001, Mann–Whitney U-test) on +all domains of the Short Form-36 (P < 0.004), with better results in the yoga group than in the control group, both at 15 day +and 90 day. +Conclusion: +An integrated approach of yoga therapy is better than therapeutic exercises as an adjunct to transcutaneous electrical stimulation +and ultrasound treatment in improving knee disability and quality of life in patients with OA knees. +Keywords: Knee disability, osteoarthritis, SF-36, yoga +INTRODUCTION +Osteoarthritis (OA) is the second most common rheumatological problem in India and has a prevalence rate of 22–39%.[1] It is +characterized primarily by articular cartilage degeneration and a secondary periarticular bone response.[2,3] Worldwide +prevalence rate of OA is 20% for men, 41% for women, and it causes pain or dysfunction in 20% of the elderly.[4] Relieving +pain stiffness and improving physical functions are the important goals of the present day therapy.[5,6] +The management of OA is still far from optimal, because the medications currently available provide limited symptomatic relief +and are fraught with a number of side-effect.[7] It is increasingly recognized that a key outcome measure for any health-care +intervention for OA is the change in health-related quality of life (QOL).[8,9] Although OA itself is not a life-threatening +disease, QOL can significantly deteriorate with pain and loss of mobility causing dependence and disability.[10] Health-related +QOL may be measured by disease-specific and generic health status questionnaires. Western Ontario and McMaster Universities +Osteoarthritis Index Score (WOMAC) is used to measure specific functional disability and SF-36 is used to measure general health +status that includes assessment of emotional functioning, energy level, and social functioning in addition to functional disability +th +th +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +2/9 +assessment. Aglamiş et al[11] Foley et al,[12] and Diracoglu et al.[13] observed greater increases in the SF-36 after the exercise +program of various durations for patients with OA knees. Kirkley et al.[14] showed that in patients assigned to arthroscopic +surgery, there was no improvement with health-related QOL. In a study by Tekur et al.[15] the role of yoga in the improvement +of QOL of patients with chronic low backache was discussed, and she showed that in the yoga group, there was significant +improvement in the scores of WHOQOL (WHO's Quality of life) brief on all domains. In a study by Sudheer et al.[16] about the +role of yoga about QOL in normal volunteers, 28% in physical, 16% in psychological, 10.17% in social, and 8.8% in the +environmental domain changed significantly after shifting to the control intervention in the second week. +There are no studies that have looked at disability and QOL measures in patients with OA knees after integrated yoga therapy +involving loosening, strengthening, asanas, etc. Hence, this study was planned with an aim to assess the effects of the integrated +approach of yoga therapy on QOL using a generic health-status tool involving SF-36 in patients with OA knee. +MATERIALS AND METHODS +A total of t patients with OA knees from the outpatient department of Dr John's Orthopedic Center, Bengaluru, were recruited +for the study. A sample size of 250 was obtained on G power software by fixing the alpha at 0.05 powered at 0.8 and an effect +size of 0.379 considering the mean and SD of an earlier study.[17] A total of t of both genders in the age group of 35–80 years +(59.56 ± 8.18) in the yoga group and (59.42 ± 10.66) control group with OA knees (one or both joints) satisfying theAmerican +College of Rheumatology (ACR) Guidelines[18] for diagnosis were included. The inclusion criteria were (i) persistent pain for 3 +months prior to recruitment, (ii) moderate-to-severe pain on walking, (iii) Kellegren and Lawrence[19] radiologic grading of II- +IV in X-rays taken within 6 months prior to entry, and (iv) those fully ambulant, literate, and willing to participate in the study. +Those with (i) grade I changes in -ray, (ii) acute knee pain, (iii) secondary osteoarthritis due to rheumatoid arthritis, gout, septic +arthritis, tuberculosis, tumor, trauma, or hemophilia, and (iv)those with major medical or psychiatric disorders were excluded. +The study was approved by the institutional review board (IRB) and ethical committee of SVYASA (Swami Vivekananda Yoga +Anusandhana Samsthana) University. Signed informed consent was obtained from all the participants. +Design +This was a prospective randomized parallel active control study on patients with OA knees in the age range of 35-80 years. +Patients attending the outpatient department of Dr John's Orthopedic Center who satisfied the inclusion criteria were recruited +for the study. After the initial screening for selection criteria, they were assigned to either the yoga group or control group. A +computer-generated random number table (www.randomization.com) was used for randomization. Numbered envelopes were used +to conceal the sequence until the intervention was assigned. Both groups were given the conventional physiotherapy using +transcutaneous electrical stimulation and ultrasound for 15 days. +Both groups had supervised practices at the center for 40 min daily (6 days/week) after physiotherapy (20 min) for 2 weeks. The +yoga classes were conducted in the basement of the hospital where one hall is exclusively dedicated for yoga therapy. The study +group was taught integrated yoga and the control group was taught the non-yogic physiotherapy exercises by certified therapists. +After this, they were asked to practice daily at home for the next 3 months. Compliance was supervised by telephone calls once +in 3 days and a weekly review was conducted once a week for 3 months. The daily review cards were checked for the regularity +and doubts if any were clarified. The evaluation was conducted by the senior research fellow. All patients were asked to tick the +practices daily after the home practice in the diary provided for the purpose; at every visit their clinical progress and therapy +received on the day were documented. All assessments were carried out on 1 , 15 , and 90 days. +Blinding and masking +As this was an interventional study, double blinding was not possible. The answer sheets of the questionnaires were coded and +analyzed only after the study was completed. Here, the statistician who did the randomization, data analysts, and the researcher +who carried out the assessments were blinded to the treatment status of the subjects. +st +th +th +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +3/9 +Intervention for the yoga group +The daily routine practiced at the center in the yoga group included 40 min of integrated yoga therapy practice after 20 min of +physiotherapy with transcutaneous electrical stimulation and ultrasound for 2 weeks [Table 1]. The integrated yoga therapy +practice included shithilikaranavyayamas (loosening practices), saktivikasaka (strengthening practices) followed by yogasanas +and relaxation techniques with devotional songs. Later patients were advised to continue the integrated yoga therapy practice for +40 min at home for the next 10 weeks. +Table 1 +Yoga module for osteoarthritis knees +The concept used to develop a specific module of an integrated approach of yoga therapy for knee pain was taken from the +traditional yoga scriptures (patanjali yoga sutras, yoga vasishtha, and upanishads) that highlight a holistic lifestyle for positive +health at physical, mental, emotional, and intellectual levels.[20] Yoga is defined as the mastery over the modifications of mind +(chittavrittinirodhah—definition of yoga by patanjali). It helps to remove the unnecessary surges of neuromuscular activation +resulting from heightened stress responses that may contribute to aging.[21] The daily routine included a 40 min practice as +follows: +Yogic sukshmavyayamas (loosening and strengthening practices): These are safe, rhythmic, repetitive stretching +movements synchronized with breathing. These practices mobilize the joints and strengthen the periarticular muscles. +Relaxation techniques: Three types of guided relaxation techniques were interspersed between the physical practices of +sukshmavyayamas and asanas. +Asanas (physical postures): Asanas are featured by effortless maintenance in the final posture by internal awareness. We +selected asanas in standing, supine and prone positions that would relax and strengthen the knee joints. +Pranayama: The practice of voluntary regulated breathing while the mind is directed to the flow of breath is called +Pranayama. These practices promote autonomic balance through mastery over the mind.[22] +Meditation: Patanjali defines meditation (dhyana) as effortless flow of a single thought like OM in the mind without +distractions (pratyayaekataanatadhyanam). This has been shown to offer physiological benefits through alertful rest to +the mind body complex.[23] +Lectures and counseling: Yogic concepts of health and disease, yama, niyama, bhakti yoga, Jnana yoga, and karma yoga were +presented in the theory classes. These sessions were aimed at understanding the need for lifestyle change, weight management, +and prevent early aging by yogic self-management of psychosocial stresses. +Intervention for the control group +The daily routine practiced at the center in the control group included 40 min of therapeutic exercises after 20 min of +physiotherapy with transcutaneous electrical stimulation and ultrasound for 2 weeks [Table 2]. These therapeutic exercises +included loosening and strengthening practices for all the joints of the upper and lower limbs, brief period of rest, specific knee +practices, and supine rest followed by light music. Later patient was advised to continue the therapeutic exercise practice of 40 +min at home for the next 12 weeks. +Table 2 +Control module for OA knees +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +4/9 +Outcome variables +Short Form 36) was used to assess QOL after the intervention in both groups on day 15 and 90. SF-36 is one of the popularly +used self-evaluation questionnaire for the assessment of general.[24] It contains 36 questions aimed at assessment of the +participant's health under eight major categories: physical functioning, role limitations due to physical health, role limitations +due to mental health, energy or fatigue, emotional well-being, social functioning, pain, and general health. The scores are then +averaged accordingly under those headings.[25] +The increase in scores indicates better for domains physical functioning, role of limitations in physical health, role of limitations +in emotional problems, social functioning, pain reduction, general health, and for domains fatigue and emotional well-being the +decrease in scores indicates better QOL. The internal consistency of the SF-36 Health Survey Questionnaire as determined by +Cronbachs was high and ranged from 0.72-0.94. +Statistical methods +The data were analyzed using SPSS Version 16. The baseline values of the two groups were checked for normal distribution by +Shapiro–Wilk's test. Baseline matching was checked by the Mann–Whitney test. Wilcoxon's signed ranks test and MannWhitney +U-test were used for assessing ‘within’ and ‘between’ groups differences, respectively. +Tables 1 and 2 show the interventions of both study and control groups. Table 3 shows the baseline characteristics which were +similar between groups on all variables (P > 0.05, Mann–Whitney test for pre values). +Table 3 +Demographic data +RESULTS +The trial profile of the study is shown in Figure 1. There were seven dropouts in the study group and eight in the control group. +Table 4 shows the results within the yoga group of 15 and 90 day. Table 5 shows the results within the control group of 15 +and 90 day, and Table 6 shows the results between the yoga and control groups. +Figure 1 +Trial profile of the study +Table 4 +Results of variations of several parameters in SF-36 before and after integrated yoga therapy +Table 5 +Results of variations of several parameters in SF-36 before and after therapeutic exercises +th +th +th +th +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +5/9 +Table 6 +Results of SF-36 variables between groups (yoga and control groups) +Quality of life +Between and within group differences were highly significant on all domains of the SF-36 (P < 0.001) with better improvement +in the yoga group than the control group on 15 day and 90 day. +Physical functioning +This measures all the physical activities including bathing or dressing. In the yoga group, the physical function (P < .001) +increased from 12.03 ± 9.94 to 39.32 ± 11.24 and further to 67.50 ± 9.09 and in the control group from 12.82 ± 10.81 to 24.95 +± 13.93 and further to 50.94 ± 14.76 on 15 day and 90 days, respectively. +Role limitation in physical health +This measures problems with work or other daily activities as a result of physical health. The role limitation in physical health +(P < 0.001) improved by increase of scores from 52.33 ± 29.59 to 86.44 ± 15.55 in the yoga group and 35.47 ± 36.14 to 58.33 +± 44.52 in the control group on the 15th and 90th days, respectively, with significantly better results in the yoga group than the +control group (P = 0.001, Mann–Whitney U test). +Role limitation due to emotional health +This evaluates problems with work or other daily activities due to physical and emotional problems. The role limitation due to +emotional health (P < 0.001) improved from 56.17 ± 22.93 to 86.41 ± 17.59 in the yoga group and from 31.02 ± 26.86 to +58.75 ± 38.94 in the control group on the 15th and 90th days, respectively, with significantly better results in the yoga group +than the control group (P = 0.001, Mann-Whitney U test). +Energy and fatigue level +These levels are evaluated by finding out whether a person feels tired and worn out or feels full of pep and energy all the time. +The energy and fatigue level improved in both groups (P <0.001, Wilcoxon's) with reduction of scores from 66.36 ± 5.66 to +50.10 ± 6.30 and further to 36.35 ± 6.08 in the yoga group and from 64.91 ± 5.41 to 58.97 ± 5.6 and to 53.20 ± 6.8 in the +control group on 15 and 90 days, respectively, with significantly better results in the yoga group than the control group (P = +0.001, Mann–Whitney U test). +Emotional well-being +This evaluates whether a person has problems or no problems with work or other daily activities as a result of emotional +problems. In the yoga group, the emotional well-being (P < 0.001, Wilcoxon's) improved with reduction in scores from 63.10 ± +7.17 to 48.88 ± 7.01 and to 34.33 ± 5.46 and in the control group from 62.46 ± 6.61 to 57.43 ± 5.78 to 52.27 ± 5.91 on the +15 and 90 days, respectively, with significantly better results in the yoga group than the control group (P = 0.001, Mann– +Whitney U test). +th +th +th +th +th +th +th +th +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +6/9 +Social functioning +This evaluates whether the social activities are limited due to physical and emotional problems. In the yoga group, the emotional +well-being (P <.001,Wilcoxon's) increased from 50.50 ± 6.82 to 57.83 ± 6.89 and to 64.04 ± 8.92 and in the control group from +51.92 ± 9.37 to (52.67 ± 9.40) and to 57.15 ± 10.42 on the 15 and 90 days, respectively, with significantly better results in +the yoga group than the control group (P = 0.001, Mann–Whitney test). +Pain +This measures the severity of pain that limits the activities. Well-being on scores of pain improved in both groups (P < 0.001, +Wilcoxon's) from 11.54 ± 11.55 to 47.88 ± 11.33 and to 73.77 ± 12.67 in the yoga group and in the control group from 11.68 +± 9.11 to 30.21 ± 9.09 and to 46.93 ± 11.22 on the 15 and 90 days, respectively, with significantly better results in the yoga +group than the control group (P = 0.001, Mann–Whitney test). +General health +This evaluates the personal health of the individual. The general health increased in both groups (P < 0.001). It increased from +36.91 ± 6.94 to 59.31 ± 12.24 to 77.47 ± 20.91 in the yoga group from 36.99 ± 11.08 to 48.75 ± 9.26 to 60.12 ± 12.57 in the +control group on the 15 and 90 days, respectively, with significantly better results in the yoga group than the control group (P += 0.001, Mann–Whitney U test). +DISCUSSION +This randomized two armed parallel control trial on 250 participants included patients of both genders (F = 175) in age 35–80 +years with osteoarthritis of knees. Results showed significantly better improvement in the yoga group than the control group on +all variables (P < 0.001, Mann–Whitney U test) of SF 36. +In a randomized controlled study on magnetic pulse treatment for knee osteoarthritis by Piptone et al. assessment of the patients +at week 6 revealed a statistically significant improvement in pain and disability of the WOMAC questionnaire (Western Ontario +and McMaster Universities) and EuroQol score (EuroQol or EQ-5D is a standardized measure of health status developed by the +EuroQol group in order to provide a simple, generic measure of health for clinical and economic appraisal) in the active +treatment group.[26] +Pain reduction +The reduction in pain observed in our study points to the beneficial effect of yoga as an add-on therapy to conventional +physiotherapy practices. +In pilot studies on OA knees involving yoga, Kolasinski et al.[27] Ranjita et al.[28] showed a better reduction of pain in the yoga +group than the control group. In our study, we added yoga after the standard physiotherapy and the degree of changes appears to +be similar in all the three yoga studies (37-47%). This may point to the efficacy of yoga when used with or without a session of +physiotherapy before the practice of yoga. +Similar effects of pain reduction ha been observed by Garfinkel et al.[29] in a randomized controlled trial on yoga for carpal +tunnel syndrome. Tekur et al.[15] studied the efficacy of the integrated approach of yoga therapy in patients with chronic low +back pain and documented 48.8% reduction in Numerical Rating Scale scores in the yoga group. Garfinkel et al.[30] studied the +effects of Iyengar yoga in patients with OA hands and found a better reduction in the pain during activity. Yogitha et al.[31] +showed a reduction in pain and tenderness in patients with common neck pain after integrated yoga. In a study by Aglamiş et al. +[11] there was a significant group differences in all domains of SF-36 (P < 0.004), while there were no group difference in +WOMAC domains (P > 0.004). Baker et al.[32] found increases in the SF-36 physical function, physical role, social and mental +health scores and physical performance scores and decreases in the WOMAC pain after a 4-month strength exercise program. +Foley et al.[12] stated that after a 6-week exercise program physical performance increased, the WOMAC score did not change, +th +th +th +th +th +th +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +7/9 +and the physical component of the SF-12 increased after hydrotherapy. Diracoglu et al.[13] observed increases in the SF-36 +physical function, physical role, and vitality scores and the WOMAC physical function scores and physical performance in a +kinesthetic group is greater than in a strength group after an 8 week exercise program. In a study by Kirkley et al.[14] in patients +assigned to arthroscopic surgery there was no improvement with respect to physical function, pain, or health-related than those +were assigned to the control group. In a study conducted at our center by Rangaji et al.[33] on the role of IAYT in the treatment +of osteoporosis, he showed that in the comparison between the groups, the exercise group showed a significant difference in +physical functioning component of SF-36 than the yoga group. +This study has revealed a statistically significant improvement in respect of all the domains of the SF 36 score with significantly +better improvements in the yoga and control groups. +Mechanisms +Several factors would have contributed to the beneficial effects observed in both groups in this study. As noted in several earlier +studies physiotherapy intervention may increase the blood glow. Better results in the yoga group could be due to its stress +reducing effect since yoga is meant to bring about better emotional stability. Yoga is defined as ‘samtvam yoga’ in +Bhagavadgita[34] which refers to ‘the balanced state of mind under any demanding life situation, be physical or psychological +(sheetaushnasukhaduhkheshusamah)’. This emotional stability is achieved by the multifactorial approach of yoga that includes +safe physical practices (asanas), breathing techniques (pranayama), meditation (dharana and dhyana), and introspective +corrections in one's cognitive errors by inputs at intellectual (jnana yoga) and emotional level (bhakti yoga).[35] This may have +contributed to better health behavior and improved QOL. +Strengths of the study +Good sample size, randomized control design, active supervised intervention for the control group for the same duration as the +experimental group and follow up for 3 months with good compliance (6% dropouts) are the strengths of this study. The result +of this study that has shown marked differences between groups on all variables offers strong evidence for incorporating this +module of IAYT for knees by the clinicians. +Suggestions for future work +A longer follow-up of ≥12 months is necessary to check for long-term efficacy and long-term acceptability. Studies using MRI +and biochemical variables may throw light on the mechanisms. +CONCLUSIONS +Adjunctive program of the integrated approach of yoga therapy for OA knees improves all components of QOL on SF36. IAYT +offers a good value addition as a nonpharmacological intervention in improving QOL in patients with OA knees. +Footnotes +Source of Support: Nil +Conflict of Interest: None declared +Article information +Int J Yoga. 2011 Jul-Dec; 4(2): 55–63. +doi: 10.4103/0973-6131.85486 +PMCID: PMC3193655 +John Ebnezar, Raghuram Nagarathna, Yogitha Bali, and Hongasandra Ramarao Nagendra +1 +1 +8/12/2014 +Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193655/ +8/9 +Department of Orthopaedics, Dr. John's Orthopaedic Centre, Karnataka, Bengaluru, India +Division of Life Sciences, Swami Vivekananda Yoga Research Foundation (SVYASA), Karnataka, Bengaluru, India +Address for correspondence: Dr. John Ebnezar, Department of Orthopaedics, Dr. John's Orthopaedic Centre, Bilekahalli, Bannerghatta Road, Bengaluru, +Karnataka, India. E-mail: johnebnezar@gmail.com +Copyright : © International Journal of Yoga +This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits +unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. +This article has been cited by other articles in PMC. +Articles from International Journal of Yoga are provided here courtesy of Medknow Publications +REFERENCES +1. Chopra A, Patil J, Bilampelly V, Relwani J, Tandle HS. Prevalence of rheumatic disease in rural population in Western India: A WHO-ILAR- +COPCORD study. J Assoc Physicians India. 2001;49:240–6. [PubMed] +2. Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am. 2004;42:1–9. [PubMed] +3. Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al. Osteoarthritis: New insights.Part 1: The disease and its risk +factors. 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Effect of yoga on pain, mobility, gait, and balance +in patients with osteoarthritis of the knee. +29. Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR., Jr Yoga-based intervention for carpal tunnel syndrome.A +randomized trial. JAMA. 1998;280:1601–3. [PubMed] +30. Garfinkel MS, Schumacher R, Husain A, Levy M, Reshetar RA. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. +J Rheumatol. 1994;21:2341–3. [PubMed] +31. Yogitha B, Nagarathna R, John E, Nagendra H. Complimentary effect of yogic sound resonance relaxation technique in patients with common +neck pain. Int J Yoga. 2010;3:18–25. [PMC free article] [PubMed] +32. Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults +with knee osteoarthritis: A randomized controlled trial. J Rheumatol. 2001;28:1655–65. [PubMed] +33. Rangaji . Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru. Karnataka: 2010. Role of IAYT in the treatment of osteoporosis. +34. Goyandaka J. 19th ed. Gorakhpur: Gita press publications; 2004. Srimadbhagavadgita tattvavivecani. +35. Nagendra HR, Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54-month prospective study. J Asthma. +1986;23:123–37. [PubMed] diff --git a/subfolder_0/Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycysti.txt b/subfolder_0/Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycysti.txt new file mode 100644 index 0000000000000000000000000000000000000000..ea9c1b92937415372317ee3f727aec1aaf43d7ac --- /dev/null +++ b/subfolder_0/Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycysti.txt @@ -0,0 +1,1111 @@ + + + +Journal of Alternative and Complementary Medicine: http://mc.manuscriptcentral.com/jaltcompmed + + + +THE EFFECTS OF A HOLISTIC YOGA PROGRAM ON +ENDOCRINE PARAMETERS IN ADOLESCENTS WITH +POLYCYSTIC OVARIAN SYNDROME: A RANDOMIZED +CONTROL TRIAL + + +Journal: Journal of Alternative and Complementary Medicine +Manuscript ID: JACM-2011-0868.R2 +Manuscript Type: Original Articles +Date Submitted by the Author: 25-Jan-2012 +Complete List of Authors: Ram, Nidhi; SVYASA, Divison of Yoga and Life Sciences +Venkatram, Padmalatha +Raghuram, Nagarathna; SVYASA, Divison of yoga and life sciences +Ram, Amritanshu; SVYASA, Divison of yoga and life sciences +Keywords: endocrinology, mind/body, Ob/Gyn, yoga +Abstract: +THE EFFECTS OF A HOLISTIC YOGA PROGRAM ON ENDOCRINE +PARAMETERS IN ADOLESCENTS WITH POLYCYSTIC OVARIAN SYNDROME: +A RANDOMIZED CONTROL TRIAL + + +Authors: Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R +ABSTRACT: +Objective: To compare the effects of a holistic yoga program with the +conventional exercise program in adolescent Polycystic Ovarian Syndrome +(PCOS). +Design: Prospective randomized active control trial +Setting: Ninety adolescent (15-18years) girls from a residential college in +Andhra Pradesh, who satisfied the Rotterdam criteria were randomized into +two groups. +Intervention: The yoga group practiced a holistic yoga module while the +control group practiced a matching set of physical exercises (1 hour/day, +for 12 weeks). +Outcome Measure: Anti-Mullerian Hormone (AMH-primary outcome), LH, +FSH, testosterone, prolactin, Body Mass Index (BMI), hirsutism and +menstrual frequency were measured at inclusion and after 12 weeks. +Results: Mann-Whitney test on difference score shows that changes in AMH +(Y= - 2.51, C= - 0.49, p=0.006), LH and LH/FSH ratio (LH: Y= - 4.09, +C=3.00, p=0.005; LH/FSH: Y= - 1.17, C= 0.49, p= 0.015) were +significantly different between the two intervention groups. Also changes in +testosterone (Y= - 6.01, C= 2.61, p=0.014) and mFG score (Y= -1.14, C= ++0.06, p=0.002) were significantly different between the two groups. On +the other hand, changes in FSH and prolactin post intervention were non- +significantly different between the two groups. Also, body weight and BMI +Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, NY 10801 +Journal of Alternative and Complementary Medicine +showed non-significantly different changes between the two groups while +changes in menstrual frequency were significantly different between the +two groups (Y=0.89, C= 0.49, p=0.049). +Conclusion: Holistic yoga program for 12 weeks is significantly better than +physical exercise in reducing AMH, LH and Testosterone, mFG score for +hirsutism and improving menstrual frequency with non significant changes +in body weight, FSH and prolactin in adolescent PCOS. +Clinical Trial Registration: REFCTRI-2008 000291 +Key Words: adolescent PCOS, AMH, endocrine parameters, yoga + + + +Page 1 of 24 +Mary Ann Liebert Inc., 140 Huguenot Street, New Rochelle, NY 10801 +Journal of Alternative and Complementary Medicine +1 +2 +3 +4 +5 +6 +7 +8 +9 +10 +11 +12 +13 +14 +15 +16 +17 +18 +19 +20 +21 +22 +23 +24 +25 +26 +27 +28 +29 +30 +31 +32 +33 +34 +35 +36 +37 +38 +39 +40 +41 +42 +43 +44 +45 +46 +47 +48 +49 +50 +51 +52 +53 +54 +55 +56 +57 +58 +59 +60 +Original Article +Effects of a Holistic Yoga Program on Endocrine Parameters +in Adolescents with Polycystic Ovarian Syndrome: +A Randomized Controlled Trial +Ram Nidhi, MSc, Venkatram Padmalatha, MBBS, Raghuram Nagarathna, MBBS, MD, +and Ram Amritanshu, MSc +Abstract +Objectives: The objectives of this trial were to compare the effects of a holistic yoga program with the con- +ventional exercise program in adolescent polycystic ovarian syndrome (PCOS). +Design: This was a prospective, randomized, active controlled trial. +Setting: Ninety (90) adolescent (15–18 years) girls from a residential college in Andhra Pradesh who satisfied the +Rotterdam criteria were randomized into two groups. +Intervention: The yoga group practiced a holistic yoga module, while the control group practiced a matching set +of physical exercises (1 hour/day, for 12 weeks). +Outcome measures: Anti-mu +¨ llerian hormone (AMH-primary outcome), luteinizing hormone (LH), follicle- +stimulating hormone (FSH), testosterone, prolactin, body–mass index (BMI), hirsutism, and menstrual frequency +were measured at inclusion and after 12 weeks. +Results: Mann-Whitney test on difference score shows that changes in AMH (Y = - 2.51, C = - 0.49, p = 0.006), +LH, and LH/FSH ratio (LH: Y = - 4.09, C = 3.00, p = 0.005; LH/FSH: Y = - 1.17, C = 0.49, p = 0.015) were signifi- +cantly different between the two intervention groups. Also, changes in testosterone (Y = - 6.01, C = 2.61, p = 0.014) +and Modified Ferriman and Gallway (mFG) score (Y = - 1.14, C = + 0.06, p = 0.002) were significantly different +between the two groups. On the other hand, changes in FSH and prolactin postintervention were nonsignifi- +cantly different between the two groups. Also, body weight and BMI showed nonsignificantly different changes +between the two groups, while changes in menstrual frequency were significantly different between the two +groups (Y = 0.89, C = 0.49, p = 0.049). +Conclusions: A holistic yoga program for 12 weeks is significantly better than physical exercise in reducing +AMH, LH, and testosterone, mFG score for hirsutism, and improving menstrual frequency with nonsignificant +changes in body weight, FSH, and prolactin in adolescent PCOS. +Introduction +P +olycystic ovarian syndrome (PCOS) is a highly prev- +alent female endocrine disorder with estimates ranging +from 2.2% to as high as 26%,1,2 depending on the diagnostic +criteria used and the ethnicity of the population studied. In a +recent survey, a 9.13% prevalence of PCOS was found in south +Indian adolescent girls.3 +In recent years, excessive production of anti-mu +¨llerian +hormone (AMH) has been implicated in the etiology of +PCOS. AMH is emerging as a diagnostic and screening tool +for PCOS.4 Several studies have shown highly increased +AMH levels in the serum, granulosa cells (75 times higher),5 +and the follicular fluid of women with PCOS.5,6 AMH, a local +inhibitor +of +follicle-stimulating +hormone +(FSH) +action,7 +shows positive correlation with luteinizing hormone (LH)8 +and negative correlation with FSH.8–10 Dysregulation of +AMH function due to aberrant sensitivity to FSH leads to +accumulation of small antral follicles and failed ovulation +trigger. There is a positive correlation between AMH and +follicle number.6,9,11,12 Serum AMH levels correlate posi- +tively with androgen levels in PCOS.7 There are no effective +therapies for PCOS, although metformin and weight reduc- +tion have shown some benefits.13 Two (2) studies observed a +small reduction in AMH levels after prolonged treatment +with metformin.4,14 Of nonconventional therapies, one study +Svyasa University, Division of Yoga and Life Sciences, Bangalore, India. +THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE +Volume 18, Number 00, 2012, pp. 1–8 +ª Mary Ann Liebert, Inc. +DOI: 10.1089/acm.2011.0868 +1 +ACM-2011-0868-ver9-Nidhi_1P +Type: research-article +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 1 +on obese women with PCOS showed no change in AMH +levels after a 20-week-long weight loss program, although +there was improvement in reproductive function.15 +There are studies suggesting that chronic stimulation of +sympathetic activity, a result of stressful lifestyle, can induce +dysregulation of the hypothalamus–pituitary–ovarian axis +(HPO axis) in women with PCOS.16 This points to the need +for stress management–based lifestyle changes that reduce +sympathetic tone and influence the HPO axis. +Yogic lifestyle, a form of holistic mind–body medicine +developed thousands of years ago, is known to reduce +stress17 and sympathetic tone.18 Hence, it is hypothesized +that a holistic yoga program would be more effective in re- +ducing the AMH levels apart from improving all other +manifestations of PCOS in comparison to a conventional +exercise program. +There is a lack of randomized controlled trials analyzing the +efficacy of lifestyle intervention in PCOS, and to date there is +no published study on yoga in PCOS. Yogic lifestyle change +may contribute to a reduction/normalization of sympathetic +nervous system/hypothalamo-pituitary axis (HPA) activation +and therefore have beneficial effects on the endocrine system +in PCOS. Many women with PCOS show psychologic +distress, which may aggravate hormonal disturbances via +chronic SNS and/or HPA-axis activation. Thus, the present +study was designed to investigate the effect of yoga on AMH, +other endocrine measures, and clinical parameters in adoles- +cent PCOS in comparison to the physical exercise program. +Materials and Methods +Participants +The study was carried out on adolescent girls aged 15 to 18 +years from a residential college in Anantapur, Andhra +Pradesh, India. Those who satisfied the Rotterdam criterion +(two thirds of the features) for PCOS were included in the +study. The following were the definitions of the three features. + Oligo/amenorrhea: absence of menstruation for 45 days +or more and/or less than eight menses per year.19 + Clinical hyperandrogenism: Modified Ferriman and +Gallway (mFG) score of 6 or higher.1 Biochemical +hyperandrogenism: Serum testosterone level of > 82 ng/ +dL in the absence of other causes of hyperandrogenism. + Polycystic ovaries: presence of > 10 cysts, 2–8 mm in +diameter, usually combined with increased ovarian +volume of > 10 cm3, and an echo-dense stroma in pelvic +ultrasound scan.20 +Exclusion +criteria +were +use +of +oral +contraceptives/ +hormone treatment/insulin-sensitizing agents within the +previous 6 weeks, smoking, hyperprolactinemia, thyroid +abnormalities, nonclassic adrenal hyperplasia, prior experi- +ence of yoga, and those who did not consent for the study. +The study was approved by the Institutional Ethical Com- +mittee of Swami Vivekananda Yoga Anusandhana Samsthana +(SVYASA) University. Signed informed consent was obtained +from the college authorities, the student, and one of the parents. +Outcome measures +We have used AMH as the primary outcome measure since +it is emerging as the most sensitive diagnostic and screening +tool for PCOS.4 The secondary outcome measures were chan- +ges in LH, FSH, testosterone, prolactin, mFG score, body–mass +index (BMI), and menstrual frequency between the groups. +Power calculation +Effect size of 0.61 was obtained by using the postintervention +mean difference between the two groups divided by the corre- +sponding pooled standard deviation for testosterone from the +study by Tang et al. on obese PCOS women that compared +6 months of metformin and lifestyle modification with a +placebo.21 A sample size of 86 with 43 subjects in each arm was +calculated keeping this effect size of 0.61, with type1 error at 0.05 +and power at 0.8. The actual recruitment was extended to 90. +Design +This was a prospective, randomized, active interventional +controlled trial in which 90 participants were randomly di- +vided into two study arms: one arm practiced yoga and the +other arm practiced conventional physical exercises for the +same duration. +Methods +All women students of standard 11 and 12 attended an +interactive introductory lecture where the purpose and de- +sign of the study were elucidated. They were asked to report +1 week later after obtaining the signed consent from their +parents. After obtaining the written consent, a clinical ex- +amination was performed. All girls with oligomenorrhea +and/or hirsutism (as per the abovementioned definitions) +were asked to come for an ultrasound scan and blood tests. +Those who satisfied the Rotterdam criteria for PCOS were +then randomly assigned to two groups by a statistician using +a computer-generated random number table by the pre- +labeled sealed-envelope method. On the basis of a random +number table, participants were assigned to two interven- +tions. Anthropometric measurements (BMI, waist and hip +circumference), endocrine parameters, details of menstrual +frequency, diet pattern, and stress history were documented. +Two (2) different halls in the college premises were allot- +ted for yoga and control group practices. Both groups +practiced their respective set of practices, 1 hour daily, 7 days +a week for 12 weeks (total 90 sessions), under the supervision +of trained instructors. The daily routine in the class consisted +of lecture (5 minutes) followed by physical practices (40 +minutes), pranayama (5 minutes), and relaxation (10minutes). +The instructors maintained the register of daily attendance +and the reason for absence, if any, for both of the groups. +Blinding and masking +Double blinding was not possible as this was an inter- +ventional study. The medical officer, ultrasonologist, and the +laboratory staff were blind to the groups. Also, the statisti- +cian who did the randomization and the final analysis was +blind to the source of the data. +Assessments +Abdominal ultrasound scanning of the pelvis with special +attention to the ovaries was carried out by a certified post- +graduate medical ultrasonologist using a Philips HD 11XE +ultrasound system. Vaginal ultrasound scanning was not +acceptable to the girls or the parents. +2 +NIDHI ET AL. +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 2 +A fasting sample of venous blood (10 mL) was drawn in the +morning (6:00 am–8:00 am) at the hostel premises. The samples +were packed in ice (3–4C) and transported to the laboratory +within 6 hours. Serum was separated by centrifugation and +stored at - 20C until it was analyzed at certified laboratories. +Hormone estimates including total testosterone, LH, FSH, +and prolactin were done by fully automated bidirectionally +interfaced chemiluminescent immunoassay. Thyroid-stimu- +lating hormone was measured by ultrasensitive sandwich +chemiluminescent immunoassay. Serum AMH levels were +assessed by using a second-generation enzyme immunoas- +say (AMH-EIA kit; Immunotech, a Beckman Coulter Com- +pany, +Marseilles, +France). +The +intra- +and +interassay +coefficients of variation were 5.1% and 6.6%, respectively for +AMH, 3.8% and 4.3% for FSH, 4.9% and 6.5% for LH, and +4.0% and 5.6% for testosterone. +Intervention +The specific modules of intervention were developed by a +team of experts that included a physiatrist, a gynecologist, +and yoga therapy physician. Care was taken to match the +lectures, practical classes, and the type of relaxation tech- +nique used in the two modules. +Yoga intervention +The concepts for the intervention were taken from tradi- +tional yoga scriptures (Patanjali yoga sutras, Upanishads, and +Yoga Vasishtha) that highlight a holistic approach to health +management at physical, mental, emotional and intellectual +levels.22 The practices consisted of asanas (yoga postures), +pranayama, relaxation techniques, meditation, and lectures on +yogic lifestyle and stress management through yogic coun- +seling. The details of the protocol are given in Table 1. All +girls received at least one session (about one hour each) of +individualized counseling that was aimed at cognitive re- +structuring based on yoga philosophy. +Control intervention +Table 1 shows the hour-long module of practices for the +control group that consisted of a set of physical movements, +nonyogic safe breathing exercises, followed by supine rest +(without instructions) that were matched with the yoga +module. One (1) individualized counseling session was en- +sured for each student in the control group also. Care was +taken by the counselors not to introduce any of the yogic +concepts during these sessions. +Data analysis +All statistical analyses were performed using SPSS version +17.0. The Kolmogorov–Smirnov test was used to check for +normal distribution. Because the hypothesis was to compare +the changes after yoga with that of exercise and the data were +not normally distributed, nonparametric analysis was done by +using the Mann-Whitney U test to compare difference scores (D +Table 1. Matched Practices Between Yoga and Control Groups +Yoga group +Time +Control group +Time +Group lecture +8 min +Group Lecture +15 min +Lectures, in the form of cognitive restructuring +based on the spiritual philosophy +underlying yogic concepts. +Lectures on conventional modern +medical concepts about a healthy +lifestyle including diet, exercise. +Surya Namaskara (Sun Salutation) +10 min +Brisk walk +15 min +Prone asanas +Prone exercises +Cobra pose (Bhujangasana) +1 min +Prone head lift +1 min +Locust pose (Salabhasana) +1 min +Prone leg rising +1 min +Bow pose (Dhanurasana) +1 min +Tiger leg stretch +1min +Standing asanas +Standing exercises +Triangle pose (Trikonasana) +1 min +Spread-leg side bending +1 min +Twisted angle pose (Parsva-konasana) +1 min +Spread-leg twisted bending +1 min +Spread-leg intense stretch (Prasarita padottanasana) +1 min +Spread-leg forward bend +1 min +Supine asanas +Supine exercises +Inverted pose (Viparita Karni) +1 min +Straight-leg raising +1 min +Shoulder stand (Sarvangasana) +1 min +Straight-leg supine twist +1 min +Plough pose (Halasana) +1 min +Cycling (clockwise–counterclockwise) +bended-knee crunches +1 min +Sitting asanas +Sitting exercises +Sitting forward stretch (Paschimottanasana) +1 min +Spread-leg forward bend +1 min +Fixed-angle pose (Baddha-konasana) +1 min +Spread-leg alternate-toe touching +1 min +Garland pose (Malasana) +1 min +Squat pose +1 min +Guided relaxation (Savasana) +10 min +Supine rest +10 min +Breathing techniques (Pranayama) +Normal breathing +8 min +Sectional breathing (Vibhagiya-Pranayama) +4 min +Forceful exhalation (Kapala Bhati) +2 min +Right-nostril breathing (Suryanuloma Viloma) +2 min +Alternate-nostril breathing (Nadi suddhi) +2 min +OM meditation (OM Dhyana) +10 min +YOGA EFFECTS ON ENDOCRINE PARAMETERS IN ADOLESCENT PCOS +3 +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 3 +change) between the two groups wherein difference score was +calculated by subtracting pre from post values for each variable. +Results +Figure 1 describes the trial profile. The recruitment was +carried out between December 2009 and January 2011. Of 986 +girls who agreed to clinical examination, 154 girls with oligo- +menorrhea and/or hirsutism (as per the abovementioned +definitions) were asked to come for ultrasound and biochem- +ical investigations. After the laboratory evaluations, 90 girls +who satisfied Rotterdam criteria of PCOS were randomized +into two groups. Of these, there were a total of 18 dropouts: 8 in +the yoga group and 10 in the control group because of less than +75% attendance. The reasons (not confirmed) given for with- +drawal were (1) sick leave and (2) unexpected events in the +family. The final analysis was done on 72 participants: 37 in the +yoga group and 35 in the control group. +Table 2 shows the demographic data. Of the 90 girls re- +cruited, 82.2% (74/90) were of normal weight (BMI = 18.5–23) +and only 17.78% (16/90) were overweight (BMI > 23), 31.11% +(28/90) had mFG score ‡ 6, and 34.44% (31/90) girls had LH/ +FSH ‡ 2. Maximum 66.67% (60/90) numbers of the girls had +their menstrual cycle length between 60 and 90 days. Only +45.56% (41/90) of the girls complained about the presence of +acne, while 54.44% (49/90) of the girls had no acne. +The baseline values were not significantly different be- +tween the yoga and control groups for all the variables in- +cluding age, BMI, menstrual frequency, serum FSH, serum +LH, LH/FSH ratio, serum prolactin, total testosterone, and +serum AMH (Table 2). +Mann-Whitney test on difference score shows that changes +in AMH were significantly different between the two inter- +vention groups (Y = - 2.51, C = - 0.49, p = 0.006). Similarly, +changes in LH and LH/FSH ratio were also significantly +different between the yoga and control groups (LH: Y = - 4.09, +C = 3.00, p = 0.005; LH/FSH: Y = - 1.17, C = 0.49, p = 0.015). +Also, changes in testosterone were significantly different be- +tween the two groups (Y = - 6.01, C = 2.61, p = 0.014). On the +other hand, changes in FSH and prolactin after the 3 months +of intervention were nonsignificantly different between the +two groups (FSH: p = 0.474, prolactin: p = 0.982) (Table 3). +The changes in the means between the groups were sig- +nificantly different (Y = - 1.14, C = + 0.06, p = 0.002) for mFG +score. Both body weight and BMI showed nonsignificantly +different changes between the two groups (weight: p = 0.882, +BMI: p = 0.910). Changes in menstrual frequency were sig- +nificantly +different +between +the +two +groups +(Y = 0.89, +C = 0.49, p = 0.049). +Discussion +This is the first randomized controlled trial comparing the +effect of a holistic yoga program with physical exercise on +adolescent PCOS, and to the authors’ knowledge this is the +first study proving the efficacy of a holistic therapy on en- +docrine parameters and menstrual frequency independent of +weight loss, within a short duration of 12 weeks. +The baseline mean AMH (6.01 ng/mL) in our population +was comparable to earlier observations that ranged from 3.3 +to 15.3 ng/mL15,23 in normal weight and obese adult PCOS. +As this is the first study of AMH in adolescent PCOS, more +studies in different races and age groups may help in de- +fining the cutoff values for the diagnosis of PCOS. +After 3 months of intervention, there was better reduction +( p = 0.006) in AMH levels after yoga (mean change 2.51) than +physical exercise (0.49). A well-designed randomized con- +trolled trial by Carlsen et al.23 on 50 women with PCOS +undergoing 26 weeks of diet, lifestyle, metformin, and an- +drogen suppression by dexamethasone showed no signifi- +cant change in AMH levels and on the contrary observed an +anomalous increase in AMH levels (12.6 ng/mL to 14.1 ng/ +mL) in the group who were given dexamethasone. Thus, a +decrease in AMH after yoga, a nonsignificant change after a +20-week weight-reduction program,15 and an increase after +dexamethasone therapy23 is noteworthy. Thus, it is interest- +ing to note that yoga therapy seems to offer better changes in +AMH than physical exercises or dexamethasone within a +short duration (3 months) which is similar to the effect with +metformin (6 months). +FIG. 1. +Trial profile. +4 +NIDHI ET AL. +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 4 +The baseline mean value for LH (9.7 mIU/mL) and FSH +(5.8 mIU/mL) in the current study’s population was lower +than a similar adolescent population of girls with PCOS from +Italy by De Leo et al.24 These differences between the study +groups could be due to ethnicity, BMI, and/or the timing of +hormonal assessment in relation to the menstrual cycle. +After 3 months of intervention, the current study showed +reduction in LH (actual mean change: Y = - 4.09, C = 3.00, +p = 0.005) and LH/FSH ratio (actual mean change: LH/FSH: +Y = - 1.17, C = 0.49, p = 0.015). This is similar to De Leo’s +study24 on the effect of metformin for 6 months in obese +teenage girls with PCOS. Although there was noteworthy +change after yoga, it is difficult to arrive at a conclusion with +certainty because of nonuniformity in the timing of hormonal +assessment in the current study’s population. +The results of increased menstrual frequency noted in both +yoga and control groups in the current study were compa- +rable to that reported by Tang et al. in their 6 months’ trial +through metformin and lifestyle modification.21 +The mFG score to define clinical hyperandrogenism is +variable, ranging from 3 to 8. On the basis of a South Asian +study by Chen et al.,1 the current study used a score of 6 as +the upper normal limit. Accordingly, only a small proportion +(31.11 %) of girls had hirsutism. The reduction in mFG scores +in the yoga group was similar to the observation by Ganie +et al. after 12 weeks of metformin therapy in 82 adolescent +and young women with PCOS.25 +Although it is known that a high androgen level is one of +the characteristic features in women with PCOS, the baseline +testosterone value in the current study group was well +within the normal range ( < 82 ng/dL). Since none of the girls +in this study had high testosterone levels, there was no need +to perform a 17-OHP test (to exclude the possibility of con- +genital adrenal hypertrophy) before inclusion in the study. +Wabitsch et al. observed much higher values (102.8 ng/dL) +of testosterone than those in the current group, which could +be due to higher BMI of girls in their study.26 Although the +baseline value of testosterone was well within the normal +range in the present study’s population, unlike many earlier +studies, a further decrease in its level after yogic intervention +may explain the significant reduction in mFG scores. +The possible mechanisms of action of yoga to explain the +above results are discussed below. +In the current study’s control group, the reduction ob- +served in FSH, prolactin, and AMH with improvement in +menstrual frequency adds evidence to the clinical benefits of +conventional exercises and lifestyle change, which is similar +to what has been observed in earlier studies.15 Thomson et al. +also observed that AMH expression may not be related to +weight reduction, although there were clinical benefits +traceable to weight reduction. The result of the current study +also seems to point to a similar conclusion, as a significant +reduction in AMH was found, although 82% of the girls were +in normal weight range and showed a nonsignificant change +in weight after the intervention in both groups. +The other factor that may influence the AMH levels seems +to be the serum androgen levels. Eldar-Geva et al. observed +that AMH is more elevated in hyperandrogenic compared +with normoandrogenic women with PCO despite compara- +ble numbers of small follicles.27 Thus, the yoga’s effect on +AMH may be related to the reduction in the androgen levels +in the girls in the current study. +Several studies have shown that women with PCOS +suffer with anxiety28 and depression.29 The beneficial effects +of yoga on stress-related disturbances are seen in anxiety.30 +Cortisol levels are positively associated with stress and +anxiety.31 Yoga has also been shown to reduce cortisol +levels both in health32 and disease33 pointing to its effect on +the HPA axis. Furthermore, the increase in AMH after +dexamethasone observed by Carlsen et al. may point to the +relation between high cortisol levels, AMH, and HPA +axis.23 +Thus, it appears that the beneficial effects of yoga in PCOS +could be mediated through both HPA and HPO axes based +on the observation that chronic stimulation of sympathetic +activity (HPA axis) can induce dysregulation of the HPO +axis in PCOS.16 There are some studies on other non- +pharmacologic therapies like acupuncture that have shown +beneficial effects on HPO axis. Electro-acupuncture restored +regular ovulation with reduction in LH/FSH ratio in more +than one third of anovulatory PCOS women.34 +Table 2. Demographics of 90 Girls Recruited +Variables +Yoga group +(n = 45) +mean (SD) +Control group +(n = 45) +mean (SD) +Age, years +16.22 (1.13) +16.22 (0.93) +Height, m +1.54 (0.06) +1.56 (0.05) +Weight, kg +48.42 (6.80) +50.99 (7.25) +BMI, kg/m2 +20.36 (2.06) +21.10 (2.98) +No. of girls with +BMI < 23a +39 (86.7%) +35 (77.8%) +No. of girls with +BMI ‡ 23a +6 (13.3%) +10 (22.2%) +mFG Score +4.60 (2.02) +4.20 (2.13) +No. of girls with +mFG score < 6a +30 (66.7%) +32 (71.1%) +No. of girls with +mFG score ‡ 6a +15 (33.3%) +13 (28.9%) +FSH, mIU/mL +5.70 (1.91) +5.80 (2.43) +LH, mIU/mL +11.19 (8.11) +8.29 (6.30) +LH/FSH ratio +2.45 (4.27) +1.46 (0.87) +No. of girls with +LH/FSH ‡ 2a +21 (46.7%) +10 (22.2%) +No. of girls with +LH/FSH < 2a +24 (53.3%) +35 (77.8%) +Prolactin, mg/mL +9.76 (3.37) +9.63 (3.92) +Total testosterone, ng/dL +39.11 (21.58) +32.43 (18.18) +AMH, ng/mL +6.45 (3.91) +5.57 (2.79) +Menstrual frequency +in months +1.41 (0.84) +1.47 (0.87) +No. of girls with cycle +length of 45–60 daysa +9 (20%) +10 (22.2%) +No. of girls with cycle +length of 60–90 daysa +31 (68.9%) +29 (64.4%) +No. of girls with cycle +length of > 90 daysa +5 (11.1%) +6 (13.3%) +No. of girls with +presence of acnea +16 (35.6%) +25 (55.6%) +No. of girls with +absence of acnea +29 (64.4%) +20 (44.4%) +aVariables = frequency (% values) are reported. +SD, standard deviation; BMI, body–mass index; mFG, Modified +Ferriman and Gallway; FSH, follicle-stimulating hormone; LH, +luteinizing hormone; AMH, anti-mu +¨llerian hormone. +YOGA EFFECTS ON ENDOCRINE PARAMETERS IN ADOLESCENT PCOS +5 +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 5 +This study was on a captive adolescent population with a +highly selective age group, which raises the question of +generalizability of the conclusions of this study. +It could be speculated that a third arm in the randomized +controlled trial with a pure control group may have been +more informative. However, a study by Vigorito et al. on +exercise intervention in young females with PCOS that used +a pure control group (with no medications throughout the +study) had shown nonsignificant changes in weight, BMI, +and endocrine measures.35 Also, another study by Piltonen +et al.4 studying females with PCOS in six different age +range groups concluded that serum AMH levels are two- to +threefold higher in women with PCOS than in normal +women in all age groups (between 25 and 35 years). +Therefore, it is theorized that the addition of a pure control +group may not have added value to the conclusions of this +study. +Other limitations of the study were that LH and FSH +measurements were not carried out at the same phase of the +menstrual cycle and that cortisol levels were not measured. +The present study provides the scientific evidence for the +treatment of PCOS through yogic lifestyle modification that +may have an effect on HPO and HPA axes. Yoga not only +addresses the problems of PCOS but also is likely to prevent +the long-term sequelae such as cardiovascular disease, dia- +betes, and so on. Furthermore, yoga as a self-corrective +therapy is potentially more cost-effective and enduring. +Hence, the authors recommend yoga as both a primary +intervention and/or as adjunct to standard medical care. +This study in Asian population points to some unusual +racial differences (normal baseline values for testosterone +and BMI) that need to be confirmed by further studies. +Studies in other cultures using yoga from other schools +may throw light on the benefits of this nonpharmacologic +modality of management of PCOS. Future studies may be +designed to include longer duration of follow-up to observe +the changes in ovarian volume and follicular size. Also, fu- +ture studies may include objective and subjective measures +of stress that may help in understanding the mechanisms. +Conclusions +Twelve (12) weeks of a holistic yoga program in adoles- +cent PCOS is significantly better than a physical exercise +program in decreasing AMH, LH, testosterone, and mFG +scores and increasing menstrual frequency, with no change +in body weight, FSH, or prolactin. +Acknowledgments +We are thankful to the Central Council for Research in +Yoga and Naturopathy (C.C.R.Y.N.), Ministry of Health, +Government of India, New Delhi for funding this project. We +would like to place on record our gratitude for the support +provided by the Vice Chancellor, SVYASA University. We +gratefully acknowledge the cooperation of the staff and ad- +ministration of Sri Sai College in recruiting the students and +carrying out the study. We are also grateful to Dr. S. Jonna, +Director of Satyam Diagnostic Labs for his assistance with +ultrasound; Dr Sheela Kashi, Director, Suhruda Laboratory, +directors of Thyrocare Laboratories and Religare Labora- +tories for their assistance with blood assays. We thank many +others involved in the interviews, database construction, and +data entry. We extend our gratitude to Dr. Ravi Kulkarni for +his help in the statistical analysis. We are thankful to all the +yoga teachers, and the physical trainers who conducted the +classes for this project and the girls for their cooperation +during the study. Clinical Trial Registration: REFCTRI-2008 +000291. +Table 3. Comparison of Change Scores Between Groups After the Intervention +Variables +Groups +Pre mean – SD +Post mean – SD +Diff score mean – SD +Change score Mann-Whitney +Wt (kg) +Y +48.24 – 6.53 +48.28 – 6.75 +0.04 – 1.34 +0.882 +C +51.83 – 7.66 +52.62 – 6.97 +0.79 – 4.13 +BMI (kg/m2) +Y +20.39 – 2.00 +20.41 – 2.07 +0.02 – 0.56 +0.910 +C +21.39 – 3.20 +21.70 – 2.88 +0.32 – 1.75 +mFG score +Y +4.51 – 2.12 +3.38 – 1.80 +1.14 – 1.44 +0.002* +C +4.03 – 2.23 +4.09 – 2.06 +0.06 – 1.51 +FSH (mIU/mL) +Y +5.97 – 1.87 +5.58 – 1.90 +0.40 – 2.27 +0.474 +C +5.76 – 2.50 +5.45 – 1.73 +0.31 – 2.70 +LH (mIU/mL) +Y +11.94 – 8.32 +7.84 – 6.13 +4.09 – 9.99 +0.005* +C +7.26 – 5.18 +10.26 – 8.66 +3.00 – 7.48 +LH/FSH ratio +Y +2.59 – 4.67 +1.42 – 0.91 +1.17 – 4.83 +0.015** +C +1.33 – 0.82 +1.82 – 1.35 +0.49 – 1.15 +Prl (mg/mL) +Y +9.61 – 3.29 +8.73 – 5.08 +0.88 – 5.07 +0.982 +C +10.00 – 4.19 +8.35 – 4.49 +1.64 – 4.67 +TT (ng/dL) +Y +39.55 – 21.40 +33.55 – 19.93 +6.01 – 15.88 +0.014** +C +29.48 – 15.27 +32.09 – 16.46 +2.61 – 13.14 +AMH (ng/mL) +Y +6.25 – 3.79 +3.73 – 2.25 +2.51 – 2.92 +0.006* +C +4.79 – 2.33 +4.30 – 2.88 +0.49 – 2.20 +Mens freq +Y +1.49 – 0.87 +2.38 – 0.64 +0.89 – 0.66 +0.049** +C +1.49 – 0.89 +1.97 – 0.79 +0.49 – 0.98 +Y, yoga (n = 37); C, control (n = 35); Wt, weight; BMI, body–mass index; mFG, Modified Ferriman Gallway Score; FSH, follicle-stimulating +hormone; LH, luteinizing hormone; Prl, prolactin; TT, total testosterone; AMH, anti-mu +¨llerian hormone; Mens freq, menstrual frequency. +*Significance at < 0.01 level. +**Significance at < 0.05 level. +6 +NIDHI ET AL. +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 6 +Disclosure Statement +It is declared that none of the authors involved in this +study have any conflict of interest and that all authors of this +article have contributed to their fullest capacities. +References +1. 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The effects of +perceived stress, traits, mood states, and stressful daily +events on salivary cortisol. Psychosom Med 1996;58:447–458. +32. Kamei T, Toriumi Y, Kimura H, et al. Decrease in serum +cortisol during yoga exercise is correlated with alpha wave +activation. Percept Mot Skills 2000;90(3 pt 1):1027– 1032. +33. Vadiraja HS, Raghavendra RM, Nagarathna R, et al. Effects +of a yoga program on cortisol rhythm and mood states in +early breast cancer patients undergoing adjuvant radio- +therapy: A randomized controlled trial. 2009;8:37–46. +YOGA EFFECTS ON ENDOCRINE PARAMETERS IN ADOLESCENT PCOS +7 +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 7 +34. Stener-Victorin E, Waldenstrom U, Tagnfors U, et al. Effects of +electro-acupuncture on anovulation in women with polycystic +ovary syndrome. Acta Obstet Gynecol Scand. 2000;79:180–188. +35. Vigorito C, Giallauria F, Palomba S, et al. Beneficial effects of +a three-month structured exercise training program on car- +diopulmonary 10 functional capacity in young women with +polycystic +ovary +syndrome. +J +Clin +Endocrinol +Metab. +2007;92:1379–1384. +Address correspondence to: +Ram Nidhi, MSc +#19, Eknath Bhavan +Gavipuram Cirlce Kempegowdanagar +Bangalore 560 019 +India +E-mail: nidhiyoga@gmail.com +8 +NIDHI ET AL. +ACM-2011-0868-ver9-Nidhi_1P.3d +06/25/12 +12:46pm +Page 8 diff --git a/subfolder_0/Effect of integrated approach of Yoga therapy on chronic constipation.txt b/subfolder_0/Effect of integrated approach of Yoga therapy on chronic constipation.txt new file mode 100644 index 0000000000000000000000000000000000000000..e39c8c6b99a13596fbf226b1c3e21939799c0428 --- /dev/null +++ b/subfolder_0/Effect of integrated approach of Yoga therapy on chronic constipation.txt @@ -0,0 +1,7147 @@ +Volume 5 Issue 1, June 2016 +ISSN 2277-7733 +Impact +factor +3.522 +ICV 2014 59.82, Standardised Value 6.19 +Voice of Research +ISSN 2277-7733 +Volume 5 Issue 1, June 2016 +Dr. Varesh Sinha (IAS) +Ex. Chief Secretary, Gujarat. +Dr. Jayanti Ravi (IAS) +Commissioner, Labour Department, Gujarat. +Shri Vinod Kumar Mall (IPS) +I.G. Police, Gujarat. +Shri U. S. Jha +Sr. DCM, Indian Railways +Cao Chenrui +HOD, Hindi Department, YMU, China +Dr. R. S. Patel +Professor and Head, Gujarat University +Dr. Akshay Agrawal +Ex. Vice-Chancellor, GTU +Dr. Sunil Shukla +Director, EDII Ahmedabad +Dr. Arbind Sinha +Retd. Professor, MICA +Dr. C. N. Ray +CEPT University, Ahmedabad +Minesh S. Jha +Management Consultant +Dr. Uma Shrivastava +Professor and Head, Jabalpur +Dr. M. N. Patel +Vice-Chancellor, Gujarat University +Dr. C. P. Bhatta +Professor, IIM, Calcutta +Dr. Rajul Gajjar +Dean (Masters and Ph.D.) GTU +Dr. G. S. Parasher +Ex. Pro Vice-Chancellor, RTMU, Nagpur +Ajay Patel +Project Scientist, BISAG +Dr. Rajneeshsingh Patel +Director, T.D. Campus, Rewa +Advisory Committee +Chief Editor +Dr. Avdhesh S. Jha, Ahmedabad. +Issue Editors +Dr. Nilesh Jha +Dr. Bharti Venkatesh +Dr. Asha Thokchom +Reg. Publication Office: E/1, Samay Apparments, Behind NID, Paldi. Ahmedabad-380007 +Prof. Philip Holt +Washington, USA +Prof. Pooja Kashyap +University of Colorado, USA +Prof. Kim Fam +Victoria University New Zealand +Dr. Kanhaiya Chaudhari +Deputy Secretary (Edn) ICAR +Dr. A. K. Kulshreshtha +DEI Agra. +Dr. Kalpana Modi +SNDT University, Mumbai +Prof. Deepti Tarani +BSSS, Bhopal +Prof. Patthira Phonngam +Loei University, Thailand +Dr. Hiren Karathia +University of Lleida, Spain +Dr. S. Ahmed Khan +BIT, Dubai. +Dr. Veena Jha +Chauhan College of Education, Bhopal +Renisha Chainani +Consultant & Expert, Finance +Dr. Madhura Kesarkar +SNDT University, Mumbai. +Dr. Shailendra Gupta +Calorx University, Ahmedabad +Dr. Anjana Bhattacharjee +Tripura University, Tripura +Dr. Sony Kumari +SVYAS University, Bangalore +Dr. Kumara Charyulu +D.ICRISAT, Hyderabad +Dr. RajshriVaishnav +Education Department, RTM University +Dr. Vivekanand Jha +Consultant +Dr. Lalima Singh +S.S. Khanna Girls Degree College, Allahabad +Dr. T. V +. Ramana +Andhra University Campus, Kakinada +Editorial Committee +An International Refereed Journal for Change and Development +After this hot summer along with the ups and downs by the UGC, we are here to welcome the monsoon, +the time of rain, time of greenery, time of satisfaction and peace. I am pleased to present this issue of Voice +of Research in green with the feel of prosperity all around. This spirit insists me to ask the authors to +conduct some research on the norms related to education, the API score, work load of teachers and the +different advertisements for the appointment of vacant positions and thus enable the society to be aware +of the facts for the detoriation in education. After more than sixty years of independence, if still, we have +to talk of caste, colour, creed, system, reservations I think we certainly need to conduct rigorous research to +find the problems and its solution because development cannot be possible on the basis of these differences +which works as a barrier for the national ethos amongst the nationals creating the disturbance in the peace +and harmony. Well, seasons change but the season of research is all time and thus we adhere to the belief of +researchers - All time is to sow and then harvest at appropriate time. With this adherence on the pathway of the +research movement, we are here with this issue with the positive attitude and commitment of the potential +researchers. The current issue highlights topics related to ICT for quality teaching, teachers’ attitude towards +inclusive education, reforms for children, information search pattern for e-resources, personality traits, +adjustment pattern, effect of yoga therapy on chronic constipation, consumer behaviour towards private +label brands, consumer satisfaction, SHGs, contract farming, ICT and sustainable development, factors for +gold prices, and investment potential to cover the problems related to the students, professionals, parents, +family, society as well nation. +To add to education Srivastava talks of ICT– as a tool for quality teaching, Rajnikumari studies of teachers’ +attitude towards inclusive education, Jha and Jose acknowledges about the education nd reforms for street +children whereas Patel and Dave discuss difficulties faced during information search pattern for e-resources. +To add to psychology Verma and Jawaid focus on personality traits of college going students, Ghosh +relates percieved adjustment pattern between housewives and married working women, Jayanti et al. checks +the effect of integrated approach of yoga therapy on chronic constipation, Mehta comes up with consumer +behaviour towards private label brands with respect to groceries, Vanara evaluates consumer satisfaction +with regards to BSNL broadband connectivity whereas Pandey describes SHGS as an agent of change for +women of rural areas. To add to management and technology Kaur and Singla discuss about contract +farming in India, Punia reviews ICT for sustainable development, Chainani analyses the factors influencing +gold prices, Khashimova and Khusanjanova describes the investment potential whereas Venkatesh and Balani +talks about successful project management. +On the whole this green issue of Voice of Research presents the recent trends and issues by addressing the +problems and presenting the solution to the issues of students, teachers, professionals, investors, parents, +family, society as well nation. I am sure, this issue will add to the enthusiastic readers and researchers and +Voice of Research is able to draw the necessary attention of the concerned people, authorities and departments +on the related issue. +Regards, +Avdhesh S. Jha +Chief Editor +EDITORIAL +1. +ICT–A TOOL FOR QUALITY TEACHING IN B.Ed. PROGRAMME +Meenakshi Srivastava ............................................................................................................................................................ 1 +2. +PREVALENCE OF TEACHERS’ ATTITUDE TOWARDS INCLUSIVE EDUCATION +WITH REGARDS TO SOME DEMOGRAPHIC VARIABLES +Rajni Kumari ......................................................................................................................................................................... 4 +3. +STREET CHILDREN: EDUCATION & REFORMS +Veena Jha and Aneesh Jose .................................................................................................................................................. 7 +4. +A STUDY OF DIFFICULTIES FACED DURING INFORMATION +SEARCH PATTERN FOR E-RESOURCES AMONG STUDENTS OF MANAGEMENT +Pramod Patel and Govind Dave ......................................................................................................................................... 10 +5. +PERSONALITY TRAITS OF COLLEGE GOING STUDENTS OF KASHMIR DIVISION: +A CASTE BASED DYNAMICS +Lokesh Verma and Jawaid Ahmad Itoo .............................................................................................................................. 14 +6. +PERCIEVED ADJUSTMENT PATTERN BETWEEN HOUSEWIVES +AND MARRIED WORKING WOMEN +Antara Ghosh ........................................................................................................................................................................ 19 +7. +EFFECT OF INTEGRATED APPROACH OF YOGA THERAPY +ON CHRONIC CONSTIPATION +Jayanti R, Kashinath G M, Amit S and Nagaratna R ........................................................................................................23 +8. +A STUDY ON CONSUMER BEHAVIOUR TOWARDS PRIVATE +LABEL BRANDS WITH RESPECT TO GROCERIES +Krupa Mehta ........................................................................................................................................................................27 +9. +A STUDY ON CONSUMER SATISFACTION WITH REGARDS +TO BSNL BROADBAND CONNECTIVITY IN AHMEDABAD CITY +Manoj B. Vanara ...................................................................................................................................................................29 +10. +GROUP MATTERS SHGS AS AN AGENT OF CHANGE FOR +WOMEN OF RURAL AREAS IN ALLAHABAD +Shashi Pandey ......................................................................................................................................................................32 +11. +CONTRACT FARMING IN INDIA: MODELS AND IMPACTS +Pavneet Kaur and Naresh Singla .......................................................................................................................................34 +12. +INFORMATION AND COMMUNICATION TECHNOLOGY +FOR SUSTAINABLE DEVELOPMENT +Yogesh Punia ........................................................................................................................................................................40 +13. +FACTORS INFLUENCING GOLD PRICES +Renisha Chainani .................................................................................................................................................................42 +14. +GENERATION OF INVESTMENT POTENTIAL +Naima Khashimova and Jamola Khusanjanova ................................................................................................................46 +15. +REQUIREMENT MANAGEMENT A KEY TO SUCCESSFUL PROJECT +MANAGEMENT FOR SOFTWARE SYSTEMS +Bharti Venkatesh and Lalit Balani .....................................................................................................................................49 +LIST OF CONTENTS +Call For Papers +Voice of Research calls for unpublished articles, research papers, book review, case study for publication. +Guidelines to Authors +• +No processing fee is charged for the review of the papers. 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PROGRAMME +Meenakshi Srivastava +Assistant Professor, S.S.Khanna Girls Degree College +Abstract +In teaching B.Ed .trainees use teaching aids, like, charts, models – static & working, specimen, slides, because teachers are given training both in +preparation and use of Audio-visual Aids. It is a known fact that majority of schools do not have appropriate teaching aids related to the school +content. So teachers have no facility to use A – V Aids during teaching. The use of A – V Aids get further restricted due to unmotivated persons +becoming teachers. Central Government realized the need of improving quality of education through the use of ICT. This helped in improving the +quality of teaching in schools having no teacher to teach the subject, less competent teacher, schools having poor or no facility of teaching aids,The +use of ICT in education lends itself to more student centered learning settings and often this creates some tensions for some teachers and students. +But with the world moving rapidly into digital media and information, the role of ICT in education is becoming More and more important and this +importance will continue to grow and develop in the 21st century. . To keep pace with the changing world, teachers must have current knowledge and +skills of educational technology.. The growing use of ICT as an instructional medium is changing and will likely continue to change many of the +strategies employed by both teachers and students in the learning process. This paper highlights-ICT–A Tool for quality teaching in B.Ed. +Programme. The paper the population for the study consisted of all the200 B.Ed. Students studying in the S.S.khanna Girls Degree Colleges of +in the academic year 2014 and 2015 at Meerapur in allahabad. +Keywords: Ict, Teaching, B.Ed. +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Education is a unique investment in the present and +future.Governments are adopting different policies and +strategies for integrating ICT into education systems (Kozma, +2008). However, the potential of ICT in education is not yet +been clearly realized (Moonen, 2008).. The use of ICT in +education lends itself to more student centered learning +settings and often this creates some tensions for some teachers +and students. But with the world moving rapidly into digital +media and information, the role of ICT in education is +becoming More and more important and this importance will +continue to grow and develop in the 21st century.To keep pace +with the changing world, teachers must have current knowledge +and skills of educational technology.. The growing use of +ICT as an instructional medium is changing and will likely +continue to change many of the strategies employed by both +teachers and students in the learning process. This paper +highlight-.ICT–A Tool for quality teaching in B.Ed. +ProgrammeThe paper the population for the study consisted +of all the200 B.Ed. Students studying in the S.S.khanna Girls +Degree Colleges of in the academic year 2014 and 2015 at +Meerapur in allahabad. +Education brings all round and harmonious development of +the personality of an individual such as physical, intellectual, +aesthetic, social, economic, religious, cultural, spiritual and +through such development of individual social needs can be +realized. A man without education is equal to animal. +Education is a unique investment in the present and +future.Governments are adopting different policies and +strategies for integrating ICT into education systems (Kozma, +2008). However, the potential of ICT in education is not yet +been clearly realised (Moonen, 2008). One reason for this is +that teaching professionals are often not adequately prepared +for teaching with ICT (McDougall, 2008). Little focus is given +to teacher education programmes, and preparing teacher +educators. Consequently this remains an under-researched area +(Koster, Brekelmans, Korthagen, &Wubbels , 2005 O.Sullivan, +2010). This is also true in regard to research about integrating +ICT in education. A considerable number of studies can be +found that focus on school teachers. Perspectives and +classroom practice of using ICT in schools +(Ertmer&Ottenbreit-Leftwich, 2010), but relatively few studies +are found that focus on the teacher educators. Perspectives of +using ICT in teacher education programs (Peeraer&Petegem, +2011), particularly in the context of a developing country +(Shohel& Power, 2010). +To enhance the quality, some teachers use teaching aids, like, +charts, models – static & working, specimen, slides, etc. because +teachers are given training both in preparation and use of +Audio-visual Aids. It is a known fact that majority of schools +do not have appropriate teaching aids related to the school +content. So teachers have no facility to use A – V Aids during +teaching. The use of A – V Aids get further restricted due to +unmotivated persons becoming teachers. Central Government +realized the need of improving quality of education through +the use of Television wherein most competent teacher teaches +the topic with the help of most appropriate teaching aids. +This helped in improving the quality of teaching in schools +having no teacher to teach the subject, less competent teacher, +schools having poor or no facility of teaching aids, etc. +Programmes offered through television were produced by +different State Institute of Educational Technology (SIET) in +different languages. Even the Video Instructional Materials +were produced and made available to teachers; still majority of +schools did not make use of them. Some of the reasons were +no facility of TV and VCR, no electricity, TV and VCR not in +working condition, not incorporated in the time table, lack of +initiation on the part of teacher and Principal, etc. Along with +A – V Aids, the print media has to go a long way in improving +the quality of teaching and learning. Format in which the +textbooks were written was not beneficial for teachers and +students. Researchers started thinking and using different +Theories of Learning for developing Instructional Material. +This gives birth to Programmed Learning Material based on +Operant Conditioning Theory of Learning. Programmed +2 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Learning Materials were compared with that of Lecture Method +or Conventional Method. Programmed Learning Material +alone as well as in combination with other methods for +teaching different subjects was found to be effective in terms +of achievement of students PLM was found to be as effective +as Structured Lecture Method in terms of achievement of +students (Chandrakala, 1976; Govinda, 1976). Lecture Method +was found more effective than Demonstration Method and +Programmed Learning Method (Ghetiya, 1999). +Information and Communication Technology +IT was limited only to the textual mode of transmission of +information with ease and fast. But the information not only in +textual form but in audio, video or any other media is also to be +transmitted to the users. Thus, the ICT = IT + Other media. It +has opened new avenues, like, Online learning, e-learning, +Virtual University, e-coaching, e-education, e-journal, etc. Third +Generation Mobiles are also part of ICT. Mobile is being used +in imparting information fast and cost effective. It provides e- +mail facility also. One can access it anywhere. It will be cost effective. +The ICT brings more rich material in the classrooms and libraries +for the teachers and students. It has provided opportunity for +the learner to use maximum senses to get the information. It +has broken the monotony and provided variety in the teaching +– learning situation. The ICT being latest, it can be used both at +school and higher education levels. +Changing Teaching Through ICT +Teachers could give many different and specific examples of +how technology had changed their work. A number of things +were being done with Web sites, from giving students notes +which one teacher described as a “low end thing,” to getting +students to create their own Web pages. One teacher was using +a Web site to enhance an actual field trip. The Web site introduces +students to the animals and tells them what they are going to +be doing while on the field trip. It shows them techniques +they can use to analyze the ecosystem and record the data. The +prior preparation through the Web site helps students benefit +from the actual field trip. +Several teachers mentioned that they used Power Point and +other computer programs to improve their presentation of +material to class. Teachers explained that technology enabled +teachers to deliver more material to students and it also +eliminated several basic problems such as; poor hand writing, +poor artistic skill, contrast, lighting, and visibility. Another +teacher makes extensive use of software programs to help +teach physics. The students go into the laboratory and collect +their data using the computer. Then they use word processing +programs along with Excel to do graphs and presentations. +The software allows the students to collect different kinds of +data using various attachments that are plugged into the +computer. Using computer technology, students have more +time to explore beyond the mechanics of counting dots and +setting up the experiment. It actually lets them look at it and +understand the concepts better. Another teacher made the +point that resource-based teaching or resource-based learning +is almost becoming “seamless, almost natural” in everything +that teachers do because information is becoming easier to +access. +Enhance the Quality of Teaching Through ICT +There is some improvement in teaching through ICT in +B.Ed.programme: Developing understanding and application +of the concepts; Developing expression power; Developing +reasoning and thinking power; Development of judgment +and decision making ability; Improving comprehension, speed +and vocabulary; Developing self-concept and value clarification; +Developing proper study habits; Developing tolerance and +ambiguity, risk taking capacity, scientific temper. +Objectives of the Study +To enhance the quality of teaching through ICT in B.Ed. +programme. +Method of Study +Normative Survey method has been adopted in this study. +Sample + Random sampling technique was adopted for the study. The +investigators have taken the sample as 100 B.Ed. students +studying in B.Ed. colleges situated in Allahabad S. S. khanna +girl’s degree college, Allahabad India. +Tools Used in the Study +The investigators have used Self constructed tool for ICT +awareness (computer awareness) of B.Ed. Students in B.Ed. +programme. +Statistical Techniques Used in the Study +Percentage Analysis were used for this study. +Analysis and Interpretation of the Data +Result +For item 1Table shows that 64.28% B.Ed. students have their +e-mail id. +For item 2 table shows that 68.9% B.Ed. students have use +internet. +For item 3 table shows that 53.2% B.Ed. students have known +the operation of MS-WORD. +For item 4 table shows that 45.0% B.Ed. trainees have known +the operation of MS-EXCEL. +For item 5 table shows that 70.3% B.Ed. trainees have heard +ICT AND QUALITY TEACHING + +Item +Percentage ( %) +yes + +No + +1 +64.28 +35.72 +2 +68.9 +31.1 +3 +53.5 +46.5 +4 +45.3 +54.7 +5 +70.3 +29.7 +6 +60.5 +39.5 +7 +77.5 +22.5 +8 +69.0 +31.0 +9 +57.1 +42.9 +10 +40.2 +59.8 +11 +66.0 +34.0 +12 +70.2 +29.8 +13 +79.5 +20.5 +14 +81.7 +18.3 +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |3 +about Google search engine. +For item 6 table shows that 60.5% B.Ed. trainees can make +presentation on power point. +For item 7 table shows that 77.5% B.Ed. trainees can send +their e-mail id. +For item 8 table shows that 69% B.Ed. trainees can open a +website. +For item 9 table shows that 57.1% B.Ed. trainees can download +their files from web. +For item 10 table shows that 40.0% B.Ed. trainee can install +software on the computer. +For item 11 table shows that 66.0% B.Ed. trainee can operate +CD on a computer. +For item 12 table shows that 70.2% B.Ed. trainees can operate +a pen-drive on the computer. +For item 13 table shows that 79.5% B.Ed. trainees have use +internet on their mobile phone. +For item 14 table shows that 81.7% B.Ed. trainees have ready +to learn computer if opportunity were given +Recommendation to Educational Administrator +There is some recommendation given to educational +administrators: +Special care and extra coaching can be provided to the B.Ed. +trainees regarding the awareness of ICT. +Better attitude towards teaching profession may be developed +among the B.Ed. trainees through guidance and counseling. +Necessary physical facilities and infrastructure facilities may be +created in B.Ed. colleges to +Strengthen the ICT literacy of the B.Ed. trainees. +Training and development opportunities should be flexible +by allowing choice and guidance +which are appropriate to the B.Ed. trainees who are at different +stages of ICT literacy, and who are at different stages in their +own career progression. +Provision should be given to the B.Ed. trainees in processing +the resources such as internet, E-mail and video conferencing +in education. +The teacher educators may advise the student-teachers to +participate in co-curricular activities such as games, sports, and +cultural events like music, dance, drama, art, painting, and clay +modelling. These co-curricular activities have their own influence +on the self-esteem of the student teachers. +Teacher trainees may be encouraged to become digitally fluent +rather than digitally literate. +Provide an environment that will offer an excellent opportunity +to improve self confidence and self-esteem of young people. +Allow the teaching community to update its knowledge based +on the development of advancements in information +technology. Thus will lead to the benefit of increased self- +esteem and confidence in the teacher trainees and will help +them in gaining better information about handling skills. +Conclusion +The use of ICT is changing teaching in several ways. . With +ICT, teachers are able to create their own material and thus +have more control over the material used in the classroom +than they have had in the past. Rather than deskilling teachers +as some scholars claim, it seems that technology is requiring +teachers to be more creative in customizing their own +material.From the investigation we know that most of the +B.Ed. trainees are in the average level in the knowledge of ICT. +To change this status, the knowledge of computers should be +important among the children from the grass root level. Hence +the curriculum developers and educational planners can take +full effort in providing ICT knowledge to the students. In +order to implement these institutions can also give their support +and suggestions. Theoretical as well as practical knowledge +should be provided to the trainees. This will be done with the +help of well trained and experts in the technology subject +especially in the computer field. From the analysis of the level +of the present study, it is inferred that most of the B.Ed. +students having the average ICT awareness. To improve their +level of awareness’ parents and teachers can take necessary steps. +Our present Indian education system more weightage is given +to the percentage of marks obtained. But we have given the +importance and much more weightage to students’ interest +towards life. oriented education and providing a proper +learning environment for construct a bright full nation. +References +Kop, R., & Bouchard, P. (2011). The role of adult educators in +the age of social media. In M. Thomas (Ed.) (2011), +Digital education opportunities for social collaboration, New +York: Palgrave Macmillan. +Davis, N., Preston, C., &Sahin, I. (2009). Training teachers to +use new technologies impacts multiple ecologies: +Evidence from a national initiative. British Journal of +Educational Technology, 40(5), 861-878. +Dede, C. (2008). Theoretical perspectives influencing the use +of iformation technology in teaching and learning. In J. +Voogt, & G. Knezek (Eds.). International handbook of +information technology in primary and secondary education (pp. +43-62). New York: Springer Science. +Rajasekar, S. &Vaiyapuri Raja, P. (2007). “Development of a test to +measure Computer Knowledge of Higher Secondary +Teachers” (CKT). Experiments in Education Vol. 35 No. 7, July +Henry Garrett, E. (2005). Statistics in psychology and education. +Paragon International Publishers, New Delhi +Ertmer, P. A. (2005). Teacher pedagogical beliefs: The final +frontier in our quest for technology integration? Educational +Technology Research and Development, 53(4), 25-39. +Henry Garrett, E. (2005). Statistics in psychology and education. +Paragon International Publishers, New Delhi. +Murray, J., & Male, T. (2005). Becoming a teacher educator: +evidence from the field. Teaching and Teacher Education, +21 (2), 125–142. +ICT AND QUALITY TEACHING +4 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Inclusion of children with disabilities is now a world-wide +philosophy. Attitudes of teachers are a critical component to +the inclusion of students with disabilities. Attitudes are a +factor in one’s daily living and therefore, play an important +role in an educator’s daily interactions with students. Teachers’ +judgements about children with disabilities could have a +significant influence on children’s emotional, social and +intellectual development. To make inclusion a successful +practice, the inculcation of positive attitudes among regular +teachers toward students with disabilities is a chief aspect. It is +the responsibility of government and teacher training institutes +to ensure that teachers possess a professional and accepting +attitude toward inclusion of students with special needs +(CWSN) in an inclusive classroom by accepting the presence +of such children in the regular classroom with a great +responsibility. Teachers’ attitude is one of the most important +variables in the education of children with disabilities (Smith, +2000). Literature on inclusive education has lay emphasis on +the importance of positive attitudes of educators toward +inclusion. In the present study, researcher attempted to study +the prevalence of attitude of regular teachers towards inclusive +education with regards to some demographic variables namely +gender, additional in-service training, presence of CWSN in +classrooms, designation and age of teachers. +Objectives +To determine teachers’ attitude towards inclusive education +To compare the teachers’ attitude towards inclusive education +with regards to their gender +To compare the teachers’ attitude towards inclusive education +with regards to the additional in-service training +To compare the teachers’ attitude towards inclusive education +with regards to the presence of CWSN in classroom +To compare the teachers’ attitude towards inclusive education +with regards to their designation +To compare the teachers’ attitude towards inclusive education +with regards to their age +Methodology +A survey was conducted on 739 teachers designated as Primary +Teachers (PRTs), Trained Graduate Teachers (TGTs) and Post +Graduate Teachers (PGTs) in government school of Union +Territory of Delhi, India, by using Sentiments, Attitude and +Concerns about Inclusive Education Revised Scale (SACIE- +R) (developed by Forlin, C., Earle, C., Loreman, T. & Sharma, +U. Forlin, C., 2011). In the light of objectives of the study, +data were statistically analyzed for Mean, Standard Deviation +and critical ratio. +Results +Prevalence of Teachers’ Attitude Towards Inclusive Education +As presented in Table-1, in dimension wise analysis, it was found +that a total of 47.361 percent teacher showed highly positive +sentiments, 46.414 percent teachers were having neutral sentiments +and 6.225 percent teachers were found with less positive +sentiments towards inclusive education. A total of 38.971 percent +teachers were having highly positive attitude, 52.639 percent +teachers were having neutral attitude and 8.390 percent teachers +had less positive attitude towards inclusive education. +Table 1 - Teachers’ Attitude towards Inclusive Education (N=739) +PREVALENCE OF TEACHERS’ ATTITUDE TOWARDS INCLUSIVE EDUCATION WITH +REGARDS TO SOME DEMOGRAPHIC VARIABLES +Rajni Kumari +Senior Research Fellow, Department of Education, Kurukshetra University, Kurukshetra +Abstract +Teachers’ judgements about children with disabilities could have a significant influence on children’s emotional, social and intellectual development. +To make inclusion a successful practice, the inculcation of positive attitudes among regular teachers toward students with disabilities is a chief +aspect. In the present study, researcher attempted to study the prevalence of attitude of regular teachers towards inclusive education with regards to +some demographic variables namely gender, additional in-service training, presence of CWSN in classrooms, designation and age of teachers. A +survey was conducted on 739 teachers designated as Primary Teachers (PRTs), Trained Graduate Teachers (TGTs) and Post Graduate Teachers +(PGTs) in government school of Union Territory of Delhi, India, by using SACIE-R, developed by Forlin, C., Earle, C., Loreman, T. & Sharma, +U. Forlin, C. (2011). In the light of objectives of the study, data were statistically analyzed for Mean, Standard Deviation and critical ratio. Results +of the study implicated that for the thriving inclusion of CWSN in regular schools, we need to make teachers’ attitude more positive in India. +Keywords: Inclusive Education, Attitude and CWSN +Variable +Level +Range +N +Percentage +(%) +Sentiments +Highly +Positive +20-15 +350 +47.361 +Neutral +14-11 +343 +46.414 +Less +Positive +10-6 +46 +6.225 +Attitude +Highly +Positive +20-15 +288 +38.971 +Neutral +14-11 +389 +52.639 +Less +Positive +10-5 +62 +8.390 +Concerns +Highly +Positive +20-15 +259 +35.047 +Neutral +14-10 +433 +58.593 +Less +Positive +9-5 +47 +6.360 +Overall +Attitude +Highly +Positive +60-45 +213 +28.823 +Neutral +44-36 +438 +59.269 +Less +Positive +35-21 +88 +11.908 +TEACHERS’ ATTITUDE TOWARDS INCLUSIVE EDUCATION +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |5 +A total of 35.047 percent teachers had highly positive concern +about inclusive education, 58.593 percent teachers had neutral +concerns towards inclusive education and 6.360 percent teachers +were having less positive concerns towards inclusive education. +Sentiments, Attitude and Concerns collectively measured +overall attitude of teachers towards inclusive education, +sentiments, attitude and concerns collectively measured the +overall attitude of teachers towards inclusive education, +therefore, a total of 28.823 percent (213 out of 739) regular +teachers were having highly positive attitude (overall) towards +inclusive education, 59.269 percent (438 out of 739) teachers +showed neutral attitude towards inclusive education and +11.908 percent (88 out of 739) teachers found with less positive +attitude towards inclusive education. +Comparison of Mean Scores of Teachers’ Attitude +Towards Inclusive Education on the Basis of Gender +It is perused from Table-2 that mean scores of male and female +teachers (overall group) were 14.20 & 14.43 (t=1.191, p=.234) +on sentiments, 14.06 & 13.63 (t=2.510, p=.012) on attitude +facet of overall attitude, 13.75 & 13.14 (t=3.117, p=.002) on +concern and 42.01 & 41.19 (t=2.130, p=.034) on overall attitude. +Group +Variable +Male +Female +SEd +t-Ratio +Significance +N +Mean +SD +N +Mean +SD +Overall +Sentiments +339 +14.20 +2.607 +400 +14.43 +2.560 +.191 +1.191 +.234 +Attitude +339 +14.06 +2.378 +400 +13.63 +2.286 +.172 +2.510* +.012 +Concern +339 +13.75 +2.838 +400 +13.14 +2.497 +.196 +3.117** +.002 +Overall +Attitude +339 +42.01 +5.554 +400 +41.19 +4.865 +.383 +2.130* +.034 +On sentiments, attitude facet +of overall attitude and overall +attitude male teachers had +scores significantly higher than +the female teachers. After +measuring gender difference +on teachers’ attitude towards +inclusive education on total +sample, H1 retained against H0. +Comparison of Mean Scores of Teachers’ Attitude +Towards Inclusive Education on the Basis of Additional +In-service Training +The t-ratios were computed between two groups, one of +teachers having additional in-service training of dealing CWSN +in regular classrooms and second of teachers having no such +in-service training, on total +26 variables considered in +the study. The difference +between two groups was +not found to be statistically +significant in 25 variables out +of total 26 variables (Table- +3). A significant difference +(t=2.065, p=.039) was +exhibited by the Concern +facet of overall attitude +towards inclusive education +in which teachers having additional in-service training (M=12.78) +were found less concern about disabilities than those teachers +not having additional in-service training (M=13.48). +Table-2: Significance of difference between the mean scores of teachers’ attitude towards inclusive education of male teachers and female teachers +H0- Gender does not result +in a difference in teachers’ +attitude towards inclusive +education +H1- Gender results in a +difference in teachers’ +attitude towards inclusive +education +H0- Additional in-service +training does not result in a +difference in teachers’ +attitude towards inclusive +education teachers +H2- Additional in-service +training results in a +difference in teachers’ +attitude towards inclusive +education teachers +Table 3 - Significance of difference between the mean scores of teachers’ attitude towards inclusive education on the basis of additional +in-service training +Results revealed that no significant differences were found on +teachers’ attitude towards inclusive education, efficacy, stress, +stress coping strategies and level of confidence to teach in +inclusive classroom due to additional in-service training +provided to teachers. Thus, results directed to accept H0 and +reject H2. +Comparison of Mean Scores of Teachers’ Attitude Towards Inclusive Education on The Basis of Presence of Children +With Special Needs in Classroom +Table 4 - Significance of difference between the mean scores of teachers’ attitude towards inclusive education on the basis of presence +of children with special needs in classroom +Variable +Have CWSN in Classroom +Don’t have CWSN in Classroom +SEd +t-Ratio +Significance +N +Mean +SD +N +Mean +SD +Sentiments +217 +14.12 +2.766 +522 +14.41 +2.499 +.208 +1.383 +.167 +Attitude +217 +13.71 +2.536 +522 +13.87 +2.250 +.189 +.868 +.386 +Concern +217 +12.96 +2.873 +522 +13.61 +2.566 +.215 +3.029** +.003 +Overall +Attitude +217 +40.79 +5.555 +522 +41.89 +5.021 +.419 +2.634** +.009 +Variable +Teachers have Additional +Training +Teachers don’t have Additional +Training +SEd +t-Ratio +Significance +N +Mean +SD +N +Mean +SD +Sentiments +67 +14.52 +2.344 +672 +14.30 +2.606 +.331 +.661 +.509 +Attitude +67 +14.10 +2.223 +672 +13.80 +2.348 +.299 +1.025 +.306 +Concern +67 +12.78 +2.341 +672 +13.48 +2.698 +.342 +2.065* +.039 +Overall +Attitude +67 +41.40 +5.003 +672 +41.58 +5.227 +.667 +.270 +.787 +TEACHERS’ ATTITUDE TOWARDS INCLUSIVE EDUCATION +6 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +H0- Presence of CWSN in +classroom does not result in +a difference in teachers’ +attitude towards inclusive +education +H3- Presence of CWSN in +classroom results in a +difference in teachers’ attitude +towards inclusive education +H0- Designation does not +result in a difference in +teachers’ attitude towards +inclusive education +H4- Designation results +in a difference in teachers’ +attitude towards inclusive +education +It is interpreted by Table-4 that +teachers, who were not having +CWSN in their classroom +(M=13.61) have showed more +concern for CWSN than the +teachers who were not having +CWSN in their classroom +(M=12.96) with a significant (p=.003) t-ratio i.e. 3.029. A +significant difference (t=2.634, p=.009) on overall attitude was +exhibited between teachers having CWSN in their classroom +(M=40.79) and teachers not having CWSN in their classroom +(M=41.89). Thus, H0 was rejected in case of overall attitude +of teachers towards inclusive education H3 was recognized. +Comparison of Mean Scores of Teachers’ Attitude +Towards Inclusive Education on the Basis of Designation +It is revealed from Table-5 that on +teachers’ attitude towards inclusive +education scale, primary teachers +(N=128), trained graduate teachers +(N=395) and post graduate teachers +(N=216) have scored more or less the same. +Table 5 - Significance of difference between the mean scores of teachers’ attitude towards inclusive education of primary teachers +(N=128), trained graduate teachers (N=395) and post graduate teachers (N=216) + + +Sum of Squares +Mean Square +F +Sig. +Between Groups (Df=2) +Within Groups (Df=736) +Total (Df=738) +Between Groups +Within Groups +Sentiments +14.065 +4905.640 +4919.705 +7.032 +6.665 1.055 .349 +Attitude +10.060 +4020.422 +4030.482 +5.030 +5.463 +.921 .399 +Concern +12.380 +5265.417 +5277.797 +6.190 +7.154 +.865 .421 +Overall Attitude +86.043 +19903.391 +19989.434 +43.021 +27.043 1.591 .204 +H0- Age does not result in +a difference in teachers’ +attitude towards inclusive +education teachers +H5- Age results in a +difference in teachers’ +attitude towards inclusive +education teachers +Thus, no significance difference was exhibited and H0 was +accepted and H4 was not retained. +Comparison of Mean Scores of Teachers’ Attitude +Towards Inclusive Education on the Basis of Age +As indicated in Table-6, sentiments (F=3.669, p=.12) and +concerns (F=2.725, p=.043) revealed a significant difference +among teachers due to their age. +Teachers from the age group of 31- +40 years (M=13.92) were having less +sentiments for children with +disabilities than the teachers from the +age group of 41-50 years (M=14.71). +Table-6: Significance of difference between the mean scores teachers’ attitude towards inclusive education of teachers of age group of +<30 (N=132), 31-40 (N=249), 41-50 (N=203) and 51< (N=155) + + +Sum of Squares +Mean Square +F +Sig. +Between Groups +(Df=3) +Within Groups +(Df=735) +Between Groups +(Df=3) +Within Groups +(Df=735) +Total (Df=738) +Sentiments +72.590 +4847.115 +4919.705 +24.197 +6.595 +3.669* +.012 +Attitude +41.444 +3989.037 +4030.482 +13.815 +5.427 +2.545 +.055 +Concern +58.054 +5219.743 +5277.797 +19.351 +7.102 +2.725* +.043 +Overall Attitude +117.507 +19871.928 +19989.434 +39.169 +27.037 +1.449 +.227 +The significant difference in concerns was between teachers +less than 30 years (13.89) and teachers from 31-40 years +(M=13.10). Overall attitude and its facet attitude did not reveal +any statistical difference among teachers due to their age (Table- +6). Therefore, H0 was preserved by rejecting H5 for overall +attitude. But, in case of sentiments and concerns H5 retained. +Conclusion +On the basis of research studies, it can be contended that the +effects of teachers’ positive attitude regarding admission of +CWSN in regular school can be a milestone in the path of +success of inclusion in India. Presents study revealed that only +28.823 percent teachers divulge high positive attitude towards +inclusive education where, 11.908 percent teachers came out +with less positive attitude towards inclusive education. Male +teachers revealed higher attitude towards inclusive education +than the female teachers. Teachers who were not having CWSN +in their classroom showed high positive attitude than the +teachers who were having CWSN in their respective regular +classroom. Sentiments and concerns revealed a significant +difference among teachers due to their age. Teachers from the +age group of 31-40 years were having fewer sentiments for +children with disabilities than the teachers from the age group +of 41-50 years. The significant difference in concerns was +between teachers less than 30 years and teachers from 31-40 +years. Teachers from the age group of 30 years & less were +more concerned about CWSN than the teachers of age group +of 31-40 years. Additional in-service training and designation +of teachers did not result in the attitude of teachers towards +inclusive education. Results of the study implicated that for +the thriving inclusion of CWSN in regular schools, we need +to make teachers’ attitude more positive in India. Additionally, +female teachers, teachers having CWSN in their classrooms +and teachers from the age group of 31-40 years would be the +priority groups in the task of inculcating more positive attitude +towards inclusive education. +References +Smith, M. K., & Smith, K. E. (2000). I believe in inclusion, +but…: Regular education early childhood teachers’ +perceptions of successful inclusion. Journal of Research in +Childhood Education, 14(2), 161-180. +TEACHERS’ ATTITUDE TOWARDS INCLUSIVE EDUCATION +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |7 +Category among street children +UNICEF has defined Street children into three types. +Street Living Children: Children who have run away from +their families and live alone on the streets. +Street Working Children: Children who spend most of the +time on the streets, fending for themselves, but returning +home on a regular basis. +Children from Street Families: Children who live on the streets +with their families. +Apart from these, Children who are open to street life includes +those who have been abandoned by their families or sent into +cities because of a family’s intense poverty, often with hopes +that a child will be able to earn money for the family and send +it home. Children who run away from home or children’s +institutions frequently end up on the street since they rarely +return home due to dysfunctional families, or physical, mental +and or sexual abuse. In several areas of the world, disabled +children are commonly abandoned, particularly in developing +countries. In addition, refugee children from armed conflict +areas, children separated from their families for long periods +of time and AIDS orphans, repeatedly find nowhere to go +but the streets. +How does a child become Street Child? +Street never gives birth to a child. As per UNICEF, 2010 Survey, +it is estimated 100 million children living in the streets in the +world. It is the condition focuses the child to be a street child. +These are the few causes +Poverty; Armed conflict; Natural and man-made disasters; +Famine; Physical and sexual abuse; Exploitation by adults; +Disinheritance or being disowned; Dislocation through +migration; Family Breakdown; Freedom from childhood itself. +Apart from these issues, so many other reasons make the +child to be part of the avenue. Children suffer more severely +than adults from these upheavals, and many lack the adequate +institutional support to address their special needs. Eventually, +they end up on the streets. Many studies have determined that +street children are most often boys and aged ten to 14. Many +girls live on the streets as well, although smaller numbers are +reported due to their being more useful in the home, taking +care of younger siblings and cooking. Girls also have a greater +vulnerability to trafficking for commercial sexual exploitation +or other forms of child labour. It is often believed that street +children are only seen in undeveloped and developing countries +but almost all countries, rich or poor, having young people +living on the street. +My observation on nature of street children at +Chennai City +During my stay at Chennai City, I got opportunity to observe +the street children especially on their daily routine. A study +conducted in 1996 identified as many as 75000 street children +in Chennai city. But this number presently is not the same but +possibilities and indications are to have increased. I mainly +focused on Kodungaiyur, Perungudi and Todiarpet areas where +you can find so many rag-pickers in the dump yards. It was +very difficult for me to get an idea about their day to day life +since they keep on moving from one area to other areas. So I +need to attract them with food article and financial aid. At last +I was able to reach out 40 to 50 children +Mostly street children (boys) have no fixed and permanent +place to live and sleep. They congregate wherever there is a +possibility to find money and food. During day time the used +to move from here to there and take rest at market places, road +side and other places. They mainly sleep in the areas like +footpaths, public parks etc. under and over the over- bridges. +I could find many girls live in the slum with their parents and +STREET CHILDREN: EDUCATION & REFORMS +Veena Jha +Principal, Chouhan College of Education, Bhopal +Aneesh Jose +Ph. D Research Scholar, Barkatullah University, Bhopal +Abstract +The word ‘Children’ seems to be equal to ‘joyful’. We bear in mind so many smiling faces of young beautiful kids. But the term street children give +an opposite impression. A street child is a term for children experiencing homelessness who live on the streets of a city, town or village.Other words +a street child is someone for whom the street has become his or her habitual abode and or source of livelihood, and who is inadequately protected, +supervised, or directed by responsible adults. Homeless youth are often called street kids and street youth. Some street children, notably in more +developed nations are part of a subcategory called thrown away children who are children that have been forced to leave home. Thrown away children +are more likely to come from single-parent homes. Street children are often subject to abuse, neglect, exploitation, or in extreme cases, murder by +clean-up squads that have been hired by local businesses or police. In western societies, such children are sometimes treated as homeless children rather +than criminals or beggars. It is estimated that more than 400000 street children in India exist. Mainly because of family conflict, they come to live +on the streets and take on the full responsibilities of caring for themselves, including working to provide for the protecting themselves. Boys and girls +of all ages are found living and working in public spaces, and are visible in the great majority of the world’s urban centres. Though street children +do sometimes band together for greater security, they are often exploited by employers and the police. +Keywords: Children, Education, Reforms +STREET CHILDREN +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +8 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +relatives. They frequently change their living places. Chennai +city faces lot of drinking water problems these days due to +recent flood. In slum areas they have to face a lot of difficulties +for collecting drinking water. Street children have to use the +dirty water from the ponds and unrepaired public bore wells +even for drinking. Beingthe bank of sea, they often take shower +in the sea. Street children to whom I had talked never used the +toilet to answer the nature calls. They use the common +grounds, public roads, railway tracks or sea beach. I could find +few common toilets in the slums of Kodungaiyur and +Perungudi. +I have seen so many street children eating from the garbage +mainly from big hotel wastes. They use their personal income +which they get it from different sources like begging, stealing +or even selling the waste goods to purchase tea, dosa etc. It +was found that many of them are able to find a source for +their daily income. Many of them are suffering from different +internal diseases like skin diseases, wound on the body etc. +They are not all aware about any external diseases. They don’t +mind of having cold, fever,sneezing,Dysentery, headache etc. +The use of drugs by street children is common in Chennai +city. Many of them have smoking habits and they use drugs +which are cheaper and easily available. +Educational status and awareness +Educational status and awareness of these children were very +poor even their parents. I could not find a single person who +is literate. They are not interested to be part of education since +their ultimate aim is earn their livelihood. They might be +interested to part of school if someone helps them for their +living. I feel, it was condition and awareness lacking in their +life. Many parents of the slum wished to send their children +to schools if they get adequate financial support because they +themselves don’t have the work and children themselves had +to earn for their living. Other issue they feel about clothing. +Most of the children have torn shirt and pant that they wear +and walk bare foot. +Many NGOs and Govt Organizations have been working for +the development of Street children of Chennai City. Chennai +Corporation launched a project to provide education and night +shelter for street children in 2009. The project would also +motivate such students to join school to make education more +inclusive. The beginning stage, the civic body identifies 824 +child labourers and admitted them in various corporation +schools. Most of them were in the 5- 17 age group and +engaged in some kind of economic activity including rag- +picking. Their parents were imparted training for proper +employment and loans have given to improve their economic +conditions. +Smile Foundation, inspired by Senge’s philosophy, a group +of young corporate professionals.was setup in 2002 to work +for the underprivileged children, youth and women through +relevant education ,innovative healthcare and market-focused +livelihood programmes. It has done so many work for the +development of street children in Chennai city itself. It has +implemented 13 welfare projects for street children out of 158 +in Chennai itself so far. +Karunalaya Social Service Society, a non profit voluntary +organisation registered in the year 1995 was started as a grass +roots organisation for the welfare and rehabilitation of street +and working children of Chennai city. It also focuses attention +towards the protection of the girl children in the community +and their counselling, shelter home care, food, clothing, health +care, formal and non formal education, vocational training in +tailoring and family reintegration. It creates a secure place for +the children of those parents who go to work and regular +school going children. One teacher and one helper have been +appointed in each centre. The children are given opportunity +to develop their skills in observation, motor development +and provided space to play. Children are trained in good health +habits to maintain personal and environmental hygiene. +Recommendation on Education & Welfare for Street Children +Education is both the means as well as the end to a better life: +the means because it empowers an individual to earn his/her +livelihood and the end because it increase one’s awareness on +a range of issues – from healthcare to appropriate social +behaviour to understanding one’s rights- and in the process +help him/her evolve as a better citizen. Lot of work have been +done by different Government and Non Government +organization for the welfare of street children and their +educational reforms. Now on seeing status of street children, +I am sure that it was not sufficient for their development. If +you take the example of Chennai more than 262 Organizations +have worked for the (As per Survey on 2010) benefit of this +group. But number has not come down, but yet it has gone +up only. So there should be unified and systematic system +should be there. +Government should set up a separate department for the +welfare of Street Children in each state with a headquarteras +well as district sub quarters. This department should take open +day care centre as per requirement. Employers who will be +appointed in these offices should be capable and able to work +with dedication. All the organization working on this area +should come under this department. There should be proper +coordination among the NGOs and other organization. State +headquarter should monitor all their work and allot the area in +which they should focus. Proper survey should be done on +their number and frequent place of visit every year.It will help +us to about their area where we can provide the shelter, +rehabilitation and then comes the education. +STREET CHILDREN +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |9 +Government should avoid completion rather it should be +attraction. How can we attract them? First foremost +employment opportunity should be given to the parents. +Through them these children will be attracted. It is the +livelihood that can attract orphan and destitute children to day +care centre. Here comes the education. Few organizations are +running their own schools. They work among these children +under the street children Education Project with support of +international volunteers. They provide them with free +education, educational materials, uniforms and play materials. +The volunteers are mainly focusing on the ways needed for +the development of these children. They are taught general +knowledge, etiquette/ norms and manners while talking, +sitting, moving, eating, reading, speaking etc. They accomplish +this with the help of the class teacher and the volunteers. +Sports and games are conducted to develop their physical +stamina. But these were not sufficient meet day to day needs. +There should be adequate day care centres in each areas and +coordination among these centres is necessary for their +rehabilitation. If the children happen to leave one centre, there +should be provision for the other centres to adopt them. All +the centres should follow single curriculum and children +should be make into different categories as per their level not +by the age. They can be given the basic lessons of all the main +subjects. They can focus on hygiene awareness, developing +other skills, creativity exercise like drawing, painting, music +and dance. Apart from this physical excessive is must. Once +they learn basic lessons, we can think about inclusive education. +They will have the capability to adjust with normal children. +But here does not end the work. There should be proper +follow up about these children. Otherwise these should be +change that they may go back to their past life. +Conclusion +Homelessness and street life have extremely detrimental effects +on children. Their unstable lifestyles, lack of medical care, and +inadequate living conditions increase young people’s +susceptibility to chronic illnesses such as respiratory or eat, +some scavenge or find exploitative physical work. Drug use by +children on the streets in common as they look for means to +numb the pain with deal with hardships associated with street +life. Studies have found that up to 90 per cent of street children +use psychoactive substance, including medicines, alcohol, +cigarettes, heroin, cannabis, and readily available industrial +products, such as shoe glue. Today, 8 million children in India +are out of school – surrounded by poverty, illness and despair; +they are fighting a daily battle for their survival. Together, we +can bring hope in their lives. Together, we can bring change +and make it last. +References +A.Langston, L. Abhott. V. Lewis, and M. Kellett, ‘Early +Childhood’. Doing Research with children and Young +People, S. Fraser, V Lewis, S. Ding, M Kellett and C. +Robinson, eds., London: Sage, pp 147-160,2004. +A. Richter- Kornweiz,- Child Poverty- Social and Economic +Policy for Children. +B. White,- Globalization and the Child Labour Problem, II +Journal of International Development, Vol, 8, no 6, pp. +829-839,1996 +C.A Hartzen and S. Priyadarsini, The Global Victimization of +Children: Problems and Solutions. New York: Springer +Science + Business Media. LLC,P 57, 2012 +C Bellamy, The State of the World’s Children, 2005: Childhood +under Threat. New York : UNICEF, 2004. +D. Remenyi, B Willams, A Money and E Swartz, Doing +Research in Business and Management: An introduction +to Process and Method. London ; Thousand Oaks, New +Delhi: Sage Publications, p 285,2003 +D W Stewart and P N Shamdasani, Focus Group Discussion: +Theory and Practice. London: SAGE, p,10.1990 +E. Rubinton and M.S Weinberg, The study of Social Problems: +Seven Perspectives, 7th ed. Oxford University Press, p, +2011. +G.R Sethi, - Street Children- A window to the Reality, II Indian +Pediatrics, vol.41- 2004 +Human Rights Watch, World Report 200: The events of 1999. +USA: Human Rights Watch +IFRC, First Aid in the community: A Manual for Trainers of +Red Cross and Red Crescent Volunteers in Africa. +M. Desai, A Right- Based Preventive Approach for +Psychological Well- Being in Childhood. New York: +P.C Shukla, Street Children and the Asphalt Life: Street +Children and the Future Direction. Adarsh Nagar, New +Delhi. India. +R.K Jain, Lifestyle for Total Development: A Unique Guide +to Develop Your Personality, New Delhi +S. Deb, children in Agony: A Source Book. New Delhi: Concept +Publishing Company. 2006 +S. Verma, - Socialization for Survival: Development issues +among working street children in India. +WHO, UNIESCO. School health education to prevent AIDS +and HIV: A resource package for curriculum planners. +1994 +WHO & Mentor Foundation Young people and substance +use: A manual on how to create use and evaluate +educational materials and activities. Geneva, 1999 +STREET CHILDREN +10 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Information Search in library science or information +management area pertains to the process where the +identification of information needs may be expressed as an +input-process-output model as promulgated by H Girja +Kumar (1980)1. It propagates three things: +1) Problem (existing situation or the task assigned); 2) Problem +Solving (process to solve the process or to complete the task), +and 3) Solution (final conclusion leading to know why the +information was needed) +Herein, the problem is analysed to decide the information +needs. It is inclusively indicative of the state of uncertainty in +knowledge. +A STUDY OF DIFFICULTIES FACED DURING INFORMATION SERACH PATTERN FOR +E-RESOURCES AMONG STUDENTS OF MANAGEMENT +Pramod Patel +Ph. D, Research Scholar, Assistant Librarian, Indukaka Ipcowala Institute of Management +Govind B Dave +Dean, Faculty of Management Studies (FMS)Principal, Indukaka Ipcowala Institute of Management (I2IM) +Abstract +In recent times, the Libraries are transforming from just storehouses of collection of documents to vibrant service centers containing E-resources; +rapidly moving towards digital libraries, e-libraries and virtual libraries. Information available in digital form demands latest methods for its handling +for both the library professionals as well as users. Hence, there is a steady need for librarians and the students to learn the new skills to cope with the +situation. There are several issues pertaining to the awareness and guidance among contemporary students regarding the methods, techniques and +mannerisms of using the digital or E resources. The researcher, hereby, aims to study the difficulties that the management students face in various +areas like awareness of library services, availability of abstract search, prominently display of e-database in library, technical support, time factor, +scattered information and issues related to power supply and backup. +Keywords: Library, E-resources, Information Science, Search Pattern, Awareness, Library Facilities +The model is as given below: +Figure 1.1: Input – Process – Output Model +Input + +Process + + Output +Problem + +Problem Solving Process + +Solution +Information Need + +Search Process + +Information Needs Fulfilled +Levels of Information Needs +In recent times, in Library and Information Science, the need +for information has acquired completely different proportions +delineating its vast scope. In the context of the present study, +the need of an individual for information has been taken into +consideration. Studies have shown that knowing the levels of +information need has not been a matter of library science but +an issue, area or an aspect of psychology and human behaviour. +However, most common needs are felt at the following levels: +1) Visceral Needs : An actual but unexpressed need for +information; 2) Conscious Needs : An ill-defined area of +decision; 3) Formal Need : An area of doubt which is expressed +in concrete terms; 4) Compromised Need : A need translated +into what the resources can deliver (Taylor, 1968) 2 +Types of Information Needs +Information needs for students of higher education like +management discipline range from personal to task +completion, from social to academic or educational or research. +Hence, based upon the purpose of the person and their specific +needs for the information, researchers have classified needs in +to two sets. They are as follows: +Set 1 : 1) Social or Pragmatic Information Needs; 2) Recreational +Information Needs; 3) Professional Information Needs; 4) +Educational Information Needs Tague (1976) 3 +Set 2 : 1) Kinetic Needs : Satisfying a special problem, diagnosed +and immediate; 2) Potential Needs : Satisfying unconscious +hidden problem under layers of attitude, Impulses and values +Childers (1975)4 +Information Search and its Patterns +Concept and Meaning of Information Search +Information is searched by individuals at individual levels. +However, at the organizational level, there are set patterns of +information search. When one needs information, he / she +knows it well that in all probability the information cannot be +obtained without searching process. So, one needs to be in +search of information. It is called the seeking phase in research. +This is how, when a person applies some patterns, strategies +or processes to search information in order to satisfy his / her +information needs, Information Search Patterns come into +existence. Information Search Patterns are basically the ways +and means used by the individual to satisfy his / her +information need. It is all about the decisions the person +takes in the process of collecting and receiving information +through reading published or online materials, discussing with +colleagues, etc. +1) According to Ching-Chih-Chen,5 “Information seeking +(search) patterns are the paths pursued by the individual in the +attempt to resolve a need.” (Krishna Kumar, 1990)6 +2) According to Giraj Kumar (1990) information seeking +behavior (search pattern) is mainly concerned with who needs +INFORMATION SEARCH PATTERN FOR E-RESOURCES +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |11 +what kinds of information for what reasons, how information +is found, evaluated and used. +3) According to Wilson (1999)7 considers “Information +behaviours (patterns) are those activities a person may engage +in when identifying his or her own needs for information, +searching for such information in any way and using or +transferring that information.” +Review of Literature +Chaya Devi (1997)8assessed the attitudes users of the National +Ship Design Research Center (NSDRC) towards online +information search and retrieval. The researcher was intended +to find out: the pattern of access to information (manual/ +online); whether online retrieval method is preferable over the +manual method and knowledge of any difficulties with online +search; formulation of search tactic; use of databases and types +of databases used. The questionnaire was used for data +collection, which were distributed to 40 employees of NSDRC, +India. The results of the study were: 1. Majority of the end +users preferred to search the information through online than +that of manual method due to the reasons of immediate and +worldwide accessibility to information. 2. Most of the end +users had the earlier experience in the use of online technology. +3. The end users prefer to search the information by subject, +keywords and natural language search was preferred more than +restricted vocabulary. 4. Most of the respondents opined that +bibliographic databases were most suitable source to access to +information and. 5. Majority of the end users agree that the +experience with the time made them expert in getting access to +information through online. The investigator satisfied the +study with the suggestion that the end users should be trained +the search pattern and the use of restricted vocabulary to make +the online search process easier. +The use of Internet resources and services in Gulbarga town +was studied by Mahesswarappa and Ebmazar (2003).9The +objectives of the study were to identify the: 1. Demographic +background of Internet users such as environment, +occupation, educational qualifications, age and gender. 2. +Computer background of Internet users such as knowledge +of computers, place of access to computers, type of computers +that they were using, operating system and the software’s that +they were familiar with and the purposes of using computers. +3. Use of Internet resources and services in Gulbarga city, +specifically to know: since how long they place’s of accessing +Internet and how often they access; the time spend, the +purpose, the frequency of use of resources and tools and +places of access; the subjects on which they search websites +and the web pages/home pages created by them (if any) the +search engines most often used and the steps taken after +accessing and retrieving Information; the opinion about +Internet facility and the extent of its usefulness as a tool +communication and as a source of information; and the +difficulties in accessing and using the internet. Data were +collected though questionnaire from one hundred and twenty +three internet users in private and public sectors covering forty +seven users form cyber cafes and seventy six users from +university and college environment. The results of the study +were: 1. Most of the respondents used computers at work +place, nearly all using Pentium systems and familiar with +windows 98 and MS office. 2. Majority using internet since last +six months and half of them have an average ability. 3. Ninety +three percent of the respondents were using internet for +sending e-mails followed by visit to websites (78.1 percent). 4. +Most frequently used resources and tools of internet were e- +mail (55.3 percent), wed browser (22.8 percent) and search +engines (10.6percent). 5. Majority of the respondent was +frequently using document file formats. 6. The subject areas +of web sites visited are diverse. 7. WWW.Yahoo.Com, +WWW.Rediff.com, WWW.Use.Com and WWW.Hotmail.Com +is the most used websites. 8. Most frequently used search +engines are Yahoo, reify, msn and Lycos. 9. Majority of the +respondents prefers to read instantly on the monitor and search +the internet on their own. 10. Seventy percent of the +respondents have not received any instructions in the use of +internet and felt the need for training. 11. A large majority +(69.9percent) was not satisfied with the facilities available for +surfing internet in Gulbarga city and 12. Slow accessibility, +getting connectivity and lack of training were the main +difficulties faced in the use of internet. +Kumbar and Shirur (2003)10conducted a study to draw +opinions from the users of Seer Jayachamarajendra College +of Engineering (SJCE) to find out: the purposes for which +the academic community in SJCE was using the internet; the +relation between prior computer experience and the use of +internet in SJCE; how far internet services has been utilized; +from which channels users were getting latest information +about websites /search engines; most used internet services; +the problems faced by the users using various internet services; +the satisfaction level of users regarding working hours, +infrastructure facilities etc. The data were collected through +questionnaire method, which were distributed among 100 +internet users of SJCE, Mysore out of which 79 members +have responded. The study reveals that: 1. Most of respondents +had started using internet for more than one year.2. Thirty +percent of academic community used the internet 2-3 times +in a week (students 33.33 percent, researchers 20.83 percent +and faculty members 45.83 percent). 3. Most of the users +(39.24 percent) learned internet through the assistance of +colleagues and friends. 4. Ninety seven percent internet users +indicated that they were using internet for e-mail service, +while 55.7 percent used obtain copies of articles. 5. Out of +seventy- nine respondents’ 44.3 percent of users acquainted +with the search engines through colleagues and friends +followed by 17.7 percent through professional books and +journals. 6. Fifty three percent users have got sufficient results +at the time of searching the information on internet. 7. Thirty +nine percent of the respondents indicated that they were +facing difficulties in browsing the internet, and thirty six +percent of the respondents indicated that they were not facing +any problems in internet use. +Objectives of the Study +To identify difficulties faced by management students during +information search; To study difficulties faced by students +based on their graduation and demographic variables like age, +qualification, etc. +Research Methodology +Type of Research: Descriptive research design was used for the +study of current research. +Sources of Data: The secondary data was collected for generating +list of management institutions and reviewing the literature. +INFORMATION SEARCH PATTERN FOR E-RESOURCES +12 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Magazines, journals, books, internet and newspapers among +many were formed part of the same. The primary data was +collected and used for analyzing the difficulties faced by +management students during information search. . +Data Collection Method: Questionnaire was used to collect +the primary data. +Sampling Plan: A total of 567 respondents finally considered +during the research. Originally the questionnaire was circulated +to the 630 respondents. However, 63 were rejected on account +of various types of errors and omission encountered. It was +administered at nine different management institutions to +management students. +Data Analysis +For data analysis Ms-Excel and SPSS Software 16.0 were used. +Table 1.1 – Frequency Distribution – Demographic Variables +From the above table it can be inferred that male and female students +comprised of the 54.3% and 45.7% respectively. As evident, 92.8% +of respondents are in the age group of 20-25 years with some 7.2% +exceptions recorded in favor of higher age group. +Table 1.2 – Frequency Distribution – Difficulties Faced by +Management Students +Gender +Age Group +Qualification +Male +20-25yrs. +BBA +308 (54.3%) +526(92.8%) +236 (41.6%) +Female +26-35yrs +B.Com +259 (45.7%) +41 (7.2%) +136 (24.0%) + +BCA +20 (3.5%) +B.Sc +66 (11.6%) +B. Tech +95 (16.8%) +B. Pharm +14 (2.5%) + + +Difficulties faced by students +Least +Difficult +Less +Difficult +Neutral +More +Difficult +Highest +Difficult +Library/General/Technical +Use of Computers +530 +13 +24 +0 +0 +Use of Internet +524 +19 +24 +0 +0 +Use of Intranet +451 +80 +36 +0 +0 +Downloading Article +359 123 +85 +0 +0 +Searching through OPAC +346 197 +24 +0 +0 +Using Search Engines +387 167 +13 +0 +0 +Lack of Training +199 294 +74 +0 +0 +Lack of awareness of Library Services 155 277 135 +0 +0 +Abstract search are not Available +116 187 216 +48 +0 +E-Database not prominently displayed +124 192 159 +92 +0 +Lack of Technical Support +150 212 149 +56 +0 +Unwilling to provide information +212 231 +76 +48 +0 +Lack of time +81 +198 208 +68 +12 +Information is too scattered +71 +203 176 117 +0 +Power supply and backup +95 +303 145 +24 +0 +Language barriers +71 +387 +85 +24 +0 +Information explosion +148 258 +69 +92 +0 +Barcode Reader +259 252 +46 +10 +0 +Speed of Access +269 266 +20 +0 +12 +Difficulties Faced by Student During Search +Commerce/Management Students (372) +Science Students (195) +Statements I face difficulty in/because of +Least +Difficult +Less +Difficult +Neutral +More +Difficult +Highest +Difficult +Least +Difficult +Less +Difficult +Neutral +More +Difficult +Highest +Difficult +Library/General/Technical +Use of Computers +335 +13 +24 +0 +0 +195 +0 +0 +0 +0 +Use of Internet +330 +18 +24 +0 +0 +194 +1 +0 +0 +0 +Use of Intranet +257 +79 +36 +0 +0 +194 +1 +0 +0 +0 +Downloading Article +211 +76 +85 +0 +0 +148 +47 +0 +0 +0 +Searching through OPAC +253 +95 +24 +0 +0 +93 +102 +0 +0 +0 +Using Search Engines +258 +101 +13 +0 +0 +129 +66 +0 +0 +0 +Lack of Training +127 +181 +64 +0 +0 +72 +113 +10 +0 +0 +Lack of awareness of Library Services +62 +198 +112 +0 +0 +93 +79 +23 +0 +0 +Abstract search are not Available +29 +153 +142 +48 +0 +87 +34 +74 +0 +0 +E-Database not prominently displayed +41 +132 +136 +63 +0 +83 +60 +23 +29 +0 +Lack of Technical Support +102 +162 +81 +27 +0 +48 +50 +68 +29 +0 +Unwilling to provide information +115 +159 +62 +36 +0 +97 +72 +14 +12 +0 +Lack of time +24 +172 +149 +15 +12 +57 +26 +59 +53 +0 +Information is too scattered +24 +158 +136 +54 +0 +47 +45 +40 +63 +0 +Power supply and backup +48 +267 +45 +12 +0 +47 +36 +100 +12 +0 +Language barriers +24 +302 +46 +0 +0 +47 +85 +39 +24 +0 +Information explosion +97 +212 +49 +14 +0 +51 +46 +20 +78 +0 +Barcode Reader +152 +196 +24 +0 +0 +107 +56 +22 +10 +0 +Speed of Access +163 +197 +0 +0 +12 +106 +69 +20 +0 +0 +  +Table 1.3 – Frequency Distribution – Difficulties Faced by Management Students Having Commerce and +Science Graduation / Qualifications +From the Tables 1.2 and 1.3, it is clearly visible that students +face difficulties while searching for information about E- +Resources. Students are not having difficulties in areas such as +use of computer, use of internet, use of intranet, downloading +articles, searching through OPAC, using search engines. +Students are having difficulties in various areas as the +respondents have rated for neutral, more difficult or highest +difficult. Areas in which students face difficulties while +information search are lack of awareness of library service +(24%), abstract search are not available (47%), E-Database are +not prominently display in library (45%), Lack of technical +support (36%), Lack of time (51%), information is too +scattered (52%) and Power supply and backup (30%). +It is clearly visible from above table that science students face +less difficulties in most of the area compare to commerce/ +management students. However for power supply and backup, +language barriers, information explosion, barcode reader and +INFORMATION SEARCH PATTERN FOR E-RESOURCES +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |13 +Crosstab +Qualification +Programme + +Use of Computer +Total + +1 +2 +3 +BBA +Count +212 +0 +24 +236 +Expected Count 220.6 +5.4 10.0 +236.0 +B Com +Count +123 +13 +0 +136 +Expected Count 127.1 +3.1 +5.8 +136.0 +BCA +Count +20 +0 +0 +20 +Expected Count +18.7 +.5 +.8 +20.0 +B Sc +Count +66 +0 +0 +66 +Expected Count +61.7 +1.5 +2.8 +66.0 +B Tech +Count +95 +0 +0 +95 +Expected Count +88.8 +2.2 +4.0 +95.0 +B Pharm +Count +14 +0 +0 +14 +Expected Count +13.1 +.3 +.6 +14.0 +Total +Count +530 +13 +24 +567 +Expected +Count +530.0 +13.0 24.0 +567.0 +speed of access, science students face more difficulties than +commerce/management students. Data also indicates that +there is vast difference for difficulties faced by students for +downloading articles, lack of training, lack of awareness of +library services, abstract search are not available, E-Database +are not prominently display in library. Clearly, the data indicates +that science students do not face difficulties in general area +compare to commerce / management students. +Hypothesis Testing +Hypothesis 1 - H1: There is a significant relationship between +age and difficulties faced by management students during +using information search +Table 1.4 – (a) Cross Tabulation between Age Groups and +Difficulties Faced by Students +Table 1.4 – (b) Chi-Square Tests +The P value for the chi-square test is 0.019 which is less than +0.05. So, it can be inferred that there is a significant relationship +between age group of students and difficulties faced by them +for information searches. +Hypothesis 2 - H1: There is a significant relationship between +qualifications i.e. background of UG Programme) and difficulties +faced by management students for information search. +Table – 1.5 (a) Cross Tabulation between Graduation Degree / +Qualification and Difficulties Faced by Students +Table 1.5 (b) – Chi-Square Tests +The P value for the chi-square test is 0.000 which is less than +0.05. So, it can be inferred that there is a significant relationship +between Qualification (UG Programme) and difficulties faced +during information searches. +Conclusion +The study clearly shows that students do face difficulties in +various areas like awareness of library services, availability of +abstract search, prominently display of e-database in library, +technical support, time factor, scattered information and issues +related to power supply and backup. +Institute should focus on these areas for more improvement. +Especially institutes/university can focus more on commerce / +management graduates as they are facing more difficulties compared +to science graduates. The research also reveals that age of the +students has significant impact on difficulty face by students while +using search engine for information searches. Also qualification +of the students has significant impact on difficulty face by students +while using computer for information searches. +References +GirjaKumar 1990, ‘Defining the Concept of Information +Needs’ in Social Science Information : Problems and Prospects, +eds J. C Binwal, A. S Chandel&VeenaSaraf, Vikas +Publishing House, New Delhi +Taylor, R.S. 1968, ‘Question Negotiation and Information +Seeking in Libraries’, College & Research Library, vol 29, +pp 178-194 +Tague, J. et..al. 1976, ‘The distribution of community +information: the role of computer and computer based +networks’, ASLIB Proceedings. vol 28; pp 314-321 +Childers, T. 1975, Information Poor in America, Scarecrow Press, +New York.p36-37 +Chen, Ching-Chin &Hernon,P. 1982 . Information Seeking: +assessing and Anticipating User Needs. Neal-Schuman, New +York +Kumar Krishan. 1990, ‘Information Seeking Behaviour of +Sociologists’ in Social Science Information : Problems and +Prospects, eds J.C. Binwal , A.S Chandel & Veena Saraf, +Vikas Publishing House, New Delhi +Wilson, T.D. 1999, ‘Models in information behavior research’, +Journal of Documentation, vol 53, no 3; pp 249-270 +Chaya Devi, V. (1997) Attitude of the end-users towards on- +line information retrieval — A case study of NSDRC +Library, Visakhapattanam. Annals of Library Science and +Documentation, 44(1), pp.18 31 +Maheswarappa, B.S. & Ebnazar, C. Emmanual. (2003) Use of +Internet resources and services in Gulbarga city: An +exploratory study. SRELS Journal of Information +Management, 40(4), pp. 404 — 420 +Kumbar, Mallinath. & Shirur, Shiddayya. (2003) Internet and +its use in Sree Jayachamarajendra College of Engineering: +A case study. SRELS Journal of Information +Management, 40(2), pp. 169- 176 +AGE Group +In +Year + +Use of search engines +Total +1 +2 +3 +20-25 Count +351 +162.0 +13.00 +526.0 +Expected Count +359.0 +154.9 +12.10 +526.0 +26-35 Count +36.00 +5.00 +0.00 +41.00 +Expected Count +28.00 +12.10 +0.90 +41.00 +Total +Count +387.0 +167.0 +13.00 +567.0 +Expected +Count +387.0 +167.0 +13.00 +567.0 +  + +Value +df Asymp. Sig. (2-sided) +Pearson Chi-Square +7.958 +2 +0.019 +Likelihood Ratio +9.888 +2 +0.007 +Linear-by-Linear Association +7.786 +1 +0.005 +N of Valid Cases +567 + + + +Value +df Asymp. Sig. (2-sided) +Pearson Chi-Square +76.217 10 +.000 +Likelihood Ratio +80.537 10 +.000 +Linear-by-Linear Association +21.329 +1 +.000 +N of Valid Cases +567 + + +INFORMATION SEARCH PATTERN FOR E-RESOURCES +14 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +A fleeting look at human societies will at once divulge that +Human societies are not only divided into groups but there is +clear cut inequality and disparity among groups. Though the +phenomenon or social stratification is ubiquitous or universal +it varies from society to society. As Sorokin observes, “Social +stratification means the differentiation of a given population +into hierarchically superposed classes. It is manifested in the +existence of upper and lower layers. Its basis and very essence +consist in an unequal distribution of rights and privileges, +duties and responsibilities, social values and privations, social +power and influences among the members of a society” +(Sookin,1959). +India is said to be home of social stratification which is found +in the form of caste, based on the birth of the individual in a +particular caste/family. Caste is an endogamous group or a +collection of groups having a common name, common origin, +possessing a traditional occupation, having the same deity. +One of the most important facts is that membership into a +caste is only by birth and one remains so till death. Each caste +stands for a way of life. Each caste has a set of rules pertaining +to endogamy, commensality and social interactions with other +caste groups (Srinivas, 1957). +Caste system may have origins in experiences derived from, +what is known in analytical psychology as, “the personal and +collective unconscious.” The personal unconscious arises from +the lifetime experiences of the individual. This is distinct from +the “collective unconscious”, which is described to represent a +form of the unconscious common to mankind as a whole +and originating in the inherited structure of the brain. This +contains inherited primitive cultural, traditional and racial +elements. Both the personal and collective unconscious, made +from our individual and ancestral experiences respectively, may +account for the manifestation of caste system in our society +today. Discrimination against members of a social group may +persist because of its deep entrenchment within our society by +the personal and collective unconscious that has become the +automatic response even when no conscious intent is present. +Definition of Caste +There is no universal definition of caste as literature is loaded +with plethora of definitions given by noted sociologist and +anthropologists. Risley (1908) an eminent scholar of Indian +Castes and Tribes defines ‘caste’ as +a collection of families or group of families bearing a common name; +claiming a common descent from a mythical ancestor, human or divine; +professing to follow the same hereditary calling; and regarded by those +who are competent to give an opinion as forming a single homogeneous +community +Castes in Kashmir Valley +In actually, (Dabla, 2012) the Kashmir Muslim society (KMS) +maintains caste as s social system but not as a set of traits of +stratification. The structure and function of caste in Kashmir +is different from its ideal Hindu traits. It has been observed +that Kashmir Muslim society compose of following castes: +I. Sayyed Castes; II. Khan Castes; III. Occupational Castes; +IV. Service Castes +First, the Sayyeds, as they claim are the descendents of the +family of the Prophet Mohammad (PBUH), have converted +locals to Islam and consider themselves as custodian of +religion. Second, the Khans composed of nobility and their +descendents who feel themselves as superior for their foreign +origin. Third, the occupational castes composed of different +occupational communities- groups dealing with trade and +commerce. Fourth, the service castes stand at the lower strata +of society which compose groups providing basic and menial +jobs to the society. They also include Hanjis and Gujjars. +Significance of the study +The notion of man being a cultural being held by many +anthropological studies shows existence of intimate relation +PERSONALITY TRAITS OF COLLEGE GOING STUDENTS OF KASHMIR DIVISION: +A CASTE BASED DYNAMICS +Lokesh Verma +Professor and Head, Department of Educational Studies, Central University of Jammu +Jawaid Ahmad Itoo +Research Scholar, Department of Educational Studies, Central University of Jammu +Abstract +Caste system may have origins in experiences derived from, what is known in analytical psychology as, “the personal and collective unconscious.” India +is said to be home of social stratification which is found in the form of caste, based on the birth of the individual in a particular caste/family. In +spite of strict religious prohibition of caste system, yet social stratification and caste like features has crept in some Muslim societies and Kashmiri +society is no exception. Although, caste system is in Kashmir is not so rigid and complex but we can’t deny the fact the kashmiri society is not caste +free society (Irshad, Ahrah and Zubar, 2013). The present study attempts to study the personality traits of college students of Kashmir +division belonging to two dominant upper caste (Syeds and Khan) and five under- privileged lower caste (Hajam, Kumar, Gurjar,Lohar and Teeli,) +will be taken into consideration. For this study a sample of 800 was drawn by using cluster sampling technique. +Keywords: Crept, dominant, under-privileged,cluster +PERSONALITY TRAITS +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |15 +between personality and culture. In every culture, there is a +basic personality type which is an outcome of cultural influences +on the individual. For Example, In Alorese of Indonesia, the +basic personality types are doubtful, quarrelling, cowardly and +parasitic which are contrary to ours (Kardiner, 1891- 1981). +Human infants went through a stage in which they learnt +what they exhibited later in the childhood (1856-1939, Freud’s +well known hypothesis “critical period hypothesis”). (Kardiner, +1891- 1981) formulated basic personality structure theory which +meant a collection of fundamental traits shared by the members +of a society acquired by adapting to a particular culture. +(Kardiner, 1891- 1981) further argues that basic personality +exists in context of cultural institutions or patterned ways of +doing things. Mead in her book “Coming of Age in Samoa” +(1929/1961) which is based on her nine months fieldwork +compares Samoan with American adolescent girls, +hypothesized that stresses related to puberty in girls were +culturally and not biologically determined. +In the light of social psychology, the caste in which an individual +is born and reared has a significant effect on the personality of +that individual (Linton, 1936). The child from an upper and +dominant caste functions in an atmosphere of positive social +acceptance and expectation whereas a child from under- +privileged caste is subjected to rejection and operates under a +pall of negative social expectations (Hansen et at., 1969; Alden +et al., 1970). Such an atmosphere moulds the mental structure +of an individual or group of persons so severely that they +turn out to be criminals or oblige them to revolt against the +society (Stiles and Beverly, 2000). The psychological +consequences of this type of life style are a sense of +powerlessness, insecurity, socio-cultural exclusion and lack of +hope for the better future (Creed and Reynolds, 2001). +In order to face the challenge of diversity, there are no simple +recipes and the complexity becomes more severe when the +challenge involves meeting of culture. Intercultural activity +demands some degree of mediation and negotiation – and +classroom learning is, of course, no exception. We may see +learning in intercultural classes as simply a collection of +compromises – but I think there could be a much more +challenging view - to see an intercultural class as an example of +a new culture, a salad bowl which retains the individual flavours +but also takes on a distinctively new taste. To provide each and +every student a barrier free education, teachers should be well +versed in culturally relevant pedagogy, which means a pedagogy +which makes modifications in instructional materials to account +for diversity. +Personality Traits +Literature is witness to the fact that various psychologists have +tried to define personality in the different says. No definition +can claim to be perfect description of personality. Although +there is disagreement in defining personality, but there is +consensus on what people do is influenced by their +characteristics, that is, their personality. Personality traits refer +to characteristics of an individual that are stable over time and +determine the behaviour of an individual. Traits reflect who +we are and determine affective, cognitive and behavioural style. +Objectives of the study +1) To study effect of Caste on personality traits viz. +1.1) Activity- Passivity; 1.2) Enthusiastic- Non- Enthusiastic; +1.3) Assertive- Submissive; 1.4) Suspicious- Trusting; 1.5) +Depressive- Non- Depressive; 1.6) Emotional Instability- +Emotional Stability +2) To study effect of income category on personality traits viz. +2.1) Activity- Passivity; 2.2) Enthusiastic- Non- Enthusiastic; +2.3) Assertive- Submissive; 2.4) Suspicious- Trusting; 2.5) +Depressive- Non- Depressive; 2.6) Emotional Instability- +Emotional Stability +3) To study interactional effect of Caste and income category +on personality traits viz. +3.1) Activity- Passivity; 3.2) Enthusiastic- Non- Enthusiastic; +3.3) Assertive- Submissive; 3.4) Suspicious- Trusting; 3.5) +Depressive- Non- Depressive; 3.6) Emotional Instability- +Emotional Stability +Hypotheses of the study +H1) There will be no significant effect of Caste on personality +traits viz. +H1.1) Activity- Passivity; H1.2) Enthusiastic- Non- +Enthusiastic; H1.3) Assertive- Submissive; H1.4) Suspicious- +Trusting; H1.5) Depressive- Non- Depressive; H1.6) +Emotional Instability- Emotional Stability; +H2) There will be no significant effect of income category on +personality traits viz. +H2.1) Activity- Passivity; H2.2) Enthusiastic- Non- +Enthusiastic; H2.3) Assertive- Submissive; H2.4) Suspicious- +Trusting; H2.5) Depressive- Non- Depressive; H2.6) +Emotional Instability- Emotional Stability +H3) There will be no significant interactional effect of Caste +and income category on personality traits viz. +H3.1) Activity- Passivity; H3.2) Enthusiastic- Non- +Enthusiastic; H3.3) Assertive- Submissive; H3.4) Suspicious- +Trusting; H3.5) Depressive- Non- Depressive; H3.6) +Emotional Instability- Emotional Stability +Sample +At first all the degree colleges of Kashmir division were listed +(46). Out of the listed colleges, only one college from each +district was selected through randomization. From the selected +colleges, all the Students belonging to two dominant upper +castes (Syeds and Khan) and five under- privileged lower castes +(Hajam, Kumar, Gurjar,Lohar and Teeli,) were taken into +PERSONALITY TRAITS +16 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +consideration in drawing a sample of 800. The technique that +was used for drawing the requisite sample was cluster sampling +technique. +Table 1 showing sample size drawn from each caste +Tool used +Dimensional personality Inventory by Mahesh Bhargava +Analysis and interpretation of data +The data collected was subjected to analysis by using +Multivariate Analysis technique (MANOVA) +Table 2 - showing Effect of Caste on Personality traits of +college students of Kashmir division belonging to various castes +viz. Kumar, Teeli, Hajam, Lohar, Gurjar, Syed and Khan +*Significant at .05 level +Table 3 - showing individual Mean differences along with level +of significance of Personality traits with respect to Caste (lower +caste= 1, Upper caste= 2) +Perusal of table 2 shows that the value of F ratio for personality +traits viz. Activity- Passivity, Enthusiastic- Non-Enthusiastic, +Assertive- Submissive, Suspicious- Trusting and Emotional +Instability- Emotional stability are .215, 1.161, 2.720, .788 and +.032 respectively which are insignificant at .05 level ( p value> +.05). Hence, it can be inferred that there is no significant effect +of caste on personality traits -Activity- Passivity, Enthusiastic- +Non-Enthusiastic, Assertive- Submissive, Suspicious- Trusting +and Emotional Instability- Emotional stability. Therefore, the +hypothesis H1 that there will be no significant effect of caste +on personality traits Activity- Passivity, Enthusiastic- Non- +Enthusiastic, Assertive- Submissive, Suspicious- Trusting and +Emotional Instability- Emotional stability (H1.1, H1.2, H1.3, +H1.4 and H1.6) is accepted. However, the value of F ratio for +personality trait- Depressive and Non- Depressive was found +to be 7.594 which is significant at .05 level (p <.05). Hence, it +can be inferred that there is significant effect of caste on +Depressive and Non- Depressive personality trait. Therefore, +the hypothesis H1.5 that there will be no significant effect of +caste on personality trait Depressive and Non- Depressive is +not accepted. A clear review of table 3 shows that the for +Depressive and Non- Depressive personality trait, mean value +of students belonging to lower caste was found to be 2.169 +which is higher than the mean score of students belong to +higher caste (1.984) which indicates that students belonging +to lower castes are more depressive as compared to students +belonging to upper castes. +Table 4 - showing Effect of Income category on Personality traits +of college students of Kashmir division belonging to various +castes viz. Kumar, Teeli, Hajam, Lohar, Gurjar, Syed and Khan +*Significant at .05 level +Table 5 - showing individual Mean differences along with level of +significance of Personality traits with respect to Income category +(lower Income category= 1, Upper Income category= 2) +Source +Dependent +Variable +Type +III +Sum of +Squares +Df +Mean +Square +F +p +value +Caste +Activity- +passivity +.202 +1 +.202 +.215 +.643 + +Enthusiastic- +non- +enthusiastic +1.058 +1 +1.058 +1.161 +.282 + +Assertive- +submissive +2.553 +1 +2.553 +2.720 +.100 + +Suspicious- +trusting +.746 +1 +.746 +.788 +.375 + +Depressive- +non- +depressive +6.245 +1 +6.245 +7.594 +.006* + +Emotional +instability- +emotional +stability +.028 +1 +.028 +.032 +.857 +Source Dependent Variable Type III +Sum of +Squares +Df Mean +Square +F +p +valu +e +Income +category +Activity- passivity +52.673 +1 +52.673 56.229 .000* +Enthusiastic-non- +enthusiastic +70.678 +1 +70.678 77.571 .000* +Assertive- submissive +44.482 +1 +44.482 47.389 .000* +Suspicious- trusting +41.570 +1 +41.570 43.935 .000* +Depressive- non- +depressive +126.046 +1 126.046 153.287 .000* +Emotional instability- +emotional stability +102.949 +1 102.949 119.046 .000* +Dependent Variable +caste +Mean +p value +Activity- passivity +1 +1.915 +.000 +2 +2.451 +Enthusiastic- Non- enthusiastic +1 +2.006 +.000 +2 +2.627 +Assertive- submissive +1 +2.464 +.000 +2 +2.957 +Suspicious- trusting +1 +2.701 +.000 +2 +2.224 +Depressive- Non- depressive +1 +2.491 +.000 +2 +1.661 +Emotional instability- Emotional +stability +1 +2.298 +.000 +2 +1.547 +S.NO +Caste +Sample Size +1 +Kumar +73 +2 +Teeli +70 +3 +Hajam +83 +4 +Gurjar +88 +5 +Lohar +69 +6 +Syed +235 +7 +Khan +181 +Total +Lower caste = 383 + +800 +Upper caste = 417 +Dependent Variable +caste +Mean +p value + + + + +Activity- passivity +1 +2.166 +.643 +2 +2.200 +Enthusiastic- Non- enthusiastic +1 +2.355 +.282 +2 +2.279 +Assertive- submissive +1 +2.652 +.100 +2 +2.770 +Suspicious- trusting +1 +2.494 +.375 +2 +2.431 +Depressive- Non- depressive +1 +2.169 +.006 +2 +1.984 +Emotional instability- Emotional +stability +1 +1.916 +.857 +2 +1.929 +PERSONALITY TRAITS +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |17 +Perusal of table 4 shows that the values of F ratio for +personality traits- Activity- Passivity, Enthusiastic- Non- +Enthusiastic, Assertive- Submissive, Suspicious- Trusting, +Depressive-Non- Depressive and Emotional Instability- +Emotional stability are 56.229, 77.571, 47.389, 43.935, 153.287 +and 119.046 respectively which are significant at .05 level (p< +.05). Hence, it can be inferred that there is significant effect of +income category on personality traits- Activity- Passivity, +Enthusiastic- Non-Enthusiastic, Assertive- Submissive, +Suspicious- Trusting, Depressive-Non- Depressive and +Emotional Instability- Emotional stability. Therefore, the +hypothesis H2 that there will be no significant effect of Income +category on personality traits (H2.1, H2.2, H2.3, H2.4, H2.5 +and H2.6) is not accepted. Further, review of table 5 shows +that mean score of first three personality traits- Activity- +Passivity, Enthusiastic- Non-Enthusiastic, Assertive- +Submissive i.e. 2.451, 2.627 and 2.957 respectively is higher +among students belonging to higher income category as +compared to students belonging to lower income category i.e. +1.919, 2.006 and 2.464 respectively. Hence, it can be inferred +that students with higher income possess more activity, +enthusiastic and assertive personality characteristics as compared +to their lower income counterparts. However, the table 5 shows +that mean score of personality traits- Suspicious- Trusting, +Depressive- Non-Depressive and Emotional instability- +Emotional stability i.e. 2.701, 2.491 and 2.298 respectively is +higher among students belonging to lower income categories +as compared to mean score of students belonging to higher +income categories i.e. 2.224, 1.661 and 1.547 respectively which +means that students with lower income category have more +of suspicious, depressive and emotional instability +characteristics as compared to students belonging to higher +income category. +Table 6 - showing interactional Effect of Caste and Income +category on Personality traits of college students of Kashmir +division belonging to various castes viz. Kumar, Teeli, Hajam, +Lohar, Gurjar, Syed and Khan +*Significant at .05 level +Perusal of table 6 shows that the Values of F-ratio for various +personality traits- Activity- Passivity, Enthusiastic- Non- +Enthusiastic, Assertive- Submissive, Suspicious- Trusting, +Depressive-Non- Depressive and Emotional Instability- +Emotional stability are .408, .714, .358, .365, .022 and 2.704 +respectively which are insignificant at .05 level (p > .05) and +hence it can be inferred that there is no significant interactional +effect of Caste and Income category on Activity- Passivity, +Enthusiastic- Non-Enthusiastic, Assertive- Submissive, +Suspicious- Trusting, Depressive-Non- Depressive, Emotional +Instability- Emotional stability. Therefore, the hypotheses H3 +that there will be no significant interactional effect of Caste +and Income category on personality traits (H3.1, H3.2, H3.3, +H3.4, H3.5 and H3.6 respectively is accepted. +Findings and Discussion +From the study it has been found that there exist significant +differences in personality traits among students belonging to +various castes. This finding is in line with (Shavita, Duhan +and Choudary, 2014) who also found that there exist significant +differences in personality traits with respect to caste, family +income and educational level. While students belonging to +higher castes have been found to be higher on Activity, +enthusiastic and assertive personality characteristics, students +belonging to lower castes have been found to possess more +of suspicious, depressive and emotional instability +characteristics. The possible reason for this could be due to the +fact that children from dominant and privileged caste function +in an atmosphere of positive social acceptance and expectation +where as children from lower and underprivileged caste caste is +subjected to rejection and operates under a pall of negative +social expectations (Hansen et at., 1969; Alden et al., 1970). +Such an atmosphere moulds the mental structure of an +individual or group of persons so severely that they turn out +to be introvert type of personality characterised by depression, +suspicion and emotional instability. Another reason for the +existence of depressive tendencies among students belonging +to lower castes could be due to the treatment meet out to +them at the hands of dominant and privileged castes e.g. On +October 2015, in Jodhpur a 12 year old dalit boy was beaten +up by his teacher for allegedly taking a palate from a stack +meant for higher castes (Khan, 2015). Education is considered +to be the tool of psycho-social, cultural and economical +development but the Educational institutions are middle class +institutions run by middle class persons along middle class +lines and when the lower caste child reaches the educational +institution he finds a different world, a foreign environment +different from what he has experienced. Due to theses +environmental inequalities, students from disadvantaged +sections are bound to have repercussions in their adjustment +to classroom which in turn has a direct bearing on their +personalities and aspirations (Getzel (1970), Soares and Soares +(1969) Jenson (1973) and (Eapen 1973). +Source +Dependent Variable Type III +Sum of +Squares +Df Mean +Square +F +p +valu +e +caste * +income +category +Activity- passivity +.382 +1 +.382 +.408 .523 +Enthusiastic-non- +enthusiastic +.650 +1 +.650 +.714 .398 +Assertive- submissive +.336 +1 +.336 +.358 .550 +Suspicious- trusting +.345 +1 +.345 +.365 .546 +Depressive- non- +depressive +.018 +1 +.018 +.022 .881 +Emotional instability- +emotional stability +2.338 +1 +2.338 2.704 .101 +PERSONALITY TRAITS +18 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +From the study it has been found that Income category has +significant effect on personality traits. This finding is in line +with (Shavita, Duhan and Choudary, 2014) who reported that +there exists a significant difference in personality with respect +to family income. Students belonging to upper Income +category have been found to be more active, enthusiastic and +assertive as compared to their lower income category +counterparts. Moreover, students belonging to lower income +category have been found to possess more of suspicious, +depressive and emotional instability characteristics. The reason +could be due to low economic status (poverty) as it is a +significant predictor of physical and mental health outcomes. +Poverty adversely influences the whole individuality of the +child as it is considered by World health organization (WHO, +1995) as world’s most ruthless killer. Poor parents are not able +to meet the daily requirements of their children as a result of +which children develop symptoms of depression, stress, +emotion instability and other mental health related problems. +Further, brain imaging research has shown that children from +lower income families tend to have smaller hippocampus than +children from affluent families (Hanson, Chandra. Wolfe and +Pollak, 2011) - a smaller hippocampus has been found to be +associated with psychic disorders such as schizophrenia, anti +social personality disorder and depression. A child because of +his lower economic status is not accepted by the rich ones and +hence always remains suspicious and wary about himself as a +result of which he becomes the victim of personality disorders. +Being suspicious about one’s own self, the children from low +income families feel hesitant in taking initiative in dealing with +the social environment which poses a serious threat to their +path of upliftment. A famous kashmiri saying, Aasun chu +heshnawan, nah aasun chu mandchawan meaning prosperity +improves ones personality, adversity cripples it highlights the +importance of economic aspect in one’s life. Children from +well-heeled families have upper hand in every aspect of their +life. They are found to be active, fervent and directive in nature, +while as children from underprivileged and hard-up families +feel shy, reluctant to participate and are submissive and +acquiescent to the commands of the rich ones. +References +Alden, S., Pettigrew, S. and sekiva, E. (1970). The effect of +individual contingent group reinforcement upon +popularity. Child development, 41, 1191-1196. +Creed, peter A. and Reynolds, Judith (2001). Economic +deprivation, experiential deprivation and social loneliness +in unemployed and employed youth. Journal of community +and applied social psychology, 11(3), 167-178. +Geetzel, J.W. (1970). Social Psychology of Education in Lindzey. +G. and Aranson, 459-523. +Hansen, J., Niland, T. and Zana, L. (1996). Model +reinforcement in group counselling with elementary +school children. Personal and guidance journal, 47, 741- 744. +Hanson, J. L., Chandra, A., Wolfe, B.L. and Pollak, S.D., (201). +Association between income and the hippocampus. PLoS +One.6 (5). +Irshad, A.W +., Ahrar, A.H. and Zuber, S.M. (2013). Revisiting +Social Stratification in Indian Society: A Review and Analysis +with Focus on Kashmiri Society. International Journal of +Humanities and Social Science Invention, 2, 2319-7714. +Jensen, Arthur R. (1973). Motivational factors in educability +and group differences +Kardiner, Abram 1939 The Individual and His Society. New +York: Columbia University Press. +Khan, Mohammad Hafiz (2015, Oct. 9). In Jodhpur, Dalit +family lives in fear after boy touches non-Dalit’s plate. +The Indian Express. +Mead, Margaret (1928). Coming Age in Samoa: A psychological study +of primitive youth for western civilization. New York: Morrow. +Mead, Margaret (1928). Coming of Age in Samoa: A +Psychological Study of Primitive Youth for Western +Civilisation. New York: Morrow. +Mead, Margaret. 1928. Coming of Age in Samoa: A +Psychological Study of Primitive Youth for Western +Civilisation. New York: Morrow. +Ralph, Linton (1936). Culture and personality. London: +Transition publishers London +Savita, Duhan,Krishna and Choudary, Krishna (2014). Role +of Personal Variables in Personality Development of +Adolescents from Disorganized Families. Journal of +Agriculture and Life sciences, 1(1). +Soares, A.T. and Soares, L.M. (1969). Self perception of +culturally disadvantaged child. American Education Research +Journal, 31-45 +Sorokin, P. A. (1959). Social and Cultura1 Mobility, Free Press, +Glencoe, Illinois +Srinivas, M. (1957). Caste in Modern India. The Journal of +Asian Studies, 16(4), 529- 548 +Stiles and Beverly (2000). Relative deprivation and deviant +adaptations: the mediated effects of negative self feelings. +Journal of Research in Crime and delinquency, 37(1), 64-90. +WHO (1995). World Health Report: Bridging the Gaps. Geneva: +World Health Organization. +PERSONALITY TRAITS +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |19 +One thing that is certain in life is change. If the change is +permanent, then we should know how to accept it. And, the +easiest way of accepting the change is to get adjusted to it. +Right from birth until death, one is subject to several +adjustments. And amongst all adjustment, marital adjustment +or adjustment to married life is an important one. Marriage, in +reality, is a way of living, and living in marriage is an adjustment. +It is not always full of roses. Success in marriage depends +upon the adjustment on the part of both the partners +involved, but marital adjustment on wife’s part is mainly +triggered by the fact that whether she is a housewife or a +married working woman. All married women, irrespective of +working or non-working, adjusts for their personal benefits +and mental satisfaction, in order to gain mental peace, and +sometimes the radical personal adjustments are often stressful +on their relationships. Marriage involves change and a change +always produces stress. Accepting the change as the way it is +will help to adjust in marriage. So, just like all relationships, +marriage, too, requires adjustment. Marital adjustment has +long been a popular topic among the researchers from various +areas of social sciences, probably because of the concept that +marital adjustment is closely related to the stability of a marriage. +The lives of married women are inextricably intertwined with +their family and their jobs. The goals of their development +cannot be achieved without inputs and resources from studies +on women and their adjustment pattern. Thus, various +researches have been conducted on the difference of adjustment +pattern between housewives and married working women. +Marital adjustment can be defined as the state in which there is +an over-all feeling in husband and wife of happiness and +satisfaction with their marriage and with each other. It refers +to the adjustment which every individual comes across after +his/her marriage. Marital adjustment is again divided into +various sub-areas which are- religion, social life, recreational +activities, mutual friends, in-laws relationship, money/financial +matters, sexual relationship, values, couple growth, +communication, conflict resolution, affection, roles, +cooperation, parenthood, mutual trust, training and +disciplining of children, and companionship. A research +conducted on marital adjustment as a moderator for genetic +and environmental influences on parenting show the results +that indicate that as marital adjustment declines, evocative effects +on parenting increase, while the role of shared family +experiences decline. However, the impact of marital +adjustment on child-based genetic and child-specific non shared +environmental contributions to parenting differed for mothers +and fathers. This study identifies a previously unexpected +mechanism through which family subsystems influence each +other (Jennifer A. Ulbricht, Jody M. Ganiban, M. M. Tanya, +Mark Feinberg, David Reiss, Jenae M. Neiderhiser, 2013). +A housewife is a married woman whose job is to stay at home +and care for the house, her husband and the children. Her +principal occupation is to manage her own household, usually +without having paid employment. The housewives increments +the family tree, are engaged in countless activities for the +ultimate welfare of the family and provide valuable +contributions to their society at a large. Sometimes housewives +are portrayed as ladies of luxury who spend their time on +hobbies and leisure and even purchase domestic services. +However, their unified status as joint householders is the +nucleus from within which they operate in society. But their +social circle is very limited, which leads to isolation in host +PERCIEVED ADJUSTMENT PATTERN BETWEEN HOUSEWIVES AND MARRIED +WORKING WOMEN +Antara Ghosh +Guest Lecturer, Bangabasi College, Calcutta University +Apurbaa Ghose Saha +Counsellor of Life Cell International +Abstract +Amongst all adjustments, marital adjustment is an important one, as marriage, in reality, is a way of living. The success of marriage depends upon +the adjustment on the part of both the partners involved. But marital adjustment on a wife’s part is mainly triggered by the issue that whether she +is a housewife or a working woman. With the rise in the number of dual career families, the adjustment and marital relationship are major challenges +for the married working women in those families. However, housewives also face challenges of adjustment in their marital relationship. The objectives +of this study are (a) to study the perceived adjustment pattern of housewives and married working women in the areas of home, health, social, +emotional and occupational, (b) to study the perceived adjustment pattern of housewives with less than 5years of married life and housewives with +more than 5 years of married life, and (c) to study the perceived adjustment pattern of married working women with less than 5 years of married life +and married working women with more than 5 years of married life. Bell’s Adjustment Inventory, a 160 items inventory assessing the individual’s +adjustment pattern in 5 situations such as - home, health, social, emotion and occupation, has been administered to 60 married women. Results reveals +that perceived adjustment pattern significantly differs between housewives and married working women and the review elaborated the previous +knowledge contribution and this study has attempted to provide an insight on future research directions. +Keywords: Study, Housewives, Women +ADJUSTMENT PATTERN +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +20 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +culture. A study on Comparative Analysis of Depression +among Housewives and Working Women in Bilal (Colony of +Kornagi area, Karachi) reveals that household average income +of housewives was more than that of working women but +still the level of depression was much higher in the housewives. +The housewives were found to have more average number of +children as compare to working women, which was one of +the causes of depression because they have the burden of +handling more babies alone. Less educational qualification of +housewives as compared to that of working women was +another reason for depression because education gives vision +and better understanding of life. Thus, there was a significant +difference in the level of depression of working women and +housewives as the level of of depression among the +housewives was twice as that of working women ( Riaz H. +Soomro, Dr. Fozia Riaz, Shahid Naved, Dr. Fida Hussain +Soomro, 2012). In another study on Marital Adjustment of +Working and Non-Working Women - A Comparative Study +indicates that the non-working women are better at marital +adjustment ( Jyoti Tiwari and Prabha Bisht, 2012). +A married working woman is a woman who is married and +pursues a career to make a living and for personal advancement. +They want to break out of the confines of being a homemaker, +determined to win independence by way of their own skills +and strengths, believing personal economic stability as the +best way to earn their freedom. However, they have to balance +in between office work and domestic work. The married +working women have to face numerous challenges both from +their families and from their jobs. Studies showed that women’s +experience of conflict between the work and family (household +work) was more problematic for the employed women than +the unemployed women. The employed women felt more +responsible for family commitments and home tasks ( Becker +and Monen, 2002 and Peake and Harris, 2002). However, research +works also revealed that flexible opportunities provided at place +of work or work-life balance policies of organizations assist the +working women to unite the domain of the profession and +family ( Lewis and Humbert, 2010). +The following Table shows the Process of Work - Family Life +Adjustments of Working Mothers : +(Taken from Work-Family Life Adjustments : Experiences of +Working Mothers at LESCO, by Aneeqa Suhail Ahmad, +University of Punjab, under Prof. Dr. Muhammad Anwar.) +Duration of married life is and important factor that +contributes to marital adjustment. Studies have shown that +newly married military housewives showed higher degree of +marital adjustment as they experienced less stress and they use +positive coping strategies than negative coping strategies, which +has positive influence on another situation of stress and marital +adjustment in them (2009). However, a Comparative Study +on Marital Adjustment of Working and Non-Working Women +reveals that marital adjustment was better in the later years of +marriage as compared with early years (Jyoti Tiwari and Prabha +Bisht, 2012). Similarly, another study on the Areas that require +Adjustments in Marriage concludes that the early period of +marriage requires a lot of adjustment between the couple - the +areas are - Sex, Pattern of Authority, Working Mother, Financial +Problems, In-laws and Extended Families (Min-Chol Kang, +2010). Again, on the other hand, in a study on the life course +factors and racial influences on homemaker or career woman, +reveals that career women with a longer span of married life, +are much more likely to seek and welcome help from their +husbands and caregivers in raising their children. They welcome +new experiences and adopt by being innovative and flexible in +order to find new ways to pursue both work and family life +(Janet Zollinger Giele, 2008). +Thus, women are integral part of the society and marriage is +the destiny that is traditionally offered to women by the society. +And,women play dual roles, one as paid worker (married +working women) and the other as unpaid worker +(housewives). The similarity between these two groups is that +both of them has to adjust to the demands of the +environment. Meeting these challenges of adjustment places +a great deal of pressure on them, almost each and every day, in +their areas of involvement. Thus, adjustment, a very +challenging and demanding process, is everything that a woman +does throughout her life. +Objectives +1) To study the perceive the adjustment pattern of housewives +and married working women in the areas of home, health, +social, emotion and occupation; 2) To study the perceive +adjustment pattern of housewives with less than 5 years of +married life and of housewives with more than 5 years of +married life in the areas of home, health, social, emotion and +occupation; 3) To study the perceive adjustment pattern of +married working women with less than 5 years of married life +and of married working women with more than 5 years of +ADJUSTMENT PATTERN +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |21 +married life in the areas of home, health, social, emotion and +occupation. +Method +Participants: A group of 60 married women (30 housewives +and 30 married working women), between age group of 25 to +40 years with minimum educational qualification of being +Graduate in case of both groups, were taken as sample in the +present study. The group of married working women were +having minimum 1 year duration of job. In the group of +housewives, 15 women were with less than 5 years of married +life and 15 women were with more than 5 years of married +life. Similarly, in the group of married working women, 15 +women were with less than 5 years of married life and 15 +women were with more than 5 years of married life. All the +married women falls within minimum 1 year to maximum 10 +years of married life. +Instruments: 1) General Information Schedule - It contains items +like name, age, address, phone number, educational +qualification, duration of marriage, duration of occupation, +type of family, number of children and the monthly income +of the family; 2) Bell’s Adjustment Inventory - This inventory +was developed by Hugh M. Bell. It is a test of personality to +assess the individual’s adjustment in variety of situations, +such as- (a) home, (b) health, (c) social, (d) emotion, and (e) +occupation. It is a 160 item inventory of personality traits for +the purpose of obtaining a better understanding of the +examinee. It can be administered individually and also in +groups. It contains 160 items in total, that is , 32 items in each +area. It is a self reporting questionnaire in “Yes”, “No” and +“?” format to measure the total level of adjustment. One +point is given to every “Yes” and zero is given to every “No” +or “?” response. The maximum score for each area is 32 and +the lowest score for each area is 0.the scores obtained in each +area were added together to determine the the total level of +adjustment. +Statistical Analysis: The present study includes the following +statistical analysis : 1) Frequencies; 2) Percentage; 3) Mean; 4) t- +test. +Result and Discussion +All of the objectives of this present study has been carefully +examined. The results reveals that the adjustment pattern of +housewives and married working women are significantly +different from each other. The computed t-values of the score +obtained by the housewives and the married working women +exceeds the critical value at the level of significance in the areas +of home, health and emotion, which indicates the adjustment +of both the groups differs significantly in the areas of home, +health and emotion. On the other hand, the computed t- +values between the two groups in the areas of social and +occupation, which is quite smaller than the critical values at the +level of significance, reveals that the differences in the +adjustment pattern of both the groups in these two areas is +insignificant and may be due to chance factors. In the obtained +mean value shows that married working women are better +adjusted than the housewives in the areas of health, emotion, +social and occupation, whereas, the housewives are better +adjusted than the married working women in the area of home. +Table 1 - Comparison between housewives and married working +in terms of their adjustment pattern and Mean Score. +*Difference is insignificant. **p<0.05. High scores indicates +lower level of adjustment and vice-versa. +Comparison between housewives on the basis of duration +of married life reveals that the adjustment patterns of both +the groups of housewives differs significantly in the areas of +home and emotional, as the computed t-values between the +groups of housewives in these two areas exceeds the critical +value at the level of significance. Comparison between married +working women on the basis of duration of married life +reveals that the adjustment pattern between the two groups +of working women differs significantly in the areas of home +and occupation, as the computed t-values between the two +groups of working women in these two areas exceeds the +critical value at the level of significance. +When compared between housewives and married working +women with less than 5 years of married life in terms of their +adjustment pattern, it has been found that the adjustment +pattern between these two groups differs significantly in the +areas of home and emotional, as the computed t-values +between these two groups in these two areas exceeds the critical +value at the level of significance. Similarly, when compared +between housewives and married working women with more +than 5 years of married life in terms of their adjustment pattern, +it has been found that the adjustment pattern between these +two groups differs significantly in the area of occupation, the +computed t-value between these two groups in this area exceeds +the critical value at the level of significance. +Areas of O +Adjustment +Housewives + +Married Working +Women +t- +value + + +N +Mean +SD +N +Mean +SD + +Home +30 +10.46 +3.39 +30 +12.50 +4.27 +2.05** +Health +30 +14.20 +2.89 +30 +12.10 +4.25 +2.23** +Social +30 +12.70 +3.84 +30 +12 +4.69 +0.63* +Emotional +30 +19.63 +3.20 +30 +17.33 +3.28 +2.74** +Occupational +30 +15.60 +4.80 +30 +13.20 +4.62 +1.98* +ADJUSTMENT PATTERN +22 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +*Difference is insignificant. +*p<0.05. +High scores indicate low level of adjustment and vice-versa. +t-value (1)=computed t-values between the housewives with less than +5 years of married life and housewives with more than 5 years of +married life. +t-value (2)=computed t-values between the working women with less +than 5 years of married life and working women with more than 5 +years of married life. +t-value (3)=computed t-values between the housewives with less than +5 years of married life and working women with less than 5 years of +married life. +t-value (4)=computed t-values between the housewives with more +than 5 years of married life and working women with more than 5 +years of married life. +Conclusion +It has been found that every woman is unlike each other. +Some are independent and free-spirited, while some has always +learnt to follow the norms set by the society. However, they +discover themselves anew in every spheres of their life. They +prove that no one is a born fighter, but every woman has the +power to derive strength from deep within. Each of them +delve deep into their hearts and discover traits no one knew +they possessed, and in the process they realize that they are +often victimized in almost every spheres of life, and this is +where they need to adjust. When they need support, there is +often no one to lend their hands of cooperation and +understanding. Thus, some continues with their life and its +adjustments, with the false expectation of cooperation and +understanding, while some go on with their life, without +expecting and adjusting all alone. Thus, living in marriage is +an adjustment. All married women, irrespective of working +or non-working, adjusts for their personal benefits and mental +satisfaction, in order to gain mental peace, and sometimes the +radical personal adjustments are often stressful on their +relationships. +In that sense, this study is significant to highlight the +requirements of empirical studies on how the perceived +adjustment pattern differs between housewives and married +working women and the review elaborated the previous +knowledge contribution and this study has attempted to +provide an insight on future research directions. +References +Books:- +Das, D. And Das, A.: Statistics in Biology and Psychology +(Latest Edition). Academic Publishers. +Garett, H. E. and Woodworth, R. S.: Statistics in Psychology +and Education. Vakils Feffer and Simons Ltd. 1981. +Reber, Arthur S. And Reber, Emily S. (2001). The Penguin +Dictionary of Psychology. Penguin Reference. +Journal Article:- +Ahmed, Aneeqa Suhail (2012). Work-family life adjustments: +Experiences of working mothers at LESCO. 3rd +International Conference on Business Management. +Kulik, Liat and Havusha-Morgenstern, Hagit (2010). An +ecological approach to explaining women’s adjustment +in the initial stage of marriage. Contemporary Family +Therapy, volume 32, Issue 2, 192-208. +Risch, Gail S.; Riley, Lisa A. And Lawler, Michael G. (2003). +Problematic issues in the early years of marriage: Content +for premarital education. Journal of Psychology and +Theology, 31:259-269. +Tiwari, Jyoti and Bisht, Prabha (2012). Marital adjustment of +working and non-working women- A comparative study. +The Journal of UGC-ASC, Volume 6, Issue 3. +Giele, Janet Zollinger (2008). Homemaker or Career Woman +: Life Course Factors and Racial Influences among Middle +Class Americans. +Soomro, Riaz H.; Riaz, Dr. Fozia; Naved, Shahid; Soomro, +Dr. Fida Hussain (2012). Comparative analysis of +depression among housewives and working women in +Bilal Colony of Kornagi area, Karachi. Interdisciplinary +Journal of Contemporary Research in Business, Volume +3, Number 11. +Ulbricht, Jennifer A.; Ganiban, Jody M. ; Tanya, M. M. ; +Feinberg, Mark; Reiss, David; Neiderhiser, Jenae M. +(2013). Marital adjustment as a moderator for genetic +and environmental influences on parenting. Journal of +Family Psychology, Volume 27(1), 42-52. +Areas of +Adjustment +Sample +size +Housewives +with less than +5 years of +married life +Housewives +with more +than 5 years of +married life +Working +women with +less than 5 +years of +married life +Working +woman with +more than 5 +years of +married life +t- +value +(1) +t- +value +(2) +t- +value(3) +t- +value(4) + +N +Mean +SD +Mean +SD +Mean +SD +Mean +SD + + + + +Home +15 +12.86 +3.44 +8.06 +3.35 +15.73 +4.14 +9.26 +4.39 +3.87** +4.15** +2.06** +0.84* +Health +15 +14.66 +3.33 +13.72 +2.38 +12.66 +3.92 +11.53 +4.54 +0.88* +0.73* +1.50* +1.66* +Social +15 +13.53 +4.16 +11.86 +3.48 +12.93 +4.97 +11.06 +4.40 +1.19* +1.09* +0.36* +0.55* +Emotional +15 +21.13 +2.28 +18.13 +3.91 +17.86 +3.20 +16.80 +3.35 +2.56** +0.89** +3.22** +1* +Occupational +15 +16 +4.43 +15.20 +5.15 +15.93 +3.99 +10.46 +5.17 +0.45* +3.24* +0.04* +2.51** +Table 2 - Comparison between Housewives and Married Working Women in terms of their Adjustment Pattern alongwith their Duration +( less than 5 years or more than 5 years) of their married life. +ADJUSTMENT PATTERN +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |23 +Constipation as the reduction in the bowel movement to +three or fewer times per week (Jamshed et al., 2011). It is one +of the most common functional gastrointestinal disorders +(Liu, 2011) prevalent all over the world (Thomsen et al., 2010). +Chronic constipation is found more commonly in women, +elderly and patients with concurrent psychiatric illness (Liu, +2011). In the long run leads to self-medication and/or medical +consultation (Dennison et al., 2005), poor health-related quality +of life, disturbed social functioning and compromises the ability +to perform daily activities (Jamshed, Lee, & Olden, 2011). 2- +27% of world population is affected by chronic constipation +(Ines, Sanchez, &Bercik et al, 2011). It is more prevalent in +western countries which account for 30% (Longstreth et al, 2006) +and eastern countries it 11% (A, Lissner S, & MA et al, 2010). +Yoga +Recently Yoga has become popular as a complementary and +alternative medicine due to its many health implications. It well +documented that, Yoga is effective in management of various +chronic health problems such as cardiovascular diseases, diabetes, +obesity, anxiety disorder, depression menstrual problems etc. +Yoga and gastro-intestinal (GI) problems +Yoga is has been used as complimentary therapies in +gastrointestinal related problems such as irritable bowel +syndrome (IBS). In one of the randomized controlled studies +on 22 male IBS patients underwent two months of yoga +practice, at the end of the study significant decrease in anxiety +and sympathetic activity along with improvement in +parasympathetic activity was observed (Taneja et al, 2004). In +a another randomized controlled study, twenty-five adolescent +IBS subjects underwent one month of yoga intervention daily +for one hour, significant improvement in gastrointestinal +symptoms, pain, functional disability, coping, anxiety and +depression was observed in yoga group as compared to control +group (Kuttner et al, 2006). These studies indicate the role of +yoga in GI related problems. +Integrated Approach of Yoga therapy (IAYT): IAYT is a +yoga based lifestyle intervention and a form of yoga. It was +consisted of asanas (physical postures), pranayama (breathing +practices), meditation, kriyas (cleansing techniques), balanced +diet, tuning to nature, counseling session etc. +Earlier studies on IAYT proved its effects on several chronic +health conditions such as chronic low back pain (Padmini T et +al, 2008), osteoarthritis (Ebnezar et al, 2014) etc. +Materials and Methods +Thirty-seven chronic constipation subjects (age range; 35 to +55 years)visitingArogyadhama (Holistic health center), +SVYASA University, Bangalore, for IAYT treatment for +chronic constipation were enrolled in this study. The subjects +were having mean 6.4±5.46 years history of chronic +constipation. Apart from the chronic constipation most of +the subjects were having hypertension and diabetes as +associated disease. +EFFECT OF INTEGRATED APPROACH OF YOGA THERAPY +ON CHRONIC CONSTIPATION +Jayanti Rao +Yoga Therapist, S-VYASA University, Bangalore +Kashinath G Metri +Assistant Professor, S-VYASA University, Bangalore +Amit Singh +Assistant professor, S-VYASA University, Bangalore +Nagaratna R +Director, Arogyadhama (Holistic Health Center) +Abstract +Constipation is most common GI problem which significantly affects health related quality of life, social functioning and compromises the ability +to perform daily activities. Yoga is one of the alternative and complementary therapies known to have positive role in various GI related chronic +problems. There is lack of evidences for role yoga in constipation. Thirty-seven participants suffering from chronic constipation, who attended one +week of IAYT program consisting of asana (physical posture), pranayama, meditation, devotional sessions, diet modification and interactive +sessions on philosophical concepts of yoga, atholistic health center S-VYASA, were enrolled in this study. The quality of life and the bowel habits +were assessed before and after the intervention using Patient Assessment of Constipation- Quality of Life (PAC-QoL) questionnaire.There is a +significant change in different domains of PAC-QoL such as reduction in the scores of physical discomfort (61.25%), psychological discomfort +(59.21%), worries and concern (55.92%) and satisfaction (44%) were found after one week IAYT intervention.This pilot study indicated the +potential role ofIAYT role in management of chronic constipation. However further randomized control studies need to be performed in order to +confirm the findings of present study. +Keywords:Yoga, Chronic constipation, PAC-QOL, IAYT +YOGA THERAPY ON CHRONIC CONSTIPATION +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +24 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Inclusion criteria +Who fulfill the Roam criteria for constipation; Subjects with +minimum 3 years history chronic constipation; Subjects within +age range 35 to 55 years; Willing to participate in the study +Exclusion criteria +Subjects having neurological disorders; Subjects with any +mental disorders or on any antipsychotics; History of any +abdominal surgery +Assessment +All the subjects were administered with PAC-QOL before and +after intervention. PAC-QOL is a self-reported questionnaire, +was used to measure the quality of life of patients (McShane +RE et al, 1985). The validated PAC-QoL is composed of 28 +items grouped into four subscales: physical discomfort, +psychosocial discomfort, worries and concerns, and satisfaction. +The first three subscales are used to assess the patient +dissatisfaction index, with an overall score ranging from 0 to +96 (where lower scores correspond to better quality of life). +The satisfaction subscale includes four items with a global +score ranging from 0 to 16, so that each patient’s self-reported +definitive outcome is defined as either poor (0-4), fairly good +(5-8), good (9-12), or excellent (13-16) +Results +Suffering since (months) (Mean ± SD): 81.24±71.46, Age +(Mean ± SD): Male (48.61±12.74), Female (44.14±9.55) +Prominent ailments: hypertension, diabetes +The patient assessment of constipation- Quality of life +questionnaire consists of 4 domains which are physical +discomfort, psychological discomfort, worries and concern and +satisfaction. +Physical discomfort +The PAC-QOL scores showed a significant reduction in the +physical discomfort after the intervention and is significant +(p<0.01). There was significant reduction in the scores from +1.91 ± 0.85 to 0.74 ± 0.73 with 61.25% of change. +Psychological discomfort +The PAC-QOL scores showed a significant reduction in the +psychological discomfort after the intervention (p<0.01). There +was significant reduction in the scores from 1.52 ± 0.81 to +0.62 ± 0.55 with 59.21% of change. +Worries and concern +The PAC-QOL scores showed a significant reduction in the +worries and concern after the intervention (p<0.01). There was +significant reduction in the scores from 1.52 ± 0.85 to 0.67 ± +0.55. The worries and concern reduction percentage was 55.92%. +Satisfaction +The PAC-QOL scores showed a significant improvement in +the satisfaction after the intervention (p<0.01). There was +significant reduction in the scores from 2.50 ± 0.84 to 1.40 ± +1.02 with percentage of 44%.There was a significant reduction +in the total score from 1.86 ± 0.46 to 0.86 ± 0.36 (p< 0.001). +Discussion +Summary +This pilot study was aimed to see the impact of IAYT in +chronic constiaption. There was significant reduction in the +scores of physical discomfort (p<0.01), psychological +discomfort (p<0.01), worries and concern (p<0.01) and +satisfaction (p<0.01) of the PAC-QoL questionnaire. And +the total score also reduced indicating a better quality of life. +Earlier studies have observed overall improvement after yoga +intervention in GID patients. There was significant decrease +in the bowel symptoms, state anxiety and there was enhanced +parasympathetic reactivity measured by heart rate parameters +in diarrhea-predominant Irritable Bowel Syndrome (Taneja et +al., 2004). Another study showed significant improvement in +the physical functioning of adolescents while young adults +recorded significant improvement in IBS symptoms, global +improvement, disability, sleep quality, fatigue and psychological +distress. A minimal clinical significant reduction in pain in +44% of adolescents and 46% of YA having IBS symptom +was recorded (Evans et al., 2014). Previous study on IBS +reported lower levels of functional disability, less use of +emotion-focused avoidance and lower anxiety in adolescents +in the yoga group and also adolescents had lower scores of +gastrointestinal symptoms (Kuttner et al., 2006). +The exact mechanism behind these findings is not known. +One of the possible mechanism can be; as constipation is +psychosomatic problem (Nehra et al., 2000), various +psychological components such as stress, anxiety, depression +etc. leads to sympathetic overdrive (Tougas, 2000), which is +related to reduced intestinal motility. Earlier studies have shown +that yoga reduces anxiety (Gupta, Khera, Vempati, Sharma, & +Bijlani, 2006), stress, depression (Streeter, Gerbarg, Ciraulo, +Brown, & Saper, 2012) and it also improves the +parasympathetic tone (Bharshankar, Bharshankar, Deshpande, +Kaore, & Gosavi, 2003), improved parasympathetic activity +might have lead to improvement in intestinal motility. +Strength of the study& limitations +To the best of our knowledge this is the first study which has +looked into impact of yoga in chronic constipation; There was +significant reduction in all the scores in such a short term; This +YOGA THERAPY ON CHRONIC CONSTIPATION +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |25 +is also having several limitations a) Lack of control group, b) +Small sample size, c) Lack of objective variables; Suggestions +for future studies; Future studies conducted with randomized +controlled design in larger sample size; Future studies should +also include objective autonomic variables; Follow studies +should be done in order to assess the consistency of the results. +Conclusion +This pilot study suggests the potential role of yoga in chronic +constipation. However further randomized control trial need +to be confirm the findings of current study. +Table 1 - Results of Physical Discomfort (paired t test) +Abbreviation: PHY_DIS - Physical Discomfort, CI – Confidence +Interval, % Change – Percentage Change +Table 2 - Results of psychological discomfort (paired t test) +Abbreviation: PSY_DIS - Psychological Discomfort, CI – Confidence +Interval, % Change – Percentage Change +Table 3 - Results of worries and concern (wilcoxon signed rank test) +Abbreviation: W_C – Worries and Concern, % Change – Percentage Change +Table 4 - Results of Satisfaction (wilcoxon signed rank test) +Abbreviation: SAT – Satisfaction, % Change – Percentage Change +Table 5 - Pre-post changes in total score of PAC-QOL +References +An Evidence-Based Approach to the Management of Chronic +Constipation in North America. (2005). Am J +Gastroenterol, 100(S1). doi:10.1111/j.1572- +0241.2005.50613.x +Basilisco, G., & Coletta, M. (2013). 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EFFECT OF YOGA BASED +LIFESTYLE INTERVENTION ON STATE AND +TRAIT ANXIETY. Indian J Physiol Pharmacol, 50(1), 41– +47. +Ines, M., Sanchez, P., & Bercik, P. (2011). Epidemiology and +burden of chronic constipation. Can J Gastroenterol, +25(October), 11–15. +Jamshed, N., Lee, Z.-E., & Olden, K. W. (2011). Diagnostic +Approach to Chronic Constipation in Adults. Am Fam +Physician, 84(3), 299–306. +Johanson, J. F., Sonnenberg, A., & Koch, T. (1989). Clinical +epide- miology of chronic constipation. J Pediatr Gastr +Nutr, 11(5), 525–536. +Kuttner, L., Chambers, C. T., Hardial, J., Israel, D. M., Mbbch, +K. J., Bsn, K. E., … Jacobson, K. (2006). A randomized +trial of yoga for adolescents with irritable bowel +syndrome. PAIN RES CL, 11(4), 217–223. +Domain + +Mean +± SD +95% +CI +% +Change +P +value +PHY_DIS +Pre +1.91 ± +0.85 +0.83 to +1.49 +-61.25 +<0.01 +Post +0.74 ± +0.73 +Domain + +Mean +± SD +95% +CI +% +Change +P +value +PSY_DIS +Pre +1.52 ± +0.81 +0.64 to +1.16 +-59.21 +<0.01 +Post +0.62 ± +0.55 +Domain + +Mean ± +SD +% Change +P value +SAT +Pre +2.50 ± +0.84 +-44 +<0.01 +Post +1.40 ± +1.02 +YOGA THERAPY ON CHRONIC CONSTIPATION +Domain + +Mean ± +SD +% Change +P value +W_C +Pre +1.52 ± +0.85 +-55.92 +<0.01 +Post +0.67 ± +0.55 +Variable + +Mean ± SD +P value +Total_score +Pre +1.86 ± 0.46 +<0.01 +Post +0.86 ± 0.36 +26 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Liu, L. W. C. (2011). Chronic constipation/ : Current +treatment options. CAN J GASTROENTEROL, +25(October), 22–28. +Locke GR, I., Pemberton, J. H., & Phillips, S. (2000). AGA +technical review on constipation. 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Assessing the safety, effectiveness, +and quality of life after the STARR procedure for +obstructed defecation: results of the German STARR +registry. Langenbeck’s Archives of Surgery 2010;395:505- +513. 14. +Schwandner O, Stuto A, Jayne D et al. Decision-making +algorithm for the STARR procedure in obstructed +defecation syndrome: position statement of the group +of STARR pioneers. Surgical Innovation, 2008;15:105- +109. 15. +Whitehead WE, Chaussade E, Corazziari E, et al. Report of +aninternational workshop on management of +constipation. Gastroenterol Int 1991;4:99–113. 16. + Zhang B, Ding JH, Yin SH, Zhang M, Zhao K. Stapled +transanal rectal resection for obstructed defecation +syndrome associated with rectocele and rectal +intussusception. World J Gastroenterol 2010;16:2542- +2548 +Tekur, P., Singphow, C., Nagendra, H. R., & Raghuram, N. +(2008). Effect of short-term intensive yoga program on +pain, functional disability and spinal flexibility in chronic +low back pain: a randomized control study. The journal +of alternative and complementary medicine, 14(6), 637-644. +Ebnezar, J., Bali, M. Y., John, R., & Gupta, O. (2014). Role +of integrated approach of yoga therapy in a failed post- +total knee replacement of bilateral knees. International +journal of yoga, 7(2), 160. +YOGA THERAPY ON CHRONIC CONSTIPATION +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |27 +A STUDY ON CONSUMER BEHAVIOUR TOWARDS +PRIVATE LABEL BRANDS WITH RESPECT TO GROCERIES +Krupa Mehta +Lecturer, S. K. Patel Institute of Management and Computer Studies +Abstract +The store brands, otherwise known as private labels, are changing the future of modern trade outlets in India. Started on a low key profile, such as +low price, low quality and limited movement, the store brands have gone a long way in establishing its credentials. The private labels have 50 % or more +than 50% market share in many parts of the developed world. The private labels are pervasive in personal care, home care, processed food, groceries +and consumer durables etc. +Keywords: FMCG, Grocery, Private brands, Retail chains. +CONSUMER BEHAVIOUR TOWARDS PRIVATE LABEL BRANDS +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +The Indian retail industry is the fifth largest in the world and +the sector can be classified as organized and unorganized sectors. +The organized retailing in India is still at a nascent stage and +private labels occupy less than 5 percent of the total Indian +market. Traditionally, the Indian retail industry has been +dominated by unorganized local players, with consumers +shopping at mom-and-pop operations, roadside markets, and +small grocery stores for their daily needs. The consumers remain +loyal to neighbourhood vendors, who offer more than just +goods by connecting with their customers on a personal level. +The neighbourhood vendors are simply more familiar to locals +and are recognized as part of the community; these vendors +also extend credit to those in need and offer home delivery. In +many areas of India, there are powerful bonds between +neighbourhood vendors and their loyal local customers. The +retail sector in India is on boom and the industry is expected +to grow at rapidly of 25-30% annually. While an estimated 85 +percent of retail outlets continue to operate in these traditional +formats, the last few years has seen a rise in modern retail +formats such as hypermarkets, department stores, multi- +storied malls, and specialty stores particularly in urban and +semi-urban areas. All the leading modern trade outlets have +introduced store brands which used to compete with national +brands. +Private Label +According to Batlas, (1997) store brands or private label brands +are brands owned, controlled, and sold exclusively by a retailer. +International private label +The international private labels can be recognized as being of +better quality than local private labels.Batra, (2000) international +private labels have an inherent cosmopolitan image, they will +be deemed more inspirational, desirable and appealing with +higher prestige than local private labels. The international +private labels can be counted better leading brands than local +private labels. The international labels would like to promote +their cosmopolitan image so as to generate greater receptivity +to their products which are of foreign origin .The consuming +international private label products can be associated with more +sophisticated personalities than local private label products. +That is, the brand personality of international private labels +will be perceived superior to local private labels. +Growth of Private Label in India +The emergence of organized retailing in India has made private +labels a reality. Though, initial growth of private label brands +in India has been limited to certain categories like grocery and +apparel, it is slowly expanding into other categories as well. +The Indian retail market is the fifth largest retail destination +globally and has been considered the most attractive emerging +market for investment. Overall, the Indian retail market is +growing at 30% annually, with the organized segment, which +currently accounts for around 9% of the Indian retail market, +registering above average growth of 30% (Report on Indian +retail industry by Cygnus, 2010). Thus, with growth of +organized retail in India, the private label brands are also +expected to grow. The growth of private label brands in India +has been limited to certain categories like grocery and apparel; +it is expected to expand into many other categories as well. +The private label brands and quality perceptions initially, private +label brands developed a low-priced strategy to compete with +national brands. They aimed at attracting low-income +consumers who were price-conscious. The observed evidence +for popularity of low-priced strategy of private labels came +from studies which indicate that the private label strength of +brands varied with economic conditions. +Factors to be Considered While Going for Private Labels +Private labels won t work by just keeping the products cheap. +Retailers must look at developing good quality and value- +added products. Also, they must make sure that they don t +over exercise the private label option. If they fall into the trap +of using too many private labels, they will end up losing +customers. It has been seen that when retail chains rely heavily +on private labels, customers feel they lack choices. Many retailers +have suffered due to this; Sainsbury is a classic example. The +UK-based retail chain was a mainline traditional retail chain, +but when it used too many private labels, customers did not +find regular brands at its stores, and as a result, sales dropped. +By this it can be understood that a retailer need to be careful +28 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +when he is coming with more number of private labels in his +stores. Customers expect more choices; they need private labels +along with various national players in a product category. Even +if the private labels are doing good sales as compared to +national brands, the retailers need to focus on national brands +in order to retain the customers for long run. +Tech & Retail Giants Expand Services +Google expanded its Express delivery service, which offers +same day delivery from stores like Costco, Whole Foods and +Target, to Boston, Chicago and Washington, DC. In October +it transitioned to a subscription model where users either pay +$10/month or $95/year for the service. +Amazon expanded Amazon Fresh, its same-day +grocery delivery service, to New York. It also launched +partnerships with the USPS to deliver groceries in San Francisco +and AgLocal to offer on-demand sustainable meat in San +Francisco. +Walmart To Go, the retailer’s on-demand delivery service, is +testing out a variety of different same-day grocery services to +meet the needs of it’s customers. Last October, it added Denver +to its list of cities – San Jose and San Francisco – offering same +day delivery. This year, the retailer began offering store pick-up +in Denver. It also launched Walmart Pickup-Grocery in +Arkansas, which is a 15,000-square-food fulfilment centre, +rather than a full-blown store. +Conclusion +Retail organizations in the organized sector are undoubtedly +facing a very challenging situation. While on the one hand they +face competition with the small retailers on the other hand +they are pitted against National Brands. There is a cut throat +competition in the market place there by putting tremendous +pressure on pricing and resultant pressure on profits. At the +moment, private labels are less than 5 per cent of the retail +business and still have a long way to go. But Indian retail is +extremely attractive for investors and it offers a proposition +that can_t be seen anywhere else in the world. Observing the +trend in the growth of private labels, the private labels are +going to give tough competition to the national brands if and +only if the retailer commits to the quality of the private label +and adds value to the product. +References +Wells, L.E., Farley, H., & Armstrong, G.A’’The importance of +packaging design for own-label food brands’’International +Journal of Retail &Distribution Management, 35(9), 677- +690, (2007). +Mieres, C.G., Martin, A.M.D., & Gutierrez, J.A.T’’A study on +Antecedents of the difference in perceived risk between +store brands and national brands’’ European Journal of +Marketing, 40(1/2), 61-82, (2005). +R, Sudarshan, S. Ravi Prakash.S & M.S, Sarma’’ Retail +management Principles and Practices’’ New Delhi: New +Century Publications, (2007). +Philip Kotler,’’Marketing Management,’’New Delhi, Pearson, +Eleventh Edition, (2003). +Suja R Nair’’ Retail Management’’ Fourth Edition, Himalaya +Publishing House, (2009). +Philip Kotler, Kevin Keller, Abraham Koshy &Mithileshwar +Jha’’Marketing +management’’(South +Asian +Perspective),13th edition, Dorling Kindersley(India) Pvt. +Ltd, (2009). +Hassan, D., & Dilhan, S. M., National Brands and Store +Brands’’Competition through Public Quality +Labels’’Agribusiness, 22(1), 21-30, (2006). +Hoch, H.J., & Shumeet Banerji’’When Do Private Labels +Succeed’’Sloan Management Review’’ 34(4), 5767, (1993). +Sahoo, S.C., & Dash, P.C’’Consumer decision making styles in +shopping malls: ‘’An empirical study in the Indian +context’’Indian Journal of Marketing, 25- 30. (2010). +CONSUMER BEHAVIOUR TOWARDS PRIVATE LABEL BRANDS +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |29 +Internet communication in India is growing rapidly, along +with the boom of wireless communication. Broadband +Internet access is on the ascent, in spite of the fact that the +present entrance rate is low. The Indian broadband segment +has an incredible chance to develop, because of a substantial +populace and the developing economy. E-government +services, e-health, e-education, and many other online services +such as online video, music downloads, and online gaming is +driving broadband adoption in India. +Peoples are getting to be occupied day by day and more +professional than before. They need to share more information +to each other because demography has changed due to the era +of globalization. Broadband has presented an enormous +change in the communication segment in our nation. It has +changed the communication structure also. People in different +occupation and pay scale levels are using broadband intensively +for their occupational purpose and personal purpose as well. +The present study under the title “A Study on Consumer +Satisfaction with Regards to BSNL Broadband Connectivity +in Ahmedabad City” is mainly undertaken in order to identify +the reason for preferring BSNL broadband services and also +to find out the level of expectation and satisfaction of the +consumer with regard to the tariff plan, charges and other +services offered by the BSNL broadband network. +Research Objective +To find out the demand for BSNL broadband; To study the +level of customer satisfaction in BSNL broadband connectivity; +To find out the awareness about the schemes of BSNL +broadband connection +Research Hypothesis +There is a significant association between monthly income +and BSNL Broadband Satisfaction.; There is a significant +association between monthly income and monthly expenditure +on BSNL broadband connectivity.; There is a significant +association between monthly income and BSNL Broadband +Rate comparison with other providers +Research Methodology +The entire research was conducted based on convenience +sample of broadband users in Ahmedabad by using a +questionnaire survey. +Sample Size +100 respondents were surveyed for this study and data +collection was based on both close-ended. The researcher used +convenience sampling method in data collection. +Tools for Analysis +There are many techniques which may be used for analyzing +the customers’ satisfaction. The researcher used SPSS packages +with percentages, and chi-square. +Literature Review +M. Muthumani, Dr. N. Thangavel, Dr. Y.L.Choudary +conducted “A study on Consumer Preference on broadband +Connections and Buyer Behavior towards Reliance in Chennai +City, to identify the primary use of a broadband connection, +and to identify the brand preference over the competing brands +and their services. His findings were 35.5% of the respondents +use the same brand from 1-2 Years and 32%of the +Respondents use the same brand for more than 2 Years. +Dr. PratyushTripathi Professor, VNS Business School, Bhopal +Prof. Satish Kr. Singh Associate Professor, TIT-MBA, Bhopal +(M.P.) conducted “ An Empirical Study of Consumer Behavior +towards The Preference and Usage of broadband Services in +Bhopal”To identify and analyze the factors which impinge on +to the satisfaction level of the customers of broadband services, +to examine and understand the attitude customer towards +various broadband Connection services and identify the factors +motivating them to select the brands. His findings were Income +being directly related with consumption is one of the +determining factors of consumption. +Dr. Mohd Rafi Bin Yaacob conducted “A study on +determinants of Customer Satisfaction towards Broadband +Services in Malaysia”, to examine association between level of +customer’s satisfaction of broadband service with price factors. +To determine the customer’s satisfaction level on stability of +A STUDY ON CONSUMER SATISFACTION WITH REGARDS TO BSNL BROADBAND +CONNECTIVITY IN AHMEDABAD CITY +Manoj B. Vanara +Lecturer I.C Engg. Govt. Polytechnic Ahmedabad +Abstract +Customer satisfaction is defined as the way that customer usually view or feel about certain services and products. Internet Broadband services +providers are of paramount importance in the developing economy of India. Many Internet Broadband service providers are offering various services +in the market. Customer satisfaction with regards to Broadband services is resulting from the evaluation of service provided by an ISP to an individual +in relation to expectations. This study is mainly focused to understand the Consumer satisfaction with regards to of BSNL Broadband services in +Ahmedabad. The outcomes of this survey can be used by the BSNL, for understanding the customers satisfaction in respect to Broadband services and +add value to their customers to increase their market share and Brand Image. This paper also attempts to understand the brand awareness, competitive +strength of the company and problems faced by the customers, which helps the company to take appropriate measures to solve the problems. The Primary +data was collected through survey method and was analyzed with the help of various statistical tools to draw meaningful conclusion. +Keywords: Customer satisfaction, Broadband +CONSUMER SATISFACTION +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +30 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +broadband services and his findings were broadband +customers were price sensitive and higher pricing from each +broadband provider would lead to low demand. It was easy +for them to get connected at anytime and anyplace, the stability +of internet service was important to them and they would +consider changing to other broadband service provider due to +stability factor. +Muhammad Sabbir Rahman, Md. MahmudulHaque& Abdul +Highe Khan “A Conceptual Study on Consumers’ Purchase +Intention of Broadband Services” to assist broadband internet +service providers to understand how technical and functional +quality, peak experience can contribute to understand the +consumer’s behavioral intention in selecting a broadband +service operator’s services. +Abdur Rahman BRAC Business school BRAC university +conducted “ A study on customers satisfaction level of prepaid +subscribers of airtel broadband in Bangladesh limited” The +broad objective of this report is to find out the customer +satisfaction level of Airtel broadband prepaid customers and +to figure out specific areas of dissatisfaction of Airtel prepaid +users. His findings were the major areas for customer +satisfaction are the availability of the recharge card / load for +prepaid, the affordability of new prepaid connection tariffs, +features of the prepaid packages, value added services , +customer services through customer care line , after sale services, +etc. the study revealed airtel to upgrade its network coverage as +soon as possible. +G.RAMDOSS, MEMBER FACULTY, VELS UNIVERSITY, +conducted “ A study on customer satisfaction of broadband +services in Tamilnadu, India” This study emphasis has been +laid over the comparative performance analysis of telecom +companies AIRTEL and BSNL by using primary sources of +data in Vellore district of Tamilnadu. His findings were network +performance, reliability, and availability and that BSNL must +improve their operating network system and performance. +V.VaratharajAsst.professor in management, S.Vasantha +Associate professor in management, R.Varadharajan associate +professor in statistics, school of management studies, VELS +university,conducted “ An empirical view on customer +satisfaction and satisfaction towards BSNL broadband +connection in Chennai city” their main objectives were to study +the customer satisfaction and satisfaction towards BSNL +broadband connection in Chennai city, and to identify the +factors that influences the customer to select BSNL broadband +services, to suggest strategies to improve the service of BSNL +broadband. They found that respondents were satisfied with +brand image, additional services, cost, advertisements,and +accessibility. +Padma K. JHA (2010) conducted “A study on consumer +behavior of Airtel broadband services” the main objectives +were to analyse the satisfaction level of customers towards Airtel +broadband services and to find out the consumer awareness. +His findings were sixty eight percent people are aware of Airtel +broadband. Airtel subscribers are very much satisfied by the +services and don’t want to switch over to other brands. +Data Analysis +Frequency Analysis +Majority of the respondents (58) were male which accounted +for 58% as compared to female 42%. The percentage of +HSC, under graduate, post graduate, and professionals were +21%, 25%, 31%, 23% respectively. In terms of occupation +28 % of respondents were students, 29% of respondents +were employees, 23% of respondents were professionals, +and 20% of respondents were businessmen. As far as +monthly income was concerned, out of 100 respondents +majority of the respondents (62) have the monthly income +of more than Rs.20000. +Chi – Square Analysis +A. Monthly Income and Monthly Expenditure over Internet +Null Hypothesis (H0); There is no association between +monthly income and monthly expenditure over internet. +Alternative Hypothesis (H1); There is a significant association +between monthly income and monthly expenditure over +internet. +The calculated chi square value is 32 which are greater than the +table value (12.5916) therefore the null hypothesis is rejected. +In other words there is an association between the monthly +income and monthly expenditure over internet. +Demographic +variables +Frequency +Percentage (%) +Age(n=100) + + +<25 +40 +40% +25 – 40 +45 +45% +41 – 55 +8 +8% +56 – 70 +4 +4% +>70 +3 +3% +Gender + + +Male +58 +58% +Female +42 +42% +Educational +qualification + + +HSC +21 +21% +Undergraduate +25 +25% +Postgraduate +31 +31% +Professionals +23 +23% +Occupation + + +Students +28 +28% +Employees +29 +29% +Professionals +23 +23% +Businessmen +20 +20% +Family monthly +income + + +Below 10000 +15 +15% +10000 – 20000 +23 +23% +Above 20000 +62 +62% +INCOME +LEVEL & +EXPENDI +TURE +Exp.Le +ss than +Rs. 250 +Exp. +Rs +250- +500 +Exp +. Rs +500 +– +1000 +Exp. +Rs +abov +e +1000 + +To +tal + +Chi - +squar +e +Below +10000 +5 +8 +1 +1 +15 +32 +DF +6 +Sig +0.000 +10000 – +20000 +3 +11 +5 +4 +23 +Above +20000 +1 +13 +36 +12 +62 +Total +9 +32 +42 +17 +100 +CONSUMER SATISFACTION +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |31 +B. Monthly Income and BSNL Broadband Satisfaction +NS - Not Significant +Null Hypothesis (H0); there is no association between monthly +income and BSNL Broadband Satisfaction. +Alternative Hypothesis (H1); there is a significant association +between monthly income and BSNL Broadband Satisfaction. +Based on Chi square value Null hypothesis is accepted and it +can be concluded that there is no association between monthly +income and BSNL Broadband Satisfaction. +C. Monthly Income and BSNL Broadband Rate +comparison with other providers +NS - Not Significant +Null Hypothesis (H0); there is no association between monthly +income and BSNL Broadband Rate comparison with other +providers. +Alternative Hypothesis (H1); there is a significant association +between monthly income and BSNL Broadband Rate +comparison with other providers. +Based on Chi square value Null hypothesis is accepted and it can +be concluded that there is no association between monthly income +and BSNL Broadband Rate comparison with other providers +Findings +From above data analysis tables it can be seen that 40% of the +respondents purchased their broadband at the initial cost of +Rs.1500 – Rs.2500. 65 % get information about offers from +internet. 42% percent of the respondents’ monthly +expenditure over internet is between Rs.500 to Rs.1000. 50% +of the respondents are using postpaid plans and 50% of the +respondents are using prepaid tariff plans. 39% of the +respondents are using their internet connection for less than 2 +years. 35% of the respondents are using their internet +connection for business purpose. Based on Chi square value +Null hypothesis is accepted and it can be concluded that there +is no association between monthly income and BSNL +Broadband Rate comparison with other providers. Based on +Chi square value Null hypothesis is accepted and it can be +concluded that there is no association between monthly +income and BSNL Broadband Satisfaction. +Discussion +Broadband services are considered as a pretty new technology +that existed for the past few years. Broadband services are only +getting more public awareness recently with the encouragement +by government as well as aggressive promotional activities by +internet service providers. Based on our literature review, there +are three constructs of price, speed and stability which were +expected to influence the customers’ satisfaction level when +adopting broadband services. Due to liberalization, +privatization and globalization, the competition among +companies increased. So it is a must for the firm to improve +its services to maintain its current customers and also give +intensive training for the staff in service department. +Most of the people prefer BSNL services for quality. The people +not aware of the products offered by BSNL. So the company has +to concentrate on creating more awareness to the public there by it +will help to achieve the mission of the BSNL Broad Band services. +Suggestions +More advertisement should be given, so that the consumers +will come to know about new plans and offers.; Employees +working in front offices should be more energetic, should be +always show patience to hear the customers.; BSNL broadband +services should provide high speed and ensure trust +worthiness to the consumer to make the consumers satisfied.; +Customers should be more educated with BSNL services & +tariffs.; Income does not seem to play major role in their +satisfaction with regard to Broadband services. +Reference +Abdur Rahman BRAC Business school BRAC university ,” A +study on customers satisfaction level of prepaid +subscribers of airtel broadband in Bangladesh limited” +Chun-wangtsoua, chun-hsiungliao, “the study on investigating +the antecedents od customer loyalty to broadband +network services in Taiwan”, Asia Pacific Management +Review 15(3) (2010) 413 – 433. +Dr. mohd Rafi Bin Yaacob, (2007) ‘Customer Satisfaction +towards Broadband Services in Malaysia’ International +Journal of Business, Humanities and Technology, +volume 1 No. 2; September. +Dr. PratyushTripathi Professor, VNS Business School, Bhopal +Prof. Satish Kr. Singh Associate Professor, TIT-MBA, +Bhopal (M.P.) “An Empirical Study of Consumer Behavior +towards The Preference and Usage of broadband Services +in Bhopal” Current Trends in Technology and Science +volume: 1, Issue: 2, September-2012, ISSN: 2279 – 0535. +ELENI KOUTRAS (2006), CONDUCTED “ A study on +the use of broadband by generation Y students at two +universities in the city of Johannesburg” +G.RAMDOSS, MEMBER FACULTY, VELS UNIVERSITY, +“A study on customer satisfaction of broadband services in +Tamilnadu, India” Iternational Journal on Global Business +Management and Research, volume 1, Issue 2, march 2013. +Jennifer Blechar, ioanna D Constantiou and jandamsgaard +(2006), European journal of marketing, april, volume 35. +M.Muthumani, Dr. N. Thangavel, Dr. Y +.L. Choundary (2007) ‘ +Consumer preference on broadband connection and buyer +behavior towards reliance in chennai city’ Journal of +Contemporary research in Management, July – December 2007. +Rajan (2005) study on broadband in rural areas. Journal of +Consumer Marketing, volume.18. +Telecommunication research group university of Colorado, +“A study on estimating consumer preference for interest +access services” +Income of the Family +Tot +al +Chi - +squar +e + +Satisfac +tory +Not +Satisfac +tory +Po +or +Excell +ent + + +Below +10000 +13 +1 +2 +0 +16 + +10000 – +20000 +54 +8 +8 +2 +72 +3.508 +NS +Above +20000 +7 +2 +3 +0 +12 +-0.774 +Total +74 +11 +13 +2 +100 + +Income of the Family +Total +Chi - +square + +Yes +No + + +Below 10000 +10 +5 +15 + +10000 – 20000 +45 +23 +68 +1.208 NS +Above 20000 +6 +6 +12 +-0.547 +Total +61 +34 +95 + +CONSUMER SATISFACTION +32 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Women in India suffer several problems in social and political +spheres of life due to prevalence of high intensity of patriarchal +values in the family. Allahabad is a cultural city where most of the +women live in rural areas, where maximum activities of women +determine by the values. In this social structure gender division +of work is fixed where women do household chores and outside +work related to the home are done by men. Since women have +less interaction beyond the four walls so they have less knowledge +about the outside world resulting in their acquisition of less +social capital and also confine their thinking to household activities. +Women participation in political activities at grassroots level is +less due to the fact that those women have lower levels of +literacy and education especially in rural area; that they are not +self-confident and assertive, and lack leadership qualities; that +they are inactive at the grassroots level of politics; and that +they do not put themselves forward as candidates. +Self-help group has emerged over the past two decades as a +leading way of thinking about human development. It plays +important role in rural areas in which interaction and +communication skill, awareness and stock of knowledge are +more important among rural women. Rural women can’t be +educated hastily but the first step which has been taken is to +increase awareness and knowledge through the interaction with +other SHG members and development organization enable +them to take decision regarding casting of votes. +Self-help group is about organising people often women to +work cooperatively in small groups to address issues of shared +concern. Before joining the SHG women politically unaware +and no knowledge that who are standing in election. Although +women are the important part of the society yet they are passive +due to more focus in household chores. The main target of +SHG is participation of women in economic, social, and political +activities which enhance their potential to realize their identity as +a voter and also an active member of society. The creation of +new identity through interaction with their peer members reveals +those at times formal groups have an influencing impact on the +lives of women. Therefore, SHG approach is frequently +considered as the model of empowerment of women. +Data reveals that SHG opens the door for the women to +connect to the activities beyond the home such as book +keeping, record keeping, distribution of money, and deposit +cash in the bank and withdraw from the bank etc. These process +make women able to take decision individually and visit +outdoors all alone and connect themselves to activities related +to community. So in this way women got a platform as a SHG +for communicating their feelings with other women and got +freedom from their traditional role in the family in some extent. +Previous research related to SHGs mainly focused on the +economic gains for households with SHG members. The most +important focus of self-help groups initiated by development +organisations is almost always economic, based on the idea that +household poverty can be combated by supporting women to +find new ways of earning income Garikipati, 2008, Swain & +Varghese, 2009, Mehta, Mishra & Singh 2011). +Ambiga devi & et al. (2012) have assessed the economic impacts +of SHG on the group members in Coimbatore and listed the +seven economic impact of SHG among the respondent. The +most important economic impact was the expansion of their +business (score 58.03). The next important impact was the +possibility of savings (score 57.41), self employed (score 57.13), +financial availabilities (score 56.8) to obtain credit, increase their +standard of living (score 54.2), and empower them (score +53.88), and provide them skill for income generation (score +52.18) while in the study of Kirankere & Subrahmanya (2013) +it revealed that the financial inclusion and economic change of +SHG members in Thirthahalli Taluk of Karnataka. The +findings exposed that majority of rural women (96%) became +entrepreneur because of SHGs and their financial support by +the SHGs (Uma & Rupa 2013). In this order Uma &Rupa +(2013) has reported the financial inclusion of women in +Hunsurtaluk of Mysore district of Karnataka on the sample +of 300 members by using survey method. The study highlights +that after the membership of SHGs there was enormous +increase in the number of bank accounts by members to the +extent of 82.7 percent from 17.3 percent before membership. +This indicates the financial condition of women has improved +after joining the SHG (Selvam and Radjaramane 2012). +Sucharita Mishra (2014) in the study of Odisha on the sample +of 128 SHGs after using the questionnaire, survey and focus +group discussions (FGDs) methods reveal that before joining +the SHG 78% of the participants were home makers or doing +household chores and only 21%, women were engaged in +little earning side by side with their traditional household works +while Suryawansi (2014) has examined the marketing strategies +of SHG women in Nanded district of Maharashtra and +observed that 62.62 percent SHGs were selling their product +only in exhibition, 3.12 percent were selling the product by +door to door sales, 18.75 percent were selling product at their +home and only 12.5 percent SHG were using proper +distribution. The SHG products were papad, candy, masala, +milk related product, beauty product, store product and others. +Less study focuses the participation of women in political +activities and empowerment of women in forms of expanded +social capital through the interaction process (Sanyal 2009). +SHGs and empowerment both are visible as synonyms in +which peer group working in systematic and manageable +manner in SHGs. Women representing as a responsible agent +in creating the consciousness about the new challenges given +GROUP MATTERS +SHGS AS AN AGENT OF CHANGE FOR WOMEN OF RURAL AREAS IN ALLAHABAD +Shashi Pandey +Guest Lecturer, Department of Sociology, S.S.Khanna Girls Degree College +A Constituent College of University of Allahabad +Abstract +One of the most significant social changes over the past 10 years in Allahabad is the membership of women in SHGs (Self-Help Group) through +the intervention of Block and bank initiatives. The group based lending with new norms has generated new role of women at family and community +level. This economic tie has positively influenced their social relations and actions. In present time 99 percent of the household women have engaged +from the SHGs in the village and as a ‘peer group’ they spread all over the village. So, present paper examines that in how political sphere is affected +due to existence of SHGs in village. This study is based on the interviews of 45 women members of SHGs in which 15 members from OBC SHG, +15 from SC and remaining 15 from mixed caste SHGs from Hathiganha village in Allahabad district, Uttar Pradesh. Study reveals that women +become important for the pachayat election due to the membership of SHG while before joining the SHG male members of the family were more +involved in political issues and women have passively obeyed the male members of the family on such issues. +Keywords: SHGs, Women, political participation +SHGS AS AN AGENT OF CHANGE +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |33 +by SHGs. Leadership one of the big challenge for the women +in the group weather they are simply housewife and have no +communication skill but it has been proved from the various +literature that women has done they work related to SHGs is +very well. It is evident from the field that SHGs women +emerging as a new class within the village not only among the +women of the village even among the men. They created new +identity which is one of the dimensions of empowerment. +So, present paper made an effort to know that what changes +has come in life of women at political dimension after the +intervention of SHG. +Sample, Study Area and Methodology +The study was conducted a villages of Allahabad district. A total of +45 respondents selected in which 15 members from OBC SHGs, +15 from SC SHGs and remaining 15 from mixing castes of SHGs +were selected for the study who was the member of SHG since ten +years. Qualitative methods for this study included observation, +interviews and narrative methods to collect key information +regarding SHG women. Daily interactions and conversations with +a diverse range of women throughout the fieldwork built rapport +and trust, and guided the collection of further data. +Objectives: The main objectives of the study are- To explore +the participation of SHG women in political activities before +and after joining the SHG; To examine the role of group +functioning in generating the awareness regarding political issues. +Results and Discussion +The result of the study reveals that before formation of the SHG +in the village, the meetings related to panchayat election attract +more men than women. As societal norms it is spread in society +that if men of the family are convinced for voting, women will be +convinced automatically. It is evident that male members of the +family work as a messenger for their family. They visit outside of +the home and collect the information whatever happening new +in the village and then narrate only that events which is important +for their family members specially their wives. So before joining +the SHG women had less knowledge about the village. +Findings reveal that after joining the SHG, all group members +discuss in meetings that whom we should give vote. +Numerically women engaged more from the SHG and get +strength from their organization. They become attractive part +for the standing people at election. For instance: group members +stated that their group meetings are important at the time of +panchayat election. During the meetings, people who are +contesting to the election request for the vote. We feel happy at +least for some time. This may be the big achievements for the +women as they were only house wife before formation of SHGs. +Data highlights that OBC group members encourages her +member to stand for the election and co-operate the candidate +at village level. On the other side SC group women give the +tremendous result that they not only encourage their group +members for standing in election even they encourage their +neighbours for co-operating her. At village level, SC members +have started going door to door and requested women to +vote on the basis of arguments related to development. They +discuss with each and every family members in village about +the achievements of previous pradhan. It indicates that SC +women not only become aware about casting votes but also +participating in meetings related to election at village level while +mixed group members were limited to discuss on the merit +and demerit of standing person in election at the time of +SHG meetings not participating programmes related to +election. These facts indicate that the collective power of the +women functioning as a means to access the resources. +On the other side members of OBC groups not participated +such programmes due to patriarchal values of the family they +touch out their self to interact with lower caste of women so +they did not participated. +Likewise, SHG activities such as group lending and using +connections with members as well as leaders in their +communities are highly valued as a development approach. +This approach also plays another important role for generating +awareness regarding political issues and promoting +empowerment of women both. For example, distribution +of loans in the group is operated by the women themselves. +This operating system brings enhancement of their group +management skills, and capacity to solve the group problems. +Women engaged in the process of empowerment from this +process at micro level. The roles of joint responsibility and +peer monitoring by each group member make it possible to +solve the troubles of collateral and high cost (Awano, 2000). +Thus, SHG has given opportunity to the women to participate +in political activities at community level that enhances their +social bonding within the community after joining the SHGs. +Conclusion +It can be concluded that SHG association is a vehicle to induce +socio-political changes in rural communities. SC women +become more affiliated to the process of empowerment rather +than OBC and mixed group due to prevailing high intensity +of patriarchal values which came to the light due to their effort. +They have proved that if they get opportunity to represent +their self they will success. The results indicate that women +participation in SHG gives the women sense of pride within +the caste. Due to this process emerges a new group within the +caste that makes them ‘specific’ in the community. +References +Ambiga devi et al. 2012. ‘Social Inclusion through Financial +Inclusion – An Empirical Study on SHG Women in +India’, International Journal of Multidisciplinary +Management Studies, Vol.2, Issue 4, April. +Awano, Haruko 2002 “From Micro-Lending Activities to +Participatory Community Development” in F. Saito (ed.), +Participatory Development, and Tokyo: Nippon Hyoron +Sha, pp. 107-134 (in Japanese). +Garikipati, S. 2008. ‘The Impact of Lending to Women on +Household Vulnerability and Women’s Empowerment: +Evidence from India’, World Development, 36 (12). +Kirankere, P. Subrahmanya, K. C. 2013. ‘Women Empowerment +in Karnataka through Entrepreneurial Finance by SHGs +GRA - Global Research Analysis Volume: 2, Issue: 12, Dec. +Mehta, S.K. Mishra, H.G. & Singh, A. 2011. ‘Role of Self Help +Groups in Socio-Economic Change of Vulnerable Poor of +Jammu Region’, International Conference on Economics and +Finance Research IPEDR vol.4, IACSIT Press, Singapore. +Randhawa and Sukhdeep 2007. ‘Structure And Functioning Of Self - +Help Groups In Punjab’, Indian J. Agric. Res., 41 (3): 157 – 163. +Sanyal, P. 2009. ‘From credit to collective action: the role of +microfinance in promoting women’s social capital and +normative influence’, American Sociological Review, 74: 529. +Selvam, P +. and Radjaramane, R. V +. 2012.‘Self Help Group and Social +Empowerment: An Impact Assessment in the Selected Villages +of Coimbatore District’, International Journal of Development +Research, Vol. 2, Issue, 1, Pp.1001-1007, January. +Suryawanshi, B.R. 2014. ‘A Case Study of Marketing of Self-Help +Group Products in Nanded District’, New Man International +Journal of Multidisciplinary Studies, Vol. 1 Issue- 3 March. +Swain, R. B., & Varghese, A. 2009. Does Self Help Group +Participation Lead to Asset Creation? World Development, +37(10), 1674-1682. doi: 10.1016/j.worlddev.2009.03.006. +Uma, H. R. & Rupa, K. N. 2013.‘The Role of SHGs in Financial +Inclusion-A Case Study’, International Journal of Scientific +and Research Publications, Volume 3, Issue 6, June. +SHGS AS AN AGENT OF CHANGE +34 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +CONTRACT FARMING IN INDIA: MODELS AND IMPACTS +Pavneet Kaur +Research Scholar, Centre for Economic Studies, Central University of Punjab +Naresh Singla +Assistant Professor, Centre for Economic Studies, Central University of Punjab +Abstract +The emerging institutional arrangements such as CF are promoted on the plea that these share production and marketing risks of the producers and +in a way these are seen as a tool to diversify the Indian agriculture and making the farmers’ viable. However, a reality check on the CF arrangements +with the farmers points a gloomy picture. The present models are not completely integrating the small and marginal farmers in the system. Most of +the studies show that the companies prefer to work with mainly medium and large farmers in contracts. +Keywords: Farming, Contract Farming, Models +CONTRACT FARMING +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Agricultural marketing in India is complex phenomenon and +its nature and structure is continuously evolving over a period +of time. With the advent of liberalization, pattern of +agricultural development has shifted from a traditional to a +market-oriented structure resulting in the emergence of new +markets for the producers.But, thetraditional production and +marketing process of fruits and vegetables (F&Vs) in India is +largely characterized by low productivity, limited irrigation +facilities, large number of intermediaries, lack of transparency +in pricing, poor infrastructure for grading/sorting, non- +existent cold chain, poor linkages in marketing channel, +mismatch between demand and supply leading to high price +fluctuations and post-harvest losses along the entire supply +chain of fresh fruits and vegetables(Mittal, 2007; Grover et al., +2012; Singla, 2012). Further, F&Vs are also susceptible to both +production (pest attack and climatic adversities) and price risks +and the lack of risk-mitigating measures such as crop insurance +or assured markets further compound these risks. It is also +argued that the lack of assured prices for F&Vs crops in contrast +to support prices for paddy and wheat acts a major deterrent +for the farmers to shift from traditional cereal crops to high +value crops (Gulati et al., 2008). +In this context, alternative institutional arrangements such as +contract farming can play a vital role to minimize transaction +costs and reduce post-harvest losses in light of increasing +uncertainty, asset specificity and market failures associated with +high value cash crops (Da Silva, 2005). In order to function +these arrangements, Government of India has formulated +the model APMC Act, 2003 that proposes to remove the +restrictions on direct marketing by farmers, development of +market infrastructure for other agencies and set up a framework +for contract farming (World Bank, 2008). By 2014, 18 states +have amended their act and paved the way for the entry of +corporate players in agri-business. Thus, it is argued that +structure and pattern of agricultural marketing would be +different in the presence of corporate players practicing contract +farming. Such arrangements parallel to the traditional marketing +channels will not only increase bargaining power of the +producers, but these may also help to provide the fresh F&Vs +at reasonable prices to the consumers. In this context, the +study has made an attempt to first understand the theory and +practice of contract farming in India along with its impact on +farmers in terms of building linkages with the farmers, +providing technical know-how and raising income. +Theory of Contract Farming +Contract farming (CF) refers to an institutional arrangement +where a farmer grows an agricultural product for a vertically +integrated corporation under a forward contract. Contracts are +generally signed at pre-sowing/planting time along with +specifying the quantity and price of the produce. Contracts +often include the provision of seed, fertilizer and technical +assistance, credit and a guaranteed price at harvest along with +the right to reject substandard produce (Glover, 1994). Basically, +CF involves four things a) pre-agreed price for the produce; b) +specified quality; c) quantity (in the forms of minimum and +maximum acreage) to be procured and d) time of delivery of +the produce (Singh, 2002). The CF arrangements generally +involve high value specialty crops which have profitable ‘niche’ +market; need for consistent and reliable supplies of agri-inputs +on the part of the buyer; a system of input and output +marketswhich cannot be met through open market purchases +and a labour intensive commodity that small holders can +produce efficiently (Dhillon and Singh, 2006). Thus, CF is +considered as an economic institution wherein a processing +firm and a grower enter into a contract and the firm delegates +the production of agricultural commodities to the grower +(Bellemare, 2012). In other words, it can be described as a +halfway between independent farm production and corporate +farming (Singh, 2005). +Contracting firms are mostly large processors, exporters or +fresh supermarket chains; rarely small-scale traders or even +wholesalers execute pre-planting contracts with farmers. To +start contracting, firms have to create a network of trained +field agents, who recruit farmers, provide technical know-how, +monitor compliance and organize collection of the produce +during harvesting. Due to large fixed cost associated with +contracting, only large firms have a bigger incentives to ensure +a steady supply of raw materials, availability of credit and +greater capacity to absorb the risks associated while offering a +fixed price for the produce (Minot and Ronchi, 2014). Mainly, +contracting firms are involved in two types of operations- +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |35 +firstly, they act as marketing link between the farmers and any +other national/international level firms. Secondly, it can also +be involved in the processing of fresh farm produce (Dhillon +and Singh, 2006). In contract arrangements, there is a proper +organized connection between the product and the factor +markets as the contracts require a specific quality of the product +which require specific inputs (Singh, 2002). +In many developing countries including India, CF firms play +an increasingly important role and there has been a long debate +about its impacts on the producers. While critics of CF believe +that firms use contracts to transfer production risk to farmers. +For others, CF is a way for small farmers to involve into growing +domestic and foreign markets for processed foods and use it +as a tool as an agri-business model (Narayanan, 2013). The +Government of India’s national policy on agriculture has also +assigned a key role to the private sector through promotion +of initiatives such as CF. Contracting is perceived as the risk +distribution institutional arrangement between the farmer and +the buyer, where farmer takes on the risk associated with food +production and buyer taking on the risk of marketing and +distribution (Rangi and Sidhu, 2007; Singh, 2007). So, there is +considerable interdependence between the two parties involved +in CF and the transfer of risk is not always equitable. Thus, +basic purpose of adoption of such a policy is to provide a +proper linkage between the farm and the market by giving +farmer an assured price and market; and procuring the farm +produce on the one hand and insuring timely and adequate +supply of inputs to the agro-based and food industry on the +other. Need for such institutional arrangements has its +beginning in the demand and supply disequilibrium in +agricultural commodities, where farmers have to dump their +produce for the want of the buyers, while agro-based industries +face difficulties in procuring quality inputs (Dhillon and Singh, +2006). +In short, CF basically involves the provisions such as- the +parties involved, specific quality and quantity of produce, timing +of delivery, responsibilities of both the firm and the farmers +regarding production and marketing practices, price fixation +criteria, duration of contract, conciliation procedure and +assignment of contracts. The requirement of contractual +relationship depends upon the nature of cropsto be grown +e.g. since grains are not perishable, these generally do not require +contractual arrangement for its prompt harvesting and +processing. But on the other side, some products like F&Vs, +flowers, organic products, tea, coffee and spices generally require +contractual relationship as these are perishability, bulky and +difficult to transport. It is also seen as a way to help small +family farms and farm labourers who require capital and +managerial assistance as they often lack the necessary production +and marketing information regarding new crops and their +varieties. Thus, CF is one such mechanism that can deal with +such constraints in integrated manner (Rehber, 2007). +Emergence of Contract Farming in India +CF in India dates back to colonial period, when Britishers +introduced several cash crops such as tea, coffee, rubber, poppy +and indigo through a central, expatriate-owned estate +surrounded by small out grower’s models (Singh, 2009; +Sharma, 2014). ITC practiced the cultivation of Virginia tobacco +in coastal Andhra Pradesh in the 1920s by incorporating most +elements of fair CF system. Various organised public and +private seed companies, which emerged in the 1960s, were +dependent on individual farms for multiplication of the seeds +under contract since they did not own lands. So, CF in India is +not a new phenomenon as informal CF has been practiced by +cooperatives for quite some time. However, corporate-led CF +system in India is a recent phenomenon. Faced with an acute +shortage of soft wood, Wimco, the country’s sole mechanized +match manufacturer instituted a novel farm-forestry scheme +for the cultivation of poplars in Punjab, Haryana and Uttar +Pradesh (Deshpande, 2005). As a new processed food exporter, +Wimco has also practiced CF with temporary success in +tomatoes to supply its paste factories in Karnataka and Andhra +Pradesh. Realizing the problems in farming economy of +Punjab, the government emphasized the diversification of +agriculture by promoting alternatives to the existing cropping +pattern through CF, encouraging agro-industries and +developing infrastructure for easy access to other agricultural +commodities (Dhillon and Singh, 2006). Singh (2004) believes +that involvement of Punjab in contractual arrangements began +in 1980s with seed and timber production and in perishables +like mustard leaves, procured by Markfed from the farmers to +process it for export market. However, this practice went +unnoticed from the attention of the policies and research. +But, most widely accepted belief about origin of CF in Punjab +is associated with Pepsi Foods Ltd. (Singh, 2002). The entry +of Pepsi was followed by another local entrepreneur (Nijjer) +who also set up tomato-processing plant with half the capacity +of Pepsi’s plant. Hindustan Lever Limited (HLL, a Unilever +subsidiary) set up its processing unit and entered into CF in +1995 (Singh, 2007). +Practice of Contract Farming in India +Procurement +The practice of CF by the companies differs across the locations +and the crops (Table 1). Most of CF companies operated +through written contracts with the farmers. Some of the +companies such as Kartikey Indo Agritech, Technico Agri +Sciences and Pepsico had their contracts in English, while others +such as Agrocel, Pratibha Syntax had contracts in Hindi. +Mahindra Shubh Labh translated contracts from English to +vernacular language so that the farmers are able to understand +the contracts. The companies supplied quality inputs such as +seeds, fertilizers and plant protection chemicals by generating +vertical linkages between the firms and the farmers. All the +companies have different price fixation criteria for procuring +the produce as Pratibha Syntax gave 15 per cent premium at +market price, while foreign and domestic firm of Karnataka +and Kartikey Indo Agritech provided pre-determined prices +and another company Pepsico procured the basmati at the +market prices. +CONTRACT FARMING +36 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +In Punjab, companies like Chambal Agritech and A.M. Todd +procured mainly through the bi-partite case of buy back and input +supply (Figure 1) and sometimes have tri-partite case of credit +supply (Figure 2) along with lifting the produce from the farm-gate +at the company’s cost, while in case of Pepsi/Fritolay and HLL, the +farmers had to deliver their produce at the pre-agreed procurement +point. FLI (Pepsi) in Maharashtra worked through an intermediary +called ‘Hundekari’ who managed the relation with small growers +on behalf of the company right from registering farmers to buy +back arrangements. In Karnataka, the company had organised +informal associations of the producers, who manage the operations +such as seed distribution and supply schedules for delivery of the +produce among themselves (Figure 3).In Kaithal, in case of organic +basmati paddy, Agrocel supplied organic inputs certified by SKAL +and seed supplied by PICRIC and procured the entire potatoes +except damaged potatoes from the farmers at the factory point +(Singh, 2007). Agrocel charged Rs. 500 from PICRIC as service +charge for coordinating contract organic basmati production with +the growers (Figure 4).The Punjab Agro Foodgrains Corporation +(PAFC), a nodal agency of government of Punjab for the +promotion of CF in the state, provided seeds and technical +supervision to CFs along with the promise of buy back entire +produce at pre-agreed prices through tri-partite agreement (Figure +5). The contract is signed between three parties in the presence of +two witnesses with the farmers (Kumar, 2006). +Figure 1 - Bi-partite Contract Farming +Figure 2 - Tri-partite Contract Farming +Figure 3 - Tri-partite (Intermediary) Contract Farming +Figure 4 - Agrocel Supply Chain for Organic Basmati Paddy +Figure 5 - State-led Contract Farming +Table 1 - Features of Contract Farming Companies in India +Source: Nagaraj et al., 2008; Singh, 2009a; Sharma, 2014. +Company +Location +Crop +Type of +contract +Language +Input supply +Price fixation +Agrocel +Gujarat, +Haryana, +Odisha +Organic cotton +Written +Hindi +Not mentioned +Premium deposited in +separate account to be +used by the farmer +group +Pratibha Syntax +Madhya +Pradesh +Organic cotton +Written +Hindi +- +15% premium on +market price +Domestic firm +Karnataka +Green chili, baby +corn +Oral +- +Seeds, fertilizers, plant +protection chemicals +Pre-determined +Foreign firm +Karnataka +Green chilli, +baby corn +Written/oral +- +Seeds, fertilizers, plant +protection chemicals +Pre-determined +Pepsico +Punjab +Potato, Basmati +Written +English +Seeds & pesticide kit +Market price- basmati +Mahindra Shubh +Labh Services +Ltd. +Punjab +Potato +Written +English +(translated to +Punjabi on +demand) +Seeds & pesticide kit +May be changed if +market price falls +Kartikey Indo +Agritech Pvt. +Ltd. +Punjab +Potato +Written +English +Seeds & pesticide kit +Pre-determined +Technico Agri +Sciences Ltd. +Punjab +Potato +Written +English +Seeds & pesticide kit +May be changed if +market price falls + + + + + +Supply of Produce + + + + + +Supply of Inputs +Source: Singh, 2005 +Farmer +Company + + + + + + Payment for Produce + + + + + + Payment for Inputs + + + + +Supply of Inputs + + +Supply of Produce + + + +Credit and payment + + + + + + + + +after deduction of dues + + +Source: Singh, 2005 +Company +Farmer +Bank + + + + + +Supply of company + + + + + +seed, extension and + + + + + +input credit under agreement + + + + + +with no liability on company + + + + + + + +Farmer selection, +Procurement + + + + package of practices, + +Farmer +at fixed or mkt. + + Supply of + payment for produce + +adoption and +linked price, + + produce + +and supervision + +tripartite + + +grading of + + + + +under agreement +agreement & + + +produce + + + + + + + +procurement + + + + + + + + + + + +Seed +supply, + + + + + + + + + + + +payment of + + + + + + + + + + + +commission +for + + + + + + + + + + + +procurement +& +distribution +services + +Source: Singh, 2007 +Farmer +Company +Collection +Centre +Company +Local +Middleman + + + + + + + + +Supply + + + + +Processing of + of produce + + + + +Paddy + + + + + + +Credit +payment + + + + + + + + + + + +after +deduction + + + + + + + + Payment of inputs + +of dues + + + + + + + + + + + + + + + + + +Payment of + + + + + + + + + +produce + + + + + +Facilitator + + +Supply of inputs + + + + + + + +on credit + + + +Source: Singh, 2007 + + +Vishnu +Edible +Ltd. +Agrocel +Bank +Organic +Input +Suppliers +Picric +Importers +Farmers + + + + + + + + + +Produce + + + + +Produce + + + + + + + + + + + Payment + + + + + +Payment +MoU + + + + + for services + + +Seed supply + + +& extension + + +Source: Singh, 2005 +Farmer +Input company +dealer +Company +State +(PAFC) +CONTRACT FARMING +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |37 +Impact on producers +In case of Pepsi, HLL, Chambal Agritech and AM Todd in +Punjab, the average size of the operational holding was higher +in case of contract growers than that in case of non-contract +growers (Kumar, 2006; Singh, 2009). This points that the +companies worked with large farmers to gain from the +economies of scale. Wimco instituted an innovative farm +forestry scheme for the cultivation of poplars in Punjab, +Haryana and Uttar Pradesh; ITC BPL in Andhra Pradesh; JK +corp and BILT sewa unit in Odisha.The marginal farmers could +not participate as the minimum number of trees to be planted +under the scheme was between 400-500 (Singh, 2004a). Kumar +(2006) also observed that direct CF was operated effectively +for all the farm size groups, but indirect contracts seem to +favour only large farmers. Food Chain Partnership (FCP) +program implemented by the transnational company, Bayer +in India was highly selective in terms of the farmers and the +crops to be covered. This limited the prospective of FCP to +replace the traditional trade system as they concentrate only on +those production regions and products that promised most +profit to the companies (Trebbin and Franz, 2010). +The studies from Punjab (Table 2) indicate the preference of +companies for medium and large farmers.The small farmers’ +participation in CF in West Bengal, Karnataka and Maharashtra +may be due to their dominance in these states. The average +size of operational land holding was 1.90 acres in West Bengal, +3.55 acres in Maharashtra and 3.82 acres in Karnataka. On the +contrary, in Punjab the average size of operational land holding +is 9.31 acres (Agricultural Census, 2010-11). Thus, the +companies prefer to work with large farmers, but if the small +farmers dominate area than the companies are left with no +choice rather than procuring from them. CF is also promoting +reverse tenancy as firms prefer to deal with relatively large farmers +(Singh, 2000; Singh, 2002; Singh, 2009). +Studies +Area of study +Contract firm +Contracted crop +Type of farmer +Singh (2002) +Punjab +HLL, Pepsi, Nijjer +Tomato, Potato, Chilli +Large +Dhillon and Singh (2006) +Punjab +Nijjer +Tomato +Medium +Sharma (2008) +Punjab +Pepsico, HLL +Basmati rice +Large +Nagaraj et al. (2008) +Karnataka +Domestic and foreign firm +Chilli, Baby corn +Small and medium +Swain (2010) +Andhra Pradesh +- +Rice seed +Small +Dev and Rao (2005) +Andhra Pradesh +AP govt. and various +processors +Oil Palm, Gherkin +Oil palm- medium and +large; Gherkin- small +Kumar (2006) +Punjab +Pepsi, HLL, Chambal +Agritech, AM Todd and +firms through PAFC +Various crops +Indirect contract- large +Kumar and Kumar (2008) +Karnataka +- +Gherkin, Baby corn, Paddy, +Groundnut, Sunflower, +Chilli, Ragi +Small +M.P. Singh (2007) +Punjab +PAFC +Basmati, Sunflower, Maize, +Hyola +Medium +Ramaswami (2009) +Andhra Pradesh +- +Poultry +- +Sharma and Singh (2013) +Punjab +Technico Agri Sciences +Ltd., Pepsico, Mahindra +Shubh Labh Services, +Kartikey Indo Agritech Pvt +ltd. +Potato, Basmati rice +Medium and large +Pandit et al. (2009) +West Bengal +Frito lay +Potato +Small +Singh (2007) +Gujarat, Maharashtra and +Karnataka, Punjab +Agrocel, FLI, AM Todd +Basmati paddy, Potato, Mint +FLI- small, Others- large +Singh (2004a) +Uttar Pradesh, Punjab, +Haryana, Andhra Pradesh, +Odisha +WIMCO, ITC BPL, JK +Corp, BILT Sewa unit +Poplar +Medium, large +Several reasons have been pointed in literature for restraining +the participation of small and marginal farmers. Like in Punjab, +socio-economic factors that influenced the farmers’ +participation in CF were education, age, farm size, access to +institutional credit, sources of off-farm income, membership +to an organization, proportion of adults and loan limit per +acreage (Sharma, 2008; Sharma, 2014). The companies involved +in CF of potato and basmati were biased in selection of farmers +with preference for those who possess financial and social +capital. The contract and non-contract dairy farmers of +Rajasthan also assesses the asset differentiation i.e. land owned +and number of milch animals (Birthal et al., 2008). The +ownership of assets acted as a significant factor for restraining +the small farmers participation in contract farmingarrangement +(Sharma and Singh, 2013). +The returns per acre of cropped area for all direct contracting +firms (Pepsi, HLL, Chambal Agritech and AM Todd) were +higher in case of direct contracted crops as compared to indirect +contract crops of PAFC and non-contracted crops (Kumar, +2006). Similarly, gherkin and tomato contracted farmers had +higher returns in Andhra Pradesh and Punjab respectively, as +compared to other crops (Dev and Rao, 2005; Rangi and Sidhu, +2007). The mint contract growers of AM Todd & Co. in Punjab +had lower cost of production; almost negligible transaction +costs as the company did not charge for extraction of oil and +higher net income than that of the non-contract growers (Table +3). It was mainly due to better quality of produce and better +prices of the new varieties besides good extension services +provided by the company (Singh, 2009). +Table 2 - Contract Farming and Socio-Economic differentiation +CONTRACT FARMING +38 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Table 3 - Cost and Returns of Mint Contract Farmers and Non- +contract Farmers in Punjab +Source: Singh, 2009 +Within CF, net returns for baby corn and chilli crop were found +to be higher under domestic contracts than foreign contracts +in Karnataka (Nagaraj et al., 2008). For growing contract crops +(rice seed) in Andhra Pradesh, cost was 31 per cent higher than +non-contract crop (rice), but the net return was eleven times +higher than the non- contract crops (Swain, 2010). Thus, most +of the studies pointed that linking the farmers with CF bring +more returns to them. But, therealso existed many problems +in such new institutional arrangements. Some studies +highlighted the problems faced by farmers while working with +contract firms such as farmers of Pepsi, HLL and Nijjer reported +problems such as poor coordination of activities, interior +technical assistance, low prices, preferences for large farmers, +delayed payments, outright cheating in dealings and +manipulation of norms by the firms (Singh, 2004; Singh, +2012), seeds of winter maize supplied by PAFC was of poor +quality (Rangi and Sidhu, 2007), undue quality cut on produce +by firms and pest attack on the contract crop that led to crop +failure (Singh, 2011). Similarly, the farmers who signed a +contract with PAFC specified companies in Punjab were not +provided with desirable extension services and their product +was also not fully procured by the contracting companies +(Kumar, 2006). +Conclusions and Policy Suggestions +The emerging institutional arrangements such as CF are +promoted on the plea that these share production and +marketing risks of the producers and in a way these are seen as +a tool to diversify the Indian agriculture and making farming +a viable unit. However, a reality check on the CF arrangements +with the farmers points a gloomy picture. The present models +are not completely integrating the small and marginal farmers +in the system. Most of the studies show that the companies +prefer to work with mainly medium and large farmers in +contracts. The preference for the small and medium farmers in +Karnataka, Maharashtra, West Bengal in some of the studies +(Singh, 2007; Pandit et al., 2009; Nagaraj et al., 2008) is due to +dominance of these farmers in such states. The companies +left with no choice than to work with the small producers. The +evidence suggests that CF firms in Punjab prefer to work with +large farmers as compare to small farmers because working +with fewer large farmers reduces their transaction costs. Further, +the performance of these fimrs reveal several problems such +as undue quality cuts, delayed payments, low price for the high +quality produce, poor technical assistance, non-procurement +of entire produce due to the glut in the market etc. In order to +make work such institutional arrangements, CF should be +legalized and violation of the contract should invite penalty +on the either side. The firms should also take additional +responsibilities such as providing institutional credit, provision +of proper training facilities and agri-input facilities at cheaper +rates in order to sustain CF arrangements as such mechanisms +will also help in building mutual trust with each other. +References +Bellemare, M.F. (2012). As You Sow, So Shall You Reap: The +Welfare Impacts of Contract Farming. World Development. +40(7): 1418-1434. +Birthal, P.S., Jha, A.k., Tiongco, M.M. and Narrod, C. (2008). +Improving Farm-to-Market Linkages through Contract +Farming. International Food Policy Research Institute. +MTID Discussion Paper No. 85. +Da Silva, C.A.B. (2005). The Growing Role of Contract +Farming in Agri-Food Systems Development: Drivers, +Theory and Practice. Agricultural Management, Marketing +and Finance Service. Retrieved from http:// +www.fao.org/fileadmin/user_upload/ags/ +publications/AGSF_WD_9.pdf +Deshpande, C.S. (2005). Contracting Farming as Means of +Value-Added Agriculture. Department of Economic +Analysis and Research. National Bank for Agriculture and +Rural Development, Mumbai. Occasional Paper- 42. +Dev, S. M. and Rao, N.C. (2005). Food Processing and Contract +Farming in Andhra Pradesh – A Small Farmer Perspective. +Economic and Political Weekly. 40(26): 2705-2713. +Dhillon, S.S. and Singh, N. (2006). Contract Farming in Punjab: +An Analysis of Problems, Challenges and Opportunities. +Pakistan Economic and Social Review. 44(1): 19-38. +Glover, D. (1994). Contract farming and commercialization +of agriculture in developing countries. In von Braun, J. +and Kennedy, E. T. (Eds.), Agricultural commercialization, +economic development, and nutrition (Pp. 166-175). Baltimore, +MD: Johns Hopkins University Press. +Agricultural Census. (2010-11). Department of Agriculture +and Cooperation. Ministry of Agriculture, Government +of India, New Delhi. +Grover, D.K., Singh, J.M., Singh, J. and Kumar, S. (2012). +Impact of Emerging Marketing Channels in Agriculture: +Benefit to Producer-Seller and Marketing Costs and +Margins of Potato and Kinnow in Punjab. AERC Study +No.: 28. Punjab Agricultural University, Ludhiana. +Gulati, A., Ganguly, K. and Landes, M.R. (2008). Toward +Contract Farming in a Changing Agri-food System. +Contract Farming in India: A Resource Book, ICAR, +IFPRI, USDA, New Delhi. +Parameter +Contract Farmers +Non-contract +Farmers +No. of farmers +20 +23 +Cost of production +10462 +11639 +Transaction cost +556 +4880 +Yield (litre) +29.89 +48.39 +Price (Rs/litre) +692.85 +473.35 +Gross income (Rs.) +20668 +22428 +Net income (Rs.) +9649 +5909 +CONTRACT FARMING +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |39 +Kumar, J. and Kumar, P.K. (2008). Contract Farming: +Problems, Prospects and its Effect on Income and +Employment. Agricultural Economics Research Review. +21(conference number): 243-250. +Kumar, P. (2006). Contract Farming through Agribusiness +Firms and State Corporation: A Case Study in Punjab. +Economic and Political Weekly. 41(52): 5367-5375. +Minot, N. and Ronchi, L. (2014). CF- Risks and Benefits of +Partnership between Farmers and Firms. Trade and +Competiveness Global Practice. The World Bank Group. 344. +Mittal, S. (2007). Can Horticulture be a Success Story for India? +Working Paper No: 197. Indian Council for Research on +International Economic Relations (ICRIER), New Delhi. +Nagaraj, N., Chandrakanth, M.G., Chengappa, P.G., Roopa, +H.S. and Chadakavate, P.M. (2008). Contract Farming +and its Implications for Input- supply, Linkages between +Markets and Farmers in Karnataka. Agricultural Economics +Research Review. 21 (Conference Issue): 307-316. +Narayanan, S. (2013). Profits from Participation in High Value +Agriculture: Evidence of Heterogeneous Benefits in +Contract Farming Schemes in Southern India. Food Policy. +44: 142-157. +Pandit, A., Pandey, N.K., Rana, R.K. and Lal, B. (2009). An +Empirical Study of Gains from Potato Contract Farming. +Indian Journal of Agricultural Economics. 64(3): 497-508. +Ramaswami, B. (2009). Grower Heterogeneity and the Gains +from Contract Farming- The Case of Indian Poultry. +Indian Growth and Development Review. 2(1): 56-74. +Rangi, P.S. and Sidhu, M.S. (2007). Contract Farming in Punjab: +Some Issues. In Bawa, R.S., Raikhy, P.S. and Dhindsa, +P.K. (Ed.). Globalization and Punjab Economy: Issues in +Agriculture and Small Scale. Pp.211-227. Guru Nanak Dev +University, Amritsar. +Rehber, E. (2007). Contract Farming: Theory and Practice. The +ICFAI University Press- Hyderabad. +Sharma, N. (2014). Contract Farming in Punjab: Institutional +Framework, Determinants and Efficiency (Unpublished +Doctoral Dissertation). IIT, Roorkee. +Sharma, N. and Singh, S.P. (2013). Contract Farming and +Farmer Participation in Punjab. Man and Development.35(4): +85-102 +Sharma, V.P. (2008). India’s Agrarian Crisis and Corporate- +Led Contract Farming: Socio-economic Implications for +Smallholder Producers. International Food and Agribusiness +Management Review. 11(4): 25-48. +Singh, M.P. (2007). Contract Farming and Emerging Agrarian +Structure: The Case of Punjab (Doctoral Dissertation). +Jawaharlal Nehru University, New Delhi. +Singh, S. (2000). Contract Farming for Agricultural +Diversification in the Indian Punjab: A Study of +Performance and Problems. Indian Journal of Agricultural +Economics. 55(3): 283-294. +Singh, S. (2002). Contracting out Solutions: Political Economy +of Contract Farming in the Indian Punjab. World +Development. 30(9): 1621-1638. +Singh, S. (2004). Crisis and Diversification in Punjab +Agriculture: Role of State and Agribusiness. Economic +and Political Weekly. 39(52): 5583-5590. +Singh, S. (2004a). Contract Farming and Forest Management. +Economic and Political Economy.39(26): 2693- 2695. +Singh, S. (2005). Contract Farming for Agricultural +development- Review of Theory and Practice with Special +Reference to India. Working Paper-2, CENTAD. +Singh, S. (2007). Leveraging Contract Farming for Improving +Supply Chain Efficiency in India: Some Innovative and +Successful Models. ISHS Acta Horticulture 794: +International Symposium on Improving the +Performance of Supply Chains in the Transitional +Economies. Retrieved from http://www.actahort.org/ +Singh, S. (2009). Supply Chains for High Value Crops: A case +Study of Mint in Punjab. Indian Journal of Agricultural +Marketing. 23(1): 93-102. +Singh, S. (2009a). Organic Produce Supply Chains in India- +Organisation and Governance. Ahmedabad: Allied +Publishers Pvt. Ltd. +Singh, S. (2011). Contract Farming for Agricultural +Development in India: A Small Holders Perspective. +Workshop on Policy Options and Investment Priorities +for Accelerating Agricultural Productivity and +Development in India, New Delhi. +Singh, S. (2012). Modern Food Value Chains in India: +Emerging Potential for the Poor. SAMSKRITI, New +Delhi. +Singla, N.(2012). Fresh Fruit and Vegetable Retail Chains and their +impact on Farmers in Punjab (Unpublished Doctoral +Dissertation). Guru Nanak Dev University, Amritsar, +India. +Swain, B.B. (2010). Productivity and Farmer’s Efficiency under +Contract Farming: A Case Study of Rice Seed Cultivation +in Southern India. Retrieved from http:// +www.mse.ac.in/Frontier/j10%20Braja.pdf +Trebbin, A. and Franz, M. (2010). Exclusivity of Private +Governance Structures in Agrofood Networks: Bayer and +the Food Retailing and Processing Sector in India. +Environment and Planning A. 42: 2043-2057. +World Bank. (2008). India: Taking Agriculture to the Market. +Report No. 35953IN. Agriculture and Rural Development +Unit, South Asia Sustainable Development Department, +South Asia Region, Washington. +CONTRACT FARMING +40 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +ICT have a major impact on economy and social relationship +among individual, community and nation. It has a major role +in globalization of capital, labour, product market and is +responsible for covering the distance among individual over +the globe. ICT is used as a tool for development used in all +spheres.ICT is much more than a computer and used in +commercial, industrial and social systems. It’s a fundamental +part of economic growth. +Sustainable development is not merely concerned with +environment and development but it is related to all round +development in every aspect. This usually comprises of three +elements and these are also termed as pillars of sustainable +development i.e. +i. Economic development: remove poverty, economic welfare, +ii. Social development: improve the quality of education, +housing, iii. Environment development: reduction of +pollution and protect other environment sources. +ICT can be divided in two broad categories, the first are those +who largely dependent on telecommunications that enables +on demand communication like, e-commerce and e- +governance. Second group of ICT applications can be called +human independent. And it is necessary to have a interaction +in all the three elements of sustainable development and +technology make it possible. ICT helps in interaction between +all these elements. +Objectives +1. To explore various dimensions of ICT; 2. To define the +success of ICT for sustainable development; 3. To discuss +various challenges and their respective measure to overcome. +Research design +This study is exploratory in nature and is an attempt to look +into the various dimensions of ICT, Sustainable development +and then for possible participative and collaboration measures +that are needed for a positive impact. +1. Various dimensions of ICT: The 4C’s of ICT are the main +dimensions of it, namely computing, connectivity, content, +capacity (human). These are as mentioned below:- +a) Computing: ICT is more than computers and for +sustainable development it requires a lot of innovations in +hardware and software. Computers and others devices +should be affordable and easy to use with inference to local +languages. +b) Connectivity: Developing countries especially rural areas are +still remain without connectivity. Universe access requires new +networking. ICT is more than connecting to internet- human +development requires integration of all forms of ICT and +Medias such as TV, radio etc. +c) Content: ICT will be relevant to sustainable development +when it provides relevant content to the end-users. There +should be appropriate efforts to make locally specific content. +ICT will help in sustainable development only if it provides +suitable content. +d) Capacity (human): Most people lack awareness of +potential of ICT, they have no knowledge regarding its +uses and benefits. There are not only technical barriers but +also barriers related to social cultural and economical. The +first goal of the government to increase literacy among its +population. +e) Success of ICT for sustainable development: Success of +ICT for sustainable development requires integration, +scalability and sustainability. +a) Integration: ICT can’t directly achieve millennium +development goals rather it need to be integrated with +development as well as societal process.ict can only help in +achieving development as it’s a mean not an end. While ICT is +INFORMATION AND COMMUNICATION TECHNOLOGY FOR SUSTAINABLE +DEVELOPMENT +Yogesh Punia +Junior Research Fellow, Dept. of Education, KUK +Abstract +Information and communication technology (ICT) stands for the combined set of resources, whether physical, infrastructure or human, that stands +for the efficient transformation of information across the globes. In the recent years, we have witnessed several changes in the global scenario as the +rapidly boundaries caused the people, society and nations to merge together for a common cause of development. The spread of information and +communication technology and global interconnectedness has great potential to accelerate human progress to bridge the digital divide and develop +knowledge societies. Sustainable development is required for maintaining proper balance between the exhausting resources and our existence. This +paper is an attempt to explore the various aspects of ICT, the challenges in its implementation and future prospects of ICT in our vision of world +as a better place - to live and to prosper. +Keywords: ICT and Sustainable Development +ICT AND SUSTAINABLE DEVELOPMENT +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |41 +concerned with sustainable development then it must be +undertaken in global inclusiveness. +b) Scalability: The challenges of development are vast in area +that it can’t be solved by a single individual or group of +people rather it requires collaboration and sharing experiences +and scaling it to the mass for its betterment. All the +stakeholders and end users have equal right to give their +participation in assessing its needs, responsibilities and +measures of success etc. +c) Sustainability: ICT for sustainable development must be +economical sufficient and provide values to the end-users. +ICT for sustainable development can only be sustainable if it +provides values to the end users. +d) Various challenges and their measures to overcome: +There are several issue that creates problem in achieving +sustainable development through ICT. The challenges +for ICT in sustainable development are divided in 4A’s +such as:- +a) Awareness: Due to illiteracy may of the people have no +knowledge regarding uses and benefits of ICT. They don’t +even know what can be done with ICT. +b) Availability: Appropriate hardware and software are not +available many times that requires in fulfilling the needs of +situation. Especially in rural areas there are less chances of +availability of computers also. +c) Accessibility: Accessibility related to the ability of using the +ICT. There are many e-learning programmes available on +internet to obtain sustainable development. Most of the +population doesn’t have any idea that how to access such e- +learning courses. +d) Affordability: all the ICT usage including hardware, +software cost it become too costly, sometimes it is beyond +the range or common people. The system software or ICT +appliances are sometimes beyond the average income or +common people. +(II) There are some measures to overcome such barriers:- To +overcome such barriers one has to pay attention towards the +various dimensions of ICT i.e. 4C’s of ICT. Measures to +overcome such barriers in 4C’s are:- +a) Computing: Computers are expensive for most people and +are difficult to use. Even most of the experts spend a lot of +time on their machines to upgrades them and regarding their +security, so there must be a complementary technology like: +mobile phones. +b) Connectivity: To have a worldwide access with technology it +is essential to have connectivity on large scale even in rural +areas. In most of the developing countries the rural areas are +beyond the connectivity or it may be expensive. +c) Content: Meaningful content should be available for the +end users. Because sometimes the content is available but it is +beyond the range or local languages. In addition rich content +demands multimedia and that result in broad based +connectivity. +d) Capacity (human): Users need to be aware, literate and well +aware about the uses of ICT. They also have the power to use +the ICT in best way to utilize its benefits with integration with +society and economy. +Conclusion +Development has been our major aim right from the +inception of life on this planet and we have travelled great +heights and lows in order to be where we are today. ICT has +done a tremendous and commendable job in bridging up +the physical boundaries and it is therefore, one of the major +transformation parameters. Although, we should not target +that life should be seen in qualitative terms and so should be +in development. Sustainable development has been the focal +point since the start of this decade and should be dealt with +immediate priority. For making our world a better, we could +make it a constitution and we take adequate steps soon. +Nature has always helped us to prosper and it’s our time to +pay our dues. +Bibliography +Albu, M. & Scott, A. (2001). Understanding Livelihoods that involve +micro-enterprise: Markets and Technological Capabilities in the +SL Framework. Bourton, UK. Intermediate Technology +Development Group. +Avital, M., Lyytinen, K., King, J. L., Gordon, M. D., Granger- +Happ, E., Mason, R. O., & Watson, R. T. (2007). +Leveraging Information Technology to Support Agents +of World Benefit. Communications of the AIS (19), pp. +567-588. +Birkeland, J. (2002). Design for Sustainability: A Sourcebook of +Integrated, Eco-Logical Solutions. London: Earthscan +Publications. +Chapman, R.T. Slaymaker, and Young, J. (2001). Livelihoods +Approaches to Information and Communication in support of +Poverty Elimination and Food Security. Overseas +Development Institute. London. +Glenn, J. C., and Gordon, T. J. (1998). State of the Future: +Issues and Opportunities. The Millennium Project, +American Council for the United Nations University, +Washington, DC. +ICT AND SUSTAINABLE DEVELOPMENT +42 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +FACTORS INFLUENCING GOLD PRICES +Renisha Chainani +Sr. Manager – Research, Edelweiss Financial Services Ltd. +Abstract +Gold is a finite source and when global economic conditions make gold more attractive, gold demand increases, making the price of gold rise. It is used +as a standard of value for currencies all over the world. Gold Price is impacted by production costs, money supply, comfort or discomfort with financial +or geopolitical stability, the demand generated by jewelry and industry, value of various currencies and actions taken by central banks. Gold can also +be used as hedge against inflation and diversifying tool in hard times. +Keywords: Gold, Safe-Heaven, Investment, Jewelry, Bullion, Interest Rate, Monetary Easing, Monetary Tightening, Crisis, Geopolitical +Tensions, ETF, FED, Correlation. +FACTORS FOR GOLD PRICES +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Archeologists claim that people have been mining and coveting +Gold for at least 5,000 years, and this precious metal is likely to +remain precious even if the price fluctuates often. If you plan +to buy gold, you need to understand that the price is impacted +by production costs, money supply, comfort or discomfort +with financial or geopolitical stability, the demand generated +by jewelry and industry, and actions taken by central banks. In +other words, gold is a finite resource and when global economic +conditions make gold more attractive, gold demand increases, +making the price of gold rise. But the actual value of gold +remains fairly stable in the long run, and the price could simply +reflect temporary uncertainty or simple currency fluctuation. +Below are seven significant influences on gold price fluctuations +that any investor with an interest in gold trading should +understand. +Supply and Demand +Like most commodities, the basic principles of supply and +demand play a major role in determining the price of gold. +However, due to the physical limitations of mining for gold, +the supply of gold in the world remains relatively stable (with +the addition of the small amounts that are mined every year). +This means that demand has a much larger impact on gold +prices than supply does. When gold consumption increases, +so does the price; the only thing that will drive prices down in +a significant way is a decrease in demand. +Supply +Only about 2,500 metric tons of gold get produced each year, +compared to an estimated 165,000 metric tons in the entire +world’s gold supply. To visualize this, imagine all of the gold +in the world filling up three-and-a-half Olympic-sized +swimming pools, and this year’s production forming a cube +that is only about 16 square feet. +Even though new production might seem modest compared +to the total supply, production costs can influence the cost of +all gold in the world. When production costs rise, miners sell +gold for more money to preserve their profits, and those +higher costs also get reflected when it comes time to sell coins +if they were minted from gold that was originally mined +yesterday or thousands of years ago. +China is the largest producer of gold in the world, accounting for +about 15% of total gold production. Asia, as a whole, produces +about 22% of newly mined gold, Central and South America +produce around 17%, and North America supplies around 15%. +Africa and the CIS (Commonwealth of Independent States) +contribute 20% and 14%, respectively, to gold production. +Demand +Safe-haven Demand: Gold is typically considered a safe haven +when currency markets are volatile. United States Treasury +Bills are also considered a safe haven even in a tumultuous +economic climate because they are backed by the full faith and +credit of the U.S. government. Increasing gold prices are a +traditional indicator of a recession or a downturn in an +economy. People run to the safety of gold when they think +the value of other investments may go down in the future. +People flock to gold when the current paper money system +experiences uncertainty. Some investors prefer the physical and +tangible security of holding gold when central banks are going +through deficits as a protection of wealth. In turn, an increased +demand drives up the value of gold even more +Investment Demand: Gold ETF demand inflows Jan to April +rose 24% from the end of 2015 as the gold price gained 20% +and the Bloomberg Dollar Spot Index fell 4%. This suggests +the 34% gold-price decline from the $1921 (2011 peak) is luring +back longer-term investors seeking a safe haven. +Gold ETF Demand and Gold Price +Physical Demand from Consuming Nations: India and China are +the world’s two largest consumers of gold, and together they +make up about 50% of gold’s global demand. Gold is treated +more as a commodity in these two countries, and its demand +is relatively inelastic. Even gold’s near 9% surge in price since +the beginning of 2016 hasn’t curbed its appeal. Instead, buying +seems to have picked up. +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |43 +Jewelry and Industry: Gold is not just valuable as a hedge fund +and a safe haven investment; gold is also used in jewelry and +industry. Over half of gold demand is from jewelry, and China, +India, and the United States are three countries with the biggest +demands. In some parts of India, gold is still regarded as a +type of currency, a display of wealth, an important gift, and a +hedge against bad times. This demand drives the price of gold +in India up. Gold, both the color and the precious metal, is a +symbol of opulence in China, and a booming Chinese economy +means that more people have money to spend on China gold. +Besides jewelry, another twelve percent of gold demand is +generated from industrial applications. Manufacturers use gold +in all sorts of electronic devices, from computers to GPS +systems, and medical devices like heart stints +Practical Applications: Gold isn’t just an object of beauty and +monetary value; it has many practical applications as well. We +use gold in electronics, computers, dentistry, medicine and +much more. When the demand for gold in any of these +industries fluctuates, it’s going to impact the price of gold. +Central Bank Buying +Central banks, like the U.S. Federal Reserve, hold both gold +and paper currency in reserve. In fact, the United States and +several European countries hold the bulk of their reserves in +gold, and they have been buying more gold for these reserves +recently. Other countries that hold gold include France, +Germany, Italy, Greece, and Portugal. When these central banks +start to buy gold in greater quantities than they sell, it drives +gold prices up. This is because the supply of currency increases +and available gold becomes more scarce. +Over the past few years, a dramatic change has taken place in +the precious metals market. The world’s central banks have +shifted from being net sellers of gold to net purchasers of +significant quantities of gold. Since 2011, central banks and +other institutions have been unwavering in their accumulation +of gold. The countries that wish to diversify risks away from +troublesome currencies may opt for gold as a backup. +Currencies +Gold is used as a standard of value for currencies all over the +world. The price of gold gets stated as a currency value, often +in U.S. dollars, and the price of gold can fluctuate with market +conditions +Dollar Index: The U.S. dollar is still the world’s dominant reserve +currency, making it one of the main currencies that different +countries hold for international trades. +There is an intrinsic correlation between gold prices and the +US dollar. When the demand for the US dollar falls, banks, as +well as investors around the world, invest more in gold. Gold +and the US dollar are both used as a hedge against uncertainties +and are favorites for central banks worldwide +Euro: The main reason for the high correlation has been the +shared perception of gold and the Euro as alternative +investments to US$. During this period the major currencies, +including gold, have tended to react in concert to economic +news from the USA. Gold, with neither an underlying +economy, nor price-sensitive supply and demand issues, is the +purest of the “currencies” and its fortunes have been a mirror +image of the dollar’s. Similarly, the Euro has been seen by +many as the natural first choice alternative currency to US$, and +has benefited from recent US$ weakness caused primarily by +the USA’s dual deficits growing to record levels. +Japanese Yen: There are several other currencies that also have +this safe haven status, two of which include the Japanese Yen +and the Swiss Franc. The Japanese Yen and Swiss Franc are +viewed as safe havens because of their strong net international +surplus. Japan is the world’s largest creditor, last year having a +surplus of over 3 trillion dollars. Switzerland ranks as 5th but +is the only other currency out of the top 5 creditors that is not +pegged or not convertible. There is also the issue of low interest +rates in both these countries. Since interest rates across the +term structure in Japan and Switzerland are close to zero, this +leaves little room for further interest rate cuts. Since interest +rates cannot be cut, in times of stress these currencies are less +likely to weaken than others where interest rates can be cut in +an attempt to lower the currency. Therefore both the yen and +the Swiss Franc are treated as safe havens. +The correlation between the USD/JPY and Gold was negative, +with the 7 year correlation standing at -0.86, 5 year -0.87, 2 year +-0.89 and 1 year -0.86. This extremely strong correlation shows +that gold is in fact viewed as a safe haven currency as opposed +to a commodity, which it is often sited as. As a reminder, gold +being negatively correlated with USD/JPY implies it is +positively correlated with JPY/USD; so we can say that gold +behaves in a similar way to the Yen +Swiss Franc: The Swiss Franc is also viewed as a safe haven +currency. Like Japan, Switzerland has a surplus of international +investment and has low interest rates across its term structure. +This has made the Swiss Franc a core safe haven currency. For +this reason Gold was very closely correlated with the USD/ +CHF. The correlation for 7 years was -0.91, 5 years -0.87, 2 +FACTORS FOR GOLD PRICES +44 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +years -0.82 and 1 year -0.35. Below is the 7-year and 5-year +charted correlation between the USD/CHF and Gold. +Macro-Economics +Interest Rates: Interest rates are not the only variable that affects +the future performance of various asset classes. Other variables +include the true inflation rate, the real interest rate (nominal +interest rate – inflation rate), the value of the dollar and +whether its value is expected to increase or decrease and how +the dollar fluctuates in comparison to other currencies, and +market expectations regarding these factors, and other variables +Due to very low interest rates, many investors look for other +investments where they can be a better rate of return. Low +interest rates mean the “cost to carry” investments is low +thereby increasing demand by some investors such as hedge +funds. As interest rates rise, demand for gold is expected to +fall which should mean decreasing gold prices. +Gold does not pay interest like treasury bonds or savings +accounts, but current gold prices often reflect increases and +declines in interest rates. As interest rates increase, gold prices +may soften as people sell gold to free up funds for other +investment opportunities. As interest rates decrease, the gold +price may increase again because there is a lower opportunity +cost to holding gold when compared to other investments. +Low interest rates equate with greater attraction to gold. One +of today’s most important factors in the determination of +the price of gold is the Fed’s potential interest rate hike. +Inflation: A common reason cited for holding gold is as a +hedge against inflation and currency devaluation. Currency +values fluctuate, but gold values, in terms of what an ounce +of gold can buy, might stay more stable in the long term. +Because gold holds value outside of politics—it is valued the +world over—gold is attractive as a low-risk, solid investment +in the midst of floundering currencies. Investors may feel +encouraged to buy gold when they believe the value of their +paper money will decline. +Gold has served as a store of value for generations now. It is +said to be a hedge against inflation, meaning that when prices +rise, investors can park their money in gold. However, at +times, the price of gold and the inflation rate show a direct +relationship with each other and the hedge does not +hold. How well gold can protect investors against inflation +remains unclear. +The chart above compares gold prices with the inflation rate. +To describe inflation in the US economy, we can use the yield +spread or the break-even spread. This measures the difference +between the ten-year US government bond yield and TIPS +(Treasury inflation-protected securities). The principal invested +in TIPS is adjusted in line with the CPI (consumer price index). +The yield spread, therefore, seems to be a good proxy for the US +inflation measure. Over the past 45 years, gold prices and the +US CPI show an average 12-month correlation of precisely zero +Outlook of other asset class +Equities: When the economy falters, it tends to send people +into panic mode. When people are in panic mode, they like to +invest in things that are proven and tangible in order to hold +on to some semblance of security. This is why people flock to +gold investment when the rest of the market is struggling; +gold has held its value throughout the centuries, and remains +an enduring and universally recognized symbol of currency +and wealth. The proven worth of gold provides comfort to +anxious investors. Because of the increased demand for gold +during tough economic times, the price gets driven up, meaning +that gold helps to buoy investment portfolios when the rest +of the Equity market is struggling. +Bonds: The negative relationship between gold and interest +rates imply positive correlations with bond prices, since the +price of bonds is negatively related to the yields they offer. +Gold is a substitute for Treasuries, especially when yields are +near zero. In such an environment, investors may simply prefer +to buy gold rather than bonds (that practically pays zero). +Yeah, the precious metals do not yield any income at all, but at +least they are not made of paper and U.S. government cannot +issue them. Hence, there may be a positive relationship between +gold and bonds due to the opportunity costs and capital flow +from bonds to gold, when prices of bonds become too high +(yields become too low). There may be also capital flows in the +opposite direction (from gold to bonds) when bond yields +increase (bond prices decrease) and provide a better alternative +than gold. This is especially true in the case of U.S. Treasuries. +They are considered as a safe-haven - but one which pays a +yield. In other words, “fear trade” may increase demand for +both gold and bonds. The latter are generally anti-cyclical, while +gold is noncyclical, but both asset classes may sometimes move +in tandem responding to changes in the stock market, as a +non-confidence vote in the U.S. economy (this is why people +invested in gold and bonds during the last financial crisis). +Moreover, the Fed typically increases the money supply by +purchasing government bonds and pushing their prices higher. +If such purchases are considered as a signal that the U.S. +economy is weak (e.g. as in the case of first quantitative easing), +the price of gold may rise simultaneously with bond prices. +FACTORS FOR GOLD PRICES +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |45 +Investors should remember that what really matters for gold +are real interest rates, not nominal yields. The chart below +shows a significant positive correlation between the price of +10-year inflation-indexed Treasury and the price of gold, or +negative relationship with real interest rates (10-year inflation +indexed Treasury rate is a proxy of U.S. long-term real interest +rate). The rates in the chart are in reverse order to show the +trend in bond prices (which are inversely related to yields). +Crude Oil: The price of Crude oil plays a crucial role in the +determination of the price of gold and gold-backed ETFs. +Like gold, the price of crude oil is determined in the US dollar. +When the US dollar rises, dollar-denominated assets usually +drop in price, as investors of other currencies find dollar- +denominated assets more expensive. Because gold and crude +oil are dollar-denominated assets, they are strongly linked. +Another important link between gold and oil is inflation. As +crude oil prices rise, inflation also rises. Gold is known to be a +good hedge against inflation. The value of gold only increases +when inflation rises. Over 60% of the time, gold and crude oil +have a direct relationship. The above chart shows historical +prices for both dollar-denominated assets. +Gold and crude oil are further related in that a rise in the price +of oil dampens economic growth due to its excessive industrial +use. Dampened economic growth adversely affects most +industries. This can lead to a fall in equity markets, which boosts +the demand for alternative assets such as gold. Gold’s magnetic +force is in play here. The recessionary phase would be good for +precious metal lovers by pushing gold prices higher. +Monetary Policy of Central Banks +Monetary easing is meant to spur a nations economy into growth +mode by making capital readily available. However, monetary +easing can also become a catalyst for inflation. When a nation +floods its system with easy credit (via low interest rates) or floods +the market with currency, it is hoping that the economy will expand. +A larger money supply pushes interest rates down, which could +encourage investors to buy gold because of the lower +opportunity cost. When overdone, this tactic this can trigger +inflation, another signal of a rising price of gold. +With policy rates close to zero in the aftermath of the Great +Financial Crisis, several central banks around the world have +introduced unconventional policies to provide additional +monetary stimulus. One example is the decision by five central +banks – DanmarksNationalbank (DN), the European Central +Bank (ECB), SverigesRiksbank, the Swiss National Bank (SNB) +and most recently the Bank of Japan (BoJ) – to move their +policy rates below zero, traditionally seen as the lower bound +for nominal interest rates. The motivations behind the +decisions differed somewhat across jurisdictions, leading to +differences in policy implementation. Such monetary loosening +with lowered interest rates gives a boost to haven investments +such as gold, which are non-interest-bearing and provide no +cash flows, just as zeroed down interest rates. +On the other hand, we have the Federal Reserve, which has +optimistic plans for the comparatively stable US economy. +The Fed had fixed on a gradual pace of raising interest rates in +2016 and on Monetary tightening cycle. The pace would have +given way to four hikes during the year. However, the global +turmoil adversely affected market sentiment in the United +States, which may have left the Fed reevaluating its plan. +Crisis/Geopolitical tensions +Because gold prices tend to rise when people lack confidence in +governments or financial markets, it often gets called a crisis +commodity. World events often have an impact on the price of +gold because gold is viewed as a source of safety amid economic +or geopolitical tumult. For example, the price of gold spiked +right after the Russians moved into the Ukraine as people became +uncertain about geopolitical stability in the region. In other cases, +military action may actually increase reassurance with geopolitical +situations. For example, the gold price softened at the beginning +of Gulf War I. The bottom line is that political chaos equates to +more interest in gold as a safe haven. +As gold prices reached higher numbers during the 2008 stock +market unrest, they have also done so during rising global +tensions. Gold famously peaked in 1980 to $850 when the +Soviet Union invaded Afghanistan. The wartime scenario +usually pushes gold the most, and silver usually follows. +On August 2, 1990, as Iraq invaded Kuwait, investors saw +gold spike, and when the initial bombardment happened in +Iraq in 1991, prices spiked again. The beginning of the Iraq +War saw gold rise considerably. However, as war subsides, +precious metal prices have been sinking. +References +http://www.kitco.com/ind/Kirtley_Sam/nov282011.html +http://www.forexdictionary.com/definition/256/ +monetary-easing +http://www.sbcgold.com/blog/10-factors-regularly- +influence-gold-prices/ +http://www.marketoracle.co.uk/Article52907.html +http://marketrealist.com/2015/12/correlation-gold-oil/ +http://marketrealist.com/2016/02/global-easing-fed- +tightening-one-will-decide-gold/ +FACTORS FOR GOLD PRICES +46 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +Contemporary understandingthe notion of the investment +potential in the literature in most cases comes from the +existence of resource base. This way can be determined any +potential, but inclusion of a wide range of private capacities, +including natural, industrial, labor and other resources +substantially eliminates the distinction between investment +and economic potential, essentially mixing these concepts. +Therefore, it seems necessary for disclosure of the essential +role of investment potential to formulate a different approach +to this category. It should reflect both sides of the investment +- the existence of investment resources (sources), investment +and the efficiency of their investments. The introduction of +the second side extends the concept of investment potential +and gives a finished look to this category. Notably, it allows +one to set a categorical connection with the investment potential +of the investment field and its elements. +In other words, the investment potential is an interactive set +of current and future investment resources, actual and possible +outcomes of their use in relevant investment field. +The formulatedin this paper definition of investment +potential sees at least two components of this category, +resources and the result of their use. As a result understanding +of the investment potential presented in our paper is +fundamentally different from the dominant approaches in +contemporary environment, which, as a rule, considers only +the resource base and its parts. This paper specifically +drawsreaders’ attention to thedifference once again, as this +interpretation of the investment potential of a static category +with specified parameters. This definition, excludes dynamics +and movement, and therefore it is not definite out of whatthe +investment potential occurs and where it goes. Considering +that in it included raw materials and other natural resources, +such an understanding of the investment potential of more +like the divine nature of origin, rather than a man formed +economic reality. +Therefore, based on this definition, almost all former Soviet +republics, and Russia in first place, after the collapse of the +Soviet Union oriented their investment base on the formation +of commodity resource economy. Countries that did not have +rich natural resources, almost entirely concentrated their +economic and even political activities around the transit +pipelines. Thus, it can be argued that the theoretical definition +of investment potential, arising from the availability of natural +resources, is not harmless, and leads to serious and far-reaching +miscalculations in the strategic development. +New definition of the investment potential presented in this +article not only reveals a categorical nature of the investment +potential, but also allows to use it effectively in the +development of theory and methodology of the mechanism +of the investment potential formation, determines goals, +directions, priorities and scope of practice to enhance +investment activities. +The investment potential cannot exist independently without +development. Moreover, development is realized only through +a particular system and requires a holistic definition, the notion +of development is a new generation of integrity. Therefore, +development is diverse, multi-level and multi-stage. But it +involves an exception to the process of its inception the system +and the moment of its dissolution, liquidation, termination +of its existence. Its occurrence is associated with the passage +and with it gives becoming. Formation is, as Hegel noted, +average between nothingness and being, rather, the unity of +being and nothingness. “From the establishment of +determinate being there ... His mediation, the establishment +is behind him; Claiming it withdrew itself and so the actual +existence appears as a kind of first, from which emanate. “ +Thus, even from Hegel can lend a logical chain in the +understanding that the resources of the investment potential +- “the first of which are based on” the development of. But +here we are faced with another fundamental concept of the +modern theory of evolution, that the development of the +“there is a state change that takes place while maintaining their +base, ie some initial state, generating new states. Saving the +original state or foundations ... only makes possible the +implementation of laws. “ This means that in our case, further +consideration of the increase of investment potential, limited +to the classical models of the theory is incorrect and does not +give the desired result, as in the understanding of the +investment potential, we again return to the natural resources, +adding to them only their reproduction and ecology. Therefore, +we are opposed to the classical theory of development, not +rejecting and challenging its postulates and laws, we introduce +the theory of the investment potential of a new concept - the +generation of investment potential. The term “generation” is +derived from the German word (Generation) and the Latin +(generâtio) origin and translates as birth, creation. And in the +modern scientific interpretations under him understand the +birth, reproduction, production. Moreover, this term is +understood and some new generation. Thus, the concept of +generation as opposed to the development of the completed +allows us to represent the complete process of the birth and +reproduction of the investment potential as a single integrated +system and trace the emergence of new investment +“generations.” +The process of origin of the investment potential is directly +related to the resources - investment sources. In turn, their +appearance due to the presence of the investment field. And +it’s obvious. In the framework of this field is generated by the +scheme investment potential: resources - resources - the result. +But this is only one cycle. This is followed by the second and +GENERATION OF INVESTMENT POTENTIAL +Naima Khashimova, Uzbekistan +Jamola Khusanjanova, Uzbekistan +Abstract +This paper proposes new approach to the disclosure of the investment potential and frames new definition of the investment potential,which extends the +concept of investment potential and gives finished look to this notion. In contrast to the classical theory of development, without rejecting and challenging +its postulates and laws, this paper firstly introduces to the theory of the investment potential, new conceptual notion - the generation of investment potential. +Keywords - investment, uzbekistan, investment potential. +INVESTMENT POTENTIAL +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |47 +the next, because the process of generating a continuous +investment potential (Fig. 1.1). +Fig. 1.1.The proses ofinvestment potential generation. Source: +developed by the author +In each cycle deep qualitative, quantitative and irreversible +changes occur. And this is precisely the main features of the +generation of investment potential. This is, firstly, a qualitative +and quantitative changes, secondly, the irreversibility of these +changes and, thirdly, the continuity and directivity of the +potential investment. +An important feature of these signs is the fact that none of +them taken alone may not be sufficient to determine the +generation of investment potencial. Any of them is insufficient. +These features generate investment potential are necessary and +sufficient to distinguish the positive generation of its possible +chaotic changes that lead to closed circulations inconclusive +mechanical motion of investment resources. This we have +seen in the administrative-command system, when an +overwhelming amount of investment resources irretrievably +stuck in objects under construction, without creating its new +quality. It was the appearance of the development, reflects the +statistics of the growth of capital investments, but not having +to generate the investment potential of nothing. Progressive +economic science at the time called it immobilization or +immobilization of capital investments. The phenomena of +this kind in the investment sphere are not compatible with +the generation of investment potential and must be constantly +monitored during the investment monitoring. But you need +to change the criteria for evaluating the investment potential +of the movement and give them comprehensive, covering all +three main features of his generation. +Thus, the introduction of contact to the theory of investment +potential of the new category of generation of investment +potential and its opposition of the category “Development” +is dictated not by the attempts to create a new terminology +form to a known process, and the need to give different quality +content development processes, expand and link together all +the elements of the investment potential of the its occurrence +until the investment result. Ultimately, such a theoretical vision +of the dynamics of the investment potential will allow the +practice in a new way to build the whole system of management +of the investment potential and to create an adequate +mechanism of its formation this. +It should be noted also that the generation is an objective +phenomenon, the phenomenon of material and spiritual +reality. It is in a certain sense does not depend on the investment +potential of the formation as a subject. As such the investment +potential of itself creates, perceives and evaluates the process +of their own generation. The complexity of generation and +other factors determine the ambiguity, the diversity of its +interpretations for different objects. In practice, usually do not +think about how goes developing a process. But any theoretical +study comes inevitably to the need to determine the type of +its formation, the development or generation. It is not +surprising, since the identification of the type of generation +makes it possible to evaluate how successful functioning +mechanism for managing this process and what are the +prospects for its development. +Therefore, in order to identify the features of the investment +process generating dwell primarily on the known theoretical +models of development, as the only way to show what +difference the investment process by generating other +approaches. The need for such a brief introductory overview +of the basic models can be characterized by well-known in the +transition model of economic reforms - shock therapy and +gradualism. Economic reforms began literature was literally +saturated with the assessment and classification of the progress +of reforms in these two grounds. But this only applies to the +processes of formation of market relations. Meanwhile, the +broader approach in this area demonstrates a philosophical +science, comprehensively and thoroughly studying the process +of development. Therefore, without going into details (it is +the case of philosophical sciences), we characterize them, in +order to understand the place that takes in all this variety of +models generate investment potential. +Let’s start with the most common and widely known +development approaches presented in any scientific literature +on philosophy. This so-called “model of dialectics.” The first +of these is known to the XVIII-XIX centuries represented by +the works of German philosophers Kant, Fichte, Schelling, +Hegel. It is named realistic, logical-epistemological model of +dialectics. Later, the dialectical materialist, gradualist and +synthetic (natural- synthetic account). We will not dwell on the +dialectical materialist conception as the degree of its abstract +submission so extensive that it see a particular application to +the generation of investment potential, it can only be an +abstraction in relation to the object at a similar level. But in +this case, to see the result of its application in the realization +of economic practice is even more difficult. +But gradualism model not only easier, but also more practical. +Another important factor is that this philosophical term in the +past decade firmly entered the lexicon of economics. In the modern +literature as gradualism understand the gradual development, +and always point out the lack of this model - denies jumps and, +therefore, the denial of qualitative changes. A variation of this +model - evolutionism without denying gradualism suggests that +its outcome will be a qualitative leap. But this theory of evolution +denied the explosive jumps species. Essentially all of this model +of gradual movement and they are constantly evolving. +Meanwhile, the general theory of evolution has long been known +emergence talking about the possibility of plosive jumps, which +are based on the creative component. In other words, different +concepts of gradualism formula reduces to the relation of +continuity and discontinuity of processes. +Synthetic (natural-scientific account) concept is very diverse in +forms, as based on the description of the various forms of +motion in nature. However, with regard to economic +developments, interest equilibrium-integration approach, +talking about the economy as an equilibrium system, all parts +INVESTMENT POTENTIAL +48 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +of which are balanced with each other and harmony devoid of +contradictions. But this statement is totally rejected by the +theory of conflict, which is contrary an absolute conflict and +overcoming the contradictions. Moreover it argues that there +is a conflict in order to meet the needs of the system changes. +There is a lot of other varieties of these basic concepts. Diverse +and their applications in economics. This once-famous +“balanced, proportionate ‘development, firmware +development, cluster development, and even the development +of the wave. But all this relates to the global macroeconomic +processes. Generation of the investment potential of the +process exists within a certain macro and micro-economic +systems and obeying the general framework of their +development has its own characteristics resulting from the +nature of the investment potential. And it is easy to see, because +the investment potential goes through several stages. In its +simplest form, is the emergence of resource use and the +achievement of results. And the result - giving new investment +resources, which again sent for and obtain a new result. Thus, +the generation of investment potential is circular in nature, +and each time getting investment result marks the repetition +of already covered. Such processes are called repetitive, cyclical. +They are a set of interrelated processes, activities, forms a +complete circle phenomena development. However, the +generation of investment potential cannot be equated with +economic cycles, which are constantly recurring fluctuations in +economic activity. This concept suggests that the growth of +social production is carried out non-linear and is accompanied +by periodic fall. If the possible phases of the economic cycle +include: crisis, depression (stagnation), recovery, recovery, the +generation of investment potential in principle has only three +components: getting the resources they use to achieve the +investment result. Moreover, this cyclical scheme has a universal +character both on a micro and macro level. +Ideally, at the end of each cycle should be ensured growth of +investment resources. It characterizes the initial increase in total +investment potential. Accordingly, increasing their volume to +further use and is expected to receive more results. That is, the +generation of investment potential is transformed from a +circular spiral in the process and is carried out on the concept +of R0 ’! I0 ’! P0 ’! R1 ’! I1 ’! P1 ’! ..., where R0- initial investment +resources, I0 - the use of primary resources, P0 - the primary +outcome, R1 - Resources of the first cycle, the first cycle of use +of resources, P1- result of the first cycle (Fig. 1.2). +Fig. 1.2. Cycles of generation investment potential Source: +developed by the author +What is ideal, but in practice it is almost unattainable thing. In +fact, in the development of such a spiral generating investment +potential, there are constant disturbance. They may be local (Fig. +1.3), and may be under the influence of the crisis and other +phenomena even lose its principled helical structure (Fig. 1.4). +Fig. 1.3.Driving small (current) disturbances in the generation +cycle of the investment potential Source: developed by the +author +Fig. 1.4.Driving disturbances such as a crisis in the cycles of +generation investment potential +Source: developed by the author +However, if we analyze the generation of investment potential +over the long term, the spiral nature of this process is obvious. +However, they are visible and unavoidable deviations caused +by the influence of economic cycles, political and +macroeconomic disturbances and other impacts of the +investment field. +Thus, the theory of investment potential we introduced an +important new component - the generation of investment +potential, which develops and supplements the classical category +of including it in the process of emergence, origin of investment +potential. The main features of generation are, firstly, the +qualitative and quantitative changes, secondly, the irreversibility +of these changes and, thirdly, continuity and orientation of the +generation of investment potential. Generation of the +investment potential of a cyclical nature and develops in a spiral, +given the micro and macroeconomic influences. +Bibliography +B. Hegel Science of Logic. T. 1. M., Nauka, 1970. 170.s. +Svidersky VI Some features of development. // Problems of +Philosophy. 1985. ¹ 7. S. 27-28. +Collegiate Dictionary businessman. +Management, marketing, computer science. Kiev, Technics, 1993 +A large German encyclopedia «DUDEN». Electronic version +of the 2010; +Great Russian Encyclopedia of Cyril and Methodius. +Electronicversionofthe 2010; +Explanatory Dictionary of foreign terms L.P.Krysina. +Electronic version of the 2010. +INVESTMENT POTENTIAL +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |49 +REQUIREMENT MANAGEMENT A KEY TO SUCCESSFUL PROJECT MANAGEMENT +FOR SOFTWARE SYSTEMS +Bharti Venkatesh +HOD (HR), V.N.S Institute of Management,Bhopal (M.P) +Lalit Balani +Research Scholar, Barkatullah University, Bhopal (M.P) +Abstract +Requirements are basic building block for any project clear requirements definitions are very important for any project. Without clearly spelt out +requirements it is very difficult to develop a stable system. Worldwide percentage of successfully completed projects is very low, and most of the failures +are attributed to unclear, ambiguous or undefined requirements. In Case of software projects, management of requirements is very critical for +successful Project Management.This paper attempts to highlight what are the common causes for failure of requirement management process in +software projects. Thispaper also highlights continuous usage of different metrics so that whenever the requirement management process performance +goes off track, corrective action can be takeninstead of acting only after completion of the phase. +Keywords: - Requirement Management, metrics, Stakeholders, Project Management +For a project to be successful it should meet all its objectives +within fixed delivery schedule using pre allocated fixed budget. +Each of the executed projects is unique in nature and is +supposed to give unique output. Each project has multiple +stakeholders and expectation of each stakeholder from the +project differs and can even be contradicting from each other. +These expectations normally keeps changing as the +environment in which the project is executed is dynamic and +changing very rapidly. As a result of these changing expectations +the stakeholders keep changing their requirements. The +developers face the problem of these changing requirements +as whatever he had developed till now becomes not useful +and he has to start the process of designing the system again +for new requirements. This cycle causes lot of rework and lot +of cost and effort is wasted in re doing things.Another +problem in managing requirements in software projects is +that a software based system is essentially a complex system +and it is difficult for a person providing requirements for such +a system to be able to provide all requirements in sufficient +detail at the very beginning of the project as a person’s mind +cannot visualizing a complex system in detail at a given time. +Requirement management is an process that is performed right +from the start of the project till the end of the project. At the +very beginning of the project, requirement management +process is intended to collect high level project requirements +and performing an feasibility study to take a decision whether +to continue with the project or not. Once a project is found to +be feasible then the aim of this process is to capture detailed +requirements, analyse the collected requirements, and +document the requirements. During project execution +requirement management process deals with finding more +detailed requirements as more clarity about the project evolves +and an important activity of requirement management process +is to ensure that all the requirements collected for the project +and only requirements collected for the project are implemented +for that project. It means that requirements identified but not +implemented will cause a rework later and implementation of +unidentified requirements is overkill and the resource (both +time and effort) spent for such activities are wasted and could +have been utilized for some other activity actually required for +the project. During the latter part of the project the purpose +of requirement management process is to validate and ensure +that all requirements are implemented in the project so that if +any requirement is not implemented, then a corrective action +can be taken to close the gap before this goes in the hands of +the customer or end user. +Definitions +Requirements:-Requirements are what stakeholder’s desire or +needs from a project. Requirement may be functional, non- +functional, technical, reliability related, statutory, performance +related, external interface requirements, environmental +requirements, resource requirements, design requirements, +quality related requirements. +Requirement management:-Requirement management can be +defined as a systematic approach to eliciting, organizing and +documenting the requirements of the system, and establishing +and maintaining agreement between the customer and the project +team on the changing of requirements of the system. +Requirements management consists of following major steps:- +Requirements Eliciting; Requirements Documenting; +Requirements Analyzing; Managing changing Requirements +Literature Review +Review of literature with respect to importance and issues +faced in Requirement Management process reveals that the +problem of changing requirements and difficulty in managing +constantly changing requirements has been identified globally. +The researchers have proposed various methods, models and +metrics to overcome the problem of managing requirements +for successful project management. Most of the research work +found in this domain has been from outside India. Even +though India is a major hub for software development but +this problem of requirement management is still relatively +less explored in Indian context. +H. Saiedian and R. Dale in the year of 1999 emphasized the +importance of ‘Effective communication’ and ‘information- +gathering skills’ along with ‘graphical representations of the +user environment’ and gave importance to ‘Customer +participatory techniques’ specifically ‘Prototyping’. Their +research primarily focused on techniques for improvement of +requirement elicitation part of requirement management. +Ann M. Hickey and Alan M. Davis in the year 2002 proposed +a mathematical model of the requirements elicitation process +that clearly shows the critical role of knowledge in its +performance. +SUCCESSFUL PROJECT MANAGEMENT +Voice of Research +Volume 5, Issue 1 +June 2016 +ISSN 2277-7733 +50 | Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 +SamuliHeinonen in the year 2006 studied the use of Software +based tools for requirement management in collaborating +environment and primarily compared the features of the +following three tools- +1.BorlandCaliberRM, 2.IBM Rational RequisitePro and 3. +Telelogic DOORS. +In the year 2008 Bill Davey and Chris Cope conducted research +on topic of “Requirements Elicitation – What’s +Missing?”.Their research revealed that interviews +(conversations between clients and consultants) are the most +effective way of eliciting requirements. +Krzysztof Wnuk from Department of Computer Science +Lund University in the year 2010 conducted research on the +topic of Understanding and Supporting Large-Scale +Requirements Management.The research concluded with +identification of following problems existing in Requirements +Management process- +1. Large number of variation points with an unmanageable +granularity; 2. Unclear responsibilities and unstable process +for the product configuration; 3. No clear traceability between +configuration parameters and initial requirements; 4. No +complete product specification available; 5. Products are +configured in an inefficient and iterative process without using +the initial requirements. +In the year of 2008 S. Arun Kumar and T.Arun Kumar from +VIT University, Vellore conducted a study of the impact of +requirements management characteristics in global software +development projects. They proposed a framework for the +successful and efficient requirements management framework +for Global Software Development Projects along with +proposing few metrics to be collected for requirement +management process. +Objective +1. This paper brings out major road blockers for inefficient +requirement management process in software projects +2. To propose set of metrics that can be used to manage +requirement management process. +Factors Affecting Requirement Management in Software +projects +1. Human limitation in Requirement Elicitation process: In a +project ultimately it is humans that are involved in requirement +management and humans have limitations when it comes to +visualizing a complex system in its totality. So a requirement +provider though wishes to bring out all requirements of the +system at the beginning itself but he fails to bring out many +requirements as he cannot visualize all requirements. This +happens mainly due to the fact of single frame of vision +problem associated with human beings which limits their +visualization beyond a certain limit. Also each person interacting +with the system does so for a specific purpose so he can bring +out only those aspects of the system and rest of the aspects +goes unnoticed. +Another major problem in collecting requirements mainly in +our country is often the person sent for requirements elicitation +to the client side is not the right person for the job. But he is +sent to client side as a reward for his performance in his previous +assignments. So he lack the skills needed for requirement +elicitation. Requirement elicitation is essentially a specialist job +and needs a altogether different skillsets and expertise, but +organizations often compromise in that front. +2. Lack of Usage of Tools for managing requirements: Once +requirements are collected it needs to be managed during +different phases of the software development phases. During +the development of the project different team members use +and update the requirements collected. If these requirements +are not managed using any tools then there is always a case +that different team members are referring to different set of +requirements.Hence it is important for the organizations to +understand the usage of proper requirement management +tools so that requirement integrity is maintained. Using such +a tools ensures that it can be easily tracked which developer is +working on which requirement, for which all requirements +design is completed, what requirement are tested, any change +in requirement by a person notifies all others individuals +through mail or message. +3. Lack of emphasis on Stakeholder management: Project +stakeholder is individuals, groups or organizations who may +effect or be effected by outcome of any project. It is critical for +the project success to identify all the stakeholders and collect +their requirement early in the project. Most of the organization +doesn’t give enough emphasis on stakeholdermanagement +early in the project and this causes significant delays. Stakeholder +management not only involves identifying and collecting +requirements from stakeholders but also include prioritizing +stakeholders based on their influence to the success of the +project. Prioritizing stakeholders is needed since often different +stakeholders have contradicting needs from the project, +prioritizing the stakeholders helps the project managers to +work on a policy how requirements can be managedthroughout +the life cycle of the project. +4. Unable to keep pace with Rapidly growing technology: The +technological advancement in the field of software +development is very rapid, this causes requirements collected +at the beginning of the project to be obsolete by the time +project comes to an end. It is imperative for the organizations +to keep a track on change in technology regularly to ensure that +the requirements collected are relevant or not with the changes +happening in the technology. +Major Causes of Failure in the Requirement Management +Process +Following list covers the major causes that results in failure of +requirement management process- +Less emphasis on planning requirement management process +Delay in capturing requirement causing rework; Development +team not on common understanding for collected +requirements due to lack of communication; Inflexible system +in place causing inability to adapt to changes in requirement; +Different interpretations due to ambiguous requirements; No +method in place to measure and assess requirements processes +performance; No mechanism in place to communicate changes +in requirements to relevant stakeholders; Lack of following +practice to obtain affirmation from customer for interpretation +of captured requirements; Little or No control over +requirement changes injected by stakeholders; Stakeholder’s +not sufficiently involved in requirement elicitation process; +Requirements not documented or inaccessible to relevant +stakeholders; Multiple teams involved in requirement +management with little or no coordination; Focus only on +functional requirements as a result of which other types of +requirements like non-functional, security are missed. +Defining and collecting data for measuring Requirement +management process performance +SUCCESSFUL PROJECT MANAGEMENT +Voice of Research, Vol. 5 Issue 1, June 2016, ISSN 2277-7733 |51 +Data collection and populating the collected data in various +metrics helps in monitoring the performance of the +requirement management process. It helps in measuring the +performance against the initially set targets, projects can +significantly improve the quality of their requirement +management process which in return will not only help in +delivering the software projects in conformity with the schedule +and budget, but will also serve as an effective tool for the +project managers to better administer the software projects. +Following metrics can be used to measure the effectiveness of +requirement management process: +Volatility Metrics: This metric provides the information as to +how much requirements are changed over a period of time. +Volatility is typically high in the initial phase of software +development and reduces as the project progresses so that +further development is not affected. +Traceability Metrics: Requirements traceability metrics links the +requirements and the work products developed. Traceability +provides information which helps in determining whether all +relationships and dependencies are addressed. +Specificity Metrics: This metrics indicates ratio of ambiguous +requirements to total requirements captured. During the start +of the project ambiguous requirement may be higher, however +as the project progresses continuous clarification of +requirement brings down ambiguous requirements. +Requirements Validation Metrics: This metric indicates the total +number of requirements validated to total number of +requirements in the project. This metrics helps in ensuring +that all the requirements are validated. +Requirement Prioritization Metrics: This metrics indicate the +priority of each requirement so that the development team +can develop requirements based on their priority value, also +this metrics is useful in preparation of test plan so that testing +team can focus more on high priority requirements as +compared to low priority ones. +Conclusion +Based on the study conducted it can be concluded that +‘Requirement Management’ is very critical for the success of +the project. Badly managed requirement can seriously +jeopardize the success of the project. In today’s world of +technological advancement where competition is very high, +any misunderstood or missed requirement can be the difference +between success and failure. It is not very practical to think of +collecting all requirements initially and then proceed with other +phases of software development. Hence change control process +needs to strengthen so that changes can be accommodated +smoothly and will have minimal negative impact if any at all. +Metrics proposed in this study can be used to continuously +monitor the performance of the requirement management +process. Usage of requirement management related metrics +will significantly improve the performance of an organization. +There are many tools available for effective requirement +management; these tools can be integrated with tools required +for other software development management process. Usage +of a requirement management tool simplifies management +of requirements along with added benefits of configuration +control and various metric generations. +Suggestions +Project Teams should follow the Best Practices mentioned in +the study for effective requirement management. For +Requirement elicitation there are many techniques of +requirement elicitation available and the selection of appropriate +techniques depends on various factors like project team, +customers, environment of project execution. Hence a team +should select combination of requirement elicitation +techniques after considering all the factors. Hence there is no +single techniquesthat is right but the right technique varies +from project to project. Organizations should be prepared for +changing requirements and should have a process in place to +manage changing requirements. Use of Change control Board +is suggested for requirement change management. Defining +and using requirement management related metrics is +advisable. Requirement management related tools needs to +be identified and used throughout the life cycle of the project. +Requirement management process should be considered as a +continuous iterative process rather than one time activity and +enough emphasis should be given on requirement +management as requirements are a basic building block of any +project and hence success or failure of any project hinges on +successful Requirement Management. +References +Ann M. Hickey,& Alan M. Davis. (2003). Requirements +elicitation and elicitation technique selection: a model for +two knowledge-intensive software development +processes. University of Colorado at Colorado Springs. +Arun kumar and t.arun kumar. (2011). study the impact of +requirements management characteristics in global +software development projects: an ontology based +approach. International journal of software engineering +& applications (ijsea). +Bill Davey,& Chris Cope. (2008). Issues in Informing Science +and Information Technology Requirements Elicitation +– What’s Missing? RMIT University, Melbourne,Australia +and Latrobe University, Bendigo Australia. +H. Saiediana, & R. Daleb. (1999). Requirements engineering: +making the connection between the software Developer +and customer. Department of Computer Science, +University of Nebraska at Omaha. +Mohammed Javeed Ali. (2006). Metrics for Requirements +Engineering. UmeÚa University Department of +Computing Science, SWEDEN. +Munns A K,&Bjeirmi B F. (1996). The Role of Project +Management in achieving project Success. University of +Dundee, Department of civil engineering. +N. RajasekharReddy,& R. J. Ramasree. (2012). The role of +Software Metrics on Software Development Life Cycle. +Department of Computer Science and Engineering, +Madanapalli Institute of Technology and Science. +Project Management Institute (2013)Project Management Body +of Knowledge (PMBOK). +Roger (2005).Software Engineering: A practitioner’s approach. +New York:Palgrave Macmillan. +SamuliHeinonen. (2006). Requirements management tool +support for software engineering in collaboration. +University of Oulu, Department of Electrical and +Information Engineering. +http://www.requirementsmanagementschool.com +https://en.wikipedia.org/wiki/Requirements_management +http://www.pmi.org/learning/Requirements- +Management.aspx +http://www.software-quality-assurance.org/cmmi- +requirementmanagement.html +http://www.hemantjha.in/content/2/requirements- +engineering.html +SUCCESSFUL PROJECT MANAGEMENT diff --git a/subfolder_0/Effect of integrated yoga therapy on nerve conduction velocity in type -2 diabetics a cross sectional clinical study.txt b/subfolder_0/Effect of integrated yoga therapy on nerve conduction velocity in type -2 diabetics a cross sectional clinical study.txt new file mode 100644 index 0000000000000000000000000000000000000000..c5598cf2c7436d70eee85768fb586fb07e435136 --- /dev/null +++ b/subfolder_0/Effect of integrated yoga therapy on nerve conduction velocity in type -2 diabetics a cross sectional clinical study.txt @@ -0,0 +1,712 @@ +EFFECT OF INTEGRATED YOGA THERAPY ON NERVE CONDUCTION +VELOCITY IN TYPE -2 DIABETICS A CROSS SECTIONAL CLINICAL STUDY +C Nagraj1 +N K Manjunath2 +H R Nataraj3 +1Research fellow, S-VYASA Bengaluru, 2Associate professor, S-VYASA Bengaluru, +3Research associate, Jindal nature cure institute, Bengaluru, Karnataka, India +INTRODUCTION +Notably, there is growing evidence that yoga +practices may aid in the prevention and +management of DM 2. By attenuating the +symptoms and signs of those with clinical +DM 2, with improved glycaemic control, +improve lipid profile and reduce insulin +resistance and thus improve its prognosis. A +study of effect of forty days of yoga done in +twenty-four type 2 DM cases provides +metabolic +and +clinical +evidence +of +improvement in glycaemic control and +autonomic functions. There was a significant +decrease in fasting blood glucose level, +postprandial blood glucose and glycosylated +hemoglobin. Also the pulse rate, systolic and +diastolic +blood +pressure +decreased +significantly. Four uncontrolled studies +targeting adults with diabetes.[i,ii] and/or +other chronic conditions,[iii,iv] demonstrated +Research Study +International Ayurvedic Medical Journal +ISSN:2320 5091 +ABSTRACT +Background: Type 2diabetes mellitus comprises an array of dysfunctions resulting from the +combination of resistance to insulin action and inadequate insulin secretion. It is characterized by +hyperglycemia and associated with micro vascular i.e., retinal, renal, possibly neuropathic, +macro vascular i.e., coronary, peripheral vascular, and neuropathic i.e., (autonomic, peripheral) +complications. Yoga has been shown to reduce the hyperglycemia and thereby reducing the +underlying nerve damages in diabetics. Objectives: To observe the nerve conduction velocity +variation among practitioners and non practitioners of yoga. And propose yoga as a better +method to manage neuropathies in type 2 diabetics. Materials and methods: Across sectional +clinical study was conducted among type 2 Diabetic patients, two groups i.e. yoga practitioners +and non yoga practitioners were made with a sample size of 30 in each group and yoga group +was prescribed with different yogic practices and both group analyzed for nerve conduction +velocity and data analyzed using Independent t-test.Results: Results were encouraging and +Independent sample t-test showed significantly higher means in yoga group for nerve conduction +velocity in right (P= 0.004), and left wrist (P=0.017). Mann-Whitney test showed similarly +significantly higher mean in +yoga group for the variable F-wave in right hand +(P=0.004).Conclusion: People practicing yoga seems to have better nerve conduction parameters +compare to control group, hence yoga can be used as useful supporting palliative treatment for +managing diabetes mellitus type 2 induced nerve damage. Keywords: Yoga therapy, Type 2 +Diabetes, Nerve conduction velocity +EFFECT OF INTEGRATED YOGA THERAPY ON NERVE CONDUCTION +VELOCITY IN TYPE -2 DIABETICS A CROSS SECTIONAL CLINICAL STUDY +C Nagraj1 +N K Manjunath2 +H R Nataraj3 +1Research fellow, S-VYASA Bengaluru, 2Associate professor, S-VYASA Bengaluru, +3Research associate, Jindal nature cure institute, Bengaluru, Karnataka, India +INTRODUCTION +Notably, there is growing evidence that yoga +practices may aid in the prevention and +management of DM 2. By attenuating the +symptoms and signs of those with clinical +DM 2, with improved glycaemic control, +improve lipid profile and reduce insulin +resistance and thus improve its prognosis. A +study of effect of forty days of yoga done in +twenty-four type 2 DM cases provides +metabolic +and +clinical +evidence +of +improvement in glycaemic control and +autonomic functions. There was a significant +decrease in fasting blood glucose level, +postprandial blood glucose and glycosylated +hemoglobin. Also the pulse rate, systolic and +diastolic +blood +pressure +decreased +significantly. Four uncontrolled studies +targeting adults with diabetes.[i,ii] and/or +other chronic conditions,[iii,iv] demonstrated +Research Study +International Ayurvedic Medical Journal +ISSN:2320 5091 +ABSTRACT +Background: Type 2diabetes mellitus comprises an array of dysfunctions resulting from the +combination of resistance to insulin action and inadequate insulin secretion. It is characterized by +hyperglycemia and associated with micro vascular i.e., retinal, renal, possibly neuropathic, +macro vascular i.e., coronary, peripheral vascular, and neuropathic i.e., (autonomic, peripheral) +complications. Yoga has been shown to reduce the hyperglycemia and thereby reducing the +underlying nerve damages in diabetics. Objectives: To observe the nerve conduction velocity +variation among practitioners and non practitioners of yoga. And propose yoga as a better +method to manage neuropathies in type 2 diabetics. Materials and methods: Across sectional +clinical study was conducted among type 2 Diabetic patients, two groups i.e. yoga practitioners +and non yoga practitioners were made with a sample size of 30 in each group and yoga group +was prescribed with different yogic practices and both group analyzed for nerve conduction +velocity and data analyzed using Independent t-test.Results: Results were encouraging and +Independent sample t-test showed significantly higher means in yoga group for nerve conduction +velocity in right (P= 0.004), and left wrist (P=0.017). Mann-Whitney test showed similarly +significantly higher mean in +yoga group for the variable F-wave in right hand +(P=0.004).Conclusion: People practicing yoga seems to have better nerve conduction parameters +compare to control group, hence yoga can be used as useful supporting palliative treatment for +managing diabetes mellitus type 2 induced nerve damage. Keywords: Yoga therapy, Type 2 +Diabetes, Nerve conduction velocity +EFFECT OF INTEGRATED YOGA THERAPY ON NERVE CONDUCTION +VELOCITY IN TYPE -2 DIABETICS A CROSS SECTIONAL CLINICAL STUDY +C Nagraj1 +N K Manjunath2 +H R Nataraj3 +1Research fellow, S-VYASA Bengaluru, 2Associate professor, S-VYASA Bengaluru, +3Research associate, Jindal nature cure institute, Bengaluru, Karnataka, India +INTRODUCTION +Notably, there is growing evidence that yoga +practices may aid in the prevention and +management of DM 2. By attenuating the +symptoms and signs of those with clinical +DM 2, with improved glycaemic control, +improve lipid profile and reduce insulin +resistance and thus improve its prognosis. A +study of effect of forty days of yoga done in +twenty-four type 2 DM cases provides +metabolic +and +clinical +evidence +of +improvement in glycaemic control and +autonomic functions. There was a significant +decrease in fasting blood glucose level, +postprandial blood glucose and glycosylated +hemoglobin. Also the pulse rate, systolic and +diastolic +blood +pressure +decreased +significantly. Four uncontrolled studies +targeting adults with diabetes.[i,ii] and/or +other chronic conditions,[iii,iv] demonstrated +Research Study +International Ayurvedic Medical Journal +ISSN:2320 5091 +ABSTRACT +Background: Type 2diabetes mellitus comprises an array of dysfunctions resulting from the +combination of resistance to insulin action and inadequate insulin secretion. It is characterized by +hyperglycemia and associated with micro vascular i.e., retinal, renal, possibly neuropathic, +macro vascular i.e., coronary, peripheral vascular, and neuropathic i.e., (autonomic, peripheral) +complications. Yoga has been shown to reduce the hyperglycemia and thereby reducing the +underlying nerve damages in diabetics. Objectives: To observe the nerve conduction velocity +variation among practitioners and non practitioners of yoga. And propose yoga as a better +method to manage neuropathies in type 2 diabetics. Materials and methods: Across sectional +clinical study was conducted among type 2 Diabetic patients, two groups i.e. yoga practitioners +and non yoga practitioners were made with a sample size of 30 in each group and yoga group +was prescribed with different yogic practices and both group analyzed for nerve conduction +velocity and data analyzed using Independent t-test.Results: Results were encouraging and +Independent sample t-test showed significantly higher means in yoga group for nerve conduction +velocity in right (P= 0.004), and left wrist (P=0.017). Mann-Whitney test showed similarly +significantly higher mean in +yoga group for the variable F-wave in right hand +(P=0.004).Conclusion: People practicing yoga seems to have better nerve conduction parameters +compare to control group, hence yoga can be used as useful supporting palliative treatment for +managing diabetes mellitus type 2 induced nerve damage. Keywords: Yoga therapy, Type 2 +Diabetes, Nerve conduction velocity +C Nagraj et;aAl: Effect of Integrated Yoga Therapy on Nerve Conduction Velocity In Type -2 Diabetics A Cross Sectional Clinical +Study +120 +www.iamj.in IAMJ: Volume 1; Issue 6; Nov– Dec2013 +significant positive changes in blood lipid +levels following yoga-based interventions +that ranged from 8 days to 3 months, +[v] in +duration. +Yoga and nerve conduction: A study with +yogic intervention has shown that yoga +asana have a beneficial effect on glycaemic +control and improve nerve function in mild +to moderate type 2 diabetes with sub-clinical +neuropathy.[vi] +Aims and Objectives: Hence the present +study is conducted with an objective of +nerve +conduction +variation +among +practitioners and non practitioners of yoga. +And to propose yoga as a better method to +manage neuropathies in type 2 Diabetics. +Materials and Methods: +Recruitment was done through public +announcements made at different yoga +therapy centers and advertisements. Those +volunteers who fulfilled the inclusion +criteria were selected for the study. The +signed informed consent of subjects was +obtained before the data recording. +Study Design +Subjects belonging to two groups (yoga and +non yoga) were assessed under standard +experimental conditions. Since this was a +two group comparative study with onetime +assessment, the present study followed a +cross sectional design. +The two groups were: +1. The patients with type two Diabetes, on +allopathic +medication +with +yoga +relearning. +2. +The patients with type two Diabetes, on +allopathic medication +Selection Criteria +A +Inclusion Criteria + +HbA1c >7 + +Fasting Bold Glucose < 270 mg/dl + +Subject with history of type 2dm who +have been on diet and exercise. + +Willing to participate by giving a written +informed consent. + +Medication- +any +anti-diabetic +medication. + +Women and men between 40-70 years +(married or singles) + +Those who are not practicing yoga since +last 3months (for non yoga group). + +Those who are practicing yoga since last +6 months (for yoga group). + +Patients with the history of DM Type-2 +for minimum of 1 year. +B Exclusion Criteria + +Renal dysfunction + +Congestive heart failure. + +BMI < 20 or > 40 + +Hypersensitive to Metformin + +Women of child bearing + +Uncontrolled hypertension + +Alcohol abuse + +Type I DM + +Retinopathy requiring laser therapy + +Recent myocardial infarction less than 3 +months. +Outcome measures: +Primary outcome measures + +Motor nerve conduction velocity. + +Sensory nerve conduction velocity + +F- wave: F-waves reflect the antidromic +conduction of the compound neural +volley to the ventral spinal cord, and the +postsynaptic activation of a portion of +the muscle fibers in the innervated +muscle. [vii] + +Amplitudes: Peak amplitude driven by +maximal stimulation reflects the number +C Nagraj et;aAl: Effect of Integrated Yoga Therapy on Nerve Conduction Velocity In Type -2 Diabetics A Cross Sectional Clinical +Study +121 +www.iamj.in IAMJ: Volume 1; Issue 6; Nov– Dec2013 +of responding fibers and the synchrony +of their activity. [viii] +Nerve +Conduction +Velocity +Testing +(NCV) +Definition +A nerve conduction study is a test that +measures the movement of an impulse +through a nerve after the deliberate stimula- +tion of the nerve. The time it takes to travel +to the other end of the nerve is measured. [ix] +Recording procedure: +Subjects have reported to the laboratory with +prior appointment which was taken with the +consent. They were made to understand the +nature of the test and they were asked to sit +on a comfortable chair and electrodes were +placed on their palms and median nerve was +stimulated in various places, through an +electrical +stimulator +with +appropriate +amount of current. Then actual values of +NCV viz, motor nerve conduction velocity, +sensory nerve conduction velocity, and F- +wave were noted for further analysis. +The nerve conduction velocity was recorded +using RMS.EMG.EP.MARK- machine of +recorders and Medicare systems pvt. Ltd +company, haryana. The equipment has an +inbuilt amplifier with digital filters along +with electrical stimulator. These filters are +mathematical filters that can distinguish +random, background electrical signals from +the actual signal produced by an activated +nerve. +Before placing electrodes in place it is very +important to apply gel on the points where +electrodes are to be placed, then electrodes +are placed in the belly and tendon method +that is, active electrode was placed on the +belly of adductor brevis muscle and refer- +ence electrode was placed on tendon of the +same muscle just below the thumb finger. +Then grounding was placed around 3 cm +away from the active electrode i.e. middle of +the palm. +Analysis +The analysis of the nerve signal involves the +study of the movement of the signal through +the nerve from one point to another. Using +characteristics such as the speed of the im- +pulse, and the shape, wavelength, and height +of the signal wave, an examiner can assess +whether the nerve is functional or defective. +Data Extraction +The measurement for motor nerve conduc- +tion study includes the onset latency, dura- +tion, and amplitude of CMAP and nerve +conduction velocity. The onset latency is the +time in milli seconds from the stimulus arti- +fact to the first negative deflection of +CMAP. For the better visualization of the +take off the latency should be measured at a +higher gain than the one used for the CMAP +amplitude measurement. The onset latency +is a measure of conduction in the fastest +conducting motor fibers. It also includes +neuromuscular transmission time and the +propagation time along the muscle mem- +brane which constitutes residual latency. +The amplitude of CMAP is measured from +baseline to the negative peak (base to peak) +the amplitude correlates with the number of +nerve fibers. The duration of CMAP is +measured from the onset to the negative or +positive peak or the final return of waveform +to the baseline. Duration correlated with the +density of small fibers. The area under the +CMAP can also be measured. However it +needs computer analysis. +Motor nerve conduction velocity is calcu- +lated by measuring the distance in millime- +ter between two points of stimulation, which +is divided by the latency difference in milli- +C Nagraj et;aAl: Effect of Integrated Yoga Therapy on Nerve Conduction Velocity In Type -2 Diabetics A Cross Sectional Clinical +Study +122 +www.iamj.in IAMJ: Volume 1; Issue 6; Nov– Dec2013 +second. The nerve conduction velocity is +expressed as m/s. Measurement of latency +between the two points of stimulation elimi- +nates the effect of residual latency. +Conduction Velocity= D/PL-DL M/S +Where PL is The Proximal Latency and DL is +the Distal Latency in ms, and D is the distance +between proximal and distal stimulation in mm. +Plan of Analysis +The data were analyzed by using Statistical +Package for Social Sciences (SPSS) version +10.0. Following statistical steps were fol- +lowed for all types of variables. + +Descriptive statistics + +Measures of central tendency and dis- +persion + +Tests for normal distribution: Box +whisker plot, stem and leaf plot + +Test for variance: F test + +Inferential statistics + +Data type : Ratio scale + +Mann-Whitney test was done in case of +non-parametric data and independent t- +test was done in case of parametric data. +INTERVENTION +Patients in group II were practicing a par- +ticular format of yoga practices (prescribed +by their Diabetologist and yoga therapist) +[Table -1] one hour per day, for the period +of 6 months. +RESULTS +Data were found to be normally distributed +except for the following variables: in yoga +group, nerve conduction velocity in right +hand elbow, nerve conduction velocity in +left hand elbow, and f-wave in right hand. +Hence non-parametric test (Mann Whitney +test) was performed on these variables and +also f-wave in left hand, which being the +counterpart of f-wave in right hand. For re- +maining variables parametric test was per- +formed (independent sample t-tests). Vari- +ances were found to be equal for all pa- +rameters in parametric tests. [Table-2] +Nerve Conduction Velocity in Right hand +Wrist (p=0.004) and Nerve Conduction Ve- +locity in Left hand Wrist (p=0.017) were +found to be statistically significant across +yoga and non yoga groups. Higher means +were observed for yoga group. Also there +was a significantly higher means noticed in +yoga group as compared to non yoga group, +F-Wave in Right hand (p=0.004). [Table-3] +DISCUSSION +The result of this cross sectional two group +comparative study on 60 patients with dia- +betes type 2 have showed statistically sig- +nificant difference in nerve conduction vari- +ables nerve conduction velocity in right +hand wrist (p=0.004) and nerve conduction +velocity in left hand wrist (p=0.017) be- +tween yoga and non yoga groups. Higher +means were observed for yoga group. Also +there was a significantly higher means no- +ticed in yoga group as compared to non yoga +group, f-wave in right hand(p=0.004). Dif- +ferences in all other parameters were found +to be statistically insignificant. In addition to +the DCCT,[x] three much smaller but long- +term prospective studies have confirmed that +maintained near-normal glycaemia prevents +the development and retard the progression +of DPN as assessed electro-physiologically. +These include the Stockholm Diabetes +Intervention Study (7.5 years), [xi] and 10 +years), [xii] the Oslo Study (8 years), [xiii] and, +in type 2 diabetes, the Kumamato Study (6 +years). [xiv] Thus these results are suggestive +of efficiency of yoga to reduce the nerve +damage occurred due to hyperglycemic +condition.The observed differences found in +the nerve conduction parameters seems to +C Nagraj et;aAl: Effect of Integrated Yoga Therapy on Nerve Conduction Velocity In Type -2 Diabetics A Cross Sectional Clinical +Study +123 +www.iamj.in IAMJ: Volume 1; Issue 6; Nov– Dec2013 +support some of the existing ideas that yoga +asana have a beneficial effect on glycaemic +control and improve nerve function in mild +to moderate Type 2 diabetes with sub- +clinical neuropathy.[xv] +CONCLUSION +People practicing yoga seems to have better +nerve +conduction +parameters +hence +suggesting yoga as a useful means for +managing diabetes mellitus type 2 induced +nerve damage. +CORRESPONDING AUTHOR +C Nagraj +Research fellow, S-VYASA Bengaluru +Source of support: Nil +Conflict of interest: None Declared +REFERENCES +i ) Divekar M, Bhat M, Mulla A. 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N Engl J Med +329:304–309, 1993 +xii Reichard P, Pihl M, Rosenqvist U, Sule J: Complications of IDDM are caused by elevated +blood glucose levels, the Stockholm Diabetes Intervention study at 10 year follow-up. +Diabetologia 39:1383–1488, 1996 +C Nagraj et;aAl: Effect of Integrated Yoga Therapy on Nerve Conduction Velocity In Type -2 Diabetics A Cross Sectional Clinical +Study +124 +www.iamj.in IAMJ: Volume 1; Issue 6; Nov– Dec2013 +xiii ) Amthor KF, Dahl-Jorgensen K, Berg TJ, Sandvik L, Hanssen KF: The effect of 8 years of +strict glycaemic control on peripheral nerve function in IDDM patients: the Oslo study. +Diabetologia 37:579–586, 1994 +xiv ) Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, +Shichiri M: Intensive insulin therapy prevents the progression of diabetic microvascular +complications in Japanese patients with non-insulin-dependent diabetes: a randomized +prospective 6-year study. Diabetes Res Clin Pract 28:103–117, 1995 +xv ) Malhotra V, Singh S, Tandon OP, Madhu SV, Prasad A, Sharma SB Effect of Yoga asana on +nerve conduction in type 2 diabetes. Indian J Physiol Pharmacol. 2002 Jul; 46(3):298-306. +LIST OF TABLES :Table-1 List of Yoga Practices Prescribed For Group-II +Sl.no +Name of the practice +Number of Repetitions +Breathing practices +1 +Shashankasana breathing +5 +2 +Tiger breathing +5 +Shithili karana vyayama +1 +Jogging +3mins +2 +Forward and backward bending +11 rounds +3 +Side bending +11 rounds +4 +Dhanurasana swing +11 rounds +5 +Uddiyana +11 rounds +6 +Surya namaskar 12 rounds +3 rounds +YOGASANA +1 +Parivritta trikonasana +1 mins +2 +Pada hastasana +3 mins +3 +Ardha chakrasana +3 mins +4 +Ardha matsyendrasana +3 mins +5 +Ushtrasana +3 mins +6 +QRT +3 mins +Kriyas +1 +Jalaneti +1/week +2 +Sutranet +1/week +C Nagraj et;aAl: Effect of Integrated Yoga Therapy on Nerve Conduction Velocity In Type -2 Diabetics A Cross Sectional Clinical +Study +125 +www.iamj.in IAMJ: Volume 1; Issue 6; Nov– Dec2013 +3 +Vamana dhouti +1/week +4 +Laghu +shankha +prakshalana +1/week +Pranayama +1 +Vibhagiya pranayama +11 rounds +2 +Nadi shudhi +9 rounds +3 +Bhramari +9 rounds +Meditation +5mins +Table: 2 Motor nerve conduction velocities recorded at wrist, elbow and axilla in both yoga +and non yoga group. +Variable +(m/s) +Yoga +Non-yoga +p-value +Mean(m/ +s) +Std .dev (m/s) +Mean(m/s) +Std .dev(m/s) +MNC_RT_W +53.7053 +7.46156 +48.0407 +7.03811 +.004 +MNC_LT_W +52.6873 +6.71670 +48.3497 +6.95866 +.017 +MNC_RT_ELⱡ +62.4690 +11.63628 +66.1430 +8.75384 +.280 +MNC_LT_ELⱡ +57.6677 +12.70624 +63.2080 +11.20706 +.066 +Table: 3 Sensory nerve conduction velocity of median nerve in right and left hand. +Variable +Yoga +Non-yoga +p-value +Mean(m/s) +Std. dev(m/s) +Mean(m/s) +Std. dev(m/s) +SNC_RT +51.3627 +6.85947 +48.3190 +10.50064 +.189 +SNC_LT +52.5860 +8.04264 +48.5060 +9.30390 +.074 +Table: 3 f-wave recorded from median nerve in left and right hand. +Variable +Yoga +Non-yoga +p-value +Mean(m/s) +St. dev (m/s) +Mean(m/s) +St. dev(m/s) +FW_RTⱡ +30.3140 +3.65324 +33.1017 +3.94996 +.004 +FW_LTⱡ +31.0700 +3.91277 +32.6500 +3.29375 +.143 +Table: 4 Demographic data +Non Yoga +yoga +Male +Female +17 +13 +23 +7 +Mean Age +53.3 +55.36 diff --git "a/subfolder_0/Effect of pranayama and meditation as an add-on therapy in rehabilitation of patients with Guillain-Barr\303\251 syndrome.txt" "b/subfolder_0/Effect of pranayama and meditation as an add-on therapy in rehabilitation of patients with Guillain-Barr\303\251 syndrome.txt" new file mode 100644 index 0000000000000000000000000000000000000000..0b19ad698c224125e70c8d654769b4e2a66f134e --- /dev/null +++ "b/subfolder_0/Effect of pranayama and meditation as an add-on therapy in rehabilitation of patients with Guillain-Barr\303\251 syndrome.txt" @@ -0,0 +1,704 @@ +1 +Disability & Rehabilitation, 2012; Early Online: 1–6 +© 2012 Informa UK, Ltd. +ISSN 0963-8288 print/ISSN 1464-5165 online +DOI: 10.3109/09638288.2012.687031 +Objective: To study the add-on effects of pranayama and +meditation in rehabilitation of patients with Guillain-Barré +syndrome (GBS). Patients and Method: This randomized +control pilot study was conducted in neurological +rehabilitation unit of university tertiary research hospital. +Twenty-two GBS patients, who consented for the study and +satisfied selection criteria, were randomly assigned to yoga +and control groups. Ten patients in each group completed +the study. The yoga group received 15 sessions in total over a +period of 3 weeks (1 h/session), one session per day on 5 days +per week that consisted of relaxation, Pranayama (breathing +practices) and Guided meditation in addition to conventional +rehabilitation therapeutics. The control group received usual +rehabilitation care. All the patients were assessed using +Pittsburgh Sleep Quality Index, Numeric pain rating scale, +Hospital anxiety and Depression scale and Barthel index +score. Mann–Whitney U test and Wilcoxon’s signed rank test +were used for statistical analysis. Results: Quality of sleep +improved significantly with reduction of PSQI score in the +yoga group (p = 0.04). There was reduction of pain scores, +anxiety and depression in both the groups without statistical +significance between groups (pain p > 0.05, anxiety p > 0.05 +and depression p > 0.05). Overall functional status improved +in both groups without significant difference (p > 0.05). +Conclusions: Significant improvement was observed in quality +of sleep with yogic relaxation, pranayama, and meditation in +GBS patients. +Keywords:  Guillain-Barré syndrome, yoga +Background +Guillain-Barré Syndrome (GBS) is an inflammatory, +demyelinating disease affecting multiple peripheral nerves. +The disease onset is acute or sub acute in nature. The +clinical features include flaccid ascending symmetrical limb +weakness/paralysis, absence of deep tendon reflexes, cranial +nerve palsies, autonomic nervous system disturbances, pain +and paraesthesia [1,2]. It has an annual incidence varying +from 0.16 to 4 cases per 100 000 populations [3–5]. There +are four clearly defined subtypes of GBS: AIDP (acute +inflammatory +demyelinating +polyradiculoneuropathy), +AMAN (acute motor axonal neuropathy), AMSAN (acute +motor and sensory axonal neuropathy) and Miller–Fisher +syndrome [6]. In general the disease outcome is expected to +be good. Wide variations are observed during the long term +RESEARCH PAPER + +“Effect of pranayama and meditation as an add-on therapy in +rehabilitation of patients with Guillain-Barré syndrome—a +randomized control pilot study” +Ragupathy Sendhilkumar1, Anupam Gupta1, Raghuram Nagarathna2 & Arun B. Taly3 +1Neurological Rehabilitation Division, Department of Psychiatric and Neurological Rehabilitation, National +Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India, 2Division of yoga and physical sciences, Swamy +Vivekanandha Yoga Anusndhana Samsthana (SVYASA), (Yoga research foundation), Kempegowda Nagar, Bangalore India, +and 3Department of Neurology, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, India +Correspondence: Dr. Anupam Gupta, Associate professor, Neurological Rehabilitation Division, Department of Psychiatric and Neurological +Rehabilitation, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Hosur Road, Bangalore-560029, India. Tel: +91 080 26995282 +(H), +91 87626 89540 (M). Fax: +91 80 2656 4830. E-mail: drgupta159@yahoo.co.in +• GBS is an inflammatory demyelinating polyneuro +radiculopathy with multiple complications requiring +long term care. +• Yoga and other rehabilitation measures contribute in +improving functional abilities, pain and sleep quality +in GBS patients. +• This randomized control trial showed that short term +yoga practice can improve the quality of sleep as com- +pare to other rehabilitation measures in GBS patients +Implications for Rehabilitation +(Accepted April 2012) +Disabil Rehabil Downloaded from informahealthcare.com by Allied Publishers Subscription Agency on 05/24/12 +For personal use only. +2  R. Sendhilkumar et al. + + +Disability & Rehabilitation +follow up with persistent sensory and motor impairments as +common sequelae [7,8]. +Multiple complications occur during the course of the +disease with several long term sequelae. Apart from physi- +cal disability persistent pain, fatigue, paraesthesia, mood +changes, anxiety, depression [2,7,9] and sleep disturbances are +common during rehabilitation [10,11]. A multidisciplinary +approach is required for the rehabilitation of the GBS patients +which includes pharmacotherapy, nutrition management, +carefully modified exercises using gentle range of motion, +assisted range of motion, manual resistance, positioning +and orthotic management [12,13]. Therapeutic methods like +cognitive behavior therapy in the management of pain [14], +and psychological education programs designed specifically +for patients and the family members have been found to be +beneficial in managing pain and psychological sequelae of +GBS [15,16]. +Integrated yoga that includes postures, pranayama, relax- +ation and meditation have been found to be effective in the +long term rehabilitation of diseases like rheumatoid arthritis +[17], bronchial asthma [18] and major depression [19]. Yoga +as an add-on to physiotherapy has shown benefits in patients +with chronic neck pain [20]. Addition of yogic prana ener- +gization technique hastens the callus formation in fracture +of long bones [21]. Many other studies have shown demon- +strable benefits of yoga after short duration of intensive inte- +grated programs either as inpatient [22] or out patient [23] +with better quality of sleep in the elderly [24] and in cancer +patients [25] have been documented. There are no studies +in the literature that have tried to observe the effect of yogic +relaxation techniques during rehabilitation of GBS patients. +The aim of the present pilot study was to examine the effect of +yoga as an add-on therapy in patients with GBS undergoing +in-patient rehabilitation. +Patients and methods +In this randomized control trial, 44 GBS patients who were +admitted in the neurological rehabilitation unit in the uni- +versity hospital after their initial treatment with either plas- +mapheresis or intravenous immunoglobulin therapy in the +acute care neurological ward or in the ICU, from April 2010 +to March 2011 were screened for our study. The inclusion +criteria were: (a) age group of 15–60 year of both gender, (b) +patients with stage 3 (able to walk 5 feet with assistance) and +4 (bed bound) of Hughes scale, (c) weaned off from venti- +lator, (d) medically stable, (e) those with fair to good trunk +balance and (f) admitted in the unit for inpatient rehabilita- +tion. The exclusion criteria were: (a) GBS with Hughes grade +1 (able to run) and 2 (able to walk independently), (b) those +with severe respiratory distress, (c) with poor trunk control, +(d) Miller–Fisher variant of GBS and (e) chronic inflamma- +tory demyelinating polyneuropathy (CIDP) patients. Patients +with grade 5 and 6 according to Hughes scale would not be +able to perform yoga whereas patients with grade 1 and 2 on +Hughes scale would not agree for 3 weeks inpatient rehabilita- +tion program as they would be independent for most of the +ADL including locomotion. This was the reason for including +patients’ only with Hughes grade 3 and 4 in the study. Twenty- +five (10 AIDP, 12 AMAN, 3 AMSAN) patients met with the +eligibility criteria. The sample size calculation for the trial not +done as it was a pilot study only. Eleven patients were recruited +in each group. The study protocol was approved by the insti- +tutes’ ethical committee. Informed consent was obtained +from all patients. Out of the total 25 patients, 22 patients who +consented to participate were recruited for the study (Figure +1). The patients from rehabilitation consultant were sent to +therapy section using serially numbered referral forms, then +they were randomly allocated to yoga or control group using a +computer generated random table. The random table was cre- +ated using software from www.Randomizer.org. It was single +blind study with blinding of outcome assessor who would +assess all patients (both the groups) at the beginning and after +end of therapy sessions (after 3 weeks) without knowing the +group of the patient (Yoga vs. conservative therapy). +Rehabilitation program +All patients in both the groups (yoga and control) received +regular rehabilitation care which included pharmacotherapy, +physiotherapy, occupational therapy and orthotic manage- +ment as per the need of individual patients. Physiotherapy +included active assisted range of motion, passive range of +motion, stretching of tight muscles, strengthening exercises +using weight cuffs, breathing exercises and gait training with +or without assistive devices. Functional ability training was +provided in the occupational therapy section which included +hand function training, trunk stability training and care +giver’s education about transfer techniques etc. +Yoga intervention +Patients in yoga group received 15 sessions of yoga (1 hour/ +day) in addition to the regular rehabilitation therapeutics by a +qualified post graduate yoga therapist. Five sessions per week +were conducted with no sessions on Saturdays and Sundays. +Patients completed sessions over a period of 3 weeks. The yoga +intervention was carried out in a place near the in-patient +neurological rehabilitation unit between 5 to 6 PM daily. +There was no scientific reason behind this particular time of +the day for conducting session. This time schedule was con- +venient for the participant to attend after their routine regular +therapy sessions like physiotherapy and occupational therapy +etc. During this time, the patients in the control group were +allowed to relax with their friends or relatives in the adjacent +open lawn. +The specific yoga module developed for GBS patients +included Quick relaxation technique (QRT), pranayama +and guided meditation (Mind Sound Resonance Technique- +MSRT) that could be practiced in supine posture in bed + +(Table I). Quick relaxation technique (QRT) could be prac- +ticed in three phases in a comfortable supine position with +eyes closed that involves synchronization of breathing with +abdominal movement and energization of the whole body as +they chant ‘aaa’ slowly during exhalation. +Pranayama, as defined by sage patanjali(swasa praswayoh +gatir vicchedah pranayamah [26]), is aimed at calming down +the mind by reducing the rate of breathing voluntarily while +Disabil Rehabil Downloaded from informahealthcare.com by Allied Publishers Subscription Agency on 05/24/12 +For personal use only. +Role of yoga in rehabilitation of GBS patients  3 +© 2012 Informa UK, Ltd. +maintaining the mindful awareness of the touch of the air +flowing in and out of the air passages. +MSRT is an eight stepped guided meditation technique +where the participants are guided to experience the soothing +sound resonance in the whole body during repeated slow chant- +ing of the Vedic syllables (a, u, m and om, etc) in a low pitch. +Measurements +Assessment for sleep, anxiety, depression and pain was done +before and after the period of intervention using Pittsburg +Sleep Quality Index (PSQI [27]), Hospital Anxiety and +Depression Scale (HADS [28]) and Numeric pain rating scale +(NPRS [29]), respectively. Functional status was recorded +using Barthel Index (BI [30]) at admission and at discharge. +Pittsburg Sleep Quality Index [27] assesses the quality of +sleep in the previous 2 weeks through seven areas: subjective +sleep quality, sleep latency, sleep duration, habitual sleep +efficiency, sleep disturbances, use of sleeping medication, and +daytime dysfunction. The client self-rates each of these seven +areas of sleep. Scoring of answers is based on a 0–3 scale, +whereby 3 reflect the negative extreme on the Likert Scale. +The responses are added to give composite global PSQI [27], +score. A global sum of “5” or greater indicates a “poor” sleeper. +Hospital Anxiety and Depression Scale [28], is used as a +screening scale to assess anxiety and depression level of the +patients. It contains a total of 14 questions related to anxiety +and depression, 7 questions each for anxiety and depression. +Each question is scored using 0–3 response, 0 being lowest +Figure 1  CONSORT flow diagram. *Reasons: age group not matching, medically unstable (e.g. uncontrolled diabetes), Hughes grades not matching. +Table I  Daily yoga practice schedule. +Name of the practice +Duration + (in minutes) +A +Pranayama +1. +Vibhagiya pranayama (sectional breathing) +5 +2. +Ujjayi pranayama (psychic breath) +5 +3. +Sheetali pranayama (cooling breath) +5 +4. +Seetkari pranayama (hissing breath) +5 +5. +Sadanta pranayama (clenched teeth breath) +5 +6. +Bhramari pranayama (humming bee breath) +5 +B. +QRT +5 +C. +MSRT +25 +QRT, quick relaxation technique; MSRT, mind sound resonance technique. +Disabil Rehabil Downloaded from informahealthcare.com by Allied Publishers Subscription Agency on 05/24/12 +For personal use only. +4  R. Sendhilkumar et al. + + +Disability & Rehabilitation +level of response and 3 being the highest level response. Scores +are added to get total anxiety score and depression scores +separately. A score between 0 and 7 is normal, 8–10 is bor- +derline abnormal and 11–21 is abnormal for both anxiety and +depression. +Numeric pain rating scale [29] evaluates the level of pain +marked by the patients in a scale containing numbers from +0 to 10, 0 being ‘No’ pain and 10 being the worst maximum +pain. +BI [30] consists of 10 items (bladder and bowel in the +preceding week, grooming, in preceding 24–48 h, toilet use, +feeding, transfers, mobility, dressing, stairs and bathing)with +scores ranging from 0 to 100. +Data analysis +Analysis was done using SPSS version 15.0 (SPSS Inc., +Chicago, IL). Descriptive statistics was made for the variables +showing the demographic details and Shapiro–Wilk’s test was +done for all the outcome measures for both groups to find out +normality of distribution. Assessment of effect of additional +yoga therapy was done by comparing the scores PSQI, HADS, +and Numeric pain rating scale at the time of starting therapy +and after the completion of 15 sessions between both the +groups using Mann–Whitney U test. Effect of therapy within +group was analyzed using Wilcoxon signed rank test. +Results +There were 11 subjects in each group with two drop outs, as +these two patients took discharge before the study completed +at their will due to their personal reasons. Age ranged from +20 to 55 years (32.30 ± 9.911) in yoga group. In the control +group age ranged from 15 to 58 years (31.30 ± 14.317). There +were eight (80%) male patients and two (20%) female patients +in the yoga group whereas five (50%) male and five (50%) +female patients in control group. Three patients (30%) had +typical AIDP, four patients (40%) had AMAN variant and +three patients (30%) had AMSAN variant in yoga group. In +the control group four (40%) had typical AIDP and six (60%) +patients had AMAN variant. The mean length of stay in the +rehabilitation unit in yoga group was 43 ± 3.8 days and in +control group was 40.70 ± 3.2 day. The baseline data did not +differ significantly between groups (p > 0.05, Shapiro–Wilk +test) although there were more males in the yoga group as +compare to control group (8 vs. 5). +Yoga schedule of the patients has been shown in Table I. +Results after 15 sessions of intervention are shown in Table II. +There was significant difference between groups (p = 0.048, +Mann–Whitney U test) in the quality of sleep. The global PSQI +[27] score in yoga group improved from 8.70 ± 4.24 to 4.00 ± +3.36 (p < 0.05, Wilcoxon’s test) with no significant change (p = +0.21) in control group from 9.30 ± 4.37 to 7.20 ± 3.49. +The anxiety score of HADS [28] showed a reduction in +yoga group from 2.90 ± 2.18 to 1.60 ± 1.64 (p < 0.05) and in +control group from 6.60 ± 4.50 to 4.20 ± 4.51 (p < 0.05). No +significant difference observed between both group (p > 0.05). +The depression score of HADS [28] also showed a reduction +in yoga group from 4.70 ± 3.59 to 1.20 ± 1.22 (p < 0.05) and +in control group from 4.90 ± 2.84 to 3.20 ± 2.70 (p < 0.05). +No significant change between the groups existed (p > 0.05). +There was a reduction in the level of pain in Numeric pain +rating scale [29] in yoga group with a shift from 3.5 ± 2.42 to +2.20 ± 1.47 (p < 0.05) and in control group from 5.90 ± 2.28 +to 3.50 ± 2.46 (p < 0.05).There was no significant difference +observed between the groups (p > 0.05). +Functional status improved in BI 30 from 33.50 ± 15.64 to +59 ± 24.58 (p < 0.05) in yoga group and from 32 ± 8.88 to 69 +± 22.82 (p < 0.05) in control group. No significant difference +observed between the groups (p > 0.05). Sub group analysis +based on gender was not done because of the unequal number +of male and female patients in yoga group. +Discussion +To our knowledge, this is the first randomized control +study using yoga techniques (QRT, pranayama and MSRT +meditation) as adjuvant therapy for rehabilitation of GBS +patients. The results showed that the patients in the yoga +Table II  Results of intervention. +Variables +Within groups +Between groups +(Mann–whitney +U test) +p Value +Yoga (Wilcoxon signed rank test) +Control (Wilcoxon signed rank test) +Median +Inter quartile +range +p Value +Median +Inter quartile +range +p Value +PSQI +Pre +9.00 +7 +0.005 +10.00 +6 +0.210 +0.048* +Post +3.00 +2 +8.00 +7 +NPRS +Pre +4.00 +3.50 +0.048 +6.50 +2.50 +0.026 +0.167 +Post +2.50 +2.50 +3.50 +3.50 +HADS (anx) +Pre +2.50 +2 +0.033 +6.50 +7 +0.017 +0.133 +Post +1.00 +2 +3.00 +6 +HADS (dep) +Pre +4.50 +7 +0.012 +4.00 +5 +0.036 +0.070 +Post +1.00 +2 +3.50 +4 +BI +Admission +25.00 +17.50 +0.007 +27.50 +15 +0.008 +0.402 +Discharge +57.50 +50 +75.00 +36.25 +PSQI, Pittsburg Sleep Quality Index; NPRS, Numeric pain rating scale; HADS (anx), Hospital Anxiety Depression Scale-anxiety domain; HADS (dep), Hospital Anxiety Depression +Scale-Depression domain; BI, Barthel Index. +*Mann–Whitney U test; significance with p < 0.05. +Disabil Rehabil Downloaded from informahealthcare.com by Allied Publishers Subscription Agency on 05/24/12 +For personal use only. +Role of yoga in rehabilitation of GBS patients  5 +© 2012 Informa UK, Ltd. +group had significantly better (p < 0.05, between groups on +Mann–Whitney) improvement in quality of sleep than the +control group, while there were significant improvements in +functional status, pain, anxiety and depression in both groups +with statistically insignificant differences between groups. +However, the results should be interpreted with caution +because its’ a pilot study only with relatively small sample size. +In one of the studies continuous sleep monitoring among +the GBS patients admitted in ICU revealed some sleep abnor- +malities in the form of reduced REM sleep latency, REM sleep +without atonia and NREM sleep with rapid eye movements. +These changes were observed even in patients staying out of +ICU [10]. Disordered breathing pattern leading to hypoxia +and hypercarbia and fragmented sleep pattern have also been +observed among GBS patients [11]. High (Global PSQI > 5) +baseline scores on PSQI [27], (Yoga = 8.70 ± 4.24, control = +9.30 ± 4.37) observed in our study reflects these observations. +The improvement in the median scores after yoga reached a +value of 4.00 ± 3.36 indicating that these patients slept nor- +mally, while the patients in control group also showed some +improvement in their scores (7.20 ± 3.49) that did not reach +normalcy. Studies using meditation and chanting similar to +the techniques used in this study showed improved quality of +sleep in the form of appearance of theta rhythm during slow +wave sleep along with low EMG and enhanced REM duration +following Transcendental Meditation(TM) among healthy +volunteers [31,32] and enhanced slow wave sleep and REM +sleep state among different age groups of healthy Vipassana +meditation practitioners [33,34]. This improved quality of +sleep may be due to the improved REM sleep and slow wave +sleep by meditation practice and regularization of breathing +through pranayama practices. +Pain control through pranayama and meditation (MSRT) +techniques in chronic pain conditions like low back pain +and neck pain was found to be significant in some studies +[20,22]. In this present study, the pain in GBS patients showed +improvement in both the groups and add on yoga techniques +did not have additional benefits. This may be due to the dif- +ficult nature of GBS pain which includes both nociceptive +and neuropathic components. In one of the earlier studies in +neurological rehabilitation unit, it was reported that about +80% admitted GBS patients had neuropathic pain and 34.3% +of these patients required more than one medications and the +pain persisted for longer duration [13]. As the neuropathic +pain is more difficult to treat, 15 yoga sessions might not have +been sufficient and the results could have been different with +more yoga therapy sessions. +The baseline median anxiety and depression scores in both +the group, showed that the anxiety and depression level were +in normal range. This can be attributed to natural history of +illness, nature of the disease progression and prognosis being +explained routinely to all patients including GBS patients in +rehabilitation unit and this might have contributed in improv- +ing relaxation and allaying mood disorders in this popula- +tion. Similar observation has been reported in a qualitative +analysis of the patients’ experiences during the acute stage +of GBS [35]. Though there was a significant improvement in +the post session scores in both anxiety and depression(less +score) there was no statistical significance existed between the +groups. When comparing the depression scores according to +HADS in our trial between yoga group and control group, we +observed a trend suggestive of better improvement in depres- +sion in yoga group as compare to control group, although it +did not reach significant levels (p = 0.07). A future trail com- +prising of healthier sample size using the same scale might +come up with some interesting findings. +Some positive findings have been reported in the manage- +ment of anxiety and depression levels with the use hyperven- +tilating type of pranayama like kapalabathi and Bashthrika or +combination of Aasanas (physical postures)and pranayama [36]. +Hyperventilation techniques are difficult to practice by the GBS +patients because of the intercostals and abdominal muscles weak- +ness. Similarly some physical postures also cannot be practiced +because of the motor paralysis of both trunk and limb muscles. +Significant functional recovery found in both groups at +discharge time without statistical significance on comparison. +In one of the earlier study similar improvement in the func- +tional status has been reported [13]. +Although study has a small sample size, it highlights the +importance of yoga in managing a number of co-morbidities +(complications) occurring as a result of GBS. Training para- +medical staff to carry out these practices or hiring trained +yoga instructors to take care of such patient group could prove +be a cost-effective method of rehabilitation. Further, although +patients showed trend for improvement across all the domains +(functional ability, sleep quality, anxiety and depression) in +both the groups, a longer duration of yoga program should be +worth exploring in future studies. +Conclusions +Significant improvement in quality of sleep was observed +in GBS patients in yoga group as compare to control group +with yogic relaxation, pranayama, and meditation. There +was reduction of pain scores, anxiety and depression in both +the groups without statistical significance between groups. +Similarly overall functional status improved in both groups +without significant difference between the groups. +Pranayama and meditation practices are simple and effec- +tive techniques, which do not require any special equipment +or space, can be used in GBS patients to improve their quality +of sleep, anxiety, depression and level of pain during their stay +in the hospital for rehabilitation. Yoga practices can also be +incorporated as home-based programs with recorded materi- +als with little direct contact training for the GBS patients. This +would also benefit many such patients, who are not able to +avail in-patient rehabilitation for various reasons. +There were some limitations of this study like it was a +single blind study. The number of yoga therapy sessions was +confined to 15 only. More sessions would have provided better +insight on the role of yoga in improving other problem areas +and issues in GBS patients during in-patient rehabilitation. +Sleep recordings and pulmonary function test can be added in +future study with healthier sample size, increased frequency +and duration of yoga practice and adequate follow up to see +the lasting effects. +Disabil Rehabil Downloaded from informahealthcare.com by Allied Publishers Subscription Agency on 05/24/12 +For personal use only. +6  R. Sendhilkumar et al. + + +Disability & Rehabilitation +Declaration of interest: The authors declare no conflict of +interest. The authors alone are responsible for the content +and writing of the paper. No funding was received from any +source for this project. +References + +  1. Ropper AH. The Guillain-Barré syndrome. N Engl J Med +1992;326:1130–1136. +  +2. Meythaler JM. Rehabilitation of Guillain-Barré syndrome. Arch Phys +Med Rehabil 1997;78:872–879. +  +3. Barzegar M, Dastgiri S, Karegarmaher MH, Varshochiani A. +Epidemiology of childhood Guillan-Barre syndrome in the north west +of Iran. BMC Neurol 2007;7:22. +  +4. Alter M. The epidemiology of Guillain-Barré syndrome. Ann Neurol +1990;27 Suppl:S7–12. +  +5. McLean M, Duclos P, Jacob P, Humphreys P. Incidence of Guillain-Barré +syndrome in Ontario and Quebec, 1983-1989, using hospital service +databases. Epidemiology 1994;5:443–448. +  +6. Hughes RA, Cornblath DR. Guillain-Barré syndrome. Lancet +2005;366:1653–1666. +  +7. 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Am Fam Physician +2010;81:981–986. +Disabil Rehabil Downloaded from informahealthcare.com by Allied Publishers Subscription Agency on 05/24/12 +For personal use only. diff --git a/subfolder_0/Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity..txt b/subfolder_0/Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity..txt new file mode 100644 index 0000000000000000000000000000000000000000..a70dfdd91013791cf1ff83de077808b0589061dd --- /dev/null +++ b/subfolder_0/Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity..txt @@ -0,0 +1,944 @@ +E +n +d +o +c +r +i +n +o +l +o +g +y + +& + +M +e +t +a +b +o +l +i +c + +S +y +n +d +r +o +m +e +ISSN: 2161-1017 +Endocrinology & Metabolic Syndrome +Rathi et al., Endocrinol Metab Syndr 2018, 7:5 +DOI: 10.4172/2161-1017.1000292 +Research Article +Open Access +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Volume 7 • Issue 5 • 1000292 +Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent +Obesity +Sunanda S Rathi1*, Ruchira R Joshi2, Padmini Tekur3, Nagaratna RN4 and Nagendra HR5 +1Swami Vivekananda Yoga Anusandhana Samsthana, Yoga and Life sciences 404 Pinnacle Pride Tilak Road, Pune, Maharashtra, India +2Chiranjiv Foundation, Pune, Maharashtra, India +3S-VYASA, Banglore, India +4Yoga consulting Physician, S-VYASA, Bangalore, India +5S-VYASA, University Campus: Prashanti Kutiram, Vivekananda Road,  Kalluballu Post, Jigani, Anekal, Bengaluru, India +Abstract +Background: Adolescent Obesity is causing serious public health concern and in many countries threatening +the viability of basic health care delivery. Many co-morbid conditions are seen in association with adolescent obesity. +Interventions based on Yoga principles are found to have effective solutions for adolescent obesity. +Aim: To evaluate the effect of the Yoga based intervention on anthropometric and physical assessments in +Adolescent Obesity. +Methods: RCT (Randomized Controlled Trial) was conducted on 53 obese adolescents for 40 days. Special +yoga based training Program was conducted for yoga group. Parameters like weight, Body Mass Index (BMI) +parameters, pulse rate, blood pressure, MAC (Mid Upper Arm Circumferences), Ac (Abdominal Circumference), Waist +Circumference (WC), HC (Hip Circumference) along with physical tests like sit ups and Flamingo balance tests were +assessed before and after intervention for both yoga and control groups. Within and between groups analyses of the +variables were analysed. +Result: The study showed significant reduction in weight, body mass index, Hip circumference, and total body +fat percentage, subcutaneous fat throughout the body in yoga group and percentage of improvement is more in yoga +group than that of control group. +Conclusion: Yoga based intervention is effective to reduced obesity in adolescent children with respect to +anthropometric and physical assessments. +*Corresponding author: Rathi SS, Swami Vivekananda Yoga Anusandhana +Samsthana Yoga and Life sciences 404 Pinnacle Pride Tilak Road, Sadhashiv +Peth, 411030, Pune, Maharashtra, India, Tel: 9860100251; 020-24330251; E-mail: +yogainitiatives@gmail.com +Received September 22, 2018; Accepted October 05, 2018; Published October +12, 2018 +Citation: Rathi SS, Joshi RR, Tekur P, Naratna RN, Nagendra HR (2018) Effect +of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity. +A Case Report. Endocrinol Metab Syndr 7: 292. doi:10.4172/2161-1017.1000292 +Copyright: © 2018 Rathi SS, et al. This is an open-access article distributed under +the terms of the Creative Commons Attribution License, which permits unrestricted +use, distribution, and reproduction in any medium, provided the original author and +source are credited. +Keywords: Obesity; Adolescence; Yoga +Introduction +Adolescent obesity +Overweight and obesity are metabolic conditions in which abnormal +or excessive fat accumulation is found to impair health. In 2016, more +than 1.9 billion adults aged 18 years and older were overweight. Of these +over 650 million adults were obese. The worldwide prevalence of obesity +nearly tripled between 1975 and 2016. The prevalence of overweight +and obesity among children and adolescents aged 5-19 years has risen +dramatically from just 4% in 1975 to just over 18% in 2016. The rise has +occurred similarly among both boys and girls: in 2016 18% of girls and +19% of boys were overweight [1]. Obesity leads to adverse impacts on +physical as well as psychological functions of the person. Energy-dense +overeating, nutrient-poor foods and a sedentary lifestyle have led to an +epidemic of obesity all over the world. Apart from physical problems +there are issues which affect psychological well-being of an individual +[2]. Children in low- and middle-income countries are more prone to +inadequate pre-natal, infant and young child nutrition. At the same +time, they are exposed to high-fat, high-sugar, high-salt, energy-dense, +micronutrient-poor foods. These dietary patterns in conjunction with +lower levels of physical activity, result in sharp increases in childhood +obesity while under nutrition issues remain unsolved [3]. +Assessment of obesity in adolescence +Obesity is a commonly used term with a wide range of meanings +with no widely accepted diagnostic definitions or cut-off points are +available for children. Mean body fat percentages and percentile curves +are available for children 5 to 18 years of age [4]. Several studies have +recommended BMI as the preferred measure for evaluating obesity +among adolescents 2 to 19 years of age. BMI can be correlated strongly +with body fat percentage as it is associated weakly with height, and it +identifies the fattest individuals correctly, with acceptable accuracy +at the upper end of the distribution like 85th or 95th percentile for age +and gender. In 1994, the Expert Committee on Clinical Guidelines +for Overweight in Adolescent Preventive Services recommended that +children whose BMI exceeds 30 kg/m2 or is more than 95th percentile +for age and gender should be considered obese [5]. +BMI is a fairly reliable indicator of body fatness for most people. +BMI does not measure boy fat directly, but research has shown that +BMI correlates to direct measures of body fat. BMI can be considered +an alternative for direct measures of body fat. Additionally, BMI is +an inexpensive and easy-to-perform method for screening for weight +categories that may lead to health problems. Measuring children’s BMI +regularly is the first step to maintaining a healthy weight. BMI being an +important variable, the full body sensor, composition monitor and scale +is used to calculate BMI and other BMI parameters. Full Body Sensing +provides a comprehensive understanding of the body composition. The +BMI machine calculates the estimated values for body fat percentage, +skeletal muscle percentage, resting metabolism and subcutaneous fat in +Research Article +Citation: Rathi SS, Joshi RR, Tekur P, Naratna RN, Nagendra HR (2018) Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity. A Case +Report. Endocrinol Metab Syndr 7: 292. doi:10.4172/2161-1017.1000292 +Page 2 of 6 +Volume 7 • Issue 5 • 1000292 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +different body parts like arms, trunk, and legs using the BI (Bioelectrical +Impedance) Method. The monitor also calculates the BMI (Body Mass +Index) and body age as well as weight. Resting metabolism is the energy +required to maintain vital functions. The total amount of energy used +by the body in a typical day contributes resting metabolism (60%-70%), +daily activity metabolism (20%-30%) and diet-induced thermogenesis +(10%). If less energy is consumed by resting metabolism that can be +consumed by daily activity metabolism. Percentage of subcutaneous +fat and skeletal muscles are inversely proposal to each other. Skeletal +muscle is the type of muscle that can see and feel. Building skeletal +muscle can help prevent rebound weight gain. The maintenance and +increase of skeletal muscle is closely linked to resting metabolism rate. +Along with BMI, waist circumference in children provides a better +estimate of visceral adipose tissue [6,7]. Alternative measures that +account for fat distribution include abdominal circumference, hip +circumference and mid arm circumference. EUROFIT tests are also one +of the assessment tools in adolescent obesity to check physical fines. The +measurement of physical fitness for each child helps them to develop +positive attitudes towards their bodies and get information about their +physical status [8]. Handgrip strength, standing broad jump, flexed +arm hang, sit‐ups, sit‐and‐reach and Flamingo balance tests are few +EUROFIT tests out of which sit‐ups and Flamingo balance tests are +significant in adolescent obesity. +Yoga for adolescent obesity +A study consisted of 709 healthy children (with mean age=8.9 +± 1.6 years) suggest that overweight and obesity are limiting factors +for fitness performance in  adolescence. Interventions promoting +children’s health should, ideally, begin early in life and involve +measures that simultaneously improve fitness and lower fatness [9]. +Yoga is widely recognized as an effective tool in maintaining a healthy +lifestyle resulting as a vaccine against lifestyle related disorders [10]. +According to a study of effect of aerobic & resistance exercise on +physical fitness conducted on 60 adolescent obese participants in +Karnataka (India), aerobic and resistance exercise in combination +reduces fat significantly [11]. But only physical activity has limited +scope of correcting the causes of obesity in preadolescence. Other than +physical causes like lack of physical exercise, genetic and sedentary +lifestyle there are few psychological causes of obesity like low self- +esteem, depression, failures to cope up to demanding situations are also +not uncommon. The negative experiences in school and at home leads +to lower self-esteem found in childhood obesity [12]. Home, child care +centre, school, and community environments can influence children's +behaviours related to food intake and physical activity also which is a +contributing factor of causes of obesity [13]. Along with this, increasing +academic stress is also a contributing factor in causes of obesity [14]. +Any form of physical activity having limited scope to manage this +supportive cause of obesity can manage weight for short duration but +fails to provide long termed constant impacts in preadolescence obesity. +Whereas Yoga based programs have a wider impact on body, mind, +habits, perception and cognition also. +In one month randomized control trial of impact of Yoga on self- +esteem in 44 adolescent participants in Hardwar (India), it is noted that +the level of self-esteem has significantly increased with experimental +group [15]. Yoga lays great significance on strengthening inherent +defensive mechanisms of human body and mind. It develops immunity +and resistance in human body and helps the body and mind in attaining +homeostatic balance. The strengthening of defence mechanism and +harmony between mind and body prevents causes of psychosomatic +disorders like obesity. The aim of yoga therefore is also the attainment +of physical, mental, social and spiritual health [16]. A study conducted +on Effect of yoga and physical exercise on physical, cognitive and +emotional measures in 98 school children, it is observed that Physical +exercise and yoga have different ways of influencing physical fitness, +cognitive performance and self-esteem. Both ways showed significant +improvements in tests for physical fitness [17]. But, this study has +two independent groups without control group and represents +geographically north part of India. The findings could be the possible +effects of the two interventions, with a degree of uncertainty due to the +absence of a control group. There was a need to check generalizability of +the findings in a sample drawn from diverse geo-graphical and cultural +backgrounds with control group. So, current study was designed to +evaluate the effect of validated and feasible yoga based intervention on +anthropometric and physical assessments in Adolescent Obesity. +Methods +The complete study has been approved by ethical committee of +Swami Vivekananda Yoga Anusandhan Samsthana, Bangalore (Figure +1). 1400 students including both genders were screened from age of 9 +year to 14 year (standard 5 to 9) in one of the reputed school in Pune +city of Maharashtra state in India. Height, weight and BMI of all the +students were recorded and obese participants (Figure 2) having BMI +>95th percentile were included who were ready to participate in the +study with written consent. Participants having any physical disability, +any psychosomatic disorder, consuming any medical drugs and +exposed to yoga within last 6 months were excluded from the study. +All the participants are randomly divided in two groups. Yoga group +(n=30) and control group (n=30). RCT (Randomized Controlled Trial) +was conducted on 60 obese adolescents for 40 days. Special yoga based +training Program was conducted for yoga group. Yoga intervention +was consisting of specially designed and validated yoga protocol of 60 +minutes duration which included set of loosening exercises, asanas, +pranayamas, suryanamskara, breathing practises and meditation. +This intervention was conducted for 5 days a week for 40 days. 4 +sessions of chanting, Karmayoga, Yoga counselling was also provided. +Participants of Yoga group were regular in throughout the intervention +and maintained 90 percent of attendance. Control group was under +observation with normal routine. The diet regulation was only provided +for both yoga and control group in order to acquire uniform base with +respect to diet. Parameters like weight, pulse rate, blood pressure, MAC +(Mid Upper Arm Circumferences), AC (Abdominal Circumference), +WC (Waist Circumference), HC (Hip Circumference) along with +physical tests like sit ups per minute and Flamingo balance test were +assessed before and after intervention for both yoga and control groups. +Body Mass Index (BMI) parameters like total body fat percentage, +resting metabolism, subcutaneous fat and muscle percentage of +whole body, arms, trunk and legs region also calculated using Body +composition monitor Model HBF-701 before and after intervention +for both yoga and control groups. In yoga group, there were 5 drop +outs and from control group 2 children were absent for post parameter +collection. +Statistical Analysis +The data was analysed using SPSS software 20 version. Normality +test was done using Shapiro Wilk test. The paired sample t test was +conducted for pre & post variables which were found normally +distributed for both the groups. For not normally distributed variables, +Wilcoxon signed ranks test was done. Between groups analysis was +done using independent sample t test for the post values of both the +groups. +Citation: Rathi SS, Joshi RR, Tekur P, Naratna RN, Nagendra HR (2018) Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity. A Case +Report. Endocrinol Metab Syndr 7: 292. doi:10.4172/2161-1017.1000292 +Page 3 of 6 +Volume 7 • Issue 5 • 1000292 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Results +The baseline demographic data of age and height of the yoga +and control group is described in Table 1. Results of within group +analysis of Yoga group are given in Table 2. Parameters like abdominal +circumference, waist circumference, hip circumference, total body +fat percentage, trunk subcutaneous fat, trunk muscle percentage, +legs subcutaneous fat, legs muscle percentage and situps per minute +were normally distributed. Hip circumference (p=0.001), total +body fat percentage (p=0.001), trunk subcutaneous fat (p=0.005) +and legs subcutaneous fat (p=0.03) reduced significantly whereas +abdominal circumference (p=0.376) reduced but without significance. +Trunk muscle percentage (p=0.021) increased significantly. Waist +circumference (p=0.553) increased but without significance. Whole +body muscle percentage (p=0.076) and legs muscle percentage +(p=0.187) increased but without significance. Number of situps per +minute (p=0.566) is decreased but without significance. +Parameters like weight, BMI, mid arm circumference, pulse rate, +systolic blood pressure, diastolic blood pressure, resting metabolism, +whole body subcutaneous fat, arm subcutaneous fat, arm muscle +percentage and flamingo balance test were not normally distributed. +Weight (p=0.018), BMI (p=0.001), whole body subcutaneous fat +(p=0.01), arm subcutaneous fat (p=0.021) reduced significantly whereas +systolic blood pressure (p=0.30), diastolic blood pressure (p=0.087) and +mid arm circumference (p=0.474) reduced but without significance. +Muscle percentage of arms (p=0.042) increased significantly whereas +pulse rate (p=0.597), Flamingo balance test (p=0.065) increased but +without significance. +A result of within group analysis of Control group is given in + +Table 3. Parameters like abdominal circumference, waist circumference, +Figure 1: Flow chart of group formation for intervention. +Figure 2: Body Mass Index for age percentile. +NO. +GROUP +YOGA +CONTROL +1 +Gender +Male +Female +Male +Female +13 +17 +14 +16 +2 +Average Age (years) +11 ± 1.4 +11 ± 1.3 +3 +Average Height (cm) +152.91 ± 6.97 +152.71 ± 9.18 +4 +Average Weight (Kg) +63.86 ± 15.52 +62.39 ± 14.21 +5 +Average BMI (Kg/m2) +27.16 ± 5.04 +26.43 ± 3.53 +Table 1: The baseline demographic data of age and height of the yoga and control +group. +Citation: Rathi SS, Joshi RR, Tekur P, Naratna RN, Nagendra HR (2018) Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity. A Case +Report. Endocrinol Metab Syndr 7: 292. doi:10.4172/2161-1017.1000292 +Page 4 of 6 +Volume 7 • Issue 5 • 1000292 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +hip circumference, total body fat percentage, trunk subcutaneous fat, +trunk muscle percentage, legs subcutaneous fat, legs muscle percentage +and sit ups per minute were normally distributed. Number of sit ups +per minute (p=0.023) decreased significantly whereas abdominal +circumference (p=0.730), hip circumference (p=0.226), total body +fat percentage (p=0.876), trunk subcutaneous fat (p=0.186) and legs +subcutaneous fat (p=0.162) reduced but without significance. Waist +circumference (p=0.244), trunk muscle percentage (p=0.427) and legs +muscle percentage (p=0.270) increased but without significance. +Parameters like weight, BMI, mid arm circumference, pulse rate, +systolic blood pressure, diastolic blood pressure, resting metabolism, +whole body subcutaneous fat, arm subcutaneous fat, arm muscle +percentage and flamingo balance test were not normally distributed. +No. +Variable +Mean (Pre) +Mean (Post) +t/z value +p value +1 +Weight +63.86 ± 15.52 +63.14 ± 15.28 +2.359a +0.018* +2 +BMI +27.16 ± 5.04 +26.47 ± 4.85 +3.344a +0.001* +3 +Pulse rate +95.5 ± 11.7 +97.37 ± 14.48 +0.529a +0.597 +4 +Systolic blood pressure +125.16 ± 11.06 +122.87 ± 13.42 +1.037a +0.30 +5 +Diastolic blood pressure +81 ± 6.83 +77.26 ± 17.63 +1.712a +0.087 +6 +Mid arm circumference +11.23 ± 1.03 +11.07 ± 0.93 +0.716a +0.474 +7 +Abdominal circumference +35.89 ± 3.69 +35.5 ± 3.77 +0.902b +0.376 +8 +Waist circumference +37.65 ± 4.48 +37.77 ± 4.81 +0.602b +0.553 +9 +Hip circumference +39.49 ± 4.63 +38.21 ± 4.71 +3.68b +0.001* +10 +Total body fat percentage +29.83 ± 3.46 +27.76 ± 2.72 +4.40b +0.001* +11 +Resting metabolism +1382.83 ± 205.34 +1404.33 ± 263.73 +1.33a +0.183 +12 +Subcutaneous fat (Whole body) +25.57 ± 5.58 +21.96 ± 4.32 +2.57a +0.01∞ +13 +Muscle percentage (Whole body) +27.13 ± 3.51 +28.26 ± 2.89 +1.77b +0.076 +14 +Subcutaneous fat (Arms) +39.23 ± 8.58 +34.62 ± 6.47 +2.315a +0.021∞ +15 +Muscle percentage (Arms) +31.01± 6.78 +33.98 ± 5.07 +2.032a +0.042∞ +16 +Subcutaneous fat (Trunk) +22.21 ± 5.35 +19.23 ± 3.29 +3.085b +0.005∞ +17 +Muscle percentage (Trunk) +20.58 ± 2.97 +21.55 ± 2.20 +2.480b +0.021∞ +18 +Subcutaneous fat (Legs) +38.35 ± 8.27 +34.27 ± 6.29 +2.307b +0.03∞ +19 +Muscle percentage (Legs) +41.94 ± 5.21 +43.94 ± 4.65 +1.359b +0.187 +20 +Sit ups +32.95 ± 7.02 + 31.5 ± 9.38 +0.582b +0.566 +21 +Flamingo Balance test +60.70 ± 37.07 +65.75 ± 38.48 +1.845 a +0.065 +aWilcox test +bPaired sample t test +*significant at 0.01 +∞significant at 0.05 +Table 2: Result of within group analysis of Yoga group (n= 25). +No. +Variable +Mean Pre value +Mean Post value +t value +p value +1 +Weight +62.39 ± 14.21 +62.8 ± 14.73 +1.646a +0.100 +2 +BMI +26.43 ± 3.53 +26.82 ± 3.58 +0.108a +0.914 +3 +Pulse rate +95.07 ± 12.7 7 +93.85 ± 11.31 +0.781a +0.435 +4 +Systolic blood pressure +125.96 ± 18.54 +119.25 ± 13.68 +2.596a +0.009∞ +5 +Diastolic blood pressure +83.71 ± 9.78 +77.5 ± 8.05 +2.90a +0.004∞ +6 +Mid arm circumference +11.21 ± 1.37 +11.35 ± 1.42 +1.160a +0.246 +7 +Abdominal circumference +35.51 ± 3.27 +35.42 ± 3.28 +0.348b +0.730 +8 +Waist circumference +36.50 ± 3.01 +36.99 ± 3.67 +1.192b +0.244 +9 +Hip circumference +38.84 ± 3.71 +38.57 ± 3.93 +1.240b +0.226 +10 +Total body fat percentage +29.02 ± 2.65 +28.96 ± 2.17 +0.157b +0.876 +11 +Resting metabolism +1369.25 ± 218.60 +1388.33 ± 238.43 +1.287a +0.198 +12 +Subcutaneous fat (Whole body) +24.80 ± 5.11 +22.75 ± 4.56 +1.150a +0.250 +13 +Muscle percentage (Whole body) +27.20 ± 3.06 +28.12 ± 2.93 +1.059a +0.290 +14 +Subcutaneous fat (Arms) +38.90 ± 8.16 +36.02 ± 7.03 +0.997a +0.319 +15 +Muscle percentage (Arms) +30.62 ± 7.27 +33.47 ± 6.61 +1.261a +0.207 +16 +Subcutaneous fat (Trunk) +21.34 ± 4.32 +20.07 ± 3.52 +1.359b +0.186 +17 +Muscle percentage (Trunk) +20.87 ± 2.40 +21.2 ± 2.08 +0.806b +0.427 +18 +Subcutaneous fat (Legs) +38.75 ± 8.81 +35.92 ± 7.71 +1.439b +0.162 +19 +Muscle percentage (Legs) +42.06 ± 4.94 +43.78 ± 4.95 +1.128b +0.270 +20 +Sit ups +30.21 ± 8.74 + 26.78 ± 7.36 +2.419b +0.023∞ +21 +Flamingo Balance test +72.17 ± 56.41 +91.89 ± 58.65 +1.173a +0.241 +aWilcox test +bPaired sample t test +∞significant at 0.05 +Table 3: Result of within group analysis of Control group (n=28). +Citation: Rathi SS, Joshi RR, Tekur P, Naratna RN, Nagendra HR (2018) Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity. A Case +Report. Endocrinol Metab Syndr 7: 292. doi:10.4172/2161-1017.1000292 +Page 5 of 6 +Volume 7 • Issue 5 • 1000292 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Systolic blood pressure (p=0.009), diastolic blood pressure (p=0.004) +reduced significantly whereas pulse rate (p=0.435), whole body +subcutaneous fat (p=0.250), arm subcutaneous fat (p=0.319) reduced +but without significance. Weight (p=0.100), BMI (p=0.914), mid arm +circumference (p=0.246), resting metabolism (p=0.198), whole body +muscle percentage (p=0.290) and Flamingo balance test (p=0.241) +increased but without significance. +Analysis of in between Yoga and control group states that +abdominal circumference of Yoga group is decreased significantly than +that of Control group (p=0.05). Weight, BMI, mid-arm circumference, +hip circumference, total body fat percentage, subcutaneous fat of whole +body, arm, trunk and legs has been reduced more in Yoga group than that +of Control group but without significance. Number of situps, systolic +blood pressure and diastolic blood pressure is decreased in control +group more than that of Yoga group but without significance. Pulse rate +is found to be increased in Yoga group whereas that of control group +is reduced but without significance. Waist circumference is increased +more in control group than that of Yoga group but without significance. +Resting metabolism, muscle percentage of whole body, arm, trunk and +legs are increased more in Yoga group than that of Control group but +without significance. Flamingo balance test has been increased more in +control group than that of Yoga group but without significance. +Discussion +Obesity especially abdominal is related to academic achievement +and cognitive functions in children. Visceral adipose tissues  have +negative impact on cognitive functions leading to academic decrease +among children with obesity because of its dangerous metabolic nature +[18]. +Excessive adipose tissue also affects the physical inactivity leading +to psychological increased sensitivity. These childhoods obesity leaded +poorer cognitive function results in decreased measures of intra +individual response, even after accounting for intellectual abilities, +aerobic fitness [19]. So focus of this study was to evaluate the yoga +based validated intervention on anthropometric and physical variables +in adolescent Obesity [20]. Specific anthropometric and physical tests +are selected as variables were selected in order to conserve comfort and +convenience of the participants with average age of 11 ± 1.4 years. Hip +circumference, total body fat percentage, subcutaneous fat of trunk +and legs whereas these parameters are reduced in control group but +without significance. Subcutaneous fat reduction leads to significant +increase of muscle percentage of trunk and leg region. This provides +evidence of efficacy of validated yoga based intervention on reduction +of adipose tissues in hip, trunk and leg region resulting in reduction +of total body fat percentage and overall body weight. Abdominal +circumference is reduced significantly in Yoga group and without +significance in control group. Yoga group has improved significantly +better in this parameter than control group. Yoga intervention practices +like dynamic surya namaskara, asana, loosening practices are focused +to reduced abdominal adipose tissue. According to one RCT, yoga +intervention had moderately strong positive effects on anthropometric +variables in women with abdominal obesity. Yoga is safe in women and +can be recommended as a technique for combating abdominal obesity +in women [21]. Our study provides efficacy of Yoga in same concern in +adolescent population. Yoga improves emotional wellbeing in children. +The mechanisms underlying these benefits have not been clearly worked +out and may involve complex neuro-chemical changes and modified +functioning of brain areas within the limbic circuit. Physical activities +of control group was not monitored and compared with test group. This +is limitation of the study. +Conclusion +Yoga based intervention is effective to reduced obesity in adolescent +No. +Variable +Yoga Group +(n= 25) +Control Group + (n= 28) +t value +p value +Pre +Post +Pre +Post +1 +Weight +63.86 ± 15.52 +63.14 ± 15.28 +62.39 ± 14.21 +62.8 ± 14.73 +0.517a +0.60 +2 +BMI +27.16 ± 5.04 +26.47 ± 4.85 +26.43 ± 3.53 +26.82 ± 3.58 +0.053a +0.95 +3 +Pulse rate +95.5 ± 11.7 +97.37 ± 14.48 +95.07 ± 12.7 7 +93.85 ± 11.31 +1.052 a +0.29 +4 +Systolic blood pressure +125.16 ± 11.06 +122.87 ± 13.43 +125.96 ± 18.54 +119.25 ± 13.68 +0.883a +0.37 +5 +Diastolic blood pressure +81 ± 6.83 +76.95 ± 8.79 +83.71 ± 9.78 +77.5 ± 8.05 +0.330a +0.74 +6 +Mid arm circumference +11.23 ± 1.03 +11.07 ± 0.93 +11.21 ± 1.37 +11.35 ± 1.42 +0.027a +0.97 +7 +Abdominal circumference +35.89 ± 3.69 +35.5 ± 3.77 +35.51 ± 3.27 +35.42 ± 3.28 +0.530b +0.05∞ +8 +Waist circumference +37.65 ± 4.48 +37.77 ± 4.81 +36.50 ± 3.01 +36.99 ± 3.67 +0.593b +0.79 +9 +Hip circumference +39.49 ± 4.63 +38.21 ± 4.71 +38.84 ± 3.71 +38.57 ± 3.93 +2.479b +0.54 +10 +Total body fat percentage +29.83 ± 3.46 +27.76 ± 2.72 +29.02 ± 2.65 +28.96 ± 2.17 +3.236b +0.92 +11 +Resting metabolism +1382.83 ± 205.34 +1404.33 ± 263.33 +1369.25 ± 218.60 +1388.33 ± 238.43 +0.579 a +0.56 +12 +Subcutaneous fat (Whole body) +25.57 ± 5.58 +21.96 ± 4.32 +24.80 ± 5.11 +22.75 ± 4.56 +0.606 a +0.54 +13 +Muscle percentage (Whole body) +27.13 ± 3.51 +28.26 ± 2.89 +27.20 ± 3.06 +28.12 ± 2.93 +0.036a +0.97 +14 +Subcutaneous fat (Arms) +39.23 ± 8.58 +34.62 ± 6.47 +38.90 ± 8.16 +36.02 ± 7.03 +0.383a +0.70 +15 +Muscle percentage (Arms ) +31.01± 6.78 +33.98 ± 5.07 +30.62 ± 7.27 +33.47 ± 6.61 +0.330a +0.74 +16 +Subcutaneous fat (Trunk) +22.21 ± 5.35 +19.23 ± 3.29 +21.34 ± 4.32 +20.07 ± 3.52 +1.241b +0.88 +17 +Muscle percentage (Trunk) +20.58 ± 2.97 +21.55 ± 2.20 +20.87 ± 2.40 +21.2 ± 2.08 +-1.637b +0.36 +18 +Subcutaneous fat (Legs) +38.35 ± 8.27 +34.27 ± 6.29 +38.75 ± 8.81 +35.92 ± 7.71 +- 0.278b +0.77 +19 +Muscle percentage (Legs) +41.94 ± 5.21 +43.94 ± 4.65 +42.06 ± 4.94 +43.78 ± 4.95 +- 0.701b +0. 14 +20 +Sit ups +32.95 ± 7.02 +31.5 ± 9.38 +30.21 ± 8.74 + 26.78 ± 7.36 +- 0.942b +0.09 +21 +Flamingo Balance test +60.70 ± 37.07 +65.75 ± 38.48 +72.17 ± 56.41 +91.89 ± 58.65 +1.568a +0.11 +aMann-Whitney U test +bIndependent samples t-test +∞significant at 0.05 +Table 4: Result of In between group analysis. +Citation: Rathi SS, Joshi RR, Tekur P, Naratna RN, Nagendra HR (2018) Effect of the Yoga on Anthropometric and Physical Assessments in Adolescent Obesity. A Case +Report. Endocrinol Metab Syndr 7: 292. doi:10.4172/2161-1017.1000292 +Page 6 of 6 +Volume 7 • Issue 5 • 1000292 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +Endocrinol Metab Syndr, an open access journal +ISSN: 2161-1017 +children with respect to anthropometric and physical assessments. This +study provides evidence to prove efficacy of Yoga to manage increased +subcutaneous adiposity in trunk, hip and leg region resulting in weight +reduction in adolescent children. +Acknowledgement +We are thankful to Mr. Ramkumar Rathi and Rathi foundation for +his support. We also acknowledge the kind cooperation of Kaveri group +of education, Pune. +References +1. WHO (2017) Obesity and overweight. +2. Batch JA, Baur L (2005) Management and prevention of obesity and its +complications in children and adolescents. Med J Aust 182: 130-135. +3. WHO (2015) Obesity and overweight. +4. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, et al. (2007) +Assessment of Child and Adolescent Overweight and Obesity. Pediatrics 120: +S193-228. +5. Koplan JP, Liverman CT, Kraak VI, (2005) Preventing Childhood Obesity: +Health in the Balance. Washington, DC: National Academies Press, Institute +of Medicine (US) Committee on Prevention of Obesity in Children and Youth. +6. Brambilla P, Bedogni G, Moreno LA, Goran MI, Gutin B, et al. (2006) +Crossvalidation of anthropometry against magnetic resonance imaging for the +assessment of visceral and subcutaneous adipose tissue in children. Int J Obes +(Lond) 30: 23-30. +7. Lofgren I, Herron K, Zern T, West K, Patalay M, et al. (2004) Waist circumference +is a better predictor than body mass index of coronary heart disease risk in +overweight premenopausal women. J Nutr 134: 1071-1076. +8. Erikoglu O, Guzel NA, Pense M, Orer GE (2015) Comparison of Physical +Fitness Parameters with EUROFIT Test Battery of Male Adolescent Soccer +Players and Sedentary Counterparts. Int JSCS. 3: 43-52. +9. Tokmakidis SP, Kasambalis A, Christodoulos AD (2006) Fitness levels of Greek +primary schoolchildren in relationship to overweight and obesity. Eur J Pediatr +165: 867-874. +10. Agarwal BB (2010) Yoga and Medical Sciences. JIMSA 23: 69-70. +11. Subhadra S, Jayable T (2017) Effect of aerobic & resistance exercise +on physical fitness components of Adolescent boys. Journal of Exercise +Rehabilitation 13: 95-100. +12. Pierce JW, Wardle J (1997) Cause and Effect Beliefs and Self-esteem of +Overweight Children. J Child Psychol Psychiatry 38: 645-650. +13. https://www.cdc.gov/chronicdisease/index.htm +14. Garcia DM (1986) The transactional model of stress and coping: Its implication +to young adolescents. University of Denver. +15. Bhardwaj KA, Agrawal G (2013) Yoga Practice Enhances the Level of Self- +Esteem in Pre-Adolescent School Children. International Journal of Physical +and Social Sciences 10: 189-199. +16. Kumar P (2016) Effects of Yoga on Mental Health. International Journal of +Science and Consciousness 2: 6-12. +17. Telles S, Singh N, Bhardwaj AK, Kumar A, Balkrishna A (2013) Effect of yoga or +physical exercise on physical, cognitive and emotional measures in children: a +randomized controlled trial. Child Adolesc Psychiatry Ment Health 7: 37. +18. Raine L, Drollette E, Kao SC, Westfall D, Chaddock-Heyman L (2018) The +Associations between Adiposity, Cognitive Function, and Achievement in +Children. Med Sci Sports Exerc 50: 1868-1874. +19. Chojnacki MR, Raine LB, Drollette ES, Scudder MR, Kramer AF, et al. (2018) +The Negative Influence of Adiposity Extends to Intraindividual Variability in +Cognitive Control among Adoloscent Children. Obesity (Silver Spring) 26: +405-411. +20. Rathi SS, Raghuaram N, Tekur P, Joshi RR, Ramarao NH (2018) Development +and validation of integrated yoga module for obesity in adolescents. Int J Yoga +11: 231-238. +21. Cramer H, Thoms MS, Anheyer D, Lauche R, Dobos G (2016) Yoga in Women +With Abdominal Obesity a Randomized Controlled Trial. Dtsch Arztebl Int 113: +645-652. diff --git a/subfolder_0/Effect of yoga on self-rated visual discomfort in computer users.txt b/subfolder_0/Effect of yoga on self-rated visual discomfort in computer users.txt new file mode 100644 index 0000000000000000000000000000000000000000..367e9c07eaa78f7f6d1d1651f1298eeffbf7d21d --- /dev/null +++ b/subfolder_0/Effect of yoga on self-rated visual discomfort in computer users.txt @@ -0,0 +1,571 @@ +BioMed +Central +Page 1 of 6 +(page number not for citation purposes) +Head & Face Medicine +Open Access +Research +Effect of yoga on self-rated visual discomfort in computer users +Shirley Telles*, KV Naveen†, Manoj Dash†, Rajendra Deginal† and +NK Manjunath† +Address: Swami Vivekananda Yoga Research Foundation, No. 19, Eknath Bhavan, K.G. Nagar, Bangalore 560 019, India +Email: Shirley Telles* - shirleytelles@gmail.com; KV Naveen - anvesana2003@yahoo.co.in; Manoj Dash - anvesana@gmail.com; +Rajendra Deginal - rajendradeginal@yahoo.com; NK Manjunath - nkmsharma@yahoo.com +* Corresponding author †Equal contributors +Abstract +Background: 'Dry eye' appears to be the main contributor to the symptoms of computer vision +syndrome. Regular breaks and the use of artificial tears or certain eye drops are some of the +options to reduce visual discomfort. A combination of yoga practices have been shown to reduce +visual strain in persons with progressive myopia. The present randomized controlled trial was +planned to evaluate the effect of a combination of yoga practices on self-rated symptoms of visual +discomfort in professional computer users in Bangalore. +Methods: Two hundred and ninety one professional computer users were randomly assigned to +two groups, yoga (YG, n = 146) and wait list control (WL, n = 145). Both groups were assessed at +baseline and after sixty days for self-rated visual discomfort using a standard questionnaire. During +these 60 days the YG group practiced an hour of yoga daily for five days in a week and the WL +group did their usual recreational activities also for an hour daily for the same duration. At 60 days +there were 62 in the YG group and 55 in the WL group. +Results: While the scores for visual discomfort of both groups were comparable at baseline, after +60 days there was a significantly decreased score in the YG group, whereas the WL group showed +significantly increased scores. +Conclusion: The results suggest that the yoga practice appeared to reduce visual discomfort, +while the group who had no yoga intervention (WL) showed an increase in discomfort at the end +of sixty days. +Background +Nowadays most people have some contact with comput- +ers either at work or at home. This change has been asso- +ciated with an increase in complaints of a number of +health problems associated with working at visual display +terminals (VDTs) [1]. Eye problems are the single most +common complaints [2]. The main visual symptoms +which VDT users report are eyestrain, irritation, tired eyes, +a burning sensation, redness, blurred vision, and double +vision [2-5]. The symptoms collectively constitute compu- +ter vision syndrome [6]. The main contributor to the +symptoms of computer vision syndrome appears to be +'dry eye'. +These symptoms are widely recognized as temporary, +however the individual does experience considerable dis- +Published: 03 December 2006 +Head & Face Medicine 2006, 2:46 +doi:10.1186/1746-160X-2-46 +Received: 15 June 2006 +Accepted: 03 December 2006 +This article is available from: http://www.head-face-med.com/content/2/1/46 +© 2006 Telles et al; licensee BioMed Central Ltd. +This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), +which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. +Head & Face Medicine 2006, 2:46 +http://www.head-face-med.com/content/2/1/46 +Page 2 of 6 +(page number not for citation purposes) +comfort [7]. Reducing visual discomfort appears to +improve productivity at work [8]. This was indirectly +inferred, as adding regular breaks to the work schedule +improved the efficiency between breaks and compensated +for the extra time spent in breaks. Apart from breaks other +options which have been tried to reduce discomfort are +modifying the computer location, the lighting and reflec- +tion, increasing humidity, the use of artificial tears [9] or +certain eye drops [10]. +Yoga is an ancient Indian science which includes the prac- +tice of specific postures, cleansing practices, regulated +breathing and meditation [11]. A combination of yoga +practices reduced symptoms of visual strain in persons +with progressive myopia [12]. Among software develop- +ment organizations worldwide, several are in Bangalore +city [13]. Hence the present randomized controlled trial +was planned to evaluate the effect of a combination of +yoga practices on self-rated symptoms of visual discom- +fort in professional computer users in Bangalore. +Methods +Participants +The participants were 291 persons working in a software +company in Bangalore, India. There was no attempt to cal- +culate the sample size when planning the study. However +based on the effect size obtained in the present study +[0.66 with 0.9 power to detect a significant difference at +alpha level 0.05], 50 subjects were required for each group +while in fact at baseline there were 146 subjects in the +yoga group and 145 in the control group. +All of them used a computer for at least 6 hours each day, +for 5 days in a week. Persons of both sexes participated in +the trial and their ages ranged between 21 and 49 years. +The participants were screened to exclude those who: (i) +had consulted a specialist for their visual symptoms, (ii) +had uncorrected errors of refraction, (iii) had clinical con- +ditions such as Sjögren's syndrome or kerato-conjunctivi- +tis sicca and (iv) used medication associated with drying +of the eyes (e.g., anti-histaminics). None of the partici- +pants had to be excluded based on these criteria. The +details of the study were described to the participants and +their consent to participate was obtained. The project was +approved by the ethics committee of the yoga research +foundation and had the approval of the human resource +department of the software company. +Design of the study +291 participants were randomized prior to assessment as +two groups using a standard random number table by the +researchers responsible. The two groups were then desig- +nated as (i) intervention (i.e., yoga, n = 146) and (ii) wait +list control (n = 145) by an office assistant from the soft- +ware company who had no other role in the study. The +yoga (YG) and wait list control (WL) groups were compa- +rable with respect to age (group average (± S.D.) 32.8 (± +8.6) years and 31.9 (± 10.2) years, respectively) and gen- +der-distribution (11 females in YG group and 13 in WL +group). +Both groups were assessed at baseline and after 60 days. +During the 60 days the YG group practiced yoga for an +hour per day, for five days in a week. While the YG group +practiced yoga the WL group spent the time in the recrea- +tion center of the software company where 60 percent of +them talked to their friends, 12 percent spent time playing +indoor games, 12 percent worked out in the gym and 16 +percent watched television. The WL group had already +been spending this time each day doing the same activities +and hence during the 60 day period they were following +their usual routine. During the 60 days there were 84 drop +outs from the trial in the YG group and 90 from the WL +group. The large number of drop outs was mainly due to +the fact that the participants had demanding work sched- +ules which interfered with their participating in: (i) the +intervention (YG group) or recreational activities (WL +group) and/or (ii) the assessments (both groups). To be +considered as regular in their participation the YG group +had to have a minimum of 38 days of attendance during +the 60 day period. The trial profile is given in Figure 1. +Assessments +Visual discomfort including dryness, irritation, burning, +redness, photo-sensitivity and possible remedial measures +(e.g., the use of lubricating eye drops) were determined +using a questionnaire [14]. It had 12 items, each of which +had 4 possible choices. These were: (i) absent, (ii) rarely +present (meaning one or two days per week), (iii) often +(meaning more than two days per week) and (iv) contin- +uous. The symptoms were considered during the week +before assessment and the four alternatives (i-iv) were +graded as '0', '1', '2' and '3', respectively. The person who +administered the questionnaire and scored the response +sheets was not aware to which group the subjects +belonged. +Intervention (yoga) +The 60 minute yoga program included yoga postures +(asanas, 15 minutes), regulated breathing (pranayamas, 10 +minutes), exercises for the joints (sithilikarana vyayama, 10 +minutes), visual cleansing exercises (trataka, 10 minutes), +and guided relaxation (15 minutes). +The practice of trataka involves two sets of eye exercises. (i) +Shifting the gaze (by moving the eyes alone) in eight +directions. During this exercise, practitioners are asked to +use their right thumb (and when gazing to the left, their +left thumb) as a cue to direct their gaze. The directions are +up, down, up to the left, down to the left, up to the right, +Head & Face Medicine 2006, 2:46 +http://www.head-face-med.com/content/2/1/46 +Page 3 of 6 +(page number not for citation purposes) +down to the right and rotation of the eyes clock-wise and +anti clock-wise. (ii) During the second exercise, practition- +ers gaze at a flame placed at eye level without blinking. +While gazing at the flame, practitioners are instructed to +focus their gaze on the flame and subsequently defocus +while keeping their gaze on the flame. Throughout the +practice practitioners should sit upright and should avoid +moving their head to shift their gaze. +These techniques were selected either because previous +research showed that they reduced physiological arousal +[15,16] or based on our unpublished clinical observa- +tions. +Data analysis +The data were analyzed using SPSS Version 10.0. Repeated +measures analyses of variance (ANOVA) were carried out +with one Between-subjects factor, viz., Groups (with two +levels, i.e., YG and WL groups) and one Within-subjects +factor, viz., Assessments (with two levels, i.e., baseline and +day 60). Post-hoc analyses for multiple comparisons +between mean values were done with Bonferroni adjust- +ment. +Results +291 participants attended their respective interventions +[yoga and control] in three blocks across 18 months from +October 2004 to April 2005. +The repeated measures analyses of variance (ANOVA) +showed a significant difference between YG and WL +groups (F = 15.369, DF = 1,115, P < .001). There was no +significant difference between assessments taken at base- +line and on day 60. The interaction between groups and +assessments was significant (F = 178.607, DF = 1,115, P < +.001), suggesting that the two factors (groups, assess- +ments) were not independent of each other. +Post-hoc assessments with multiple comparisons of mean +values showed a significant decrease in scores of self-rated +visual discomfort for the YG group on day 60 compared +to baseline (P < .001). In contrast, there was a significant +increase in scores of self rated visual discomfort for the WL +group on day 60 compared to baseline (P < .001). +The groups mean values with 95% C.I. are given in Table +1. The details of the ANOVA are given in Table 2. +Discussion +In the present single blind, randomized, prospective trial +291 persons working in a software company were evalu- +ated for self-rated symptoms of visual discomfort. They +were randomized as yoga (YG) and wait list (WL) control +groups. Both groups showed comparable discomfort at +baseline. At the end of sixty days the YG group showed +decreased scores, whereas the WL group showed an +increase in visual discomfort. +Trial profile of the randomized controlled study +Figure 1 +Trial profile of the randomized controlled study. +Total number selected & randomly assigned to two groups=291 +Yoga +Group +Pre +(n=146) +Pre +(n=145) +Post +(n= 62) +Post +(n= 55) +Drop outs, unable to +regularly attend: +1. Recreational +activities (n=59) +2. Assessments (n=31) +Drop outs, unable to +regularly attend: +1. Intervention (n=57) +2. Assessments (n=27) +Control +Group +Head & Face Medicine 2006, 2:46 +http://www.head-face-med.com/content/2/1/46 +Page 4 of 6 +(page number not for citation purposes) +Visual discomfort in professional computer users is con- +tributed to by various factors such as lighting, glare, dis- +play quality, ergonomic positioning of the monitor and +regularity of work breaks [6]. The symptom which largely +contributes to subjectively rated visual discomfort is 'dry +eye'. Dry eye is itself contributed to by various factors, +including certain diseases (e.g., Sjögren's syndrome, use of +certain medication (e.g., anti-histaminics), gender (being +more common in females)), and individual factors [17]. +Individual factors include blink rate and completeness of +blinking which significantly affect tear film dynamics and +ocular surface health [18,19]. Blink rate especially has +been shown to vary with the task performed [20]. The +mean (± S.D.) rate of blinking was 22 (± 9) per minute +under relaxed conditions, 10 (± 6) per minute while the +subjects were reading a book at table level, and 7 (± 7) per +minute while working at a video display terminal. Hence +the frequency of blinking reduces while mentally alert and +with gaze focused. +Specific yoga practices have been found to bring about +physiological changes suggestive of 'alertful rest' [21]. This +description was based on a simultaneous decrease in heart +rate and oxygen consumption along with a reduction in +peripheral cutaneous blood flow. Also the visual cleans- +ing practices used in the present trial have been shown to +facilitate visual perceptual sensitivity in terms of a +decrease in optical illusion [22]. A reduction in anxiety +has been found to be associated with better visual percep- +tual sensitivity [23]. A relaxed state (as described above) is +associated with a higher frequency of blinking. Yoga prac- +tice has been associated with better self rated relaxation +[24] as well as with physiological relaxation [25]. Hence +the reduction in visual discomfort in the yoga group in the +present study may be attributed to an improvement in the +ability to focus while remaining relaxed which may have +increased the blink rate. +In contrast to the yoga group the control group showed an +increase in self rated visual discomfort. These differences +between the groups could be due to psychological bene- +fits that are reported with 'additional care' [26]. In the +present study the frequent meetings which the yoga group +had with the instructor could serve as additional care and +may have contributed to the benefits seen in the yoga +group. The absence of this psychological support and the +yoga practice in the control group may have contributed +to increased visual discomfort at follow-up. +A main limitation of the study is that well recognized +objective indicators of visual discomfort (especially dry- +ness) were not measured. It would have been ideal to have +carried out a semi-quantitative estimation of the superfi- +cial lipid layer or have measured the tear breakup time +[27]. However another variable which is an objective indi- +cator of VDT related fatigue was measured in these sub- +jects, and the results were reported elsewhere [28]. This is +the critical flicker fusion frequency (CFF), which is the +flicker frequency rate beyond which one can no longer +perceive the flicker. Flicker related changes in the visual +system from working at a cathode ray tube (CRT) compu- +ter screen have also been measured [29]. A group of sub- +jects worked for 3 hours at simulated CRT displays with +different flicker rates. The CFF was found to decrease. A +similar result was obtained when the effect of performing +the same task on a CRT was compared with the perform- +ance on a back slide projection system (BPS) [30]. The +CFF of the group decreased after working on the CRT com- +puter screen while it did not change when working on the +BPS. These studies suggest that the visual system possibly +gets fatigued as a result of viewing supra-threshold flicker. +Table 2: Analysis of variance for scores in the 'Dry Eye Questionnaire' +Source +df +MS +F +P' values +Within subjects factor (Assessments) +1 +0.133 +3.221 +0.075 +Between subjects factor (Groups) +1 +8.326 +15.369 +0.001 +Interaction (Assessments and Groups) +1 +7.381 +178.607 +0.001 +Error (Within subjects factor) +115 +4.133 +Error (Between subjects factor) +115 +0.542 +Greenhouse-Geisser epsilon = 1.000, hence Sphericity Assumed +Table 1: Scores of the questionnaire for visual discomfort for yoga and control groups at baseline [BL] and day 60. +Descriptive values +YOGA [n = 62] +CONTROL [n = 55] +BL +Day 60 +BL +Day 60 +Mean (95 % C.I.) +1.03 (.91–1.15) +0.7*** (.58–.94) +1.05 (.89–1.21) +1.5*** (1.34–1.66) +*** P < .001, post-hoc test for multiple comparisons +Head & Face Medicine 2006, 2:46 +http://www.head-face-med.com/content/2/1/46 +Page 5 of 6 +(page number not for citation purposes) +In the subjects of this study critical flicker fusion fre- +quency was measured using a standard electronic appara- +tus [28]. Each subject was assessed in 10 trials (5 each, +ascending and descending, given alternately). The fre- +quency of flicker for the ascending trials was gradually +increased from a minimum of 8 Hz, with 1 Hz incre- +ments, till the subjects reported that the light appeared +"fused" or steady. This was the fusion threshold. For +descending trials, the frequency was gradually reduced (1 +Hz per step) from 49 Hz, till the subject perceived the +stimulus as "flickering". This was the flickering threshold. +The average value of the ascending and descending trials +was used for statistical analysis. +After sixty days the yoga group showed an increase in CFF +from a group average (± SD) of 31.8 (± 2.6) at baseline to +an average of 33.6 (± 2.5) after sixty days. In contrast, the +wait list control group showed a decrease in CFF, from a +group average of 32.5 (± 2.5) at baseline to a group aver- +age of 31.4 (± 2.5) at the end of sixty days. Hence the yoga +group showed an average increase of 1.8 Hz in the CFF, +compared with an average decrease of 1.1 Hz in the wait +list control. This may suggest that the wait-list control +group might have remained prone to visual fatigue, +whereas the yoga group was not. +These results suggest that sixty days of yoga practice may +have reduced visual fatigue based on the self-rated symp- +toms presented in this study and the CFF findings +reported earlier [28]. However other factors may have +influenced the subjective assessment of visual dryness. For +example, certain personality traits were reported to be +higher in contact lens wearers who had dryness of the eyes +[31]. This study subjectively evaluated personality traits +using the Yatabe Guilford Personality Test. No personality +assessment was carried out in the participants studied +here, which can be considered a limitation of the study. +Also, it has been shown that for yoga practice to be effec- +tive participants should be motivated to learn and practice +yoga [32]. Hence it would also have been useful to assess +levels of motivation in the yoga group and correlate them +with the reduction in self-rated visual discomfort which +was found. +Conclusion +The results of the present study suggest that a combination +of yoga techniques practiced for 60 days improves self- +rated visual discomfort in computer professionals. In con- +trast, the wait list control group who continued with their +usual routine showed an increase in self-rated visual dis- +comfort. Hence the practice of yoga can be a potential +non-pharmacological intervention for visual discomfort +related to working at visual display terminals (VDTs). +Competing interests +The principal author and four co-authors declare that they +have no competing interests. +Authors' contributions +ST conceived and designed the study and prepared the +manuscript. NKV participated in the conception and +design of the study and in compiling the manuscript. MD +co-ordinated the project and supervised the intervention +and data collection. RD participated in the recruitment of +subjects, data collection and assisted in statistical analysis. +MNK carried out data extraction and analysis. All authors +read and approved the final manuscript. +Acknowledgements +The research was funded by the Central Council for Research in Yoga and +Naturopathy, Department of AYUSH, Ministry of Health and Family Wel- +fare, Government of India, New Delhi, India. +References +1. +Smith MJ, Cohen BG, Stammerjohn WL Jr: An investigation of +health complaints and job stress in Video Display operations. +Hum Factors 1981, 23:387-400. +2. +Collins MJ, Brown B, Bowman KJ: Visual Discomfort and VDTs. +Report for National Occupational Health and Safety Commission (Australia) +1998. +3. +Lie I, Watten RG: VDT work, Oculomotor strain and subjec- +tive complaints – an experimental and clinical study. Ergo- +nomics 1994, 37:1419-1433. +4. +Bergqvist UO, Knave BG: Eye discomfort work with visual dis- +play terminals. Scand J Work Environ Health 1994, 20:27-33. +5. +Cole BL, Maddocks JD, Sharpe K: Effect of VDUs on the eyes – +report of a six-year epidemiological study. Optom Vis Sci 1996, +73:512-528. +6. +Blehm C, Vishnu S, Khattak A, Mitra S, Yee RW: Computer Vision +Syndrome: a review. Surv Ophthalmol 2005, 50:253-262. +7. +Yeow PT, Taylor SP: Effect of short-term VDT usage on visual +functions. Optom Vis Sci 1989, 66:459-466. +8. +Grandjean E: Fitting the task to the man London: Taylor and Francis; +1980. +9. +Sheedy JE, Shaw-McMinn PG: Diagnosing and treating computer related +vision problems Burlington, MA: Butterworth-Heinemann; 2003. +10. +Apostol S, Filip M, Dragne C, Filip A: Dry eye syndrome. Etiolog- +ical and therapeutic aspects. Oftalmologia 2003, 59:28-31. +11. +Visweswaraiah NK, Telles S: Randomized trial of yoga as a com- +plementary therapy for pulmonary tuberculosis. Respirology +2004, 9:96-101. +12. +Nagendra HR, Vaidehi S, Nagarathna R: Integrated approach of yoga +therapy for ophthalmic disorders. Institutional report VKYOCTAS/84/015 +Bangalore: Vivekananda Kendra Yoga Therapy and Research Center; +1984. +13. +Killcrece G, Kossakowski K-P, Ruefle R: Organizational models for com- +puter security incident response teams (CSIRTs). Pittsburgh: SEI: Hand book +Carnegie-Mellon University (CMU)/Software Engineering Institute 2003- +HB-001-15213-3890 2003. +14. +Bandeen-Roche K, Munoz B, Tielsch JM, West SK, Schein OD: Self- +reported assessment of dry eye in a population-based set- +ting. Invest Ophthalmol Vis Sci 1997, 38:2469-2475. +15. +Tran MD, Holly RG, Lashbrook J, Amsterdam EA: Effects of hatha +yoga practice on the health-related aspects of physical fit- +ness. Prev Cardiol 2001, 4:165-170. +16. +Vempati RP, Telles S: Yoga based guided relaxation reduces +sympathetic activity in subjects based on baseline levels. Psy- +chol Rep 2002, 90:487-494. +17. +Duncan DD, Munoz B, Bandeen-Roche K, West SK: Assessment of +Ocular exposure to ultraviolet-B for population studies. +Salisbury Eye Evaluation Project Team. Photochem Photobiol +1997, 66:701-709. +Publish with BioMed + Central + and +every +scientist can read your work free of charge +"BioMed Central will be the most significant development for +disseminating the results of biomedical research in our lifetime." +Sir Paul Nurse, Cancer Research UK +Your research papers will be: +available free of charge to the entire biomedical community +peer reviewed and published +immediately upon acceptance +cited in PubMed and archived on PubMed Central +yours — you keep the copyright +Submit your manuscript here: +http://www.biomedcentral.com/info/publishing_adv.asp +BioMedcentral +Head & Face Medicine 2006, 2:46 +http://www.head-face-med.com/content/2/1/46 +Page 6 of 6 +(page number not for citation purposes) +18. +Lemp MA: Report on the National Eye Institute/Industry +workshop on Clinical Trials in Dry Eyes. CLAOJ 1995, +21:221-232. +19. +Albietz JM: Prevalence of dry eye sub types in clinical optom- +etry practice. Optom Vis Sci 2000, 77:357-363. +20. +Tsubota K, Nakamori K: Dry eyes and Video Display Terminals. +N Engl J Med 1993, 328:584. +21. +Telles S, Nagarathna R, Nagendra HR: Improvement in visual per- +ception following yoga training. J Indian Psychol 1995, 13:30-32. +22. +Vani PR, Nagarathna R, Nagendra HR, Telles S: Progressive +increase in critical flicker fusion frequency following yoga +training. Indian J Physiol Pharmacol 1997, 41:71-74. +23. +Brown D, Forte M, Dysart M: Differences in visual sensitivity +among mindfulness meditators and non-meditators. Percept +Mot Skills 1984, 58(3):727-733. +24. +Manjunath NK, Telles S: Influence of Yoga and Ayurveda on self +rated sleep in a geriatric population. Indian J Med Res 2005, +121:683-690. +25. +Malathi A, Damodaran A: Stress due to exams in medical stu- +dents – role of yoga. Indian J Physiol Pharmacol 1999, +43(2):218-224. +26. +Delbanco T: The healing roles of doctor and patient. Healing and the mind +Edited by: InMoyers B. New York: David Grubin Productions; +1993:7-23. +27. +Brasche S, Bullinger M, Petrovich A, Mayer E, Gebhardt H, Herzog V, +Bischof W: Self reported eye symptoms and related diagnos- +tic findings-comparison of risk factor profiles. Indoor Air +2005:56-64. +28. +Telles S, Dash M, Manjunath NK, Deginal R, Naveen KV: Effect of +yoga on visual perception and visual strain. Opt Acta (Lond) [cur- +rently called Journal of Modern Optics] 2006 in press. +29. +Laubli T, Hunting W, Grandjean E, Fellmann T, Brauninger U, Gierer +R: Load factors at visual display terminals. Klin Monatsbl Augen- +heilkd 1982, 180(5):363-366. +30. +Harwood K, Foley P: Temporal resolution: an insight into the +visual display terminal (VDT) "problem". Hum Factors 1987, +29:447-452. +31. +Chikama T, Ueda K, Nishida T: Clinical interpretation of the sub- +jective complaint of dryness in contact lens wearers. Nippon +Ganka Gakkai Zasshi 2005, 109(6):355-361. +32. +Manjunath NK, Telles S: Factors influencing changes in tweezer +dexterity scores following yoga training. Indian J Physiol Pharma- +col 1999, 43(2):225-229. diff --git a/subfolder_0/Effect of yoga on somatic indicators of distress in professional computer users.txt b/subfolder_0/Effect of yoga on somatic indicators of distress in professional computer users.txt new file mode 100644 index 0000000000000000000000000000000000000000..2f17e29a317368c027360851722dac5671dcebdc --- /dev/null +++ b/subfolder_0/Effect of yoga on somatic indicators of distress in professional computer users.txt @@ -0,0 +1,238 @@ +PERS +ON +Effect of yoga on somatic indicators of distress in profes- +sional computer users +Comments to: +Association between occupational asthenopia and psycho-phy- +siological indicators of visual strain in workers using video dis- +play terminals +Ruta Ustinaviciene, Vidmantas Januskevicius +Med Sci Monit, 2006; 12(7): CR296–301 +Dear Editor, +Ophthalmologic and psycho-physiological indicators con- +fi + rmed the subjective perception of visual strain due to vi- +sual display terminal [VDT] work in two hundred and eight +professional computer users [1]. The report also mentio- +ned that easily accessible and simple examinations could +be used to evaluate strain at the work place related to pre- +ventive programs or interventional studies. +Various interventions have been used to reduce visu- +al discomfort, including breaks during work, modifying +the computer location, lighting and refl + ection, modify- +ing the indoor environment, and the use of certain eye +drops [2]. +Yoga is an ancient Indian science which includes the practi- +ce of specifi + c postures, cleansing practices, regulated bre- +athing, and meditation [3]. A controlled trial was carried +out to evaluate the effect of a combination of yoga practi- +ces on self-rated symptoms of visual discomfort in profes- +sional computer users in India [4]. At the end of sixty days +of yoga practice there was a signifi + cant decrease in self-ra- +ted visual discomfort, while the non-yoga control group +showed an increase. +Apart from visual strain, VDT workers experienced a grea- +ter subjective perception of stress than offi + ce workers [5]. +Stress is related to high work load, high work pressure, +diminished job control and stress related to the use of new +technology. The practice of yoga has been shown to redu- +ce psycho-physiological indicators of mental stress in per- +sons with high baseline stress levels associated with a phy- +sical disability [6], their social circumstances [7] or their +occupation [8]. +Somatic indicators of distress were assessed in two hundred +and ninety one professional computer users with ages be- +tween 21 and 49 years, who were randomly assigned to two +groups, yoga (YG, n=146) and wait-list control (WL, n=145). +The participants were from a software company in Bangalore +city (India) and they all used a computer for more than six +LE21 +Electronic PDF security powered by IndexCopernicus.com +opy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for p +PERSONAL USE +ONLY +hours each day, for fi + ve days a week. All of them had normal +health based on a clinical history and examination. Both +groups had comparable job assignments and responsibili- +ties as rated by the human resource personnel from the sof- +tware company. Both groups were assessed at baseline and +after sixty days. At the end of sixty days there were 62 per- +sons in the YG group and 56 in the WL group. +The YG group (average age of 32.8 years (±8.6 S.D.); 11 fe- +males) practiced yoga for sixty minutes each day for fi + ve days +in a week. The practice consisted of joint loosening tech- +niques (shithilikarana vyayama) for 10 minutes, physical po- +stures (asanas, 15 minutes), regulated breathing practices +(pranayamas, 10 minutes), eye cleansing exercises (trataka, +10 minutes) and guided relaxation techniques (15 minu- +tes). The WL group (average age of 31.9 years (±10.2 S.D.); +13 females) spent the same time talking to friends (60%), +watching television (16%), playing indoor games (12%) +or exercising in the gym (12%). This was how they usual- +ly spent the time allotted as a work break. Hence they were +carrying on with their usual routine. +A section of the symptom checklist 90 – Revised [SCL-90-R] +specifi + c to ‘somatization’ with 12 items was administered +to both groups at baseline and after two months of the in- +terventions. The checklist was administered and scored by +the investigator who was blind to the allocation of subjects +to YG and WL groups. Each item was rated on a 0 to 4 sca- +le for distress. The sum of the scores for the 12 items was +analyzed using a repeated measures analysis of variance +(ANOVA) followed by post hoc analyses with Bonferroni ad- +justment (SPSS version 10). +Both groups (YG and WL) had comparable baseline sco- +res for the somatization dimension of the SCL-90-R as fol- +lows: group average of 12.03 (±6.62 S.D.) and 9.93 (±7.38 +S.D.), respectively (p>0.05). At the end of two months the +YG group showed a decrease in scores [average score of +6.34 (±6.13 S.D.)], (p<0.001) whereas the WL group sho- +wed an increase in the score [average score of 12.82 (±8.24 +S.D.)], (p=0.003). +The somatization dimension of the SCL-90-R refl + ects distress +related to the way physical sensations are perceived [9]. The +cardiovascular, gastrointestinal, respiratory, and other sy- +stems with autonomic mediation are included. It has alrea- +dy been reported that physical and psychological symptoms +have signifi + cantly decreased following a 10 week behavio- +ral medicine intervention, with a greater reduction in tho- +se who were ‘high somatizers’ at baseline [10]. +Hence in the present study practicing yoga for sixty days +reduced somatic indicators of distress in professional com- +puter users. Based on these results it may be interesting +to determine whether yoga practice prevents the develop- +ment of actual somatic illness in asymptomatic professio- +nal computer users. +Sincerely, +Shirley Telles and Naveen K.V., +Swami Vivekananda Yoga Research Foundation, +No. 19, K.G. Nagar, Bangalore 560 019, India, +e-mail: anvesana@gmail.com +REFERENCES: + 1. Ustinaviciene R, Januskevicius V: Association between occupational asthe- +nopia and psycho-physiological indicators of visual strain in workers using +video display terminals. Med Sci Monit, 2006; 12(7): CR296–301 + 2. Sheedy JE, Shaw-McMinn PG: Diagnosing and treating computer rela- +ted vision problems. Burlington, MA, Butterworth-Heinemann, 2003 + 3. Visweswaraiah NK, Telles S: Randomized trial of yoga as a complemen- +tary therapy for pulmonary tuberculosis. Respirology, 2004, 9: 96–101 + 4. Telles S, Dash M, Manjunath NK et al: Effect of yoga on visual percep- +tion and visual strain. J Mod Optics, 2006; in press + 5. Tomei G, Rosati MV, Martini A et al: Assessment of subjective stress in +video display terminal workers. Ind Health, 2006; 44(2): 291–95 + 6. Telles S, Srinivas RB: Autonomic and respiratory measures in children +with impaired vision following yoga and physical activity programs. Int +J Rehab Health, 1999; 4(2): 117–22 + 7. Telles S, Narendran S, Raghuraj P et al: Comparison of changes in au- +tonomic and respiratory parameters of girls after yoga and games at a +community home. Percept Mot Skills, 1997; 84: 251–57 + 8. Vempati RP, Telles S: Baseline occupational stress levels and physiologi- +cal responses to a two day stress management program. J Indian Psychol, +2000; 18(1–2): 33–37 + 9. Holi MM, Marttunen M, Aalberg V: Comparison of the GHQ – 36, the +GHQ – 12 and the SCL – 90 as psychiatric screening instruments in the +Finnish population. Nord J Psychiatry, 2003; 57(3): 233–38 + 10. Nakao M, Myers P, Fricchione G et al: Somatization and symptom re- +duction through a behavioral medicine intervention in mind/body me- +dicine clinic. Behav Med, 2001; 26(4): 169–76 +Received: 2006.08.25 +LE22 +Electronic PDF security powered by IndexCopernicus.com +opy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for personal use only - distribu +PERSONAL USE +ONLY +Index +Copernicus +integrates +www.IndexCopernicus.com +Index Copernicus +Global Scientific Information Systems +for Scientists by Scientists +Index +Copernicus +integrates +IC Virtual Research Groups [VRG] +Web-based complete research +environment which enables researchers +to work on one project from distant +locations. VRG provides: +  +customizable and individually +self-tailored electronic research +protocols and data capture tools, +  +statistical analysis and report +creation tools, +  +profiled information on literature, +publications, grants and patents +related to the research project, +  +administration tools. +IC Scientists +Effective search tool for +collaborators worldwide. +Provides easy global +networking for scientists. +C.V.'s and dossiers on selected +scientists available. Increase +your professional visibility. +IC Patents +Provides information on patent +registration process, patent offices +and other legal issues. Provides +links to companies that may want +to license or purchase a patent. +IC Lab & Clinical Trial Register +Provides list of on-going laboratory +or clinical trials, including +research summaries and calls for +co-investigators. +IC Grant Awareness +Need grant assistance? +Step-by-step information on +how to apply for a grant. Provides +a list of grant institutions and +their requirements. +IC Journal Master List +Scientific literature database, +including abstracts, full text, +and journal ranking. +Instructions for authors +available from selected journals. +IC Conferences +Effective search tool for +worldwide medical conferences +and local meetings. +Index +Copernicus +integrates +EVALUATION & BENCHMARKING +PROFILED INFORMATION +NETWORKING & COOPERATION +VIRTUAL RESEARCH GROUPS +GRANTS +PATENTS +CLINICAL TRIALS +JOBS +STRATEGIC & FINANCIAL DECISIONS +EVALUATION & BENCHMARKING +PROFILED INFORMATION +NETWORKING & COOPERATION +VIRTUAL RESEARCH GROUPS +GRANTS +PATENTS +CLINICAL TRIALS +JOBS +STRATEGIC & FINANCIAL DECISIONS +Electronic PDF security powered by IndexCopernicus.com +opy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. This copy is for personal use only - distribution prohibited. 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This copy is for personal use only - distribu diff --git a/subfolder_0/Effect of yoga therapy on quality of life and depression in premenopausal nursing students with mastalgia A randomized controlled trial.txt b/subfolder_0/Effect of yoga therapy on quality of life and depression in premenopausal nursing students with mastalgia A randomized controlled trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..35646eedb04f0602ac5042e6ca5adb0302318b4a --- /dev/null +++ b/subfolder_0/Effect of yoga therapy on quality of life and depression in premenopausal nursing students with mastalgia A randomized controlled trial.txt @@ -0,0 +1,1046 @@ +Official Publication of +Academy of Advanced Dental Research +Journal of +Health Research & Reviews +Volume 3| Issue 2 | May-Aug 2016 +www.jhrr.org +ISSN 2394-2010 +© 2016 Journal of Health Research and Reviews | Published by Wolters Kluwer - Medknow +48 +Effect of yoga therapy on quality of life and depression +in premenopausal nursing students with mastalgia: +A randomized controlled trial with 6‑month follow‑up +Sukanya Raghunath, Nagarathna Raghuram, Sandhya Ravi1, Nidhi C Ram, Amritanshu Ram +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, 1Prameya Wellness Private Limited, +Bengaluru, Karnataka, India +INTRODUCTION +Mastalgia or breast pain is a common problem[1,2] with a +prevalence of 41–79%.[3‑5] Although the etiology of mastalgia is +not clearly understood, several factors including stress, anxiety, +and depression[6,7] have been a concern. A review of several +randomized controlled trials (RCTs) concluded that yoga was +better than many control interventions in reducing pain in +different parts of the body.[8,9] +Literature says that there has been no research on yoga in +mastalgia. Hence, this study was planned to assess the role of +yoga therapy on the quality of life (QoL) and depression among +subjects with mastalgia through an randomized controlled +trial (RCT). +Introduction: Mastalgia is a common problem and disturbs women’s reproductive lives. There is no known organic etiology +for mastalgia and also no definitive treatment. Considering the impact of mastalgia on the quality of life (QoL), it appears +that mind–body interventions such as yoga would play an important role. Yoga has shown a beneficial effect in reducing +pain, anxiety, and depression, thereby improving the QoL. Objective: To compare the benefits of yoga with the physical +activity in improving the QoL in nursing students with mastalgia. Materials and Methods: An institutional ethical committee +approved this randomized active control trial (RCT) with a follow‑up of 6 months on premenopausal women above 18 years +with breast pain (pain score >2) of more than 3 months duration. Women already practicing yoga, on hormonal treatment, +or diagnosed with malignancy were excluded. Eighty consenting nursing students were randomized into the yoga therapy +or control (brisk walk) arm (for 12 weeks). QoL and Beck Depression Inventory (BDI) questionnaires were administered prior +to the intervention and 3 months and 6 months after the intervention. Results: RM‑ANOVA group effect was significant in +BDI, F (1, 67) = 2632.72, P (<0.001) and in overall QoL, F (1, 67) =6881.41, (P < 0.001). Post hoc test (paired sample t‑test) +showed better improvement in the yoga group (0–3 months, 0–6 months) in both QoL (P < 0.001) (in all the four domains) +and depression scores (P < 0.001) compared to the control group. Conclusion: QoL and depression scores improved with +yoga in nursing students with mastalgia. +Keywords: Depression, mastalgia, nursing students, quality of life, yoga +ABSTRACT +Access this article online +Quick Response Code: +Website: +www.jhrr.org +DOI: +10.4103/2394-2010.184229 +Address for correspondence: Mrs. Sukanya Raghunath, +324, 5th Cross, 1st Block Jayanagar, Bangalore ‑ 560 011, +Karnataka, India. +E‑mail: sukanya.raghu@gmail.com +How to cite this article: Raghunath S, Raghuram N, Ravi S, Ram NC, Ram A. +Effect of yoga therapy on quality of life and depression in premenopausal +nursing students with mastalgia: A randomized controlled trial with 6-month +follow-up. J Health Res Rev 2016;3:48-54. +This is an open access article distributed under the terms of the Creative +Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows +others to remix, tweak, and build upon the work non‑commercially, as long as the +author is credited and the new creations are licensed under the identical terms. +For reprints contact: reprints@medknow.com +Original Article +Raghunath, et al.: Yoga in improving women’s quality of life with mastalgia/yoga in improving quality of life in women with mastalgia +Journal of Health Research and Reviews | May ‑ August 2016 | Volume 3 | Issue 2 +49 +MATERIALS AND METHODS +Female students between 18 years and 25 years of age, from two +residential nursing colleges, namely, IKON College of Nursing +in Bidadi and Sri Rajarajeswari College of Nursing in Bengaluru, +both in Karnataka in South India were the subjects of the study. +All the students lived in the hostel and had come from semi‑urban +and rural areas of six different states of India  (Karnataka, +Andhra Pradesh, Tamil Nadu, Maharashtra, and Kashmir) and +some parts of Nepal. They all had breast pain (cyclical or acyclical) +of more than 3 months. +To ascertain the optimum sample size for the study, effect size +values obtained from our pilot study on 10 women with breast +pain in the same setting was used. Severity of pain, QoL, anxiety, +and depression were measured before and after 12  weeks of +yoga therapy practice. Results of seven women who completed +the study indicated reduction in pain [effect size (ES) =3.09], +anxiety (ES = 1.59) and depression (ES = 2.21), and increase in +QoL (ES = 0.80). Using these ES values of QoL powered at 0.95 +for two‑tailed analysis a sample size of 23/arm was obtained; +anticipating an attrition rate of 70% due to the forthcoming +academic year, it was planned that 40 subjects would be recruited +in each arm. +Inclusion criteria were: Premenopausal women 18  years and +above, breast pain more than 3 months requiring reassurance +and/or nondrug therapy, breast pain cyclical or acyclical, +unilateral or bilateral, with or without fibrocystic disease +of the breast, and those who satisfied  +  Cleeland’s Breif pain +inventory with a pain score of >2. Women with malignancy, +postmenopausal women, those with hypothyroidism, those who +were on hormonal treatment or oral contraceptive pills, and those +already practicing yoga were excluded from the study. +The trial started after the approval from the Institutional Ethical +Committee of Swami Vivekananda Yoga Anusandhana Samsthana +(SVYASA) University  (RES/IEC‑SVYASA/16/201). The written +approval was also obtained from the administrative heads of +both the colleges. This study was registered with the Clinical +Trial Registry of India (CTRI/2014/08/004911). +After giving an introductory lecture, all the students were +asked to give signed informed consent, along with a filled +checklist of symptoms, which included questions regarding +their breast health, breast pain cyclical or acyclical, history of +fibroadenoma, fibrocystic disease, history of breast cancer, age +of menarche, menstrual cycle, information about past diagnosis, +management, scanning, surgery, other illness, their stress level, +happiness scores, diet, shifts in work, lifestyle pattern, along with +anthropometric and demographic data. +The Research Medical Officer and a breast surgeon educated +the girls about the procedure and the importance of screening in +detail to make them comfortable. Along with four female medical +officers from the state government, the breast surgeon conducted +a detailed physical/clinical examination (breast screening) to look +for the features/signs and symptoms. Uniformity was maintained +by all the medical officers during the screening. Counseling and +educating them with regard to breast care were done during this +individual interaction. The screening was conducted in a hygienic +environment (biology laboratory of the college) providing them +privacy and comfort. +This was a randomized, active control interventional trial wherein +80 participants were randomly divided into two arms. Concealed +envelope procedure was performed for randomization. One group +underwent yoga therapy and the control arm did brisk walk under +supervision for the same duration. +This was an interventional study, and so double blinding was not +possible. Computer (www.randomizer.org)‑generated random +number table was used and the allocation of the subjects was +done by the prelabeled sealed envelope method. The research +medical officer and four gynecologists, ultrasonologists, and the +laboratory team were blind to the groups. The statistician had to +be blind as randomization and the final analysis was done by him. +The coded answer sheets of the questionnaires were decoded +only after completion of the scoring. +The yoga group followed the precise list of practices 75 min +daily, 6 days a week for 3 months. During the 1st month, the +yoga sessions were taught by the certified yoga therapist for all +the 6 days. After this, the supervised 1‑h sessions were given +3  days a week by the therapist and subjects were asked to +do self‑practice for the other 3 days of the week for the next +2 months. After 3 months, they were asked to practice daily +on their own with weekly follow‑up classes when the therapist +reviewed their diary of daily practice and clarified the queries +of both groups. The detailed list of yoga therapy practices is +given in Table 1. +The control group subjects did brisk walk for 1.5 h followed by +supine rest for 6 days 1 week under supervision. Lectures were +given on breast health, medical concept of a healthy lifestyle, +and benefits of diet and exercise. Attendance was taken for both +the groups. +Sociodemographic details were obtained with the screening check +list. Cleeland’s Breif pain inventory and body mass index (BMI) +were documented after the clinical examination by the clinician. +Ultrasound scanning of the breast to look for fibroadenoma/cysts +and blood test to look for hypothyroidism were performed before +starting the intervention. Psychological assessments were done +by administering QoL and Beck Depression Inventory  (BDI) +questionnaires before and at 3 months and 6 months after the +intervention. +BDI, developed by Dr. Beck in 1961,[10] aims to evaluate the +risk of depression and level of depressive symptoms objectively. +The inventory consists of 21 questions, each with four possible +answers scored between 0 and 3, with the total score ranging +0–63. The total score demonstrates the level of depression. +The score for each item ranges 0–3 and the range of total +score is 0–63. A score of 0 ≤ 9: No depression, 10–19: Mild +depression, 20–25: Moderate depression, and 26 and above: +Severe depression. BDI has been used widely and has Cronbach’s +alpha coefficient of 0.80 and r 0.74. This instrument has a +reliability of 0.48–0.86 and validity of 0.67 with the Diagnostic +Raghunath, et al.: Yoga in improving women’s quality of life with mastalgia/yoga in improving quality of life in women with mastalgia +Journal of Health Research and Reviews | May ‑ August 2016 | Volume 3 | Issue 2 +50 +and Statistical Manual of Mental Disorders (DSM) diagnostic +criteria for depression.[11] +BDI questionnaire attempts to measure the intensity, severity, +and depth of depression. It is commonly used in a clinical setting +as a novel way of diagnosing and categorizing depression in +psychiatric settings. +QoL reflects the psychological imbalances that result from amplified +responses to incorrectly perceived environmental situations. The +World Health Organization quality of life‑BREF (WHOQOL‑BREF), +which is the short version of the WHOQOL‑100, is widely used. +WHOQOL‑BREF consists of 26 items assessing the QoL in four +domains (Physical health, Psychological health, Social relationships +and Environment) and a general evaluative facet (overall QoL and +general health). The psychometric properties of the WHOQOL‑BREF +is considered good for assessment of QoL in women with benign +breast disease.[12] Higher the scores in WHOQOL‑BREF, higher is +the QoL. Chronbach’s alpha being >0.70. +Statistical analysis +Data was analyzed using  + “R” software (ver. 3.1.0). Although the +data were not distributed normally, parametric tests were conducted +because of the large sample size. The paired and independent t‑tests +were used to compare within and between group differences. The +data for the 6 month follow‑up were compared using repeated +measures analysis of variance (ANOVA). All tests were two‑tailed, +with an alpha level of 0.05 and the power maintained at 0.8. +RESULTS +Detailed participant flow chart is given in Figure 1. +The recruitment for the trial, data collection, and the baseline to +the 3rd month intervention, along with postdata collection were +from October 2013 to February 2014. Six months follow‑up was +done from March 2014 to August 2014. +All the 80 residential subjects were unmarried [Mean (M) =19.84, +standard deviation (SD) =1.15] (range: 18–25 years), the onset of +menarche was M = 12.66, SD = 0.97 (range: 11–15 years), the +duration of breast pain was M = 13.13, SD = 10.06 (range: 4–60 +months), and the BMI was M = 20.61, SD = 3.23. The breast pain +score in the pain analog scale was M = 3.67, SD = 1.11 (range: +3–6), a majority of the students, i.e., 58 (72.5%) had cyclical +mastalgia while 22  (27%) students had acyclical mastalgia. +Practice sessions varied from 56.89 ± 4.29 (out of 72 sessions) +in the yoga group and 54.83 ± 4.4 in the control group. +Average scores in QoL were 87.28 ± 6.16 in the yoga group and +86.88 ± 7.07 in the control group. BDI scores were 15.28 ± 6.75 +in the yoga group and 14.48 ± 4.67 in the control group. Detailed +sociodemographic data, along with psychological variables, are +shown in Table 2. +Results after the intervention +In QoL, comparison of means of the two groups by repeated +measures ANOVA  +  showed highly significant between group +Table 1: List of yoga practices +Sl. +No +List of practices +Time (1 h 15 min) +I +Breathing exercises +Hands in and out breathing +Saśanka (moon) breathing +Tiger breathing/stretch +Bhujanga (cobra) breathing +Salabha (plough) breathing +II +Loosening exercises +Upper body twist +4 min +Lateral bend +Forward-backward bend +III +Sun salutation (ṣūrya namaskāra) +10 min +IV +Postures (āsanaās) +Standing poses +Half‑waist wheel pose (ardha kati cakrāsana) +1 min +Half‑wheel pose (ārdha cakrāsana) +1 min +Triangle pose (trikonāsana) +1 min +Tree pose (vrkśāsana) +1 min +Sitting poses +Cow face pose (gomukhāsana) +1 min +Camel pose (uśtrāsana) +1 min +Moon pose (ṣaśankāsana) +1 min +Twisted pose (vakrāsana) +1 min +Prone poses +Cobra pose (bhujangāsana) +1 min +Bow pose (dhanurāsana) +1 min +Plough pose (ṣalabhāsana) +1 min +Supine poses +Shoulder stand (sarvāngāsana) +1 min +V +Altered breathing (pranāyāma) and cleansing +technique (kriya) +Kriya +Active exhalation (kapāla bhāti) +1 min +Sectional breathing +Abdominal, thoracic, clavicular, full yogic +breathing (vibhāgīya prānāyāma) +2 min +Alternate nostril breathing (anuloma‑viloma) +3 min +VI +Deep relaxation (śavāsana) +10 min +VII +Meditation +Chanting of A, U, M, and Om (nādānusandhāna) +4 min +Observing silence (dhyāna) + 5 min +VIII +Lectures +About culturing emotions, sātvik diet and +yogic counseling +20 min +Figure 1: Participant flowchart +Raghunath, et al.: Yoga in improving women’s quality of life with mastalgia/yoga in improving quality of life in women with mastalgia +Journal of Health Research and Reviews | May ‑ August 2016 | Volume 3 | Issue 2 +51 +effect, F (1, 67) =6881.41 (P < 0.001) in overall QoL. The +post hoc test (paired sample t‑test) showed highly significant +improvement at 3 months, t (37) =‑9.08, (P <.001) *** and +6 months, t (37) = ‑7.34, (P <.001) *** in the yoga group as +compared to the control group. The detailed results of all the four +domains are presented in Table 3. +In BDI, comparison of means of the two groups by repeated +measures ANOVA showed highly significant reduction in +depression scores group effect: F (1, 67) =2632.72, P (<0.001). +The post hoc test (paired sample t‑test) showed significantly better +reduction at both 3 months: t (37) =12.96, (P <.001) *** and +6 months: t (37) =8.90, (P <.001) *** in the yoga group as +compared to the control group [Table 3]. Degrees of depression +before and after intervention in both the groups are presented +in Table 4. +DISCUSSIONS +The present RCT on 80 nursing students in the age range of +18–25 years with nonorganic breast pain looked at the effect +of yoga on QoL and depression in a 6‑month period. Results +of repeated measures ANOVA showed significant group time +interaction  (P  <  0.001). Post hoc tests revealed significant +improvement within the yoga group at the 3rd month and 6th month +follow‑up on all four domains of QoL and BDI [Figures 2 and 3]. +Although some studies point to a negative association of pain and +depression with QoL in women with nonorganic mastalgia,[13] +very few interventional studies have measured QoL. Those +that did look at QoL after pharmacotherapy did not show a +significant change in QoL as many of them were associated with +adverse effects.[14] Looking at nonpharmacological therapies, +Table 2: Baseline characteristics of both the groups +Variables +Yoga (n=40) +Control (n=40) +Total (n=80) +Mean or N +SD or % +Mean or N +SD or % +Mean or N +SD or % +Age (years) +20.10 +1.28 +19.58 +0.96 +19.84 +1.15 +Height (cm) +155.08 +7.35 +155.95 +4.50 +155.51 +6.07 +Weight (kg) +48.90 +6.86 +50.85 +9.72 +49.88 +8.42 +BMI +20.33 +2.43 +20.90 +3.88 +20.61 +3.23 +Age at menarche +12.48 +1.06 +12.85 +0.83 +12.66 +0.97 +Numberof students +I BSc +3 +7.5 +3 +7.5 +6 +7.5 +II BSc +13 +16.25 +11 +27.5 +24 +30 +III BSc +13 +16.25 +12 +30 +25 +31.25 +I GNM +8 +20 +8 +20 +16 +20 +II GNM +3 +7.5 +6 +15 +9 +11.25 +Regular menstrual cycle (n) +28 +70 +33 +82.5 +61 +76.25 +Irregular menstrual cycle (n) +12 +30 +7 +17.5 +19 +23.75 +Menstrual pain (n) +2 +5 +30 +75 +32 +40 +Mastalgia (n) +Cyclical +30 +75 +28 +70 +58 +72.5 +Acyclical +10 +25 +12 +30 +22 +27.5 +Breast pain: Duration in months (mean) +13.78 +11.05 +12.38 +8.97 +13.13 +10.06 +Breast pain score (mean) +3.85 +1.17 +3.63 +1.10 +3.67 +1.11 +Family history of breast cancer +2 +5 +0 +0 +2 +5 +BMI: Body mass index, BSC: Bachelor of Science, GNM: General nursing midwifery, SD: Standard deviation. The two groups were matched on all variables +(P>0.05 in independent samples t‑test) +Table 3: Results after intervention in both the groups +Variable +Group +Baseline +3 Months +Sig within groups +(0-3 months) +6 Months +Sig within groups +(0‑6 months) +RM ANOVA +between groups +Mean +SD +Mean +SD +T (p) +Mean +SD +T (p) +QoL D1 +Yoga +26.45 +2.82 +30.84 +3.96 +7.08 (<0.01) +30.39 +3.07 +5.71 (<0.001) +1045.01(<0.001) +Control +25.61 +3.21 +24.4 +2.45 +2.92 (=0.01) +27.2 +3.61 +2.28 (0.02) +QoL D2 +Yoga +21.16 +2.15 +25.6 +2.55 +−7.88 (<0.001) +25.6 +3.42 +6.3 (<0.001) +471.58(<0.001) +Control +20.55 +1.8 +20.4 +2.06 +0.31 (=0.75) +22.9 +3.25 +3.77 (0.001) +QoL D3 +Yoga +11.5 +1.43 +13.4 +1.64 +−5.68 (<0.001) +12.7 +2.42 +2.79 (0.008) +167.96(<0.001) +Control +12.16 +1.0 +11.6 +0.99 +2.53 (=0.01) +11.8 +1.24 +1.07 (0.29) +QoL D4 +Yoga +28.37 +3.16 +34.7 +3.79 +−8.06 (<0.001) +34.2 +4.71 +6.91 (<0.001) +1087.42(<0.001) +Control +29.13 +3.03 +28.1 +2.65 +1.87 (=0.07) +30 +3.94 +1.05 (0.30) +QoL total +Yoga +87.47 +6.25 +105 +11.0 +−9.08 (<0.001) +103 +11.6 +7.34 (<0.001) +6881.41(<0.001) +Control +87.45 +7.22 +84.5 +6.19 +2.60 (=0.01) +91.9 +10.7 +2.19 (0.03) +BDI +Yoga +15.11 +6.88 +1.08 +1.22 +12.96 (<0.001) +3.21 +5.79 +8.90 (<0.001) +2632.72(<0.001) +Control +15.19 +4.94 +12.1 +5.61 +2.60 (=0.01) +19.1 +4.74 +3.72 (=0.001) +BDI: Beck depression inventory, ANOVA: Analysis of variance, D1 to D4: Domain 1 to domain 4, RM: Repeated measures, QoL: Quality of life +Raghunath, et al.: Yoga in improving women’s quality of life with mastalgia/yoga in improving quality of life in women with mastalgia +Journal of Health Research and Reviews | May ‑ August 2016 | Volume 3 | Issue 2 +52 +a pilot study of acupuncture on 37 women with noncyclic +breast pain gave four acupuncture sessions over two weeks, +with 3 months follow‑up showing no significant improvement +in any of the domains (mental, physical, emotional, social, or +spiritual well‑being) of QoL although there was a significant +reduction (P < 0.05) in the pain scores by about 67% and pain +interference by about 56%. +A randomized pre‑post intervention study on 98 (66 experimental +and 32 control) Turkish patients with nonorganic mastalgia +looked at the effect of a session of psychoeducation on QoL and +pain [visual analog scale (VAS)]. While the baseline QOL in both +groups was poorer than the normative values for Turkish women, +the QoL of those who had psychoeducation was significantly +better (SF‑36) after 2 months as compared to the control group.[15] +As there are no published studies on yoga in patients with +mastalgia, we have made an attempt to compare the effect +of integrated yoga (similar yoga module in a similar setting) +with that of other nonorganic pain conditions. In patients with +mechanical chronic lower back pain admitted for yoga therapy,[16] +the baseline mean QoL (12 to 13) was much lower in all domains +of WHOQOL‑BREF than our study (22 to 29) except the social +domain in which it was 11.5 in our study. The improvement +observed was highly significant in both studies (16–28% in back +pain study and 10– 20% in the present study) although the groups +were different in their demography (both genders and higher age +in the back pain study). A similar work by Deshpande et al. on +normal volunteers also looked at the QoL, which showed similar +improvements after 3 months intervention on all domains of +WHOQOL‑100.[17] +Results of integrated yoga in patients with osteoarthritis of the +knee showed about 20–30% increase in (SF36) QoL.[18] +In the survey on 105 Turkish women with mastalgia with a mean +score of 5 on VAS (1–10), 58% were depressive, 30% were +anxious, and 4% were depressive and anxious.[13] Yilmaz, Enver +Demirel et al. showed that anxiety, depression, harm avoidance, +self‑directedness, and self‑transcendence scores were significantly +higher in premenopausal women with mastalgia in comparison +with the age‑matched healthy control group of premenopausal +women.[19] +A BDI score [Table 4] less than 9 indicates no depression and that +between 10 and 19 indicates mild depression. The mean baseline +scores in our sample (around 15) showed that both the groups +were in this range of mild depression and the yoga group moved +to normal values (<9) at 3 months. In the control group, there +were a good number (16) of subjects with reduced depression +scores at the 3rd month who reverted back to depression in the +6th month although they had the same instructions, monitoring, +and counseling by the therapists at regular intervals; the BDI +scores in the back pain study also showed similar trends with +significant reduction in mean scores moving from mild depression +zone (12.13) to no depression zone (6.43).[16] +The various domains of the WHOQOL‑BREF assessed in this +study are described below. +The physical health domain deals with features such as +mobility, fatigue, pain, sleep, and work capacity. The observed +improvement can be attributed to better physical stamina that +Table 4: BDI-Number of subjects in different degrees of depression before and after intervention (n yoga-38; control-31) +BDI +scores +Depression +Baseline +3 months +6 months +Y +C +Y +C +Y +C +n +% +n +% +n +% +n +% +N +% +n +% +0-9 +Nil +7 +18.42 +0 +0 +38 +100 +16 +51.61 +32 +84.21 +0 +0 +10-19 +Mild +22 +57.89 +27 +71.05 +0 +0 +9 +29.03 +5 +13.16 +14 +45.16 +20-25 +Moderate +9 +23.68 +4 +10.53 +0 +0 +6 +19.35 +1 +2.63 +17 +54.84 +>26 +Severe +0 +0 +0 +0 +0 +0 +0 +0 +0 +0 +0 +0 +BDI: Beck depression inventory +0.00 +5.00 +10.00 +15.00 +20.00 +25.00 +30.00 +35.00 +Baseline (0) +3 month +6 month +Quality Of Life Yoga +Quality Of Life Control +Figure 2: Bar graph for QoL mean shift from the baseline, intervention +at the end of 3 months, and follow-up after 6 months between the yoga +group (n = 38) and control group (n = 31) +0 +5 +10 +15 +20 +25 +Baseline (0) +3 month +6 month +BDI Yoga +BDI Control +Figure 3: Bar graph for Beck Depression Inventory (BDI) mean shift from +the baseline, intervention at the end of 3 months, and follow-up after 6 +months between the yoga group (n = 38) and control group (n = 31) +Raghunath, et al.: Yoga in improving women’s quality of life with mastalgia/yoga in improving quality of life in women with mastalgia +Journal of Health Research and Reviews | May ‑ August 2016 | Volume 3 | Issue 2 +53 +occurs after maintained stretches followed by deep rest. Other +studies on integrated yoga in healthy children and adults have +shown better physical stamina.[20] Better quality and duration of +sleep after yoga have been reported in the elderly too.[21] +In the psychological health domain, the improvement seen +deals with questions relating to feelings, self‑esteem, spirituality, +thinking, learning, memory, etc., may be attributed to a reduction +in depression. Yoga is defined as “mastery over the modifications +of the mind” (Patañjali),[22] which is the goal of our integrated +yoga program; several studies have shown the effect of yoga in +reducing anxiety,[23] depression,[24] and stress,[25] with enhanced +mental health as observed by improved perceptual sharpness[26] +and memory.[27] +Social health domain has questions relating to problems with +interpersonal relationships, social support, etc., which could +be the main source of stress contributing to mastalgia. In this +domain, the baseline scores [Table 3] were lesser than the other +three domains in both the groups of students, which improved +significantly after the intervention. These were addressed during +lectures and at a personal level in yoga counseling sessions. They +were aimed at achieving an introspective cognitive change by +recognizing the psychological freedom “to react, not to react or +change the usual pattern of reaction to situations” highlighted +in yoga texts.[28] +Environmental health domain has questions that deal with +problems relating to financial resources, physical safety, and +adaptability to physical environment such as pollution, noise, +and climate. One of the definitions of yoga (Bhagavad Gīta) says +that yoga results in equanimity and balance (samatvam) that can +help in better tolerance to environmental changes.[29] +Studies have shown that yoga changes the physiological +responses to stressors by improving autonomic stability with +better parasympathetic tone in normal adults.[30] +There is evidence to suggest that cyclical mastalgia is caused +by a latent stress‑induced hormonal imbalance as indicated +by hyper prolactinemia.[31] It is observed that patients with +cyclic mastalgia and noncyclic mastalgia have increased +catecholamine and decreased baseline dopamine level, which +suggests that catecholamine may be released due to stress, +resulting in altered abnormal sensitivity of the breast tissue.[32] +Yoga may improve the QoL by promoting voluntary reduction +in violence and aggressiveness.[33] Mastery over the emotional +reactions of anxiety[34] or depression[24] is achieved through restful +awareness during all the practices in general and meditation +in particular.[35] Kundalini yoga is found to be beneficial in +cases of depression. It stimulates the various autonomic nerve +plexus  (chakras) and activates pineal organ, which in turn +brings homeostasis between sympathetic and parasympathetic +activities.[36] This mastery over emotional surges leads to +controlled and need‑based physiological responses that may +reduce the overtones of hypothalamus‑pituitary‑adrenal (HPA) +axis[37] during chronic pain. Yoga has an influence on the HPA +axis as evidenced by a reduction in cortisol levels in normal[38] +and sick individuals.[39,40] +Hence, it appears that the beneficial effects of yoga in mastalgia +could be mediated through HPA axis by stabilizing the HPA axis +and promoting autonomic balance. We may hypothesize that +yoga helps in restoring the normal biorhythm of reproductive +hormones in cases of cyclical or noncyclical mastalgia and thus, +improve the QoL . +Strength of the study +To the best of our knowledge, this is the first randomized +controlled study (RCT) on the role of yoga therapy in measuring +QoL and depression in nursing students with mastalgia. The +strengths of this RCT study are adequate sample size, supervised +practice sessions, randomization, and the 6 months follow‑up +with very few dropouts. The uniqueness of the results was the +highly significant reduction in depression scores and improved +QoL scores. This offers the first evidence to introduce yoga as +a noninvasive and cost‑effective therapy in treating mastalgia. +Limitations of the study +This study only addressed mastalgia as a solicited symptom. +Further study on patients presenting with mastalgia with or +without associated fibroadenosis and fibrocystic breast condition +will provide an insight into the use and acceptability of yoga as +an intervention in a clinical setting. +CONCLUSION +This randomized control study of 12 weeks of integrated yoga +therapy with 6 months follow‑up has shown that nursing students +with mastalgia showed a good improvement in QoL and the +decreased depression scores than physical therapy exercises for +mastalgia. +Acknowledgements +We are thankful to the Research Officer and the Vice Chancellor, +SVYASA, Bengaluru, Karnataka, India for funding and supporting +this project. We extend our gratitude to the Principal of the +college for permitting us to carry out the trial and the teachers +and the staff for assisting us in data collection and supervising +both the trial groups. We thank Dr. Judu Ilavarasu for his help +in the statistical analysis. We also thank the yoga therapists +for giving the sessions. We also extend our heartfelt thanks to +all the nursing students for their wholehearted participation in +the study. +Financial support and sponsorship +Institutional funding, SVYASA, Bangalore, Karnataka, India. +Conflicts of interest +We do not have any conflicts of interest. +REFERENCES +1. +Naz N, Sohail S, Memon MA. Utility of breast imaging in mastalgia. +J Liaquat Uni Med Health Sci 2010;9:12‑6. +2. +Saeed Na. Is oil of evening primrose effective for mastalgia: A comparison +with danazol. ISRA Med J 2012;4:235-8. +3. +Deschamps M, Band PR, Coldman AJ, Hislop TG, Longley DJ. Clinical +determinants of mammographic dysplasia patterns. 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An eight‑week yoga intervention is +associated with improvements in pain, psychological functioning and +mindfulness, and changes in cortisol levels in women with fibromyalgia. +J Pain Res 2011;4:189‑201. diff --git a/subfolder_0/Effects of an integrated yoga program on chemotherapy induced nausea and emesis in breast cancer patients..txt b/subfolder_0/Effects of an integrated yoga program on chemotherapy induced nausea and emesis in breast cancer patients..txt new file mode 100644 index 0000000000000000000000000000000000000000..9dba19ffc14c9312d9cf3039e2b0c683511e87aa --- /dev/null +++ b/subfolder_0/Effects of an integrated yoga program on chemotherapy induced nausea and emesis in breast cancer patients..txt @@ -0,0 +1,1710 @@ +© 2007 The Authors +Journal compilation © 2007 Blackwell Publishing Ltd +European Journal of Cancer Care, 2007, 16, 462–474 +Original article +Effects of an integrated yoga programme on chemotherapy- +induced nausea and emesis in breast cancer patients +R.M. RAGHAVENDRA, bnys, phd, Department of Life Sciences, Swami Vivekananda Yoga Anusandhana Samst- +hana, R. NAGARATHNA, md, frcp (edin), Department of Life Sciences, Swami Vivekananda Yoga Anusandhana +Samsthana, H.R. NAGENDRA, phd, Department of Life Sciences, Swami Vivekananda Yoga Anusandhana Sam- +sthana, K.S. GOPINATH, ms, Department of Surgical Oncology, Bangalore Institute of Oncology, B.S. SRINATH, +ms, Department of Surgical Oncology, Bangalore Institute of Oncology, B.D. RAVI, md, Department of Medical +Oncology, Bangalore Institute of Oncology, S. PATIL, md, Department of Medical Oncology, Bangalore Institute +of Oncology, B.S. RAMESH, md, Department of Radiation Oncology, Bangalore Institute of Oncology, & +R. NALINI, md, Department of Radiation Oncology, Bangalore Institute of Oncology, Bangalore, India +RAGHAVENDRA R.M., NAGARATHNA R., NAGENDRA H.R., GOPINATH K.S., SRINATH B.S., +RAVI B.D., PATIL S., RAMESH B.S. & NALINI R. (2007) European Journal of Cancer Care 16, 462–474 +Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients +This study examined the effect of an integrated yoga programme on chemotherapy-related nausea and emesis +in early operable breast cancer outpatients. Sixty-two subjects were randomly allocated to receive yoga (n = 28) +or supportive therapy intervention (n = 34) during the course of their chemotherapy. Both groups had similar +socio-demographic and medical characteristics. Intervention consisted of both supervised and home practice +of yoga sessions lasting for 60 min daily, while the control group received supportive therapy and coping +preparation during their hospital visits over a complete course of chemotherapy. The primary outcome +measure was the Morrow Assessment of Nausea and Emesis (MANE) assessed after the fourth cycle of +chemotherapy. Secondary outcomes included measures for anxiety, depression, quality of life, distressful +symptoms and treatment-related toxicity assessed before and during the course of chemotherapy. Following +yoga, there was a significant decrease in post-chemotherapy-induced nausea frequency (P = 0.01) and nausea +intensity (P = 0.01), and intensity of anticipatory nausea (P = 0.01) and anticipatory vomiting (P = 0.05) as +compared with the control group. There was a significant positive correlation between MANE scores and +anxiety, depression and distressful symptoms. In conclusion, the results suggest a possible use for stress +reduction interventions such as yoga in complementing conventional antiemetics to manage chemotherapy- +related nausea and emesis. +Keywords: yoga, meditation, nausea, vomiting, complementary therapies, supportive care, stress. +Correspondence address: Raghuram Nagarathna, Dean, Division of Life +Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, No-19, +Eknath Bhavan, Gavipuram Circle, K.G Nagar, Bangalore-560019, India +(e-mail: rn44@rediffmail.com). +Accepted 18 September 2006 +DOI: 10.1111/j.1365-2354.2006.00739.x +INTRODUCTION +Nausea and emesis are two of the most distressing side +effects of chemotherapy and are experienced by as many as +66–91% of patients receiving chemotherapy (Rhodes & +McDaniel 2001). Complete control of emesis (i.e. no vom- +iting with currently available antiemetic agents) is achiev- +able in a majority of patients in the first 24 h and in only +Yoga for CINV +© 2007 The Authors +463 +Journal compilation © 2007 Blackwell Publishing Ltd +45% of patients during the first 5–7 days of chemotherapy +(Gralla et al. 1999; Roila et al. 2005). However, chemo- +therapy-induced nausea occurs at a greater frequency than +vomiting and, despite the use of new-generation antiemet- +ics, complete control rates for nausea remain low as com- +pared with those for emesis (Perez et al. 1998). Another +significant problem is that a substantial gap remains +between antiemetic guidelines and practice and that most +of these guidelines may not be widely implemented even +in developed countries (De Angelis et al. 2003). This is +even more so for developing countries such as India and +other countries where nausea and emesis following che- +motherapy are not adequately managed because of low +affordability of new-generation antiemetic medications. +However, various psychological techniques, such as cog- +nitive behaviour therapy, biofeedback, relaxation, sup- +portive therapy and coping preparation interventions, +have been shown to complement antiemetics in managing +chemotherapy-related nausea and emesis (Burish et al. +1991; Burish & Tope 1992). We therefore evaluated the +benefits of using traditional intervention strategies such +as yoga and meditation in comparison with standard +supportive care and coping preparation in managing +chemotherapy-related nausea and emesis. +There is a high prevalence of nausea and emesis follow- +ing chemotherapy. This is attributed to high doses of eme- +togenic antineoplastic agents and anticipatory nausea and +emesis (King 1997). Distressing symptoms (such as nau- +sea, vomiting, retching, anorexia, motion sickness, head- +aches, etc.) commonly occur after chemotherapy and +antiemetogenic administration. These distressing symp- +toms can impede the ability of patients to perform normal +household tasks, enjoy meals, and maintain daily function +and recreation, thereby reducing their quality of life +(Osoba et al. 1997). Some patients may even see the treat- +ment and resulting distress worse than the disease itself +(Rimer et al. 1983), while some may even discontinue the +prescribed course of chemotherapy (Burish & Tope 1992), +thereby reducing hope of recovery and life expectancy +(Gilbar 1991). +Studies have shown that some of these side effects that +develop after chemotherapy may be partly psychological +rather than purely pharmacological in nature (Burish & +Tope 1992). Nearly 70% of patients who experience ant- +icipatory nausea and emesis attribute these side effects to +a psychological aetiology (Morrow 1982). This may be +because the information from the vomiting centre in the +brain to higher brain centres is involved in the perception +of nausea and vice versa (Hawthorn 1995). Various studies +have shown risk factors such as motion sickness, vomit- +ing related to particular foods, and pre-treatment anxiety +and expectations (Jacobsen et al. 1988; Morrow et al. +1991) +to +have +a +strong +predisposition +for +post- +chemotherapy and anticipatory nausea and vomiting, and +these can further exacerbate the responses to conditioned +stimuli in these subjects (Mattes et al. 1987). Therefore, +these strong relationships between psychosocial variables, +nausea and emesis justify the need for integrating mind/ +body therapies with pharmacological interventions in +managing treatment-related nausea and emesis (Schwartz +et al. 1996). +Studies show that complementary and alternative med- +icine (CAM) and mind/body approaches such as hypnosis, +progressive muscle relaxation training with guided imag- +ery, music therapy, acupuncture, acupressure, systematic +desensitization, biofeedback and distraction are useful in +reducing nausea and emesis either alone or in combina- +tion with antiemetics and anxiolytic medications (Redd +et al. 2001; Mundy et al. 2003). Of these, relaxation with +guided imageries has been studied extensively, and has +been shown to reduce the duration and frequency of both +acute and delayed nausea and emesis following chemo- +therapy in subjects with poor control of nausea and vom- +iting (Burish & Tope 1992; Arakawa 1997; Molassiotis +et al. 2002). Most of these techniques reduce anxiety, +physiological arousal and psychological distress in cancer +patients through stress reduction (Morrow & Rosenthal +1996). A growing interest in the use of these therapies +reflects a need for a more holistic approach to cancer treat- +ment (Cassileth 1999). +Yoga as a complementary modality is being practised +increasingly in both Indian and western population. Yoga +practices have been used for therapeutic benefits in +numerous health-care concerns, such as asthma (Nagar- +athna & Nagendra 1985), diabetes (Sahay & Sahay 2002), +hypertension (Sainani 2003), heart disease (Jayasinghe +2004), musculoskeletal disorders (Raub 2002), cancer +(Cohen et al. 2004) and others in which mental stress +(Gimbel 1998; Bijlani 2004) was believed to play a role. +These practices include several techniques, such as +asanas (postures done with awareness), pranayama (vol- +untarily regulated nostril breathing), yoga nidra (guided +relaxation with imagery) and meditation, which promote +physical well-being and mental calmness. These practices +are known to build inner awareness and attention of men- +tal phenomena. This is thought to alter the perceptions +and mental responses to both external and internal stim- +uli, slow down reactivity and responses to such stimuli, +and instill a greater control over stressful situations. This +could be particularly useful in cancer patients who per- +ceive cancer as a threat. Recent randomized waitlist con- +trolled studies using meditation and mindfulness yoga +RAGHAVENDRA et al. +464 +© 2007 The Authors +Journal compilation © 2007 Blackwell Publishing Ltd +components (Mindfulness-Based Stress Reduction pro- +gramme) have found beneficial effects in terms of +improved affective states; decrease in mood disturbance, +stress symptoms and disturbed sleep; improved quality of +life; and benefits in terms of improved immune responses +in early breast (Speca et al. 2000; Targ & Levine 2002) and +prostate cancer patients (Carlson et al. 2003). However, +most of these studies involve heterogeneous cancer pop- +ulations at varying stages of their disease and treatment, +and evaluate quality of life and psychosocial outcomes. +However, studies reviewed using yoga/meditation com- +ponents do not address issues pertaining to conventional +treatment toxicity and chemotherapy-related nausea and +vomiting. +The purpose of this trial was to study whether a support +intervention based on mind/body and psycho-spiritual +interventions such as yoga might be a viable alternative to +standard supportive therapy and coping preparation in +reducing the frequency and intensity of nausea and emesis +in chemotherapy-naïve stage II and III breast cancer +patients receiving adjuvant chemotherapy. +METHODS +Subjects +This study is a part and continuation of the original ran- +domized control study that recruited 98 recently diag- +nosed women with stage II and III operable breast cancer +to assess the effect of a yoga programme on mood, quality +of life, distressful symptoms, toxicity and immune +responses in early breast cancer patients undergoing con- +ventional treatment. These patients were recruited from +Bangalore Institute of Oncology, a comprehensive cancer +care centre in Bangalore, India, over a 2.5-year period from +January 2000 to June 2002. Only subjects who were on +adjuvant chemotherapy were included for analysis in this +study. Patients were eligible to participate in this study if +they met the following selection criteria at the start of the +study: (1) recently diagnosed operable breast cancer; (2) +aged between 30 and 70 years; (3) Zubrod’s performance +status 0–2 (ambulatory >50% of time); (4) high-school edu- +cation; (5) having a treatment plan with surgery followed +by adjuvant chemotherapy or by both adjuvant radiother- +apy and chemotherapy; and (6) consenting to participate in +the study. Subjects were excluded if they had any concur- +rent medical condition that was likely to interfere with +the treatment, major psychiatric, neurological illness or +autoimmune disorders, and any known metastases. Sub- +jects were excluded from analyses in the current study if +they had a history of intestinal obstruction and any +known sensitivity to any class of antiemetics (such as +5HT3 receptor antagonists or dopamine receptor antago- +nists) and corticosteroids (such as dexamethasone). Of the +98 subjects who were randomized to yoga and supportive +therapy initially at the start of the study, 62 subjects (yoga +n = 28; control n = 34) completed their prescribed chemo- +therapy cycles. There were 29 dropouts immediately fol- +lowing surgery, and seven subjects did not receive +chemotherapy (see trial profile, Fig. 1). The reasons for +dropouts were migration to other hospitals, use of other +complementary therapies (e.g. homeopathy or ayurveda), +lack of interest, time constraints and other concurrent +illness. + +Randomization + +Subjects consenting to participate in this study to com- +pare two interventions, ‘yoga versus supportive therapy +and coping preparation’, were randomly allocated to +receive either one of these interventions prior to their pri- +mary treatment or surgery, using random numbers gener- +ated by a random number table. These subjects were then +followed up with interventions and assessments during +their adjuvant treatment (radiotherapy and chemother- +apy). Randomization was performed using opaque enve- +lopes with group assignments. The envelopes were opened +sequentially in the order of assignment during rec- +ruitment, with the names and registration numbers of +the participants written on the covers. The order of ran- +domization was verified with the hospital date of admis- +sion records for surgery at study intervals to make sure +that field personnel had not altered the sequence of ran- +domization to suit the allocation of consenting partici- +pants into two study arms. +Procedure +This study evaluated the effects of yoga intervention ver- +sus supportive therapy and coping preparation in chemo- +therapy-naïve early stage II and III breast cancer patients +undergoing adjuvant chemotherapy. The subjects in the +study were prescribed four to eight cycles of FAC or CMF +or both as adjuvant chemotherapy protocols following +surgery, which was the standard care in the hospital +during the study period. The FAC protocol consisted of +5-fluorouracil (600 mg/m2), adriamycin (60 mg/m2) and +cyclophosphamide (600 mg/m2), and the CMF protocol +consisted of cyclophosphamide (600 mg/m2), methotrex- +ate (50 mg/m2) and 5-fluorouracil (600 mg/m2). The stan- +dard approach to chemotherapy-related nausea and emesis +in the hospital when the study was conducted was 8-mg +Yoga for CINV +© 2007 The Authors +465 +Journal compilation © 2007 Blackwell Publishing Ltd +intravenous odansetron, with 8-mg dexamethasone given +as a bolus injection 30 min before chemotherapy. This +was followed by per-oral administration of either 8-mg +odansetron (Emeses) bid for the next 3 days after chemo- +therapy or 10-mg domperidone (Doomster) qid for 2 days +to control delayed nausea and vomiting. Some subjects in +the study were also prescribed anxiolytic medication, +such as lorazepam (Aprazolam 0.5 mg o.d.), by the medical +oncologists, who were blinded to the intervention. +During the chemotherapy protocol, subjects in both +groups were given intervention before starting their first +adjuvant chemotherapy cycle. Subjects who were on che- +motherapy were given a bolus injection of dexamethasone +8 mg, with odansetron 8 mg intravenous 30 min before +chemotherapy. Thereafter, subjects in the yoga group were +taught bedside yoga relaxation by the instructor for the +next 30 min, while the participants and their spouses in +the control group were educated about chemotherapy- +related nausea and vomiting, food aversions, nutrition, +etc., and were counselled by the same yoga instructor, +who was trained in counselling cancer patients. Thereaf- +ter, subjects in the yoga group were provided with audio +and video cassettes of the yoga modules for home practice +and were asked to practise them every day for 1 h. Their +practice was also supervised once in 10 days by their +trainer through house visits. The supportive counselling +and coping preparation sessions were of 60-min duration +initially and lasted 30 min for the control group, given +during their hospital visits for chemotherapy and investi- +gations (once in 10 days). After each chemotherapy infu- +sion, patients were prescribed antiemetic regimens as +described above. They were asked to note down the epi- +sodes of vomiting and nausea duration after every cycle of +chemotherapy and, at the fourth cycle, they were asked to +complete the Morrow Assessment of Nausea and Emesis +(MANE) questionnaire, State Trait Anxiety Inventory +Figure 1. Patient flow chart. CT, chemo- +therapy; RT, radiotherapy. +174 patients screened +44 refused +32 not eligible +98 randomized +Yoga +12 discontinued +Surgery +Supportive therapy +17 discontinued +Post surgery 33 completed +/analysed +Post RT 32 completed/ +analysed/ +I did not receive RT +Number of CT cycles received +4 cycles. 6 cycles. 8 cycles +(n = 3). +(n = 22). +(n = 3). +Exclusions due to +sensitivity ot CT +or antienetics in +both groups = Nil +Mid CT (4th cycle) 28 +completed/analysed +5 did not receive CT +Mid CT (4th cycle) +34 completed/analysed +2 did not receive CT +Number of CT cycles received +4 cycles. 6 cycles. 8 cycles +(n = 3). +(n = 27). +(n = 4). +Post RT 35 completed/ +analysed +I did not receive RT +Post surgery 36 completed +/analysed +(RT) +(CT) +RAGHAVENDRA et al. +466 +© 2007 The Authors +Journal compilation © 2007 Blackwell Publishing Ltd +(STAI), Beck’s Depression Inventory (BDI), Functional +Living Index for Cancer (FLIC) and symptom checklist +questionnaires. +Sixty-two patients (yoga n = 28; control n = 34) contrib- +uted data for the current analysis during chemotherapy. +Signed +informed +consent +was +obtained +from +all +participants. +Measures +During the initial visit, demographic information, includ- +ing age, marital status, education, occupation, obstetric +and gynaecological history, medical history and intake +of medications, was obtained, and clinical data were +abstracted on the history of breast cancer, investigative +notes and chemotherapy treatment regimen. The follow- +ing self-report questionnaires were distributed to the sub- +jects during the study. +The primary outcome measures were frequency and +intensity of both post-chemotherapy and anticipatory +nausea and vomiting assessed using the MANE scale. The +test–retest reliability of this descriptive scale has been +reported to range from 0.72 to 0.96 with different cancer +patient samples and different chemotherapy protocols +(Morrow 1992). Subjects were administered this question- +naire after the fourth chemotherapy cycle as anticipatory +nausea and emesis, which are learned responses to che- +motherapy, develop by about the fourth cycle in 25% of +the patients (Morrow & Rosenthal 1996). +The secondary outcome measures were anxiety state +and trait assessed using standard instruments such as +Spielberger’s STAI (Spielberger et al. 1970), depression +using BDI (Beck et al. 1961) and global quality of life +assessed using FLIC (Schipper et al. 1984). Subjective +symptom checklist was developed during the pilot phase +to assess treatment-related side effects, problems with +sexuality and image, and relevant psychological and +somatic symptoms. The checklist consisted of 31 items, +each evaluated on two dimensions: severity, graded from +no to very severe (0–4), and distress, graded from not at all +to very much (0–4). This scale measured the total number +of symptoms experienced, total and mean severity and dis- +tress, and was evaluated previously in a similar breast +cancer population (Bhaskaran 1996). Finally, treatment- +related toxicity and side effects were objectively analysed +by the investigators using the World Health Organization +(WHO, 1979) Toxicity Criteria during chemotherapy. +These secondary outcome measures were used to study +relationships between the psychological states, frequency +and intensity of post-chemotherapy and anticipatory nau- +sea and vomiting. Assessments were carried out before +starting the first cycle of chemotherapy, during the mid- +cycle and after chemotherapy, except for MANE and WHO +Toxicity Criteria, which was assessed following the fourth +cycle of chemotherapy. +Interventions +The intervention group received an ‘integrated yoga pro- +gramme’ and the control group received ‘supportive coun- +seling and coping preparation’. The yoga intervention +consisted of a set of asanas (postures done with awareness) +breathing exercises, pranayama (voluntarily regulated +nostril breathing), meditation and yogic relaxation tech- +niques with imagery. These practices were based on prin- +ciples of attention diversion, mindful awareness and +relaxation to cope with day-to-day stressful experiences. +The yoga intervention was tailored to the patient’s needs +during chemotherapy infusion and home practice. The +yoga session was conducted 30 min before the start of che- +motherapy infusion. This session consisted of yogic relax- +ation, meditation using breath awareness and impulses of +touch emanating from palms and fingers, or chanting a +mantra from a Vedic text for 30 min. These sessions were +administered by an instructor at the subject’s bedside +before chemotherapy infusion. Subjects were also pro- +vided with audiotapes of these exercises for home prac- +tice, using the instructor’s voice, so that a familiar voice +could be heard on the cassette. The subjects were asked to +practise daily for 1 h for 6 days/week as homework during +the intervals between chemotherapy cycles. They were +required to practise a minimum of 3 h per week, but were +told to practise for 6 h per week in their homes. These +home sessions started with a few easy yoga postures, +breathing exercises and pranayama (voluntarily regulated +nostril breathing), and yogic relaxation. After this prepa- +ratory practice for about 20 min, the subjects were guided +through any one of the meditation practices for the next +30 min, which included focusing awareness on sounds and +chants from Vedic texts, or breath awareness and impulses +of touch emanating from palms and fingers while practis- +ing yogic mudras, or a dynamic form of meditation that +involved practising with eyes closed of four yoga postures +interspersed with relaxation while supine, thus achieving +a combination of both ‘stimulating’ and ‘calming’ prac- +tice. These sessions were followed by informal individual +counselling sessions, which focused on problems related +to impediments in home practice, clarification of the par- +ticipant’s doubts, motivation, education and supportive +interaction with spouses. The participants were also +informed about practical day-to-day application of aware- +ness and relaxation to attain a state of equanimity during +Yoga for CINV +© 2007 The Authors +467 +Journal compilation © 2007 Blackwell Publishing Ltd +stressful situations, and were given homework in learning +to adapt to such situations in their daily life by applying +these principles. +The subjects were encouraged to practise one of these +meditation techniques daily, were given booklets and +instructions on these practices, and were encouraged to +pursue relevant themes and gain greater depth through +proficiency in practice. Their homework was monitored +daily by their instructor, who conducted house visits +(once in 10 days), and participants were encouraged to +maintain a daily log, listing the yoga practices done, use of +audiovisual aids for practice, duration of practice, experi- +ence of distressful symptoms, intake of medication and +diet history. +The control intervention consisted of a psychodynamic +supportive–expressive therapy with coping preparation. +Supportive–expressive counselling sessions also included +education as an important component. We chose to have +this as a control intervention mainly to control for the +non-specific effects of the yoga programme that may be +associated with adjustment, such as attention, support +and a sense of control. We also incorporated coping +preparation sessions as a control intervention along with +supportive–expressive therapy to enhance patients’ +knowledge of their disease and treatment options, thereby +reducing any apprehensions and anxiety regarding their +treatment. This coping preparation consisted of a single +60-min session held at the treatment clinic before the +start of the first chemotherapy cycle. Family members +were invited to join the patient during the session, which +included a tour of the oncology clinic and treatment area, +describing the chemotherapy procedure, providing infor- +mation about a variety of common questions, showing a +patient coping successfully with the treatment, and +finally, providing dietary advice and taking questions and +answers. These didactic educational interventions are +known to serve as an effective coping preparation in con- +trolling chemotherapy-related side effects (Burish & Tope +1992). +This counselling was extended over the course of the +patients’ chemotherapy cycles during their hospital visits +(30-min sessions, once in 10 days). Subjects in the sup- +portive therapy group also completed daily logs or diaries +on episodes of nausea and vomiting. This therapy mainly +involved preparing the patient to adequately cope with +chemotherapy side effects, such as nausea and emesis. +Similar supportive sessions have been used successfully as +a control comparison group to evaluate psychotherapeutic +interventions (Jacobs et al. 1983; Greer et al. 1992), and +similar coping preparations have been effective in control- +ling chemotherapy-related nausea and emesis (Burish +et al. 1991). All subjects had received either yoga inter- +vention or supportive counselling and coping preparation +earlier during their surgery and radiotherapy period, and +were followed up with their respective interventions dur- +ing chemotherapy. +Data analysis +Data were analysed using Statistical Package for Social +Sciences version 10.0. Descriptive statistics were used +with all questionnaires of the study to summarize the +data. Wherever differences between groups were sought, +independent samples t-tests were used for analysis. Pear- +son correlation coefficient was used to study the relation- +ship and associations between various primary and +secondary outcome measures. +RESULTS +Sixty-two subjects (yoga n = 28; control n = 34) received +their prescribed chemotherapy cycles. The age, stages of +disease, grade and node status were similar in the yoga and +control groups, which received chemotherapy. The mean +years of education were 10.4 ± 5 and 13.5 ± 3 years in the +yoga and control groups respectively. Subjects were put on +a chemotherapy treatment protocol of either FAC, CMF or +CMF + FAC, conforming to the standard clinical protocol +followed during that time at the hospital. All subjects +were ambulatory and had a Zubrod’s performance status +score of 0–2. All patients had prior mastectomy, 38 sub- +jects had received radiotherapy before chemotherapy, and +24 subjects received chemotherapy as the first adjuvant +following mastectomy. A majority of the subjects (90.3%) +received six or more cycles of chemotherapy, and six +(9.7%) received only four cycles of chemotherapy. The two +groups did not differ with respect to age, stage of disease, +tumour grade, menopausal status, chemotherapy regimen, +number of chemotherapy cycles and antiemetic regimen. +Twenty-nine (47%) subjects were on antidopaminergics +(domperidone), and 33 (53%) were on odansetron. Medical +oncologists who were blinded to the intervention pre- +scribed anxiolytic medication (lorazepam) (Alprazolam) +0.5 mg bid to 22 subjects: 12 (35.3%) in controls and 10 +(28%) in the experimental group. A goodness-of-fit test +between the socio-demographic and medical characteris- +tics of the study sample revealed no significant differences +between the two groups in any of the characteristics +examined (P > 0.05) (Table 1). +Overall, the administration of anxiolytic medication, +chemotherapy treatment regimens (CMF/FAC) and +antiemetic regimens (antidopaminergics/5-HT3 receptor +RAGHAVENDRA et al. +468 +© 2007 The Authors +Journal compilation © 2007 Blackwell Publishing Ltd +antagonists) had no significant influence on measures of +nausea and emesis as assessed using the MANE question- +naire. Overall, there was a significant influence only for +age group on nausea frequency, with subjects aged less +than 50 years having a greater frequency of nausea than +those more than 50 years old (Table 2). +Post-chemotherapy-related nausea and vomiting +The severity of post-chemotherapy-related vomiting was +mild to moderate in both the groups, and nausea severity +was moderate to severe in controls and mild to moderate +in the yoga group. Anticipatory vomiting was very mild in +both groups, and nausea was mild to moderate in controls +and very mild in the yoga group as seen with any moder- +ately emetogenic treatment. Both the groups received +antiemetics for an average of 2.6 ± 0.5 days. +Independent samples t-tests on MANE scores showed that +yoga intervention significantly reduced post-chemotherapy +nausea frequency (t = 2.587, P = 0.01) and nausea severity +(t = −2.670, P = 0.01), but not frequency of vomiting and +severity, even though they tended to decrease more so in the +yoga group as compared with controls (Table 3). +Pearson correlation analysis was performed to see the +relationship between MANE scores, anxiety states, +depression, symptom number, severity and distress, +chemotherapy-related toxicity and global quality-of-life +scores during the mid-cycle of chemotherapy. Post- +chemotherapy-related nausea frequency, nausea severity, +vomiting frequency and severity correlated significantly +and positively with anxiety state, depression, chemother- +apy-related toxicity and distressful symptoms, and +inversely with quality of life. The correlation was not sig- +nificant for chemotherapy regimen and number of chemo- +therapy cycles (Table 4). +Anticipatory nausea and vomiting (Tables 2,4,5) +Independent samples t-tests on anticipatory nausea and +vomiting showed a significant reduction in anticipatory +Table 1. Medical characteristics of the study population +Yoga group +(n = 28) +n (%) +Control group +(n = 34) +n (%) +All subjects +(n = 62) +n (%) +P-value +Stage of breast cancer +II +16 (57.1) +14 (41.1) +30 (48.4) +NS +III +12 (42.9) +20 (58.8) +32 (51.6) +Grade of tumour +I +1 (3.5) +0 (0) +1 (1.6) +NS +II +5 (17.8) +2 (5.9) +7 (11.2) +III +22 (78.6) +32 (94.1) +54 (87.1) +Menopausal status +Pre-menopausal +18 (64.2) +13 (38.2) +31 (50.0) +NS +Post-menopausal +8 (28.6) +20 (58.8) +28 (45.2) +Perimenopausal +1(3.5) +0 (0) +1 (1.6) +Post-hysterectomy +1 (3.5) +1 (2.9) +2 (3.2) +CT regimen +FAC +17 (60.7) +18 (52.9) +35 (56.4) +NS +CMF +10 (35.7) +11 (32.4) +21 (33.9) +FAC + CMF +1 (3.5) +5 (14.7) +6 (9.7) +Number of CT cycles +6 +22 (78.6) +27 (79.4) +49 (79.0) +NS +8 +3 (10.7) +4 (11.8) +7 (11.3) +4 +3 (10.7) +3 (8.8) +6 (9.7) +Treatment regimen +S + RT + CT +18 (64.2) +20 (58.8) +38 (61.3) +NS +S + CT + RT +2 (7.1) +2 (5.9) +4 (6.5) +S + CT3 + RT + CT3 +7 (25.0) +10 (29.4) +17 (27.4) +S + CT +1 (3.5) +2 (5.9) +3 (4.8) +Antiemetic regimen +5-HT3 receptor antagonists +15 (54) +18 (53) +33 (53) +NS +Antidopaminergic +13 (46) +16 (47) +29 (47) +NS +Anxiolytic administration +Yes +13 (46.4) +17 (50) +30 (48.4) +NS +No +15 (53.6) +17 (50) +32 (51.6) +NS, not significant for goodness-of-fit test. +CT, chemotherapy; RT, radiotherapy; S, surgery. +Yoga for CINV +© 2007 The Authors +469 +Journal compilation © 2007 Blackwell Publishing Ltd +Table 2. Influence of age group (<50 years or >50 years), chemotherapy treatment regimen, class of antiemetic treatment regimen and +days of oral antiemetic administration following chemotherapy on measures of Morrow Assessment of Nausea and Emesis (MANE) +MANE outcome measure +Nausea +intensity +Nausea +frequency +Vomiting +frequency +Vomiting +intensity +An Nau +frequency +An Nau +intensity +An Vom +frequency +An Vom +intensity +Age group +<50 years (n = 33), mean ± SD +2.79 ± 1.2 +4.45 ± 1.2 +2.76 ± 1.4 +1.94 ± 1.3 +1.79 ± 1.2 +1.13 ± 1.5 +1.33 ± 0.96 +0.63 ± 1.2 +>50 years (n = 29), mean ± SD +2.97 ± 1.3 +3.72 ± 1.4 +2.45 ± 1.4 +1.86 ± 1.3 +1.45 ± 1.1 +1.21 ± 1.3 +0.97 ± 0.5 +0.57 ± 0.9 +t-value +d.f. +−0.56 +60 +2.25 +60 +0.87 +60 +0.24 +60 +1.14 +60 +−0.24 +58 +1.86 +58 +0.22 +56 +P-value +0.58 +0.028 +0.39 +0.81 +0.26 +0.81 +0.07 +0.83 +CT regimen +FAC (n = 35), mean ± SD +2.94 ± 1.2 +4.11 ± 1.3 +2.56 ± 1.2 +1.86 ± 1.13 +1.58 ± 1 +1.08 ± 1.3 +1.06 ± 0.5 +0.48 ± 0.83 +CMF (n = 21), mean ± SD +2.7 ± 1.3 +3.95 ± 1.5 +2.55 ± 1.5 +1.75 ± 1.3 +1.80 ± 1.4 +1.47 ± 1.5 +1.4 ± 1.19 +0.89 ± 1.5 +t-value +0.70 +0.42 +0.02 +0.33 +−0.66 +−0.97 +−1.76 +−1.28 +d.f. +54 +54 +54 +54 +54 +53 +54 +50 +P-value +0.49 +0.68 +0.99 +0.75 +0.51 +0.36 +0.084 +0.28 +Class of antiemetic treatment +5HT3 receptor antagonists +(n = 33), mean ± SD +2.94 ± 1.3 +4.09 ± 1.3 +2.52 ± 1.4 +1.7 ± 1.9 +1.55 ± 1 + 124 ± 1.4 +1.03 ± 0.5 +0.55 ± 0.89 +Antidopaminergics (n = 29), +mean ± SD +2.8 ± 1.2 +4.14 ± 1.5 +2.72 ± 1.4 +2.14 ± 1.3 +1.72 ± 1.4 +1.07 ± 1.5 +1.31 ± 1.0 +0.67 ± 1.3 +t-value +0.46 +−0.14 +−0.59 +−1.39 +−0.59 +0.46 +−1.39 +−0.49 +d.f. +60 +60 +60 +60 +60 +60 +60 +56 +P-value +0.64 +0.89 +0.56 +0.17 +0.56 +0.65 +0.17 +0.68 +No. of days of antiemetic administration +2 days (n = 25), mean ± SD +2.64 ± 1.3 +4.28 ± 1.3 +2.6 ± 1.4 + 2 ± 1.4 +1.76 ± 1.5 +1.09 ± 1.6 +1.28 ± 1.06 +0.63 ± 1.4 +3 days (n = 37), mean ± SD +3.03 ± 1.2 +4.0 ± 1.33 +2.62 ± 1.4 +1.84 ± 1.1 +1.54 ± 0.96 +1.22 ± 1.3 +1.08 ± 0.55 +0.59 ± 0.89 +t-value d.f +−1.21 +60 +0.82 +60 +−0.059 +60 +0.49 +60 +0.72 +60 +−0.34 +58 +0.97 +60 +0.13 +60 +P-value +0.23 +0.42 +0.95 +0.64 +0.51 +0.73 +0.39 +0.90 +An Nau, anticipatory nausea; An Vom, anticipatory vomiting; CT, chemotherapy; RT, radiotherapy; SD, standard deviation. +Table 3. Independent samples t-test on measures of Morrow Assessment of Nausea and Emesis scores between yoga and control groups +during CT +Groups +Yoga group +(n = 28) +Mean ± SD +Control group +(n = 34) +Mean ± SD +t-value (d.f.) +P-value +Post-CT nausea frequency +3.6 ± 1.6 +4.5 ± 0.9 +−2.67 (60) +0.01 +Post-CT nausea intensity +2.3 ± 1.2 +3.4 ± 1.1 +−3.71 (57) +<0.001 +Post-CT vomiting frequency +2.3 ± 1.4 +2.9 ± 1.4 +−1.9 (58) +0.06 +Post-CT vomiting intensity +1.6 ± 1.0 +2.2 ± 1.4 +−1.99 (60) +0.05 +Anticipatory nausea frequency +1.3 ± 0.98 +1.9 ± 1.3 +−1.9 (60) +0.06 +Anticipatory nausea intensity +0.6 ± 1.03 +1.7 ± 1.5 +−3.17 (55) +0.003 +Anticipatory vomiting frequency +1.1 ± 0.88 +1.2 ± 0.73 +−0.476 (53) +0.63 +Anticipatory vomiting intensity +0.3 ± 0.67 +0.87 ± 1.3 +−2.05 (56) +0.04 +CT, chemotherapy; SD, standard deviation. +Table 4. Pearson correlation between Morrow Assessment of Nausea and Emesis measures, mood states, quality of life and toxicity +scores during chemotherapy +All subjects (n = 62) +Pearson correlation coefficient values, r +Nausea +frequency +Nausea +intensity +Vomiting +frequency +Vomiting +intensity +An Nau +frequency +An Nau +intensity +An Vom +frequency +An Vom +intensity +STAI score +0.29* +0.56** +0.42** +0.43** +0.50** +0.59** +0.27* +0.50* +BDI score +0.38** +0.53** +0.441** +0.41** +0.38** +0.39** +0.14 +0.33* +Symptom distress score +0.50** +0.62** +0.44** +0.35** +0.37** +0.35** +0.28* +0.19 +FLIC score +−0.46** +−0.59** +−0.50** +−0.37** +−0.47** +−0.43** +−0.32* +−0.34* +CT regimen +0.17 +0.01 +0.12 +0.14 +0.01 +0.04 +0.08 +0.09 +No. of CT cycles +0.08 +−0.06 +−0.12 +0.03 +−0.07 +0.03 +0.00 +0.05 +Mid CT toxicity score +0.37** +0.47** +0.36** +0.42** +0.30* +0.30* +0.23 +0.27* +*P < 0.05, **P < 0.01. +An Nau, anticipatory nausea; An Vom, anticipatory vomiting; BDI, Beck’s Depression Inventory; CT, chemotherapy; FLIC, Functional +Living Index for Cancer; STAI, State Trait Anxiety Inventory. +RAGHAVENDRA et al. +470 +© 2007 The Authors +Journal compilation © 2007 Blackwell Publishing Ltd +nausea frequency (t = 1.979, P = 0.053), nausea severity +(t = −3.08, P = 0.003) and vomiting severity (t = −2.056, P = +0.044) in the yoga group as compared with controls +(Table 3). +Anticipatory nausea frequency and severity correlated +significantly and positively with anxiety state, depression, +chemotherapy-related toxicity and distressful symptoms, +and inversely with quality of life. Anticipatory vomiting +frequency correlated significantly and positively with +anxiety state and distressful symptoms, and inversely +with quality of life. Severity of anticipatory vomiting +correlated significantly and positively with anxiety state, +depression and chemotherapy-related toxicity, and in- +versely with quality of life (Table 4). +Approximately 35% of the subjects in the study +received anxiolytic administration in both the groups. +Administration of anxiolytic tended to be beneficial in +reducing the severity of post-chemotherapy vomiting +overall in both the groups (t = 4.04, P < 0.001), and indi- +vidually in the intervention (t = 2.147, P = 0.04) and con- +trol groups (t = 3.39, P = 0.002). Anxiolytics were also +effective in reducing nausea severity (t = 2.01, P = 0.05) +and anticipatory nausea frequency (t = 2.56, P = 0.016) in +the control group alone (Table 5). +When intervention effects were compared in the sample +who did not use anxiolytics, the interventions were found +to reduce significantly post-treatment related nausea +frequency (t = 2.03, P = 0.05) and severity (t = 3.42, P = +0.002), and vomiting frequency (t = 2.16, P = 0.039) and +severity (t = 2.29, P = 0.03). Yoga intervention was also +effective in significantly reducing anticipatory nausea +severity (t = 2.49, P = 0.02) and anticipatory vomiting +severity (t = 2.77, P = 0.01) (Table 6). +Secondary outcome measures (Table 7) +There was a significant decrease in reactive anxiety states, +depression, number of treatment-related distressful symp- +toms, severity of symptoms and distress experienced, and +improvement in quality of life during chemotherapy in +the yoga group as compared with controls. +Common toxicity criteria (Table 3) +Common toxicity criteria guidelines were used to evalu- +ate the chemotherapy-induced systemic and organ toxic- +ity. Both systemic and organ toxicity were graded from 0 +to 4 (no toxicity to very severe toxicity) using clinical +notes and laboratory data , and the total score was extrap- +olated. Independent samples t-test showed the yoga group +with significantly reduced toxicity scores as compared +with controls (t = −4.1, P < 0.001). +Table 5. Effects of anxiolytic administration on measures of Morrow Assessment of Nausea and Emesis in each group and in the overall study sample. +Nausea +intensity +Nausea +frequency +Vomiting +frequency +Vomiting +intensity +An Nau +frequency +An Nau +intensity +An Vom +frequency +An Vom +intensity +Administration of anxiolytics +Yoga group +Yes (n = 10), mean ± SD +2.22 ± 1.2 +3.3 ± 1.6 +2.06 ± 1.4 +1.28 ± 0.89 +1.22 ± 1 +0.61 ± 1.0 +1.1 ± 1.08 +0.22 ± 0.55 +No (n = 18), mean ± SD +2.4 ± 1.1 +4.2 ± 1.5 +2.6 ± 1.2 +2.1 ± 1.1* +1.5 ± 0.97 +0.6 ± 1.1 +1.1 ± 0.32 +0.44 ± 0.88 +Control group +Yes (n = 14), mean ± SD +3.05 ± 1.1 +4.35 ± 0.93 +2.55 ± 1.32 +1.60 ± 0.88 +1.45 ± 1.1 +1.28 ± 1.13 +1.15 ± 0.59 +0.56 ± 0.78 +No (n = 20), mean ± SD +3.79 ± 1.1* +4.71 ± 0.8 +3.43 ± 1.34 +3.0 ± 1.52** +2.5 ± 1.3* +2.14 ± 1.83 +1.29 ± 0.91 +1.31 ± 0.75 +Overall +Yes (n = 24), mean ± SD +2.7 ± 1.9 +3.87 ± 1.4 +2.32 ± 1.3 +1.45 ± 0.89 +1.3 ± 1.0 +0.94 ± 1.1 +1.13 ± 0.84 +0.39 ± 0.69 +No (n = 38), mean ± SD +3.21 ± 1.3 +4.50 ± 1.1 +3.1 ± 1.3 +2.63 ± 1.4 +2.08 ± 1.3 +1.5 ± 1.7 +1.21 ± 0.72 +0.95 ± 1.5 +t-value +1.74 +1.87 +2.17 +4.04 +2.52 +1.51 +0.36 +1.96 +d.f. +60 +60 +60 +60 +60 +58 +60 +56 +P-value +0.087 +0.067 +0.034 +<0.001 +0.014 +0.134 +0.714 +0.055 +An Nau, anticipatory nausea; An Vom, anticipatory vomiting. +*p < 0.05. +**p < 0.01. +Yoga for CINV +© 2007 The Authors +471 +Journal compilation © 2007 Blackwell Publishing Ltd +DISCUSSION +The results of the study suggest that yoga intervention +helped reduce post-chemotherapy-related nausea and +anticipatory nausea and vomiting compared with support- +ive therapy and coping preparation in stage II and III breast +cancer subjects receiving adjuvant chemotherapy. There +was a trend towards reduction in post-chemotherapy- +related vomiting in the yoga group. +Yoga intervention helped significantly to reduce the fre- +quency and intensity of post-chemotherapy nausea by +18% as compared with the supportive therapy group. Our +intervention was also helpful in significantly reducing the +frequency and intensity of anticipatory nausea by 12% +and 18%, and vomiting intensity by 9% as compared with +controls. Even though yoga intervention helped reduce +the frequency and intensity of post-chemotherapy vomit- +ing by 13% and 10% and anticipatory vomiting frequency +by 2% compared with controls, the effects were not sig- +nificant. However, when the effects of intervention were +compared in the yoga and control groups, which did not +receive anxiolytic medications, yoga intervention de- +creased nausea intensity by 39%, nausea frequency by +21.8%, vomiting frequency by 33.65%, vomiting intensity +by 39.9%, anticipatory nausea intensity by 63.2%, and an- +ticipatory vomiting intensity by 83%. These results indi- +cate that addition of anxiolytics may have created a floor +effect (Razavi et al. 1993), masking the actual effects of +yoga intervention. Furthermore, these results also indi- +cate that yoga may have had a significant anxiolytic effect +in subjects who were not on any anxiolytic medication. +Another reason why the intervention was not effective +in reducing post-treatment vomiting could be that admin- +istration of 5-HT3 receptor antagonist class of antiemetics +may have significantly decreased the episodes of vomiting +but increased the frequency and duration of nausea (Roscoe +et al. 2000). Our results are similar to the studies reviewed +by Burish and Tope (1992), in which supportive therapy and +coping preparation interventions have been beneficial in +reducing the conditioned side effects of chemotherapy. +Our results are similar to other studies using behav- +ioural interventions that have shown reductions in +anticipatory and post-chemotherapy-related nausea and +emesis, anxiety and levels of distress associated with che- +motherapy (Redd et al. 2001; Mundy et al. 2003). Our +results are also in congruence with other studies using +relaxation that have shown decreases in the frequency and +duration of chemotherapy-related nausea and emesis (Bur- +ish & Tope 1992; Arakawa 1997; Molassiotis et al. 2002). +However, the effect sizes seen with our intervention on +nausea and vomiting variables was larger compared to +above studies using relaxation. We could attribute these +effects to two reasons. First, unlike earlier studies using +relaxation intervention, where subjects were followed up +over a single chemotherapy cycle, interventions in our +study were given over the complete course of chemother- +Table 6. Effects of intervention on measures of Morrow Assessment of Nausea and Emesis in subjects not on anxiolytic medication +during chemotherapy +Nausea +intensity +Nausea +frequency +Vomiting +frequency +Vomiting +intensity +An Nau +frequency +An Nau +intensity +An Vom +frequency +An Vom +intensity +Yoga group (n = 15), +mean ± SD +2.07 ± 1.0 +3.4 ± 1.6 +2.07 ± 1.4 +1.13 ± 0.8 +1.27 ± 1 +0.53 ± 0.92 +1.13 ± 1.1 +0.13 ± 0.35 +Control group (n = 17), +mean ± SD +3.41 ± 1.2 +4.35 ± 0.9 +3.12 ± 1.3 +1.88 ± 0.9 +2.5 ± 1.3 +2.14 ± 1.83 +1.29 ± 0.91 +1.31 ± 1.75 +t-value +1.74 +1.87 +2.17 +4.04 +2.52 +1.51 +0.36 +1.96 +d.f. +60 +60 +60 +60 +60 +58 +60 +56 +P-value +0.087 +0.067 +0.034 +<0.001 +0.014 +0.134 +0.714 +0.055 +An Nau, anticipatory nausea; An Vom, anticipatory vomiting. +Table 7. Comparison of scores of STAI, BDI, symptom number, severity, distress and FLIC during chemotherapy in yoga and control +groups +Secondary outcome measure +Yoga (n = 28) +Mean ± SD +Control (n = 34) +Mean ± SD +t-value +d.f +P-value +STAI – anxiety state score +29.2 ± 3.8 +37.5 ± 7.6 +−5.18 +59 +<0.001 +Beck’s depression score +6.6 ± 4.6 +14.2 ± 6.6 +−5.50 +57 +Number of distressful symptoms +11.4 ± 4.5 +14.7 ± 3.6 +−3.34 +53 +0.002 +Severity of symptoms +17.6 ± 9.3 +27.3 ± 9.2 +−3.89 +58 +<0.001 +Symptom distress +16.6 ± 10.1 +29.9 ± 11.2 +−4.70 +59 +<0.001 +FLIC – overall quality of life +142.1 ± 10.2 +111.7 ± 25.5 +6.48 +59 +<0.001 +Total toxicity score +7.3 ± 2.7 +11.1 ± 4.3 +−4.1 +56 +<0.001 +BDI, Beck’s Depression Inventory; FLIC, Functional Living Index for Cancer; STAI, State Trait Anxiety Inventory. +RAGHAVENDRA et al. +472 +© 2007 The Authors +Journal compilation © 2007 Blackwell Publishing Ltd +apy. Second, subjects in both the groups were given the +intervention much before the commencement of chemo- +therapy, during their surgery and radiotherapy. This long- +term intervention may have contributed to increasing +benefits resulting from our intervention against the earlier +studies using relaxation. +This long-term intervention may have also helped in +improving quality of life and reducing anxiety, depression, +distressful symptoms and treatment-related toxicity. +Thus, maintenance of such interventions over a longer +period could enhance the care provided to cancer patients +and help them control the undesirable effects of +chemotherapy. +One of the major limitations of this study was that man- +agement of delayed emesis was not according to current +guidelines and consensus statements, as this study was +carried out much before the publication of these guide- +lines (Gralla et al. 1999). Thus, the results of this study +may be applicable only to chemotherapy patients with a +poor control of delayed nausea and emesis. Second, sub- +jects in the control group were offered supportive coun- +selling and coping preparation less frequently than their +counterparts who received yoga intervention, and this dis- +crepancy in the duration of interventions could account +for the significant differences seen between the groups. +However, it should be noted that most of these CAM +interventions are time-intensive and involve more +contact hours than these standard supportive therapy +sessions. For practical purposes, this difference was +acceptable, as we are using supportive therapy interven- +tions only with an intention of negating the confounding +variables, such as social support, attention, education and +self-control, which are known to improve the psycholog- +ical and social functioning of cancer patients (Roscoe et al. +2000). Since both the groups received the same supportive +therapy and coping preparation programme, in addition to +yoga intervention in the yoga group, it is possible to +attribute the effects of the yoga programme to stress +reduction rather than supportive care. However, because +of the desire to incorporate support and education in the +yoga programme, it is not clear whether a yoga programme +without support and education would have resulted in the +same benefits. Third, subjects were given yoga interven- +tion much before the start of chemotherapy during sur- +gery and radiotherapy, and pre-exposure to interventions +before chemotherapy may have reduced the responses of +patients to conditioning stimuli during chemotherapy. +This may also be the reason why our intervention was bet- +ter than coping preparation and counselling which had the +same beneficial effects as progressive muscle relaxation +training in earlier studies (Burish et al. 1991). Finally, +because of the overlap with physical symptoms of cancer, +the use of BDI and STAI in cancer populations has its lim- +itations and results should be interpreted with caution. +Overall, the beneficial effects observed in this study can +be attributed to yoga practices that helped in stress reduc- +tion, rather than to mere social support and education. +This is consistent with other behaviourally orientated +programmes, which have shown better results with stress +reduction than with purely supportive interventions +(Telch & Telch 1986; Vasterling et al. 1993). It is in this +context that our study has been able to elucidate the +effects of a yoga-based stress reduction programme. +Several studies mentioned above have demonstrated the +effectiveness of attention-diversion strategies for the +reduction of stress and pain. It is likely that relaxation and +deep somatic restfulness induced by yoga practices may +reduce anxiety, physiological arousal and stress associated +with chemotherapy and prevent the exacerbation of +responses induced by post-chemotherapy nausea and vom- +iting, thereby reducing the general feelings of distress. The +yoga postures may have also helped reduce muscular con- +tractions in the gastrointestinal tract (Taneja et al. 2004) +that accompany post-chemotherapy nausea and vomiting, +or may have decreased the sensitivity of chemoreceptor +trigger zone to vomiting response (stimuli) (Borison & +McCarthy 1983). +This indicates that yoga probably shares some common +techniques with other behavioural interventions that +influence pathways from stress to somatic symptoms. +Yoga is one such intervention, which is gaining popularity +among the Indian masses, and oncology clinics could +adopt these interventions by training nurses involved in +cancer care. Approximately 56% of the cancer patients in +a developing country like India take recourse to comple- +mentary and alternative therapies with an intention to +gain benefit and not because of dissatisfaction with con- +ventional treatment (Gupta et al. 2002). The popular +beliefs associated with these treatments have helped can- +cer patients to adopt healthy self-care behaviours. Use of +these interventions in a hospital setting could help com- +plement the effects of conventional antiemetic treatments +in managing chemotherapy-related nausea and emesis. +These interventions can be particularly useful in the +Indian context and in developing countries where subjec- +tive concerns regarding treatment-related side effects are +not given due their concern. Moreover, infrastructure for +offering supportive care and cancer support groups rarely +exists, and access to care is not affordable for the majority +of the cancer population. +In summary, our yoga-based intervention was more +effective in reducing post-chemotherapy and anticipatory +Yoga for CINV +© 2007 The Authors +473 +Journal compilation © 2007 Blackwell Publishing Ltd +nausea compared with supportive therapy and coping +preparation. Yoga intervention served as a useful additive +to antiemetic treatment in reducing post-chemotherapy +and anticipatory vomiting. However, larger experimental +studies under controlled conditions are required to vali- +date our findings. +ACKNOWLEDGEMENTS +This research was supported by a grant from the Central +Council for Research in Yoga and Naturopathy, Ministry +of Health and Family Welfare, Government of India. We +are thankful to Dr Jayashree and Mrs Anupama for impart- +ing the yoga intervention. +REFERENCES +Arakawa S. 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WHO Offset Publication, +Geneva, Switzerland. 48, 16–21. diff --git a/subfolder_0/Effects of integrated yoga on quality of life and interpersonal relationship of pregnant women.txt b/subfolder_0/Effects of integrated yoga on quality of life and interpersonal relationship of pregnant women.txt new file mode 100644 index 0000000000000000000000000000000000000000..b31b81740f7c559d0c7d8beb42137ef4724b24a4 --- /dev/null +++ b/subfolder_0/Effects of integrated yoga on quality of life and interpersonal relationship of pregnant women.txt @@ -0,0 +1,1107 @@ +Effects of integrated yoga on quality of life and interpersonal +relationship of pregnant women +Abbas Rakhshani • Satyapriya Maharana • +Nagarathna Raghuram • Hongasandra R. Nagendra • +Padmalatha Venkatram +Accepted: 29 June 2010 / Published online: 15 July 2010 + Springer Science+Business Media B.V. 2010 +Abstract +Purpose +The objective of this study was to investigate the +effects of integrated yoga on the quality of life and inter- +personal relationships in normal pregnant women. +Methods +One hundred and two pregnant women between +18 and 20 weeks of gestation who met the inclusion criteria +were recruited from the obstetric units in Bangalore and +were randomly assigned to two groups of yoga (n = 51) +and control (n = 51). Women with medical conditions that +could potentially lead to pregnancy complications and +those with abnormal fetal parameters were excluded. The +yoga group received integrated yoga while control group +received standard antenatal exercises, both for 1-h three +times a week from 20th to 36th week of gestation. Pre and +post assessments were done using WHOQOL-100 and +FIRO-B questionnaires. +Results +Of the six domains of WHOQOL-100, between +groups analysis showed significant improvements in the +yoga group compared to the control in the physical +(P = 0.001), +psychological +(P \ 0.001), +social +(P = +0.003), and environmental domains (P = 0.001). In FIRO-B, +the yoga group showed significant improvements in +‘Expressed Inclusion’ (P = 0.02) and ‘Wanted Control’ +(P = 0.009) domains compared to the control group. +Conclusion +The integrated yoga is an efficacious means of +improving the quality of life of pregnant women and +enhancing certain aspects of their interpersonal relationships. +Keywords +Yoga  Pregnancy  World Health +Organization Quality of Life  WHOQOL-100  +Fundamental Interpersonal Relationships Orientation  +FIRO-B +Abbreviations +WHOQOL +World Health Organization Quality of Life +FIRO +Fundamental Interpersonal Relationships +Orientation +Introduction +World Health Organization defines health as ‘‘a state of +physical, mental, social and spiritual [1] well-being, and +not merely the absence of disease or infirmity’’ [2]. This +broad definition of well-being is reflected in an increasing +appreciation of quality of life issues and the interper- +sonal relationships of the subject with his/her environment +[3]. +Chronic psychosocial stress has become prevalent in +modern society [4] and is associated with a substantial +reduction in the quality of life [5]. Maternal psychological +stress has been associated with reduced placental perfusion +[6] and endothelial dysfunction [7], which are known as the +main causes of many pregnancy complications, including +intrauterine growth restriction (IUGR), pregnancy-induced +hypertension (PIH), and preeclampsia [7]. In particular, +maternal stress is strongly linked to many hypertension- +related complications of pregnancy [8]. However, it is now +documented that PIH and related complications can be +reversed [9]. +Stress can affect maternal immunity adversely [10], +contribute to reduced placental perfusion [11], and nega- +tively impact the pregnancy outcome [12]. In addition, +A. Rakhshani (&)  S. Maharana  N. Raghuram  +H. R. Nagendra  P. Venkatram +SVYASA University, Bangalore, India +e-mail: abbas616@gmail.com +123 +Qual Life Res (2010) 19:1447–1455 +DOI 10.1007/s11136-010-9709-2 +pregnancy itself represents a time of significant physical, +emotional, and psychological stress for the mother [13], +which has been shown to take away from her overall +quality of life and alter her ability to cope with her +expected role [14]. In fact, social relationships have been +shown to have a direct impact on our physical health and +psychological well-being [15] and that these influences are +not just spurious findings attributable to our personalities +[16]. Therefore, it is important to take into consideration +the social and interpersonal relationships of women when +directing treatment during pregnancy. +It is now well documented that yoga and meditation help +in stress reduction [17–19]. Furthermore, yoga has been +shown to improve not only the quality of life of healthy +subjects [20] but also patients suffering from variety of +ailments, including pulmonary disorders [21], cardiovas- +cular dysfunctions [22], cancer [23], diabetes [24], rheu- +matoid arthritis [25], menopause [26], and schizophrenia +[27]. +The purpose of this study was to assess the effect of +yoga in improving quality of life as well as the sources of +tension, incompatibility, and dissatisfaction in women +during their normal pregnancy that could potentially affect +their interpersonal relationships. +Materials and methods +Subjects +Two hundred and twenty normal pregnant women at +18–20 weeks of gestation between 20 and 35 years of age +were interviewed at antenatal clinics in south of Bangalore, +India. One hundred and fifty of these women met the entry +criteria for the study and only 111 agreed to sign the +informed consent form. These 111 selected subjects were +randomly assigned to yoga and control groups (n = 56 and +n = 55, respectively) using a computerized random gen- +erator number. During the course of the study five subjects +dropped out of the yoga group and four dropped out +of control (mostly due to relocation), leaving 51 subjects +in each group for data analysis. Our power analysis +(alpha = 0.05, power = 0.8, effect size = 0.54) had yiel- +ded 44 subjects per group. +The recruitment criteria aimed at normal pregnancies that +were either primigravida or multigravida with at least one +living child. High-risk pregnancy conditions that would +heighten the stress adaptation responses during pregnancy +were avoided. These exclusion criteria incorporated: (a) +medical conditions that could potentially lead to pregnancy +complications (such as diabetes or hypertension), (b) mul- +tiple pregnancy, (c) IVF pregnancy, (d) previous history +of +IUGR, +preeclampsia, +or +other +severe +pregnancy +complications, (e) maternal structural abnormalities, (f) +multigravida, (g) fetal abnormality on ultrasound scanning, +and (h) previous exposure to yoga. +Signed informed consent was obtained from all subjects +before randomization and the project had received clear- +ance from the ethical committee of SVYASA University +prior to recruitment of the subjects. +Design +The study had adopted a prospective two-armed random- +ized parallel controlled design with supervised practices for +both groups from the time of recruitment until delivery. +Assessments were obtained at baseline (18–20 weeks +gestation) and at 36 weeks gestation. The yoga group +practiced specific set of integrated yoga while the control +group practiced standard antenatal exercises (both set of +practices are listed in Table 1). Subjects in both groups +received 1-h sessions from trained instructors 3 days per +week (yoga classes were held on Monday, Wednesday, and +Fridays while antenatal sessions were on Tuesday, Thurs- +day, and Saturday) for the first month. All instructors were +trained at SVYASA University in Bangalore, India. +Thereafter, they continued their respective practices at +home using a pre-recorded cassette until delivery. Addi- +tionally, every time the subjects of each group came to the +hospital for their regular antenatal check up, they received +a refresher class of 1-h duration. The frequency and dura- +tion of the daily practices of subjects at home were mon- +itored closely by research staff through an ‘exercise diary’ +that was maintained by the subjects in each group. The +follow-ups were through phone and in person when sub- +jects visited the hospital. No incentives were given to the +subjects for attending the classes. +Due to the nature of the study, blinding was not a pos- +sibility. However, all efforts were made to mask the staff +whenever possible. The team who did the assessments was +not involved in administering the intervention. The statis- +tician who did the randomization and analysis was blind to +the source of the data. Care was taken to avoid interaction +and exchange of techniques between participants of the two +groups by staggering the timings and venue of the classes +for the two groups. +Interventions +Integrated approach of yoga +Detailed information about yoga and its mechanism of +action as a mind–body medicine from the yogic point of view +can be found in many books including one by Nagendra and +Nagarathna [28]. Briefly, integrated approach of yoga (IAY) +is a holistic approach to well-being at physical, emotional, +1448 +Qual Life Res (2010) 19:1447–1455 +123 +mental, and spiritual levels. It is designed to reduce chronic +psychological stress that, from the yogic point of view, is the +root causes of psychosomatic ailments [28]. +Practice modules +The practices of IAY used in this study were selected +carefully by the investigators for normal pregnancy. This +means that certain yogic practices that are not advisable for +pregnant women (such as postures that can put too much +pressure on the uterus) were omitted. The practices for the +control group involved simple stretches approved by the +Executive Council of the society of Obstetrician and +Gynecologists of Canada, and by the board of directors of +the Canadian society for exercise physiology. The control +exercises were followed by supine rest. Table 1 lists the +Table 1 Interventions for the yoga and control groups +Yoga group practices +2nd +trimester +3rd +trimester +Control group practices +2nd +trimester +3rd +trimester +Lecture topics +15 min +10 min +Lecture topics +15 min +10 min +Pregnancy is physiological, child birth, yogic +concepts of healthy life style, and yogic +management of stress including diet, daily +activities, thinking, feeling and behavior +Yes +Yes +Pregnancy is physiological, child birth, modern +scientific concepts of healthy life style, and +modern management of stress including diet, +daily activities, thinking, feeling and behavior. +Yes +Yes +Breathing exercises +10 min +5 min +Loosening exercises +10 min +5 min +Hasta a +¯ya +¯ma s +´vasanam (Hands in and out +breathing) +Yes +Yes +Twisting +Yes +Yes +Hasta vista +¯ra s +´vasanam (Hands stretch +breathing) +Yes +Yes +Forward and backward bend +Yes +No +Gulpha vista +¯ra s +´vasanam (Ankle stretch +breathing) +Yes +No +Side bending +Yes +Yes +Vya +¯ghra s +´vasanam (Tiger breathing) +Yes +Yes +Calf-raise +Yes +Yes +Setu bandha s +´vasanam (Bridge posture +breathing) +Yes +No +Hamstring stretch +Yes +Yes +Lat pulls-up and down +Yes +No +Calf extension +Yes +No +Hip abduction +No +Yes +Asanas +15 min +10 min +Stretch exercises +15 min +10 min +Tadasana (tree pose) +Yes +Yes +Thigh stretch +Yes +Yes +Ardhakati-chakrasana (Lateral Arc Pose) +Yes +Yes +Push-up and Down +Yes +Yes +Trikonasana (triangle pose) +Yes +Yes +Pulls downs +Yes +No +Vajrasana (The Ankle Posture) +Yes +Yes +Low-back lift +Yes +No +Vakrasana (spine twist pose) +Yes +No +Inner thigh stretch +Yes +Yes +Siddhasana (sage pose) +No +Yes +Calf stretch +Yes +Yes +BaddhaKonasana (Bound Ankle Pose) +No +Yes +Dips +Yes +No +UpavistaKonasana (sit with legs apart) +No +Yes +Squatting +No +Yes +Squatting (Garland pose) +No +Yes +Hip abduction +Yes +Yes +Viparita karani (half shoulder stand) +Yes +No +Shoulder-chest stretch +Yes +Yes +ardha-pavanamuktasana (folded leg lumbar +stretch) +Yes +Yes +Neck and upper back stretch +Yes +Yes +Seated rowing +Yes +Yes +Oblique curis +Yes +Yes +Kick backs +Yes +Yes +Pelvic floor exercise +Yes +Yes +Pelvic Tilt +Yes +Yes +Pranayama and meditation +10 min +20 min +Supine rest +10 min +20 min +Sectional breathing, nadishiddhi, Sheetali, +bharamari, Nadanusandhana, Om meditation +Yes +Yes +Slow walking +10 min +20 min +DRT (Deep relaxation technique) +10 min +15 min +Supine rest +10 min +15 min +Qual Life Res (2010) 19:1447–1455 +1449 +123 +practices for each group in greater detail. All subjects had +sufficient understanding of English language and instruc- +tions for both groups were given in English. There was no +need to use any props, chairs, or wall support to practice +the yoga poses. However, women sat in Siddhasana instead +of Vajrasana in their third trimester. +Instruments +WHOQOL-100 instrument +World Health Organization Quality of Life assessment +instrument (WHOQOL-100) is a generic, client-completed +measure of health-related quality of life that was simulta- +neously developed in 15 sites worldwide [29]. It is focused +around the definition of quality of life advocated by the +World Health Organization which includes the culture +and context which influence an individual’s perception +of health [29]. It consists of six domains (physical +health, psychological health, level of independence, social +relationships, +environment, +spirituality/religion/personal +beliefs) and 24 facets, each consisting of four items, dis- +tributed across domains plus a general facet (overall quality +of life and general health) [30]. Items are scaled on five- +point Likert scale and scoring is available for domain, +facet, and overall—with higher scores indicating higher +quality of life [30]. The WHOQOL-100 instrument is +widely used to compare the QOL of different populations. +Its growing popularity is in part due to the substantial +evidence that the questionnaire is sensitive and responsive +to important changes in the physical and emotional +domains of QOL [31]. +FIRO-B instrument +Fundamental Interpersonal Relations Orientation (FIRO) is +a theory of interpersonal relations, introduced by William +Schutz in 1958 [32]. Schutz in this theory formulated three +dimensions of interpersonal relations, which he believed +were necessary and sufficient to explain most human inter- +actions [32]. He named these dimensions as: Inclusion, +Control and Affection [32]. Within these spaces, the level of +interaction an individual wants can be measured in the areas +of socializing, leadership and responsibilities, and more +intimate personal relations [33]. FIRO-B scores are graded +from 0 to 9 in scales of expressed and wanted behavior, +which define how much a person expresses to others, and +how much he wants from others [33]. Therefore, the stan- +dard FIRO-B questionnaire consists of six different spheres: +Expressed Inclusion (EI), Wanted Inclusion (WI), Expres- +sed Control (EC), Wanted Control (WC), Expressed +Affection (EA), and Wanted Affection (WA). Historically, +FIRO-B is used in the corporate environment to determine +leadership style and to identify team building and personal +development requirements. However, to do so, the instru- +ment tries to identify the sources of tension, incompatibility, +and dissatisfaction. In the study, we wanted to know how +yoga can contribute to the improvement of these factors in +the stressful period of pregnancy. +Data collection and analysis +Statistical software SPSS version 16.0.1 was used for all +data analysis. Test of normality (Kolmogorov–Smirnov) +was performed on the data of each domain for both +instruments. When the data was found not to be normal +(P \ 0.05), the non-parametric Mann–Whitney test was +used for comparison between groups and Wilcoxon’s +signed rank’s test for within groups. We used paired t-test +for within groups and Independent Sample t-test for +between groups for analyzing the data that was normally +distributed. Chi-squared test and Independent Samples +t-tests were used for baseline comparisons of the two +groups. +Results +Table 2 shows the demographic data of the subjects in both +groups. All baseline maternal characteristics were matched +between the two groups and there were no statistically +significant differences between them except for profession. +WHOQOL-100 test +This study compared the mean test and retest scores for each +domain of WHOQOL-100 instrument. Table 3 shows the +results on all domains of WHOQOL-100 instrument. +There were significant differences between groups with +higher improvements in yoga than the control group in the +Physical (P \ 0.01, Mann–Whitney test, effect size = +0.48), Psychological (P \ 0.01, Independent Sample t-test, +effect size = 0.65), Social Relationships (P \ 0.01, Inde- +pendent Sample t-test, effect size = 0.65), and the General +Health +(P \ 0.01 +Independent +Sample +t-test, +effect +size = 0.65) domains. +FIRO-B test +We compared the mean pre-interventions and post-inter- +ventions scores for each domain of FIRO-B questionnaire. +The between groups statistical analysis showed signifi- +cance in ‘‘Expressed Inclusion’’ (P = 0.02, Independent +Sample t-test) and ‘‘Wanted Control’’ (P = 0.009, Mann– +Whitney test) domains. However, within group analysis +showed significant improvements in all domains for the +1450 +Qual Life Res (2010) 19:1447–1455 +123 +yoga group (Expressed Inclusion: P = 0.038, Wanted +Inclusion: +P = 0.001, +Expressed +Control: +P = 0.013, +Wanted Control: P = 0.01, Expressed Affection: P = +0.007, Wanted Affection: P = 0.001) while no significant +improvement in any domain for the control group. Table 4 +outlines our results. Large effect sizes in each of the +domains of the yoga group are notable. +Discussion +This prospective two-armed randomized controlled study +of 102 normotensive pregnant women compared the qual- +ity of life and interpersonal relationships of normal preg- +nant women who received integrated yoga interventions +from the twentieth week of gestation until 36 weeks ges- +tation to those who received standard antenatal practices +during the same period. Our study has shown that inte- +grated yoga interventions can significantly improve the +quality of life of pregnant women in the physical, psy- +chological, social, and general health domains using +WHOQOL-100 instrument. In the Independence domain, +our results were just above the borderline (P = 0.065). +Overall, the effect sizes for the IAY interventions used +in the yoga group were significantly higher than those used +in the control group, except for the spiritual domain that the +control group scored higher (P: 0.27 control vs. 0.12 yoga). +Aside from the general health quality, the largest effect size +among the six domains of WHOQOL-100 in the yoga +group was of the psychological domain (0.65) followed by +social relationships (0.59), physical (0.48), and environ- +mental (0.48) domains. Our results are consistent with +previous studies that have used WHOQOL instrument in +evaluating the quality of life of patients with various ail- +ments using yoga interventions [34–36]. +In the FIRO-B instrument, our within groups’ analysis +showed significant improvements in each domain (EI: +P = 0.038; WI: P \ 0.001; EC: P = 0.013; WC: P = +0.01; EA: P = 0.007; WA: P = 0.001) for the yoga group +and no statistically significant improvements for the control +group. The between groups’ analysis showed statistically +significant improvements in the Expressed Inclusion and +Wanted Control. A quick glance of the pre-interventions +means for the subjects in both groups (listed in Table 4) +shows that the scores are all low to moderate across the +board. To understand the significance of this, we must +review Schutz’s own classifications of the scores. He +identified individuals based on their scores in each of the +FIRO-B domains into the following nine categories [32]: +I. +Inclusion types +a. +The under-social (low EI, low WI) +b. +The over-social (high EI, high WI) +c. +The social (moderate EI, moderate WI) +II. +Control types +a. +The under-controller or abdicrat (low EC, high +WC) +b. +The over-controller or autocrat (high EC, low +WC) +c. +The democrat (moderate EC, moderate WC) +III. +Affection types +a. +The under-personal (low EA, low WA) +b. +The over-personal (high EA, high WA) +c. +The personal (moderate EA moderate WA) +Using Schutz’s above classification, our subjects in this +study could be described as generally under-social, under- +control, and under-personal. The nature of our subjects +could have a direct impact on our results. In fact, Schutz +himself warned that many factors, including cultural +influences, could affect these scores. To our knowledge, +there has not been a large cohort study that can provide the +normative values for FIRO-B instrument among normal +pregnant Indian women. But if our data is any indication, +Table 2 Demographic data on the subjects +Variables +Yoga (n = 51) +Control (n = 51) +P-values +Age +26.23 ± 2.98 +25.47 ± 2.87 +0.50* +Height (cms) +63.58 ± 1.96 +62.98 ± 2.04 +0.13* +Weight (kg) +Pre +63.45 ± 10.06 +62.90 ± 8.82 +0.77* +Post +72.30 ± 10.37 +71.65 ± 9.05 +0.74* +BMI +Pre +25.07 ± 3.45 +25.45 ± 3.85 +0.60* +Post +28.55 ± 3.53 +28.89 ± 3.76 +0.64* +BP (Sys) +Pre +114.53 ± 14.62 +115.88 ± 7.87 +0.57* +Post +116.60 ± 10.18 +110.16 ± 0.04 +0.40* +BP (Dia) +Pre +73.57 ± 5.54 +73.22 ± 6.36 +0.77* +Post +74.68 ± 5.31 +75.94 ± 6.37 +0.28* +Gravida +G1 +45 (88.24%) +43 (84.31%) +0.77^ +G2 +6 (11.76%) +8 (15.69%) +Profession +W +33 (64.71%) +21 (38.18%) +0.03^ +HW +18 (35.29%) +30 (58.82%) +BP blood pressure (sys-systolic and dia-diastolic), BMI body mass +index, G1 prime, G2 Gravida 2, HW house wife, W working +P-values were calculated using: ^Chi-Square; *Independent Samples +t-tests +There were no significant differences between groups on any of +maternal characteristics except in the profession +Qual Life Res (2010) 19:1447–1455 +1451 +123 +the values would be expected to be lower than those of +similar population in the western countries. +As mentioned above, we found statistical significance in +the Expressed Inclusion and Wanted Control domains and +near significance in the Wanted Affection domain in the +yoga group when compared to the control. In other words, +compared to non-yoga group, the integrated yoga interven- +tions helped the subjects in developing a sense of belonging, +wanting more influence on their environment, and desiring +more warmth and closeness. One might wonder if these +could be considered improvements to the subjects’ inter- +personal relationships. For example, if a subject wants more +influence on her environment but cannot get it, would not +that add to her frustrations? Of course, it could if she totally +fails in gaining any control. However, the chances are that +she will gain a certain degree of control on her environment +and that would be an improvement. +We also used paired sample test to compare the means +within groups. The yoga interventions showed statistically +significant improvements in all domains: EI (P = 0.038), +WI (P \ 0.001), EC (P = 0.01), WC (P = 0.013), EA +(P = 0.007), +and +WA +(P = 0.001). In +contrast, +the +improvements of the control interventions were not statis- +tically significant in any of the FIRO-B spheres. +Finally, we obtained bivariate Pearson correlations +between the domains of WHOQOL-100 and FIRO-B +instruments. The correlations were low and statistically +insignificant. However, this does not mean that there is no +relationship between the two instruments. A more plausible +explanation would be that our study was not large enough to +find such correlations. After all, it would be logical to think +that individuals feeling less control over their environment or +those who perceive less affection from their environment +could be more prone to have a lower quality of life than +Table 3 Results of the +WHOQOL-100 test after +intervention in both groups +Statistically significant P-values +are shown in bold +a Independent Sample t-test +b Mann–Whitney test +c Paired samples test +Domain +Groups +Between groups +P-values +Mean ± standard deviation [95% confidence interval] +Yoga +Control +Physical (n = 51) +Pre +14.55 ± 2.4 [13.88–15.22] +14.27 ± 2.32 [13.62–14.92] +0.001b +Post +15.79 ± 2.77 [15–16.57] +14.12 ± 2.14 [13.51–14.72] +Effect size +0.48 +0.07 +Psychological (n = 51) +Pre +14.6 ± 2.42 [13.92–15.28] +14.5 ± 1.83 [13.98–15.01] +0.001a +Post +16.08 ± 2.12 [15–16.57] +14.7 ± 1.63 [14.24–15.17] +Effect size +0.65 +0.12 +Independence (n = 51) +Pre +15.44 ± 2.31 [14.79–16.08] +14.94 ± 2.14 [14.34–15.54] +0.065a +Post +15.91 ± 2.2 [15.29–16.53] +15.01 ± 2.1 [15.01 ± 2.1] +Effect size +0.21 +0.03 +Social relationships (n = 51) +Pre +15.58 ± 2.46 [14.89–16.27] +15.11 ± 2.76 [14.34–15.89] +0.003a +Post +16.88 ± 1.91 [16.34–17.42] +15.67 ± 2.09 [15.08–16.26] +Effect size +0.59 +0.23 +Environment (n = 51) +Pre +15.32 ± 1.86 [14.8–15.85] +14.93 ± 2.49 [14.23–15.63] +0.001b +Post +16.25 ± 2 [15.69–16.82] +15 ± 1.69 [14.52–15.47] +Effect size +0.48 +0.03 +Spiritual (n = 51) +Pre +15.73 ± 2.48 [15.03–16.42] +14.71 ± 2.44 [14.02–15.39] +0.23b +Post +16.02 ± 2.42 [15.34–16.70] +15.41 ± 2.67 [14.66–16.16] +Effect size +0.12 +0.27 +General health quality (n = 51) +Pre +15.76 ± 2.84 [14.97–16.56] +14.98 ± 1.94 [14.43–15.53] +0.001b +Post +17.08 ± 2.31 [16.43–17.73] +15.35 ± 2.51 [14.65–16.06] +Effect size +0.51 +0.17 +1452 +Qual Life Res (2010) 19:1447–1455 +123 +otherwise. But this has to be proven by a larger multi-center +study. +Our data demonstrates that QOL of pregnant women can +be substantially improved after 16 weeks of integrated +yoga practices. These results reaffirm that on most +dimensions, changes in the scores of WHOQOL-100 are +responsive to behavioral, emotional, and physical change +over time. Our results are in-line with other studies that +have used yoga to improve quality of life of patients with +other ailments using WHOQOL instrument [35, 36]. Even +in healthy non-pregnant subjects, yoga has shown to +improve the quality of life [27]. Oken et al. used the SF-36 +instrument to assess health-related quality-of-life of heal- +thy seniors using yoga interventions [27]. Their results +demonstrated a significant yoga assignment group effect on +vitality/energy +and +fatigue +(P = 0.006), +role-physical +(P = 0.001), bodily pain (P = 0.006), social functioning +(P = 0.015), and the physical composite scale (P = 0.005) +[27]. While it is not possible to compare the different +components of SF-36 and WHOQOL-100 instruments +directly, it is meaningful to observe the closeness of the +results in the pregnant and non-pregnant population. +Strength of this study +This study has several prominent features: (1) both study +and control groups received supervised training, (2) the +groups were matched at baseline for maternal characteris- +tics, (3) the sample size was sufficiently large to reduce the +possibility of type 1 and type 2 errors. We used the data +from 51 subjects in each group for our data analysis. +Qualified instructors for both yoga and control interven- +tions were used throughout the 16 weeks study. Further- +more, this is the first study that we are aware of that has +focused on improving and assessing the quality of life of +women during pregnancy using yoga. The WHOQOL-100 +and FIRO-B instruments are widely used and their reli- +ability has been well-documented globally and within dif- +ferent socioeconomic populations. We were not able to find +the exact reliability and validity of these two instruments +for the Indian population; however, the internal reliability +of WHOQOL (as measured by Cronbach alpha) has been +shown to range from 0.65 to 0.93 globally. +We believe the results obtained in this study can be used +effectively with future projects as the foundation for +Table 4 Results from the FIRO-B test +Domain +Measurements in +time and effect sizes +Groups +Pre-post +P-values +Mean ± standard deviation [95% confidence interval] +Yoga +Control +Expressed Inclusion (EI) +Pre +5.24 ± 2.17 [4.64–5.87] +5.18 ± 2.06 [4.6–5.75] +0.02a +Post +5.84 ± 2.09 [5.24–6.43] +4.88 ± 2.07 [4.3–5.46] +Effect size +0.29 +0.15 +Wanted Inclusion (WI) +Pre +2.47 ± 2.46 [1.78–3.16] +2.25 ± 2.82 [1.46–3.05] +0.07b +Post +1.29 ± 1.91 [0.76–1.83] +2.16 ± 2.56 [1.44–2.88] +Effect size +0.54 +0.03 +Expressed Control (EC) +Pre +2.61 ± 1.98 [2.05–3.16] +3.16 ± 2.77 [2.38–3.94] +0.3b +Post +3.43 ± 2.06 [2.85–4.01] +3.12 ± 2.71 [2.36–3.88] +Effect size +0.41 +0.02 +Wanted Control (WC) +Pre +3.37 ± 2.17 [2.76–3.98] +3.94 ± 2.56 [3.22–4.66] +0.009b +Post +2.41 ± 2.39 [1.74–3.08] +3.69 ± 2.6 [2.95–4.42] +Effect size +0.42 +0.1 +Expressed Affection (EA) +Pre +2.67 ± 2.31 [2.02–3.32] +3.06 ± 2.03 [2.49–3.63] +0.29b +Post +3.61 ± 2.26 [2.97–4.24] +3.10 ± 1.81 [2.59–3.61] +Effect size +0.41 +0.02 +Wanted Affection (WA) +Pre +3.1 ± 2.3 [2.45–3.74] +2.84 ± 2.1 [2.25–3.43] +0.057b +Post +2.12 ± 1.98 [1.56–2.67] +2.76 ± 1.98 [2.21–3.32] +Effect size +0.46 +0.04 +Statistically significant P-values are shown in bold +a Independent Sample t-test +b Mann–Whitney test +c Paired samples test +Qual Life Res (2010) 19:1447–1455 +1453 +123 +improving the quality of life of women at such a special +and crucial period of their lives. +Limitations +This study excluded high-risk pregnancies. Among these +risk factors were women with hypertension and diabetes, +which are quite prevalent in India. That could raise the +question that whether the results of this study would apply +to the general population. A larger sample size could have +produced a different result, particularly in the FIRO-B data. +Suggestions for future direction +Future +larger +multi-center +studies +with +interventions +beginning at earlier gestational age (or even prior to +pregnancy) are needed to establish the exact role that +integrated yoga practices can play in improving the inter- +personal relationships of pregnant women. Large cross- +cultural cohort studies using FIRO-B and WHOQOL-100 +instruments would offer normative data for these instru- +ments. Finally, it would be interesting to see if similar +results could be obtained from a study targeting high-risk +pregnancy population. +Applications of this study +The stressful lifestyle of modern women superimposed on +the challenges that pregnancy imposes on the mothers can +be too much to cope with. Many women turn to medica- +tions for help, which can compromise the health of their +pregnancy. Yoga is non-invasive, economical, and easy to +learn solution to improve the quality of life of pregnant +women, improve their abilities to perform their social roles, +and potentially prevent adverse obstetrics outcome. Preg- +nancy is a very special time in a woman’s life. Yoga can +give her the opportunity and the tools to enjoy this +miraculous period to the fullest. +Conclusion +This prospective randomized controlled trial was able to +show that integrated yoga practices can be used effectively +to improve the quality of life of pregnant women who are +distressed by the overwhelming physiological, psycholog- +ical, and emotional changes of pregnancy. We were also +able to show that yoga interventions as well as other simple +exercises could have a certain level of impact on the +interpersonal relationships of the pregnant women. +Acknowledgments +We acknowledge with deep gratitude the efforts +made by the staff members of Maiya Hospital and SVYASA Uni- +versity who facilitated this study. We particularly appreciate Dr. Ravi +Kulkarni’s guidance during the data analysis and Mrs. Sushama +Kirtikar’s assistance in proof reading the article. 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Yoga therapy as an add-on treatment in the manage- +ment of patients with schizophrenia—A randomized controlled +trial. Acta Psychiatrica Scandinavica, 116, 226–232. +Qual Life Res (2010) 19:1447–1455 +1455 +123 diff --git a/subfolder_0/Effects of yoga program on quality of life and affect the early breast cancer.txt b/subfolder_0/Effects of yoga program on quality of life and affect the early breast cancer.txt new file mode 100644 index 0000000000000000000000000000000000000000..c44008247d8ea763d614bce0891ec7924e62b4a8 --- /dev/null +++ b/subfolder_0/Effects of yoga program on quality of life and affect the early breast cancer.txt @@ -0,0 +1,898 @@ +This article appeared in a journal published by Elsevier. The attached +copy is furnished to the author for internal non-commercial research +and education use, including for instruction at the authors institution +and sharing with colleagues. +Other uses, including reproduction and distribution, or selling or +licensing copies, or posting to personal, institutional or third party +websites are prohibited. +In most cases authors are permitted to post their version of the +article (e.g. in Word or Tex form) to their personal website or +institutional repository. Authors requiring further information +regarding Elsevier’s archiving and manuscript policies are +encouraged to visit: +http://www.elsevier.com/copyright +Author's personal copy +Complementary Therapies in Medicine (2009) 17, 274—280 +available at www.sciencedirect.com +journal homepage: www.elsevierhealth.com/journals/ctim +Effects of yoga program on quality of life and affect +in early breast cancer patients undergoing adjuvant +radiotherapy: A randomized controlled trial +H.S. Vadiraja a, M. Raghavendra Rao b, Raghuram Nagarathna a,∗, +H.R. Nagendra a, M. Rekha a, N. Vanitha a, K.S. Gopinath b, +B.S. Srinath b, M.S. Vishweshwara c, Y.S. Madhavi c, B.S. Ajaikumar c, +S. Ramesh Bilimagga b, Nalini Rao b +a Department of Yoga Research, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India +b Departments of Complementary and Alternative Medicine, Surgical Oncology and Radiation Oncology, Bangalore Institute of +Oncology, Bangalore, India +c Department of Radiation Oncology, Bharath Hospital Institute of Oncology, Mysore, India +Available online 28 October 2009 +KEYWORDS +Yoga; +Breast cancer; +Meditation; +Quality of life; +Affect +Summary +Objectives: This study compares the effects of an integrated yoga program with brief supportive +therapy in breast cancer outpatients undergoing adjuvant radiotherapy at a cancer centre. +Methods: Eighty-eight stage II and III breast cancer outpatients were randomly assigned to +receive yoga (n = 44) or brief supportive therapy (n = 44) prior to their radiotherapy treatment. +Intervention consisted of yoga sessions lasting 60 min daily while the control group was imparted +supportive therapy once in 10 days. Assessments included European Organization for Research +in the Treatment of Cancer-Quality of Life (EORTCQoL C30) functional scales and Positive and +Negative Affect Schedule (PANAS). Assessments were done at baseline and after 6 weeks of +radiotherapy treatment. +Results: An intention to treat GLM repeated measures ANOVA showed significant difference +across groups over time for positive affect, negative affect and emotional function and social +function. There was significant improvement in positive affect (ES = 0.59, p = 0.007, 95%CI 1.25 +to 7.8), emotional function (ES = 0.71, p = 0.001, 95%CI 6.45 to 25.33) and cognitive function +(ES = 0.48, p = 0.03, 95%CI 1.2 to 18.5), and decrease in negative affect (ES = 0.84, p < 0.001, +95%CI −13.4 to −4.4) in the yoga group as compared to controls. There was a significant positive +correlation between positive affect with role function, social function and global quality of life. +There was a significant negative correlation between negative affect with physical function, +role function, emotional function and social function. + Sources of support: Central Council for Research in Yoga and Naturopathy, Ministry of Health and Family Welfare, Govt. of India. +∗Corresponding author at: Division of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, No-19, Eknath Bhavan, +Gavipuram Circle, K.G. Nagar, Bangalore 560019, Karnataka, India. +Tel.: +91 080 26507585; fax: +91 080 26608645. +E-mail address: rnagaratna@gmail.com (R. Nagarathna). +0965-2299/$ — see front matter © 2009 Elsevier Ltd. All rights reserved. +doi:10.1016/j.ctim.2009.06.004 +Author's personal copy +Effects of yoga program +275 +Conclusion: The results suggest a possible role for yoga to improve quality of life and affect in +breast cancer outpatients. +© 2009 Elsevier Ltd. All rights reserved. +Introduction +Quality of life is an important concern and outcome of +cancer treatment. Several studies have documented that +both diagnosis and treatment of breast cancer have an +impact on quality of life.1,2 Further, there is evidence to +suggest that decrements in quality of life are related to +treatment related distress and psychological well being.2,3 +Various dimensions of quality of life such as physical, +emotional, social, functional and spiritual well being are +affected in both newly diagnosed and long-term survivors +of breast cancer.2,4—6 However, growing evidence suggests +that psychosocial and psycho-educational interventions are +beneficial adjunctive treatments for cancer patients.7—11 +Patients who have used active behavioral coping meth- +ods have reported positive affective states, decrease in +anxiety and depression, higher levels of self-esteem and +fewer physical symptoms while those with avoidance cop- +ing showed greater depression, anxiety and lower quality +of life.12 Similarly mind—body approaches such as prayer, +meditation, affirmation, imagery and movement therapies +have shown improvements in overall quality of life in cancer +patients.13—15 +Yoga as a mind—body intervention is being practiced +increasingly in both Indian and western populations. It is +an ancient Indian science that has been used for thera- +peutic benefits in numerous health care concerns where +stress is believed to play a role.16 Beneficial effects have +been seen on a variety of outcomes, including sleep quality, +mood, stress, cancer-related distress, cancer-related symp- +toms, and overall quality of life, as well as functional and +physiological measures. These effects were similar across a +number of different therapeutic approaches that employed +postures, meditation breathing practices or a combination +of all these.17 The results from these studies are bolstered by +several randomized studies using yoga interventions in both +healthy and chronically ill populations.18—20 Results from +recent randomized controlled studies are mixed with one +study showing improvement in various quality of life domains +in breast cancer population at different stages of cancer +treatment21 and the other showing no improvement in qual- +ity of life domains.22 In both these studies adherence to +intervention and contact time for yoga intervention was low +compared to our earlier study that has shown decrements in +anxiety states23; reduction in chemotherapy induced nau- +sea and emesis24 and improved immune outcomes.25 In the +former adherence seemed to be affected by radiotherapy +treatment and distress and in the latter the intervention +was based on a different form of yoga intervention known +as Tibetan yoga. +Overall effects following yoga or similar interventions +have been attributed to an improvement in positive affect +and decrease in negative affect.26—28 Patients on radiother- +apy experience distressing side effects such as fatigue, skin +changes, pulmonary symptoms during radiotherapy and anx- +iety and depression before, during, and after radiotherapy.29 +Reducing treatment related distress and improving quality +of life is known to improve adjustment later30 and manage +related morbidity that accumulates over time.31 Moreover +earlier study has shown radiotherapy to predict poorer +adherence to yoga intervention.21 +We hypothesize that yoga intervention would help +improve quality of life, improve positive affect and decrease +negative affect in stage II and III breast cancer patients +undergoing adjuvant radiotherapy. +In this study, we compared the effects of a 6-week +‘‘Integrated yoga program’’ with ‘‘Brief supportive ther- +apy’’ as a control intervention in early operable breast +cancer patients undergoing adjuvant radiotherapy. +Methods +Subjects +This randomized control trial recruited 85 recently diag- +nosed women with stage II and III breast cancer from two +different urban cancer centres. All subjects had undergone +primary treatment as surgery and were receiving adjuvant +radiotherapy. Subjects in this study were recruited over a 2- +year period from January 2004 to June 2006. Patients were +eligible to participate in this study if they met the following +selection criteria at the study start: (i) women with recently +diagnosed operable breast cancer, (ii) age between 30 and +70 years, (iii) Zubrod’s performance status 0—2 (ambulatory +>50% of time), (iv) high school education and, (v) consent- +ing to participate in the study. Subjects were excluded, (i) if +they had any concurrent medical condition that was likely to +interfere with the treatment, (ii) major psychiatric, neuro- +logical illness or autoimmune disorders, and, (iii) any known +metastases. Each study participant was prescribed adjuvant +radiotherapy with a cumulative dose of 50.4 Gy with frac- +tionations spread over 6 weeks. The details of the study were +explained to the participants and their informed consent was +obtained in writing. +Randomization +Of the 103 eligible participants 88 (85.4%) consented to +participate and were randomized to receive yoga (n = 44) +or supportive therapy (n = 44) initially before intervention +(prior to radiotherapy) using computer generated ran- +dom numbers. Randomization was performed using opaque +envelopes with group assignments. Personnel who had no +part in the trial performed randomization. The envelopes +were opened sequentially in the order of assignment dur- +ing recruitment, with the names and registration numbers +of the participants written on the covers. The order of +Author's personal copy +276 +H.S. Vadiraja et al. +randomization was verified with the hospital date of admis- +sion records for radiation therapy at study intervals to make +sure that field personnel had not altered the sequence of +randomization to suit the allocation of consenting partici- +pants into two study arms. +Sample size +Earlier study with Mindfulness Based Stress Reduction Pro- +gram (MBSR) had shown a modest effect size (ES = 0.38) on +EORTC QLC30 global quality of life measure.32 We used G +power to calculate the sample size with ˛ = 0.05 and ˇ = 0.2 +and above effect size of 0.38 for repeated measures ANOVA +between factor effects. The sample size thus required was +n = 44 in each group. +Among the 88 participants 75 (yoga n = 42; control n = 33) +completed their prescribed radiation therapy of 6 weeks +and follow-up assessment. There were 13 dropouts in the +study (see trial profile, Fig. 1). The reasons for dropouts +were migration to other hospitals (n = 4), use of other com- +plementary therapies (e.g. homeopathy or ayurveda) (n = 2), +refusal to continue the study (n = 2), time constraints (n = 4) +and other concurrent illnesses such as infections delaying +radiotherapy and intervention (n = 1). +Measures +During the initial visit, demographic information, including +age, marital status, education, occupation, obstetric and +gynecological history, medical history and intake of med- +ications, was obtained, and clinical data were abstracted +on the history of breast cancer. The following self-report +questionnaires were distributed to the subjects during the +study. +Figure 1 +Trial profile. +Positive and Negative Affect Schedule (PANAS) +Positive affect and negative affect was assessed using the +PANAS scale.33 PANAS contains two subscales, each consist- +ing of 10 items: positive affect (PA) and negative affect (NA). +PA reflects the extent to which a person feels enthusiastic, +active, and alert. A high PA score reflects a state of high +energy, full concentration, and pleasurable engagement. In +contrast, NA is a general dimension of subjective distress +with a variety of aversive mood states, and a high NA score +indicates more distress. Patients were instructed to indicate +how they had been feeling during the last 2 weeks. The reli- +ability of this descriptive scale has been reported to range +from 0.86 to 0.90 for PA and from 0.84 to 0.87 for NA.33 +European Organization for Research and Treatment +of Cancer-Quality of life C30 +Health related quality of life was assessed using the Euro- +pean Organization for the Research and Treatment of +Cancer-Quality of Life (EORTCQoL C30 questionnaire ver- +sion 1).34 This 30-item questionnaire provides a measure +on the dimensions of global health status, physical, role, +emotional, cognitive and social functioning (with high scores +representing good quality of life) and cancer-related symp- +tomatology. The reliability of this descriptive scale during +the study has been reported to range from 0.52 to 0.89 +for functional and global quality of life scales. Assessments +were carried out before and after radiotherapy treatment. +However, we report results for only functional quality of life +subscales in this study. +Interventions +The intervention group received integrated yoga program +and the control group received brief supportive therapy both +imparted individually. This integrated yoga program has a +combination of a set of asanas (postures done with aware- +ness) breathing exercises, pranayama (voluntarily regulated +nostril breathing), meditation and yogic relaxation that are +based on principles of stimulation and relaxation taken from +ancient Indian texts called Upanishads. Contrary to the west +where yoga is considered to be a form of exercise and various +components such as asanas, meditation and breathing exer- +cises are being used separately, in the east these practices +are interspersed with a view to developing greater relax- +ation and internal awareness.35 Subjects develop insight in +recognizing inherent tensions and stress responses and learn +ways to relax them. This would be particularly useful in +cancer patients who perceive cancer as a threat. These +practices were based on principles of attention diversion, +mindful awareness and relaxation to cope with day-to-day +stressful experiences. Participants were asked to attend a +minimum of at least three in-person sessions/week for 6 +weeks during their adjuvant radiotherapy treatment in the +hospital with self-practice as homework on the remaining +days. Each of these sessions lasted 1 h and was administered +by a trained yoga therapist either before or after radiother- +apy. These sessions started with a few easy yoga postures, +breathing exercises and pranayama (voluntarily regulated +nostril breathing), and yogic relaxation. After this prepara- +Author's personal copy +Effects of yoga program +277 +tory practice for about 20 min, the subjects were guided +through any one of the meditation practices for the next +30 min, which included focusing awareness on sounds and +chants from Vedic texts,36 or breath awareness and impulses +of touch emanating from palms and fingers while practic- +ing yogic mudras, or a dynamic form of meditation that +involved practicing with eyes closed of four yoga postures +interspersed with relaxation while supine, thus achieving a +combination of both ‘stimulating’ and ‘calming’ practice.37 +The instructions were recorded on an audio tape so that +the patients could practice the same at home. The control +intervention consisted of brief supportive therapy with edu- +cation as a component that is routinely offered to patients +as a part of their care in this centre. We chose to have +this as a control intervention mainly to control for the non- +specific effects of the yoga program that may be associated +with factors such as attention, support and a sense of con- +trol as described in our earlier study.23 Subjects and their +caretakers underwent counseling by a trained social worker +(once in 10 days, 15 min sessions) during their hospital vis- +its for adjuvant radiotherapy. The control group received +3—4 such counseling sessions during a 6-week period, where +as the intervention group received anywhere between 18 +and 24 yoga sessions. Supportive counseling was a part of +routine care offered in hospitals. While the goals of yoga +intervention were stress reduction and appraisal changes, +the goals of supportive therapy were education, reinforcing +social support and coping preparation. +Data analysis +Data were analyzed using Statistical Package for Social +Sciences version 10.0. Descriptive statistics were used +to +summarize +the +data. +A +GLM +repeated +measures +ANOVA was done with the within-subjects factor being +time/assessments at two levels and between-subjects fac- +tor being groups at two levels (yoga vs. supportive therapy). +Both group by time interaction effects, between-subjects +and within-subjects effect were assessed. Post hoc tests +were done using Holms—Bonferroni correction for changes +at different time points between groups. Intention to treat +analysis was also done on the initially randomized sample +(n = 88) with baseline measure (T1) and post-measure (post- +RT +, T2) for all participants. Missing value analysis was done +using SPSS 16 by regression using the corresponding baseline +Table 1 +Demographic and medical characteristics of the initially randomized sample. +All subjects +Yoga group +Control group +n = 88 +% +n = 44 +% +n = 44 +% +Religion +Hindu +73 +83 +36 +81.8 +37 +84.1 +Muslim +9 +10.2 +6 +13.7 +3 +6.9 +Christian +6 +6.8 +2 +4.5 +4 +9 +Stage of breast cancer +I +5 +5.7 +2 +4.5 +3 +6.8 +II +18 +20.4 +11 +25.0 +7 +15.9 +III +65 +73.9 +31 +70.5 +34 +77.3 +Grade of breast cancer +I +1 +1.1 +1 +2.3 +0 +0 +II +33 +37.5 +21 +47.7 +10 +22.7 +III +54 +61.4 +22 +50 +34 +77.3 +Menopausal status +Pre +48 +54.5 +26 +59.1 +23 +52.3 +Post +40 +45.5 +18 +40.9 +21 +47.7 +Histopathology type +IDC +72 +81.8 +37 +84.1 +35 +39.7 +ILC +7 +7.9 +2 +4.5 +5 +11.4 +IPC +3 +3.4 +2 +4.5 +1 +2.2 +DCI +2 +2.2 +2 +4.5 +0 +0 +CC +2 +2.2 +1 +2.3 +1 +2.2 +PC +2 +2.2 +0 +0 +2 +4.5 +Regimen +After ChemoTherapy +68 +77.3 +32 +72.7 +37 +84 +After surgery +20 +22.7 +12 +27.3 +7 +15.9 +Marital status +Single +2 +2.2 +1 +2.3 +1 +2.2 +Married +86 +97.8 +43 +97.7 +43 +97.8 +IDC- Infiltrating Ductal Carcinoma, IPC- Infiltrating Papillary Carcinoma, ILC- Infiltrating Lobular Carcinoma, CC- Comedo Carcinoma, PC- +Papillary Carcinoma. +Author's personal copy +278 +H.S. Vadiraja et al. +Table 2 +Comparison of scores for affect and functional scales of EORTCQoL C30 scores using GLM repeated measures ANOVA +between yoga and control groups. +Outcome variables +Yoga (n = 47) +Control (n = 44) +Effect size, Cohen’s f +Pre-mean (SD) +Post-mean (SD) +Pre-mean (SD) +Post-mean (SD) +PANAS-positive +24.05 (7.28) +27.85(7.11)** +21.81 (7.37) +23.33(8.3) +0.59 +PANAS-negative +22.15 (10.6) +12.91 (10.39)** +25.22 (8.82) +21.85 (10.86) +0.84 +Physical function +73.2 (23.2) +73.26 (25.33) +62.72 (30.98) +68.96 (30.12) +0.16 +Role function +72.72 (34.86) +79.88 (34.41) +71.59 (36.40) +72.85 (39.94) +0.19 +Emotional function +56.45 (19.77) +75.12 (21.16)** +51.58 (17.44) +59.23 (23.32) +0.71 +Cognitive function +85.29 (18.0) +90.57 (15.88)* +82.67 (21.12) +80.77 (24.10) +0.48 +Social function +52.82 (26.55) +54.96 (23.98) +52.41 (24.43) +49.93 (24.23) +0.21 +* p-Values < 0.05, for post hoc tests comparing groups at pre and post-radiotherapy using Holms—Bonferroni correction. +** p-Values < 0.01, for post hoc tests comparing groups at pre and post-radiotherapy using Holms—Bonferroni correction. +value as predictors. Pearson correlation analyses were used +to study the bivariate relationships between quality of life +domains and affect. +Results +75 Participants (yoga n = 42; control n = 33) completed the +prescribed radiotherapy regimen. All participants were +ambulatory and had a Zubrod’s performance status score +of 0—2. All patients had mastectomy as primary treatment, +16 subjects received radiotherapy following mastectomy +and 59 subjects received radiotherapy following mastec- +tomy and three cycles of chemotherapy. The mean age of +the study population in yoga group was (46.7 ± 9.3 years) +and control group was (48.5 ± 10.2 years). Majority of sub- +jects belonged to middle class (94.2%) and remaining 5.8% +belonged to upper middle class. 9% of the population had +some previous exposure to yoga practices though none of +them seemed to practice it in the last few years. Par- +ticipants in both groups were comparable with respect to +socio-demographic and medical characteristics (Table 1). All +subjects in the intervention group tolerated the intervention +with out any adverse events. +Outcome measures +A repeated measures analysis of variance was done using +post hoc Holms—Bonferroni correction on positive affect +scores. Intention to treat analysis on the initially randomized +sample showed significant improvement in PA (Mean dif- +ference ± SE, p-value, 95%CI) (4.52 ± 1.7, p = 0.007, 1.25 to +7.8), decrease in NA (−8.95 ± 2.3, p < 0.001, −13.4 to −4.4), +improvement in emotional function (15.88 ± 4.75, p = 0.001, +6.45 to 25.33) and cognitive function (9.8 ± 4.35, p = 0.03, +1.2 to 18.5) in yoga group as compared to controls following +intervention. There was a significant improvement in posi- +tive affect (−3.81 ± 1.1, p < 0.001, 1.75 to 5.89), decrease +in negative affect (9.25 ± 1.45, p < 0.001, 6.4 to 12.1), +improvement in emotional (−18.63 ± 2.8, p < 0.001, −24.3 +to −12.9) and cognitive function (5.27 ± 2.69, p = 0.05, +−10.63 to −0.007) in yoga group following intervention +(T1—T2). There was also a significant decrease in negative +affect (3.37 ± 1.5, p = 0.02, 0.49 to 6.24), improvement in +physical function (−6.23 ± 2.9, p = 0.03, −11.9 to −0.49) +and emotional function (−7.66 ± 2.88, p = 0.009, −13.4 to +−1.9), in control group following intervention. +There was no significant change in social function and role +function following intervention in both the groups (Table 2). +Bivariate relationships +Bivariate relationships were determined between the out- +come measures. There was a significant positive correlation +between PA with physical function (p = 0.002), emotional +function (p < 0.001), cognitive function (p = 0.01), social +function (p = 0.007) and global quality of life (p < 0.001). +There was a significant negative correlation between +NA with emotional function (p < 0.01), physical function +(p = 0.004), cognitive function (p = 0.001), global quality of +life (p = 0.001) and social function (p = 0.008) (Table 3). +Adherence to intervention +Adherence to intervention was good with 29.7% attending +10—20 supervised sessions, 56.7% attending 20—25 super- +vised sessions and 13.7% attending >25 supervised sessions +over a 6-week period. Level of adherence did not seem to +affect quality of life or affect scores (results not shown). +Table 3 +Pearson correlation (r-values) between affect +(PANAS) and functional subscales on EORTCQoL C30. +Functional subscales +on EORTCQoL C30 +PANAS-P +, r +PANAS-N, r +Physical function +0.32** +−0.31** +Role function +0.26* +−0.16 +Cognitive function +0.27*** +−0.35** +Emotional function +0.4*** +−0.64*** +Social function +0.29** +−0.28** +GQOL +0.50*** +−0.36** +p-Values for Pearson correlation coefficients. +* p < 0.05. +** p < 0.01. +*** p < 0.001. +Author's personal copy +Effects of yoga program +279 +Discussion +We compared the effects of a 6-week integrated yoga pro- +gram with supportive therapy in stage II and III breast cancer +patients undergoing adjuvant radiotherapy. There was a +significant difference across groups over time for positive +affect, negative affect, and emotional function. There was +significant improvement in positive affect, emotional func- +tion and cognitive function, and decrease in negative affect +in the yoga group as compared to controls. +Though intervention showed small to large effect size for +these outcome measures, the effect size was highest for +decrease in negative affect and lowest for physical function +scores on quality of life subscale. This is in contrast to earlier +study (Moadel et al.) that has shown improvements in qual- +ity of life, emotional, social and spiritual well being even +with poor adherence to yoga intervention. This could be +due to the fact that their study21 lacked a control interven- +tion and differed from ours with respect to scales used for +measuring QoL (Functional Assessment of Cancer Treatment- +Breast), ethnicity of study population and heterogeneity in +conventional cancer treatments. In their study radiother- +apy predicted poor adherence to treatment and outcome +measures. However, adherence to intervention was better in +our study with 56.7% attending 20—25 supervised yoga ses- +sions and 13.7% attending >25 supervised yoga sessions over +a 6-week period. This was primarily due to the fact that all +patients were undergoing adjuvant radiotherapy and were +visiting the hospital 5 days a week for six consecutive weeks +and this could have contributed to improved adherence. Our +results are also in contrast to earlier study using MBSR inter- +vention that has shown some improvement in functional +scales that were not significant following intervention. In +this study too adherence to intervention, duration and het- +erogeneity in cancer population could have confounded the +actual effects of intervention.32 However, adherence did not +seem to influence the outcome measures possibly due to +the fact that an improved adherence created an ‘‘overall +floor effect’’ thereby not influencing the outcome mea- +sures. +Several studies have shown that both psychological and +treatment related distress affect quality of life concerns +in cancer patients.38—41 Cancer patients have to constantly +make lifestyle changes to adjust and cope with these treat- +ment related distress and seek supportive care.42 Yoga +and exercise as a lifestyle and stress reduction interven- +tion has shown to decrease negative affect and improve +positive affect.26—28 This change in affect could have con- +tributed to improvement in quality of life concerns in these +patients. This is further corroborated by our results with +decrease in negative affect being related to improvement +in physical function, emotional function and social func- +tion and improvement in positive affect being related to +improvement in role function. Possible threat perceptions +and intrusive thoughts could motivate cancer patients to +pursue health care behaviors that offer spiritual solace.43 +It is here that yoga as a psycho-spiritual intervention could +offer much needed support. However, in our study we were +not able to assess this spiritual component in quality of life, +nevertheless it could be one of the possible mechanisms +by which yoga could have influenced other quality of life +domains. +Using patients with high school education could have +affected the generalizability of the study findings. Though +the intervention was imparted as individual sessions, group +sessions could have been more feasible and far more acces- +sible. Sessions in a group setting could have instilled a sense +of community where patients could model successful coping +and gain self-esteem and motivation in their ability to help +others in a group contributing to improvement in outcome +measures.44,7 This could have confounded the effects of our +intervention and hence we chose to have individual sessions +in this study. However, considering the adherence neither +access nor feasibility was a problem. None of the subjects +who underwent intervention had any adverse effects of +intervention suggesting that these interventions were safe +and feasible. +The contrast in results from earlier studies could be due +to lack of concordance between EORTCQoL C30 and FACT +scales on several domains of quality of life.45 Though this +could be a limitation, our results still offer support for +improving quality of life concerns in a homogenous group of +breast cancer patients similar to our earlier observations on +reductions in anxiety23 and distressful symptoms.24 However, +larger randomized controlled studies using more structured +behavioral approaches and multiple assessment tools are +needed to further validate our findings. +Acknowledgements +We are thankful to Ms. Jayalakshmi for imparting the yoga +intervention. We are thankful to Dr Ravi Kulkarni for his +advice and help with statistical analyses. +References +1. 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Comparison of two quality-of-life instruments for cancer +patients: the functional assessment of cancer therapy-general +and the European Organization for Research and Treatment +of Cancer Quality of Life Questionnaire-C30. J Clin Oncol +1999;17:2932—40. diff --git a/subfolder_0/Efficacy of yoga based life style modification program on medication score and lipid profile in type 2 diabetes.txt b/subfolder_0/Efficacy of yoga based life style modification program on medication score and lipid profile in type 2 diabetes.txt new file mode 100644 index 0000000000000000000000000000000000000000..74d8b39bd4328e2969fbba256412a554c9018298 --- /dev/null +++ b/subfolder_0/Efficacy of yoga based life style modification program on medication score and lipid profile in type 2 diabetes.txt @@ -0,0 +1,1100 @@ +ORIGINAL ARTICLE +Efficacy of yoga based life style modification program +on medication score and lipid profile in type 2 +diabetes—a randomized control study +R. Nagarathna & M. R. Usharani & A. Raghavendra Rao & R. Chaku & +R. Kulkarni & H. R. Nagendra +Received: 13 April 2011 /Accepted: 15 May 2012 /Published online: 1 August 2012 +# Research Society for Study of Diabetes in India 2012 +Abstract Several studies have documented the beneficial +short term effects of yoga in type 2 diabetics. In this pro- +spective two-armed interventional randomized control study, +277 type 2 diabetics of both genders aged above 28 years +who satisfied the study criteria were recruited from 5 zones +in and around Bengaluru, India. They were allocated to a +yoga-based life style modification program or exercise-based +life style modification program. Integrated yoga special tech- +nique for diabetes included yogasanas, pranayama, medita- +tion and lectures on yogic life style. Control intervention +included physical exercises and life style education. Medi- +cation score, blood glucose, HbA1c and lipid profile were +assessed at baseline and after 9 months. Intention to treat +analysis showed better reduction (P<0.05, Mann-Whitney +test) in the dose of oral hypoglycemic medication required +(Yoga - 12.8 %) (Yoga-12.3 %) and increase in HDL (Yoga- +7 %) in Yoga as compared to the control group; FBG +reduced (7.2 %, P00.016) only in the Yoga group. There +was significant reduction within groups (P<0.01) in PPBG +(Yoga-14.6 %, Control-9 %), HbA1c (Yoga-14.1 %, +Control-0.5 %), Triglycerides (Yoga-15.4 %, Control- +16.3 %), VLDL (Yoga-21.5 %, Control-5.2 %) and total +cholesterol (Yoga-11.3 %, Control-8.6 %). Thus, Yoga based +life style modification program is similar to exercise-based +life style modification in reducing blood glucose, HbA1c, +triglycerides, total cholesterol and VLDL. Yoga is better than +exercise in decreasing oral hypoglycemic medication re- +quirement and LDL; and increasing HDL in type 2 diabetics. +Keywords Yoga . Exercise . Hypoglycemic agent . HDL . +Blood glucose +Introduction +Diabetes mellitus is a major global health problem affecting +150 million people worldwide. In India, the prevalence of +type 2 diabetes (T2DM) and premature coronary artery +disease is rapidly escalating in all socioeconomic groups +parallel with the obesity epidemic [1]. +R. Nagarathna (*) +Division of Yoga and Life Sciences, Swami Vivekananda +Yoga Anusandhana Samsthana, (SVYASA) University, +Eknath Bhavan, 19, Gavipuram circle, Kempegowda Nagar, +Bengaluru 560019, India +e-mail: rnagaratna@gmail.com +R. Nagarathna +e-mail: hrn@vyasa.org +M. R. Usharani: A. R. Rao: R. Chaku: R. Kulkarni: +H. R. Nagendra +SVYASA University, +Eknath Bhavan, 19, Gavipuram circle, Kempegowda Nagar, +Bengaluru 560019, India +M. R. Usharani +e-mail: ushaayur@rediffmail.com +A. R. Rao +e-mail: rao_raghav@yahoo.com +R. Chaku +e-mail: chattha.ritu@yahoo.com +R. Kulkarni +e-mail: ravithek@gmail.com +H. R. Nagendra +e-mail: hrn@vyasa.org +R. Chaku +WHO project, Morarji Desai National Institute of Yoga, +New Delhi, India +Present Address: +A. R. Rao +HOD, Department of Complementary and Alternative Medicine, +Bangalore Insititute of Oncology, +Bengaluru 560027, India +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 +DOI 10.1007/s13410-012-0078-y +The primary reasons for this rapid global epidemiological +transition include aging of the population [2], genetic factors +[3], changing life style with altered dietary patterns with +decreased physical activity [4], and psychosocial stresses +[5]. The associated lipoprotein abnormalities such as elevated +concentrations of triglycerides and LDL, with decreased +HDL, and the oxidative stress play an important role in the +occurrence of early atherosclerosis in diabetics. Hence, the +primary role of life style modification programs that include +exercise, diet and stress reduction has been widely accepted +to reduce the incidence of type 2 diabetes [6, 7, 8]. There are +reports that the physician’s advice in a diabetic clinic is +usually ineffective [8]. Studies have also shown that people +have considerable interest in lifestyle interventions than a +pharmaceutical trial [9]. Incidence of type 2 diabetes has +reduced by 40 to 60 % over 3 to 4 years in high risk +population in USA after modest weight loss through diet +and physical activity [7]. +Alternative methods of exercise, stress reduction [10], +and relaxation techniques [11] including cognitive behav- +iour therapy [12] have been shown to improve the mood +with better glycemic control and prevention of complica- +tions of the metabolic syndrome. Psychological stresses +resulting in depression contributes to poor compliance and +outcome of therapeutic measures [6] and its treatment has +shown better glycemic control and improved quality of life +[13]. Yoga has been explored scientifically since the 1970’s +as a widely available resource for life style-related problems +such as hypertension [14], bronchial asthma [15], diabetes +[16] and coronary artery disease [17]. A critical review of all +published literature from 1970 to 2006 on the effects of +yoga based programs on the risk profiles in adults with +T2DM showed that yoga reduces the risk profiles and may +help in prevention and management of its cardiovascular +complications [18]. These beneficial effects of yoga seem to +be due to the relaxation response [16] that has the potential +to reduce the heightened stress responses through techni- +ques that promote mastery over the modifications of mind +[19]. +Studies in India have also shown the beneficial effects of +yoga in diabetics. Damodaran et al observed decrease in +blood pressure, drug scores, sympathetic activity (VMA +catecholamine and MDA), oxidant stress (vitamin C cholin- +esterase) and improvements in risk factors such as blood +glucose, cholesterol and triglycerides with better subjective +well being and quality of life in a non randomized study +on outpatients for 3 months [20]. Singh et al showed +significant decrease in fasting and post prandial blood +glucose levels and glycosylated hemoglobin with stable +autonomic functions after forty days of yogic exercises in +Type 2 Diabetics [21]. +More recently, Hegde et al (2011) in south India in a +stratified control trial studied diabetics with and without +complications (peripheral neuropathy or microvascular or +macrovascular) and observed significant reduction in BMI, +improved glycemic control, and oxidative stress within +3 months when yoga was added to standard care [22]. Yoga +improved the ‘heart friendly’ status of lipid profile in peri +and post-menopausal patients receiving standard medical +treatment for type 2 DM with decrease in low density +lipoprotein as well as fasting and postprandial blood glucose +levels within six weeks [23]. A review by the American +diabetes association on yoga and other mind body interven- +tion concluded that clinical trials on patients with diabetes +have shown improvement in measures of quality of life and +stress but consistent long-term improvements in glycemic +control or HbA1C have not been documented [24]. +There are not many long-term follow up studies which +have directly compared the effects of exercise with yoga on +medication requirement and lipid profile. Hence, the present +study was planned with an objective to compare the efficacy +of a Yoga based Life Style modification Program (YLSP) +with conventional Exercise based Life Style modification +Program (ELSP) in type 2 diabetics, with the hypothesis that +YLSP will be better than ELSP, in achieving better control +of diabetes with favourable changes in medication require- +ment and lipid profile. +Subjects and methods +Design +The study Registered Trial number - CTRI/2008/091/ +000293 was a prospective randomized two arm parallel +control study with active intervention for the control group. +The research protocol was approved by the Ethics Committee +of SVYASA University. Signed informed consent was +obtained from all participants before recruitment. +Subjects +The participants were selected from five different zones +(east, west, north, south and central) in and around Bengaluru +city, India, between 2003–2007. Inclusion criteria were, (a) +type 2 diabetics of both sexes above 25 years, (b) fasting +venous blood glucose level >120 mg% at the time of diag- +nosis (checked from their records), (c) T2DM of more than +one year, (d) those stabilized on a stable dosage of oral +hypoglycemic agents or insulin for at least three weeks +and (e) no prior exposure to yoga practice. Those with major +complications of T2DM such as chronic infections (tubercu- +losis, HIV), coronary artery disease, severe hypertension, +nephropathy, proliferative retinopathy and/or cerebrovascular +disease were excluded. Those with peripheral neuropathy, +mild urinary or cutaneous fungal infections, mild to moderate +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 +123 +hypertension and obesity were not excluded. The sample size +was calculated by Cohen’s formula [25] with alpha of 0.05, +powered at 0.80 for an effect size of 0.34 based on our earlier +interventional study [16]. All participants who satisfied the +selection criteria and signed the informed consent were +assigned a numbered envelope containing a computer gener- +ated random number (using www.randomizer.org). To conceal +bias during randomization, the statistician at the university +centre, who was not involved in administering the interven- +tion, allocated them to yoga or control groups. Different +random number tables were used for five different venues. +Masking +As this was an interventional study blinding was not possible. +The laboratory staff and the statistician were blind to the +source of the data. Care was taken to prevent crossover of +participants or interaction between the two groups. +Methods +Within one week after recruitment all baseline data were +documented. Those who needed any change in the dosage of +oral hypoglycemic medication or insulin were made to wait +for 3 weeks for a second assessment before starting the +intervention. Both groups were trained by certified thera- +pists through daily (one hour/day - 5 days /week) classes, for +12 weeks followed by weekly follow up classes for 2 h for +9 months. During the follow up period they were asked to +continue the practices for 1 h daily at home using a pre- +recorded instruction audio tape. All participants were pro- +vided with a diary to tick the type and duration of their daily +recommended practice, monthly fasting and post-prandial +blood glucose levels, body weight, visits to family physician +for any health problem, episodes of hypoglycemia, and any +change in their diet, medication or daily practice of yoga or +exercise. The medical officer and the dietitian were avail- +able at the venue once a month to check their progress and +advise suitable changes. All outcome measures for the study +were checked at the end of 9 months. +Intervention +The modules of intervention for the two groups were care- +fully developed by a team consisting of two senior yoga +experts of the university, a psychiatrist and a diabetologist. +Table 1 shows the details of the intervention for the two +groups. The interventions for both modules were aimed at +achieving, (a) conventional diabetes education, (b) stress man- +agement, and (c) empowerment for adherence to long term life +style change. The specific yoga module for YLSP was the +same as that used in our earlier study on yoga in diabetes [16]. +This ‘Integrated Approach of Yoga for Diabetes (IAYD)’ is +based on the knowledge culled out from yoga scriptures +(Patanjali yoga sutras, Bhagvadgita and Mandukya karika). +The practices included (i) physical practices such as cleans- +ing techniques (kriyas), loosening practices (shithilikarana +vyayama), sun salutation (suryanamaskara) and yoga pos- +tures (asanas) to provide mild intensity physical exercise +effect. (ii) Pranayama and meditation (dharana and dhyana) +for calmness of mind, (iii) devotional sessions (Bhakti +yoga) for better emotional stability and (iv) lectures and +yogic counseling for notional correction through self +analysis (Jnana yoga) [16, 26]. The kriyas (Neti, Dhouti +and Shankaprakshalana) were done once a week. The ELSP +module consisted of (i) standard physical training (PT) exer- +cises and walking designed to achieve a comparable intensity +of physical exertion, (ii) non-yogic breathing exercises used in +physiotherapy and (iii) supine rest. Both groups had access to +reading material on conventional diabetes education. +Measurements +Baseline measurements before recruitment included demo- +graphic data and investigations to satisfy the selection crite- +ria. They were (i) fasting blood glucose, (ii) resting blood +pressure using a sphygmomanometer, (iii) electrocardio- +gram using a portable ECG recorder (one channel recorder, +version 6108 T, BPL, India), (iv) fundoscopy by a certified +ophthalmologist and (v) serum urea and creatinine [27] to +look for nephropathy. +Outcome measures +A semi-structured interview for medical history, and demo- +graphic data were recorded by the medical officer after +recruitment. +1. +Medication score: The oral medication scores (standard +quantity of the drug per tablet as indicated in CIMS +India [28] expressed as number of tablets per day) were +calculated separately for each category i.e. Oral Hypo- +glycemic Agents (OHA), Lipid Lowering Drugs (LLD) +and Antihypertensive drugs (AHT). Total medication +score indicates the total number of tablets of all drugs +consumed in a day. The insulin score was calculated by +using a scoring system ranging from 0–3 (00nil, 1e15 +units, 2016–30 units, 3>30 units), for the total number +of units of insulin injected in 24 h. +2. +Biochemical measures included blood glucose, HbA1c +and lipid profile. Blood samples were drawn from an ante- +cubital vein in the fasting state (Fasting Blood Glucose— +FBG) between 8 am and 9 am, and 2 h after breakfast +(Post-Prandial Blood Glucose—PPBG) between 10 am +and 11 am. The participants were instructed to abstain +from morning yoga or PT exercises on the day of blood +124 +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 +Table 1 Practices used for the +intervention in both groups +YLSP Yoga based Life Style +change Program, ELSP Exercise +based Life Style change Program +Practices for Yoga (YLSP) group +Practices for control (ELSP) group +Breathing Exercises +Exercises in standing position +Shasha Shwasa (Rabbit Breathing) +Forward backward bending +Vyaghra Shwasa(Tiger Breathing ) +Side bending +Navasana Shwasa (Boat Breathing) +Jogging +Shithilikarana Vyayama (yogic loosening) +Sit-up +Padahatasana Ardha Cakrasana Chalana +(Forward Backward Bending) +Twisting +Cross leg lifting +Trikonasana Chalana (Side Bending) +Alternative toe touching +Kati Parivartana Chalana (Twisting) +Hip rotation +Dhanurasana Chalana (Swinging in Bow) +Knee rotation +Pavanamuktasana Kriya (wind releasing) +forward drill +Surya Namaskara (Sun Salutation) +Backward drill +Shavaansa (Quick Relaxation Technique—QRT) +Sideward drill +Asanas (Yoga postures) +Neck movements +Parivritta Trikonasana (Twisted triangle) +Shoulder rotation +Vakrasana or Ardha Matsyendrasana +(Spinal Twist or Sage Matsyendra posture) +Full arm rotation +Ustrasana (Camel) +Free walking +Hamsasana or Mayurasana (Swan or Peacock) +Exercises in sitting position +Bhujangasana (Cobra) +Knee cap tightening +Dhanurasana (Bow) +Swimming +Sarvangasana (Whole Body Inverted posture) +Supine relaxation +Matsyasana (Fish) +Half butterfly exercise +Deep Relaxation Technique (DRT) +Chakki chalana (waist twisting)) +Bandhas (locks) and Kriyas (cleansing) +Ankle bend exercise +Jala Neti (nasal wash with water) +Toe Bend exercise +Sutra Neti (nasal wash with catheter) +Crow walking +Vaman Dhouti (yogic vomiting) +Knee rotation +Shankha Prakshalana(yogic bowel cleansing) +Exercises in prone position +Uddiyana Bandha (diaphragm lock) +Prone bow swing +Agnisara Kriya( abdominal flap) +Prone Alternate +Kapalabhati (Blasting breath) +head and leg swing +Pranayama (yogic breathing) +Boating +Vibhagiya Pranayama (Sectional Breathing) +Rolling +ujjayi (glottis breathing) +Alternate Arm swing +Nadi Suddhi (alternate nostril) +Hip stretch +Sitali or Sitkari (cooling breath) +Exercises in Supine position. +Bhramari (Bee Breathing) +Cycling +Meditation (Dharana and Dhaya) +Straight leg rising +Nadanusandhana (sound resonance Merger) +Side leg rising +Om Meditation (meditation on Om syllable) +Knee exercise +Lectures—topics covered +Dorsal Stretch +Diabetes: burden, causes, management +Rolling and rocking +Yogic concepts of healthy life style +Supine rest +including thinking, feeling and behaviour, +Lectures—topics covered +Yogic management of stress, +Diabetes: burden, cause, management causes, management. +Diabetes and yoga Diet, +Modern scientific concepts of healthy life style including +thinking, feeling and behaviour +How to stop smoking, the yogic way +Modern concepts of management of stress and how to stop +smoking +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 +125 +collection. The sera were separated within an hour of +collection. A certified technician carried out all the tests +at the SVYASA university laboratory. Heparinised blood +was used to analyze HbA1c by using affinity assay meth- +od on a Nycocord reader [29]. The concentration of +glucose was determined by using glucose-oxidase method +[30] and serum total cholesterol, triglyceride and HDL by +enzymatic methods [31]. High density lipoprotein was +measured after precipitating VLDL and LDL cholesterol +in the presence of magnesium ions. The VLDL and LDL +fractions were calculated by the Friedwald’s formula [32]. +Statistical analysis +Data were analyzed using SPSS version 16. The baseline data +were not normally distributed (Shapiro Wilk’s test P<0.05). +Mann Whitney test was used for pre values for checking the +baseline matching. As there was an attrition rate of about 38 % +by the 9th month, we carried out ‘intention to treat analysis’ +considering both pre and post data as predictors [33–35] based +on the concept of ‘Expectation Maximisation’. Wilcoxon’s +signed ranks test was used to compare the pre-post changes +and Mann-Whitney ‘U’ test to compare groups. +Results +Figure 1 shows the trial profile. Out of 520 screened, 277 +(87 females) participants (141 in YLSP and 136 in ELSP), +were randomized into two groups; 264 completed the initial +12 weeks of training and 173 (88 in yoga and 85 in control +group) completed the study. The reasons for drop outs are +given in Fig. 1. Table 2 shows the demographic features. +There was no baseline matching between groups in mean +duration of diabetes before recruitment (6.19±5.49 years +in YLSP and 4.75±4.18 years in ELSP). The baseline +measurements used to rule out nephropathy before recruit- +ment was matched for creatinine concentration and blood +urea nitrogen in both groups. +Medication score (Table 3) +Oral hypoglycemic drug requirement reduced in 30 partic- +ipants in YLSP and 14 in ELSP with significant reduction of +mean scores in YLSP (12.8 %, P<0.001) and non-signifi- +cant reduction (3.7 %) in ELSP. There was significant dif- +ference between groups at P00.05 (Mann Whitney). The +total medication that included all categories of drugs re- +duced by 10.9 % in YLSP (P00.004) with no significant +difference in ELSP or between groups. It reduced in 35 +patients in YLSP and 19 patients in ELSP. Amongst those +who were taking insulin (16 in YLSP and 10 in ELSP) at the +time of recruitment, five in YLSP group and one in ELSP +had discontinued (no significant statistical change). +Lipid profile (Table 4) +HDL increased by 7 % in YLSP (P00.002) with significant +difference between groups (P00.007). LDL reduced signif- +icantly in YLSP by 12.3 % (P<0.001), with difference +between groups at P00.003. Triglycerides, total cholesterol +and VLDL reduced significantly in both groups with non +significant differences between groups and better effect +sizes in yoga group. +Changes in blood glucose (Table 4) +There was a significant reduction in FBG by 7.2 % in +YLSP (P00.016) at 9th month. PPBG reduced significant- +ly in both the groups, 14.6 % in YLSP (P<0.001) and +8.9 % in ELSP (P00.019) groups, with non-significant +difference between groups. The concentration of HbA1c +reduced in both groups, 14.1 % in YLSP (P<0.001) and +0.5 % in ELSP (P00.002) with no significant difference +between groups. +Subgroup analysis based on duration of illness: +A subgroup analysis was done between groups with a +median cut off of 5 years for duration of illness. The +trends observed between groups when duration of +illness was <5 years or >5 years was similar to trends +seen when groups were compared without cut offs for +duration of illnesses as reported above. Hence, this has +not been reported separately in tables. +Discussion +This was a prospective randomized control study that com- +pared YLSP with ELSP on 277 participants with type 2 +diabetes selected from 5 zones in and around Bengaluru. +After 9 months of intervention there was significant differ- +ence between groups (P<0.01) in HDL, LDL and medica- +tion requirement with higher effect sizes in YLSP group. +There was reduction in PPBG and HbA1c, triglycerides, +total cholesterol and VLDL in both groups with better effect +sizes in yoga group (non-significant differences between +groups) whereas FBG reduced significantly only in the yoga +group. A review by Innes KE et al [18] of 25 yoga studies +on type 2 diabetics (of which 4 were RCTs), concluded that +yoga practice was associated with reduction of 6.1–34.4 % +126 +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 +in blood glucose and 10.5–27.3 % in HbA1c. A recent three +armed RCT showed a 30 % reduction in FBG with no +changes in HbA1c or medication scores after 6 months of +yoga [36]. Our study adds evidence to the efficacy of yoga +in a south Indian diabetic population. This is the first study +that has documented significantly better reduction in oral +hypoglycemic agents (12.8 %) in YLSP than ELSP. +Significant reduction in serum total cholesterol, triglycer- +ides and LDL concentrations in type 2 diabetics after yoga +exercises [37] and Sudarshan Kriya Yoga (SKY) [38] have +Table 2 Demographic data +YLSP Yoga based Life Style +change Program, ELSP Exercise +based Life Style change +Programs +Variables +YLSP group (141) +ELSP group (136) +1 +Gender +Males +91 +99 +Females +50 +37 +2 +Age +Range +30–78 years +30–74 years +Mean±SD +53.46±8.86 +51.38±8.39 +3 +Education +School +78 +73 +Undergraduates +36 +38 +Graduates +27 +22 +Post Graduates +– +3 +4 +Socio-Economic Status +Upper class +1 +0 +Middle class +140 +136 +5 +Duration of DM +Mean±SD +6.19±5.49 +4.75±4.18 +1–5 +92 +96 +5.1–10 +25 +29 +10–20 +20 +9 +20–30 +2 +1 +30–40 +2 +1 +6 +Family History of DM2 +63 +45 +7 +Tobacco chewing +19 +9 +8 +Alcohol Consumption +13 +12 +Control group -136 +Yoga group - 141 +SCREENED - 520 +Recruited & Randomized - 277 +Not interested - 63 +Did not fulfill the selection criteria - 78 +Interested but could not commit for the +study - 102 +9 months - 88 +(62.4%) +Drop outs - 53 +Time constraints - 13 +Minor Illnesses - 6 +Personal reasons - 15 +Secondary complications - 3 +Shifted to other systems - 6 +Change of address - 10 +4 weeks -135 +(96%) +Drop outs - 51 +Time constraints - 12 +Minor Illnesses - 4 +Personal reasons-10 +Secondary complications - 8 +Shifted to yoga - 5 +Shifted to other systems - 5 +Change of address - 7 +Death - 1 +4 weeks -129 +(95%) +3 months -112 +3 months -105 +6 months - 97 +6 months - 91 +9 months - 85 +(62.5%) +Fig. 1 Trial profile +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 +127 +Table 3 Results- Changes in +medication scores after 9 months +of intervention in both groups +OHA Oral Hypoglycemic +Agents, LLD Lipid Lowering +Drugs, Anti HT Antihyperten- +sive drugs, ES Effect Size, NS +Not Significant +Variable +Group +Pre-intervention +Post-intervention +% Change +Within groups +Between groups +Mean±SD +Mean±SD +P +ES +P +ES +Total +YLSP (N0141) +3.38±2.19 +3.01±1.88 +10.94 +0.004 +0.29 +NS +– +ELSP (N0136) +3.24±1.95 +3.15±1.74 +2.77 +0.37 +0.09 +OHA +YLSP +2.27±1.29 +1.98±1.27 +12.77 +<0.001 +0.37 +0.05 +0.25 +ELSP +2.41±1.52 +2.32±1.42 +3.65 +0.22 +0.11 +NS +– +LLD +YLSP +0.76±0.44 +0.88±0.48 +15.79 +NS +– +NS +– +ELSP +0.77±0.43 +0.92±0.28 +19.48 +NS +Anti HT +YLSP +1.10±0.52 +1.08±0.47 +1.81 +NS +– +NS +– +ELSP +0.98±0.68 +1.02±0.51 +4.08 +NS +Table 4 Changes in glycemic control and lipids in both groups after 9 months of intervention +Variables +YLSP (N0141) +ELSP (N0136) +Between Groups +Mean±SD +95% CI +pre-post +Mean±SD +95% CI +pre-post +ES +P Post YLSP vs +Post ELSP +LB +% +P +LB +% +P +UB +ES +UB +ES +FBG +Pre +133.72±44.52 +126.65 +7.2% +0.016 +130.31±39.58 +123.21 +3.9 % +NS +0.03 +0.53 +140.78 +137.40 +Post +124.08±32.46 +118.93 +0.22 +125.20±32.65 +119.34 +0.12 +129.23 +131.05 +PPBG +Pre +184.02±72.53 +172.51 +14.6% +<0.001 +171.90±65.25 +160.21 +8.9% +0.019 +0.01 +0.72 +195.53 +183.60 +Post +157.19±55.22 +148.43 +0.36 +156.48±55.01 +146.62 +0.21 +165.95 +166.34 +HbA1c +Pre +8.54±1.68 +8.27 +14.1% +<0.001 +8.07±1.42 +7.81 +0.5% +0.002 +0.19 +0.11 +8.80 +8.32 +Post +7.33±3.00 +6.86 +0.38 +8.03±4.26 +7.27 +0.01 +7.81 +8.80 +HDL +Pre +44.75±13.82 +42.56 +7% +0.002 +45.11±13.43 +42.70 +2.1% +NS +0.32 +0.007 +46.95 +47.52 +Post +47.88±11.80 +46.01 +0.20 +44.16±11.51 +42.10 +0.06 +49.75 +46.22 +LDL +Pre +91.16±33.10 +85.90 +12.3% +0.001 +92.59±35.26 +86.27 +0.9% +NS +0.38 +0.003 +96.41 +98.91 +Post +79.89±30.20 +75.10 +0.28 +91.72±31.93 +86.00 +0.02 +84.68 +97.45 +Trigly +Pre +174.10±81.22 +161.22 +15.4% +<0.001 +180.86±102.59 +162.47 +16.3% +0.018 +0.08 +0.64 +186.99 +199.25 +Post +147.28±49.14 +139.49 +0.31 +151.38±51.66 +142.12 +0.28 +155.08 +160.64 +T.Cho +Pre +182.86±39.55 +176.58 +11.3% +<0.001 +182.09±41.31 +174.69 +8.6% +<0.001 +0.11 +0.38 +189.13 +189.50 +Post +162.20±36.74 +156.37 +0.47 +166.34±37.94 +159.54 +0.32 +168.03 +173.14 +VLDL +Pre +44.30±23.26 +40.61 +21.5% +<0.001 +42.33±17.71 +39.16 +5.2% +0.009 +0.23 +0.18 +47.99 +45.50 +Post +34.76±12.12 +32.84 +0.38 +40.13±31.14 +34.55 +0.06 +36.69 +45.71 +YLSP Yoga based Life Style change Program, ELSP Exercise based Life Style change Program, ES Effect Size, FBG Fasting Blood Glucose, PPBG +Post Prandial Blood Glucose, HbA1c Glycosylated Hemoglobin, HDL High Density Lipoprotein, LDL Low Density Lipoprotein, Trigly +Triglycerides, T.chol Total Cholesterol, VLDL Very Low Density Lipoprotein +128 +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 +been observed. The yoga exercise study [37] showed an +increase in HDL whereas this was not achieved after SKY. +Significant improvement in HDL and LDL profiles in YLSP +group in the present study with an increase in HDL (7 %) in +the yoga group is noteworthy. +Several studies have proven the efficacy of different +types of exercises in increasing HDL and decreasing LDL +[6, 10–12, 39]. It appears that moderate intensity exercises +(and not vigorous intensity exercises) are effective in reduc- +ing VLDL complex of triglycerides, whereas sustained in- +crease in HDL may occur only after vigorous exercises such +as jogging [39]. This may explain the non-significant +changes in HDL and LDL in our ELSP group. This also +seems to indicate that the increase in HDL found in the +YLSP group may involve pathways other than its exercise +component. Activation of hypothalamic pituitary axis +(HPA) axis and sympatho-adrenal system is known to in- +hibit glucose uptake by peripheral tissues by inhibiting +insulin release, inducing insulin resistance and increasing +hepatic glucose production [40]. Better sympathovagal bal- +ance [16, 41] better insulin receptor sensitivity [42, 43] and +reduced oxidative stress [44] may have contributed to the +beneficial effects of the integrated yoga practices. +Major strengths of this study includes, the longitudinal +prospective randomized multi-venue control design with +good sample size selected from five zones of a metropolitan +city in south India, active intervention for the control group, +follow up duration of nine months and the results showing +significant reduction in oral hypoglycemic medication better +than control group. Limitations of this study were: (a) the +data of body weight, BMI and calorie intake before and after +the intervention could not be reported because different +instruments were used in different venues. These parameters +were documented in the diaries and used for advice during +the monthly medical monitoring; (b) the compliance for the +initial classes of 12 weeks was good with 95 % attendance +with an attrition rate of 38 % by 9th month. This attrition rate +is similar to that reported in clinical trials involving diabetics +for self monitoring and management of diabetes (2.3 % – +50 %) [33]. This attrition rate could be attributed to longer +duration of intervention. The yoga based lifestyle program +was safe and did not cause any injuries to participants. All +facets of the yoga program were equally adhered to by the +participants. +In conclusion, YLSP is better than ELSP in reducing the +requirement of oral hypoglycemic agents, increasing HDL +and decreasing LDL and YLSP is similar to ELSP in reduc- +ing blood glucose, HbA1c, triglycerides, VLDL and total +cholesterol levels. Our study suggests that yoga, a non- +expensive technique that has become popular around the +globe with good acceptability and generalizability, may be +incorporated in all primary and secondary prevention pro- +grams for type 2 diabetics in clinical practice. +Future research should be three armed randomised con- +trol designs to control for other confounding variables such +as diet, weight and monitoring of VO2 max to match the +intensity of exercises between groups and inclusion of other +measures to understand the underlying mechanisms. +Acknowledgments +The study was funded by the Department of +Ayurveda, Yoga, Unani, Siddha and Homoeopathy (AYUSH), Ministry +of Health and family welfare, New Delhi, India under the ‘Extra Mural +Research’ scheme. The AYUSH technical expert committee had +reviewed the study design. We thank Dr Srikanta SS, Dr Vadiraja +HS, Dr Shruddha K, Dr Bogavi L, Dr Mallikarjuna, Dr Srividya, Dr +Pradhan B, Omkar G, the management, doctors and the paramedical +staff of TVS company, and BEML company the management of Satya +Sai trust, Diwakar hospital. +References +1. Mohan V, Jaydip R, Deepa R. Type 2 diabetes in Asian Indian +youth. Pediatr Diabetes. 2007;8 Suppl 9:28–34. +2. Winer N, Sowers JR. Diabetes and arterial stiffening. Adv Cardiol. +2007;44:245–51. +3. Ramachandran A, Snehalatha C, Sivasankari S, Hitman GA, Vijay V. +Parental influence on the spectrum of type 2 diabetes in the offspring +among Indians. J Assoc Physicians India. 2007;55:560–2. +4. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiol- +ogy of type 2 diabetes: Indian scenario. Indian J Med Res. +2007;125:217–30. +5. Chandola T, Brunner E, Marmot M. Chronic stress at work and the +metabolic syndrome: prospective study. BMJ. 2006;332:521–5. +6. 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Singh S, Malhotra V, Singh K, Sharma S. A preliminary report on +the role of yoga asanas on oxidative stress in non-insulin +dependant diabetes. Indian J Clin Biochem. 2001;16:216–20. +130 +Int J Diabetes Dev Ctries (July–September 2012) 32(3):122–130 diff --git "a/subfolder_0/Evaluation and Comparison of Sleep Quality among Medical and Yogic Students \342\200\223 A Questionnaire Based Study..txt" "b/subfolder_0/Evaluation and Comparison of Sleep Quality among Medical and Yogic Students \342\200\223 A Questionnaire Based Study..txt" new file mode 100644 index 0000000000000000000000000000000000000000..a6c913c5cc3079e23b65d575b167af7cff705ded --- /dev/null +++ "b/subfolder_0/Evaluation and Comparison of Sleep Quality among Medical and Yogic Students \342\200\223 A Questionnaire Based Study..txt" @@ -0,0 +1,416 @@ +Vidyashree HM et al. Comparative Sleep Quality Study +National Journal of Physiology, Pharmacy & Pharmacology | 2013 | Vol 3 | Issue 1 | 71 – 74 + +RESEARCH ARTICLE + +Evaluation and Comparison of Sleep Quality Among +Medical and Yogic Students – A Questionnaire Based Study + +Vidyashree HM1, Parwati P Patil1, Vinay Moodnur2, Deepeshwar Singh3 + +ABSTRACT + +Background: Sleep related disorders are recognized in one +third of the western population. Poor sleep quality has major +negative long term impact on health, prevention programs +should focus especially on the subjective sleep quality. + +Objective: To Evaluate and compare the sleeping behavior +and to analyze sleep quality among medical and yogic +students. + +Materials and Methods: 1st year medical students from J N +Medical College who were randomly selected and yogic +students from S-VYASA completed questionnaires assessing +sleep quality. + +Results: Yogic students showed better quality of sleep. +Daytime sleepiness scale score was found with p<0.05 and +feeling of being refreshed on wakening in the morning was +higher with p<0.001. The sleep latency was lower in yogic +students as compared to medical students with p value < 0.05 +the sleep duration was found to be higher in medical students. + +Conclusion: Study suggests poor sleep in medical students +which may adversely impact their academic performance, +yoga interventions to improve sleep hygiene can be suggested +to improve their quality of sleep. + +KEY WORDS: Sleep Quality; Medical Students; Yogic Students + + + + + + + + + + + + + +1 Department of Physiology, J N +Medical College, Belgaum, India + +2 Volante Software Technologies, +Chennai, India + +3 +Swami +Vivekananda +Yoga +Anusandhana +Samsthana +(S- +VYASA), Bangalore, India + +Correspondence to: +Vidyashree HM +(vidyabin@gmail.com) + +Received: 12.10.2012 +Accepted: 12.10.2012 + +DOI: 10.5455/njppp.2013.3.71-74 +Vidyashree HM et al. Comparative Sleep Quality Study +National Journal of Physiology, Pharmacy & Pharmacology | 2013 | Vol 3 | Issue 1 | 71 – 74 + +INTRODUCTION + +Sleep related disorders are recognized in one +third of the western population. It affects the +mood, behavior, work and quality of life and pose +several health problems, their recognition and +treatment can help in improving the functional +ability of the individual while preventing +hypertension, psychological disturbances and +accidents.[1] From a behavioral standpoint, sleep +is +a +state +of +decreased +awareness +of +environmental stimuli that is distinguished from +states such as coma or hibernation by its +relatively rapid reversibility. Sleep plays an +important role in normal development and +everyday functioning[1] and sleep problems can +lead to significant morbidity, such as depressive +symptoms[1], behavior problems[2], impaired +neurobehavior functioning[3], sleep loss due to +voluntary bed time curtailment has become +hallmark of modern life, owing to their hectic +schedules medical students are known to have +erratic sleep patterns. Sleep itself is in short +supply for young physicians in their formative +years because they stay up late to cram for +examinations in medical college followed by +prolonged stints at the hospital.[4] + +Studies in the psychological literature have +linked sleepiness and fatigue to decrease in +vigilance, reaction time, memory, psychomotor +coordination, +information +processing, +and +decision making.[5] + +Yoga is ancient Indian Science and a way of life +which brings about relaxation and also induces a +balanced mental state.[6] + +Studies have shown that the practice of yoga +reduces signs of physiological arousal in normal +volunteers based on measurements of autonomic +and +respiratory +variables +and +oxygen +consumption +and +decrease +in +plasma +catecholamine levels.[7] + +Recent study has shown that Mindfulness +techniques & practicing cyclic meditation twice a +day improved the objective and subjective +quality of sleep on the following night.[8] +This study aims at evaluation and comparison of +sleep quality among medical and yogic students +and to explore the effect of yoga on sleep quality. + +MATERIALS AND METHODS + +This study was carried out after obtaining +institutional ethical committee clearance and +informed consent. + +Participants were Medical students from JNMC, +KLE University, Belgaum, and Yogic Students +from S-VYASA, Bangalore, Karnataka, India. + +Questionnaire was distributed randomly among +thirty 1st year medical students from JNMC +Belgaum and thirty 2nd semester B.Sc. Yogic +students from S-VYASA, Bangalore. All the +students were explained about how to fill the +questionnaire. + +Inclusion criteria + + +Normal healthy volunteers aged between 18- +23 years + +Exclusion criteria + + +Students with physical/psychological illness + +Individuals under any kind of medications + +Individuals with Previously diagnosed sleep +disorders. + +Sample size + +30 individuals from each group who fulfilled the +criteria + +Design + +Two Groups onetime assessment study of sleep +quality. Standardized Questionnaire on sleep +pattern and Epworth sleepiness scale score, [9] +and modified Pittsburgh Sleep Quality Index was +used to evaluate the sleep quantity and quality. +Questionnaire was distributed among willing +participants. + +Data Analysis + +Percentage of students with their sleeping times, +the sleeping Quality scoring data of both group +Vidyashree HM et al. Comparative Sleep Quality Study +National Journal of Physiology, Pharmacy & Pharmacology | 2013 | Vol 3 | Issue 1 | 71 – 74 + +students was statistically analyzed using two +sample t-test. The results were computed by +SPSS Software version 19. + +RESULTS + +Total of 60 students were included in the study, +30 medical and 30 yogic students. The mean age +group of medical students with S.D was 17.23 ± +0.43 and mean age group of yogic students with +S.D was 17.16 ± 0.56. Among two groups, yogic +students showed better quality of sleep. + + +Figure-1: Sleep Quality (ESS- EpWorth sleepiness scale, +SD- Sleep duration, SL- Sleep Latency, FS- Freshness after +sleep) + + +Figure-2: Epworth Sleepiness Chart + + +Figure-3: Sleep Latency Chart + +There was significant decrease in day time +sleepiness (p<0.05) and sleep latency (p<0.001) +in yogic students and feeling of being refreshed +on wakening in the morning was higher in yogic +students with p<0.001. + +The average sleep duration of medical and yogic +students was 6.78 ± 0.8197 and 5.96 ± 1.0560 +hours respectively. + + +Figure-4: Sleep Duration Chart + +DISCUSSION + +To our knowledge, this is the first comparative +study of sleep quality among medical and yogic +students. Using a validated measure of self- +reported sleep quality, we found that the yogic +students had a better quality of sleep than +medical students. + +It suggest that the practice of yoga by medical +students may increase their quality of sleep by +decreasing day time sleepiness and sleep latency +which significantly influences the subjective +sleep quality. + +In the present study the improvement in sleep +following yoga was in agreement with earlier +reports. Poor sleep and erratic sleep pattern +reported by medical students could have been +influenced by factors like their hectic schedule. + +According to normative sleep stage data across +age groups, the sleep latency in minutes for age +group between 20-29 is 6.3 minutes in an +average; in our study we found that the highest +sleep latency in medical students to be 30 +minutes. Taking into account that poor sleep +quality has major negative long term impact on +health. +Prevention +programs +should +focus +especially on the association between depressive +symptoms and subjective sleep quality that is +significantly influenced by sleep onset latency. +Vidyashree HM et al. Comparative Sleep Quality Study +National Journal of Physiology, Pharmacy & Pharmacology | 2013 | Vol 3 | Issue 1 | 71 – 74 + +Meditation has been shown to reduce stress and +increase feeling of peace and calm.[10] This +suggests +several +application +and +possible +benefits of practicing meditation; one of them is +probably improvement in sleep. Assumption may +be made based on the fact that real-world stress +influences cardio-respiratory functions during +sleep, hence influencing the restorative function +of sleep.[11] In keeping with this, yoga and +meditation techniques have been found to +improve the quality of sleep.[12] + +Sleep is shown to play a key role in important +cognitive and psychological processes, including +learning and offline memory consolidation[13], +human heuristic creativity and insightfulness[14], +cognitive abilities[15], consolidation of emotional +memory[16]. Collectively, these data emphasize +the beneficial effects of restoring sleep on +physical, cognitive, and psychological well- +being.[17] + +One limitation of our study was that sleep was +subjectively assessed and no objective measures +of sleep were obtained. + +CONCLUSION + +The study concludes that yoga practice which +includes +asana, +relaxation with +awareness +improves sleep quality, feeling of being refreshed +and less day time sleepiness. + +Taking into account that poor sleep quality has +major negative long term impact on health, +prevention programs should focus especially on +the subjective sleep quality. Yoga interventions to +improve sleep hygiene can be suggested to +medical students who have erratic sleep pattern +due to their hectic schedules, as the practice of +yoga helps to induce sleep and relaxation and +relieves stress and tension. + +REFERENCES + +1. +Sinha S. Sleep in Wilson’s disease - Questionnaire +based study. Ann Indian Acad Neurol 2011; 14:31- 4. +2. +Lavigne JV, Arend R, Rosenbaum D, Smith A, +Weissbluth M, Binns HJ. Sleep and behavior +problems among preschoolers. J Dev Behav Pediatr +1999; 20:164 - 9. +3. +Ali NJ, Pitson DJ, Stradling JR. Snoring, sleep +disturbance, and behavior in 4-5 year olds. Arch Dis +Child 1993; 68:360-6. +4. +Rosen C, Rosekind M, Rosevear C, Cole WE, Dement +WC. Physcian Education in Sleep and Sleep +Disorders. A National Survey of U.S. Medical Schools. +Sleep 1993; 16: 249-254. +5. +Lyznicki JM, Doege TC, Davis, RM, Williams WA. +Sleepiness, driving, motor vehicle crashes. JAMA +1998 ; 279(23):1908-13. +6. +Vempati RP, Telles S. Yoga-based guided relaxation +reduces sympathetic activity judged from baseline +levels, Psychol Rep. 2002 ; 90(2):487-94. +7. +Udupa KN, Singh RH, Yadav RA. Certain studies on +psychological and biochemical responses to the +practice in Hatha Yoga in young normal volunteers. +Indian J Med Res. 1973 ;61(2):237-44. +8. +Patra S, Telles S.Positive impact of cyclic meditation +on subsequent sleep. Sci Monit. 2009; 15(7):CR375- +81. +9. +Johns MW.A new method for measuring daytime +sleepiness: +the +Epworth +Sleepiness +scale.sleep.14:540-5. +10. Oman D, Shapiro SL, Thoresen CE. Meditation lowers +stress and supports forgiveness among college +students: a randomized controlled trial. J Am Coll +Health 2008; 56(5): 569–78. +11. Sakakibara M, Kanematsu T, Yasuma F, Hayano J. +Impact of real-world stress on cardiorespiratory +resting +function +during +sleep +in +daily +life. +Psychophysiology 2008; 45(4): 667–70. +12. Winbush NY, Gross CR, Kreitzer MJ. The effects of +mindfulness based stress reduction on sleep +disturbance: a systematic review. Explore (NY) +2007; 3(6): 585–91. +13. Walker MP, Stickgold R. Sleep, memory, and +plasticity. Annu Rev Psychol 2006;57:139–166. +14. Wagner U, Gais S, Haider H. Sleep inspires insight. +Nature 2004; 427:352–355. +15. Bódizs R, Kis T, Lázár AS. Prediction of general +mental ability based on neural oscillation measures +of sleep. J Sleep Res 2005;14: 285–292. +16. Nishida M, Pearsall J, Buckner RL, Walker MP. REM +sleep, prefrontal theta, and the consolidation of +human +emotional +memory. +Cereb +Cortex +2009;19:1158–66. +17. Cirelli C, Tononi G. Is sleep essential? PLoS Biol +2008;6:216. + +Cite this article as: Vidyashree HM, Patil PP, Moodnur +V, Singh D. Evaluation and comparison of sleep quality +among medical and yogic students – A questionnaire +based study. Natl J Physiol Pharm Pharmacol 2013; +3:71-74. +Source of Support: Nil +Conflict of interest: None declared + diff --git a/subfolder_0/Exploration of Prana The future of yoga research.txt b/subfolder_0/Exploration of Prana The future of yoga research.txt new file mode 100644 index 0000000000000000000000000000000000000000..00356eaaea6223f5931688bb0ce520cd309f4478 --- /dev/null +++ b/subfolder_0/Exploration of Prana The future of yoga research.txt @@ -0,0 +1,208 @@ +27 +© 2019 International Journal of Yoga - Philosophy, Psychology and Parapsychology | Published by Wolters Kluwer - Medknow +Exploration of Prana: The Future of Yoga Research +dimensions of human systems, superhuman beings until +they found the Reality in its purest form going beyond +Space‑Time and Causation having infinite power, +freedom, bliss, and knowledge. We discuss here in our +editorials, the key features of those dimensions as found +and written in ancient books of Yoga  (Patanjali Yoga +Sutras) and Philosophy (Upanishads) which fathom the +dimensions of Parapsychology and beyond too. +Just as we have found energy as the basic fabric +of everything in the physical world, Yoga texts call +Prana as the basic fabric of all biological systems +as mentioned in Prashnopanishad.[3] Then, what is +the difference between energy and Prana? Prana, +in contrast to energy, can change by itself by the +processes of expansion and contraction  (svayameva +prasarati svayam sankocameti) as postulated in Yoga +Vasishtha.[4] While the electromagnetic field spreads all +over the physical world, Pranic field spreads over all +biological entities  (Pranamaya Kosha) as mentioned +in Taittiriya upanishad.[3] We may call it a bioplasmic +field. This field forms the basis of all the physiological +processes that happen inside the body, and it can also +be modulated by the mind. Hence, this bioplasmic field +forms a crucial link between mind and body. However, +how such a fundamental factor escaped the attention +of modern scientists and still this is not a subject of +exploration in mainstream science, is really surprising. +Is it for the want of knowledge or suitable means of +investigation? +Science always progresses with technological tools that +help in measurement and quantification. It is important +to have suitable tool to empirically elucidate Prana. Is +it possible to measure Prana as we measure energy? +How do we photograph Prana as we do with the +physical systems using modern gadgets? Prana being +very subtle and intangible in nature, its measurement is +indeed a great challenge. However, its manifestations +at physical and near‑physical levels may be measured +and quantified. The earlier works of the Kirlians is +considered a seminal work in this area, where they +demonstrated coronal discharge due to the application +of high‑frequency and high‑voltage electric pulse around +various objects.[5] Later, more sophisticated equipment +such as Gas Discharge Visualization[6] was developed to +photograph these coronal discharges of various animate +and inanimate objects, and they were also extensively +correlated with health status of human systems.[7] Some +works have also attempted to replicate one of the strongly +critiqued phantom leaf effects.[8] Continuous development +of such equipment is going on to discover more and +Editorial +Science developed in the western part of the globe +has grown to a great height in fathoming reality of the +physical world. Starting from the classical Newtonian +mechanics featured by determinacy to the Quantum +mechanics +characterized +by +probabilistic +features +attempts to explain various dimensions of the universe. +The famous equation E  =  mc2, which portrays the +underlying unity between matter and energy, is nothing +less than a great awe for humanity. In a sense, we have +fathomed the complete knowledge about the physical +universe, and hence, we have had great success in all +challenges related to the physical world. This has made +science and technology acceptable to one and all. +However, is that all we had to fathom or anything else +still remains enigmatic for us, which calls our attention? +The modern multidimensional challenges of stress, +noncommunicable diseases, etc., which are unresolved, +have necessitated deeper understanding of our universe. +It is in this context that the ancient texts of the Indian +philosophy  (Upanishads) and Yoga are attracting +the attention of the top contemporary scientists and +researchers. As Capra wrote, a time has come to go +beyond to understand the deeper and subtler dimensions +of our universe.[1] Hence, we are in a transition phase +to go beyond the physical world, grounded on the +matter‑based paradigm by turning our tables toward +consciousness‑based paradigm as mentioned by Prof. +Goswami.[2] +Science has moved slowly and steadily over centuries +to unfold the deeper and deeper secrets of our physical +world and trying to understand more and more about +other physical worlds such as planets, stars, and +galaxies through various powerful instruments such as +ultramodern telescopes and space satellites. Science is +also trying to understand the functioning of microscopic +particles through sophisticated microscopes. Using these +instruments, biological systems starting with a single cell +are being studied, trying to understand how they have +the capacity to move and replicate by themselves without +any external interventions, marking the beginning of life +processes. While probabilistic mechanics brought to light +the fact that the laws of subtle world of molecules and +atoms do not follow the laws of classical mechanics, we +need to find out the laws and the structure that govern +the life entities which do not appear to follow all the +physical laws. +In India, having a tradition of thousands of years, the +ancient seers and sages were not only able to track +the structure and laws of biological systems but also the +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Nagendra: Prana and yoga +28 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 2  ¦  July‑December 2019 +more features of biological systems. The rationale behind +assuming that these Kirlian‑based images can possibly +measure manifested effects of Prana is that these images +are formed due to the electronic excitation of surface and +near‑inner surface of the study objects. Since electrons +and photons form the most fundamental aspect of +physical measurement, we can assume that these images +obtained during this process of electronic excitation can +give the best estimate of pranic activities as well. Some +efforts to catch such aura round the physical and living +entities are pursued using infrared camera. Here, it is +assumed that the change in temperature gradient around +a body is a function of the pranic activity. +In this context, it is worth mentioning that the ancient +Yoga masters were able to feel the aura around a body +by their refined mind and sharpened sense of touch. +Some were able to see the aura around the leaf and +even human bodies by sensitizing their eyes beyond +the normal range of vision. However, they all are +considered as subjective experiences and strongly +critiqued by scientists, on the one side, and admired by +supporters of such phenomena, on the other side. This +mixed emotion around this unconventional and gray +area of research will remain in the future too. Need of +the hour is an amalgamation of insights from intuitive +experiences of subtle phenomenon and empirical +investigation of such phenomena using the best available +tools with strict control over confounding factors. This +calls for tremendous grit, skill, and intuitive insights in +researchers working in this area of pranic research. This +is an area which has tremendous scope to answer some +of the unresolved mysteries of modern science. More +research is needed to understand several dimensions +of Prana in biological systems starting from plants, +animal world, human beings, and the possible unknown +superhuman systems. We invite all such experiments and +theoretical dimensions as articles in this journal. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +HR Nagendra +Chancellor, Swami Vivekananda Yoga Anusandhana +Samsthana, 19, Eknath Bhavan, Gavipuram Circle, K.G. Nagar, +Bengaluru ‑ 560 019, Karnataka, India. +E‑mail: chancellor@svyasa.edu.in +References +1. +Capra F. The Tao of Physics. Shambhala: Boulder; 1975. +2. +Goswami A. The Self-Aware Universe: How Consciousness +Creates the Material World. Penguin: New York; 1995. +3. +Swami  +G. +Eight +Upanisads +with +the +Commentary +of +Sankaracharya, (Isa, Kena, Katha and Taittiriya). 2nd ed. Calcutta: +Advaita Ashrama; 1989‑90. +4. +Shastri DN. Yoga Vasishtha. Vol. 6. 4th ed. Bengaluru: Hemanta +Sahitya; 2010. p. 4284. +5. +Mills A. Kirlian photography. Hist Photogr; 2009;33:278‑87. +6. +Korotkov  +K. +Sсienсe +of +Measuring +Energy +Fields: +A  revolutionary teсhnique to visualize energy fields of humans +and nature. In: Rosh  P. editor. Bioeleсtromagnetiс and Subtle +Energy Mediсine. London, New York: СRС Press; 2015. +7. +Korotkov  K. Review of EPI papers on medicine and +psychophysiology published in 2008‑2018. Int J Complement Alt +Med 2018;11:311‑5. +8. +Hubacher  J. The phantom leaf effect: A  replication, part  1. +J Altern Complement Med 2015;21:83‑90. +Access this article online +Quick Response Code: +Website: www.ijoyppp.org +DOI: 10.4103/2347-5633.269479 +This is an open access journal, and articles are distributed under the terms of the +Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows +others to remix, tweak, and build upon the work non-commercially, as long as +appropriate credit is given and the new creations are licensed under the identical terms. +How to cite this article: Nagendra HR. Exploration of Prana: The future +of yoga research. Int J Yoga - Philosop Psychol Parapsychol 2019;7:27-8. +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] diff --git a/subfolder_0/Factor analysis of Greene_s Climacteric Scale for Indian women.txt b/subfolder_0/Factor analysis of Greene_s Climacteric Scale for Indian women.txt new file mode 100644 index 0000000000000000000000000000000000000000..2ede34ce2fd65a7b97bbe1fb255a0a6451ae005f --- /dev/null +++ b/subfolder_0/Factor analysis of Greene_s Climacteric Scale for Indian women.txt @@ -0,0 +1,501 @@ +Maturitas 59 (2008) 22–27 +Available online at www.sciencedirect.com +Factor analysis of Greene’s Climacteric +Scale for Indian women +Ritu Chattha, Ravi Kulkarni ∗, +R. Nagarathna, H.R. Nagendra +Swami Vivekananda Yoga Research Foundation, +Bangalore, India +Received 20 September 2007; received in revised form 25 October 2007; accepted 29 October 2007 +Abstract +Objective: Do a factor analysis of the Greene Climacteric Scale for a population of Indian perimenopausal women and establish +normative values. +Methods: Five hundred and eighteen women, in the age range 45–55 years were selected and asked to fill out the Greene +Climacteric Scale. +Results: The mean age of the women was 48.03 ± 3.40 years. A factor analysis of the data using an oblique rotation yielded +three distinct factors with loadings more than 0.4. The breakup of the psychological factor into an anxiety and a depression factor +which has been hypothesized earlier could only be verified using varimax rotation. The last item, “Loss of sexual interest” is +shown to be part of the vasomotor factor. The means of the scores on the three factors are: psychological: 8.28 ± 5.87, somatic: +4.64 ± 3.73 and vasomotor: 2.39 ± 2.10. These are much lower than the values given by Greene, but are in consonance with +values published in two earlier studies for different populations. +© 2007 Elsevier Ireland Ltd. All rights reserved. +Keywords: Perimenopause; Climacteric; Greene Climacteric Scale; Factor analysis; Indian women +1. Introduction +The Indian subcontinent is a mix of many ethnic +groups and cultures where perception of menopause +varies [1]. Since the average life span of women in +India is now estimated to be 62 years, the problems of +∗Corresponding author. Tel.: +91 9964041911; +fax: +91 8026608645. +E-mail address: ravi.kulk@gmail.com (R. Kulkarni). +menopause have attained a greater significance [2] and +are emerging as an issue owing to rapid urbanization +[3]. At the time of menopause, some women present a +clinical picture of not only the specificity of estrogen +deficiency, such as hot flushes, but also a non-specific +psychologic syndrome characterized largely by anxiety +and depression [4]. +The average age of Indian menopausal women is +47 years [5]. Till date, several instruments have been +designed to measure and assess symptoms during +0378-5122/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. +doi:10.1016/j.maturitas.2007.10.011 +R. Chattha et al. / Maturitas 59 (2008) 22–27 +23 +this phase [6–9]. Attempts to delineate symptoms +characteristic of menopausal phase of the climac- +terium have resulted in considerable debate. The Blatt +Menopausal Index [6] and the Menopause Check- +list of Neugarten & Kraines [10] were the first +widely used instruments to assess menopausal symp- +toms. A standard climacteric scale, now called the +Greene Climacteric Scale (GCS) was developed by +Greene [11] in 1998, which independently measures +psychological, somatic and vasomotor symptoms. +In the light of our results, it is of relevance to +briefly consider the history and construction of the +GCS. +The development of the GCS, a scale of 21 items, +was motivated by the examination of seven separate +studies in which the number of items on the scale to +assess the climacteric varied considerably (from 17 +to 36). Greene [12] initially conducted a factor anal- +ysis on a list of 30 symptoms reported by women aged +40–55yearsusinga30-itemquestionnaireintheUnited +Kingdom. He identified three symptom clusters and +labelled them as vasomotor, somatic and psycholog- +ical. This was followed by an analysis on an Indian +population by Indira and Murthy [13] who also used +the same 30-item questionnaire and found eight fac- +tors. Other studies [14–18] found between four and +seven factors. The items in these latter studies however +were not the same as the 30 items of Greene’s orig- +inal questionnaire, though they were similar. Greene +formulated his 21-item scale (the GCS) by retain- +ing 16 items of his original scale, adding four items +based on the later studies and adding one item on +loss of sexual interest. This composite scale of 21 +items (Appendix A) is the one that is studied in this +paper. The major change in perception of the climac- +teric between the original 30-item questionnaire and +the instrument now called the GCS was that the factor +that Greene (and others) had labelled as psycholog- +ical was recognized to be a composite of two factors +identifiedas“anxiety”and“depression”[11].Theaddi- +tional item on “loss of sexual interest” was added as +a probe item, whose status was left for later evalua- +tion. +The goal of this paper is explore the factor structure +of the 21-item Greene Climacteric Scale in Indian per- +imenopausal women. This was part of a larger study +whose aim was to aid menopausal women alleviate +their symptoms. +2. Methods +2.1. Subjects and sampling +This cohort study comprised 518 Indian women +who satisfied the inclusion criteria of age between +45 and 55 years. Women who had undergone hys- +terectomy with retained ovaries were also included. +Women unfamiliar with spoken English, with less than +highschooleducation,womentakinghormonereplace- +ment therapy (HRT), with gynaecological problems +like endometriosis, fibroids, ovarian cysts, prolapsed +uterus, etc., or with other medical disorders (like hyper- +tension, diabetes mellitus, hypo/hyperthyroidism) and +those on psychiatric medication were excluded from +the study. +The study was conducted at Swami Vivekananda +Yoga Research Foundation (SVYASA), a yoga univer- +sity, Bangalore, India. Formal approval for the study +was obtained by the institutional review board and +the ethical committee of the university. The data was +collected from various places (banks, staff of schools +and colleges, ladies clubs and gynaecology outpatient +clinics). The women who satisfied the inclusion crite- +ria were registered and signed informed consent was +obtained. The participants were requested to fill the +Greene Climacteric Scale and were assured that their +responses would be kept confidential. +2.2. The Greene Climacteric Scale (GCS) +The Greene Climacteric Scale measures a total of +21 symptoms (Appendix A). Each symptom is rated +by the woman herself according to its current sever- +ity using a four-point rating scale: not at all (0); +a little (1); quite a bit (2) and extremely (3). The +symptoms are related to psychological (anxiety and +depression), somatic and vasomotor functions in the +climacteric. +2.3. Statistical analysis +The data were analysed using SPSS 10. In his +paper [12], Greene used the direct oblimin method +to extract factors. A method using oblique rotations +rather than orthogonal rotations is preferred when +one expects some correlations between the extracted +factors. Greene had indeed found such correlations +24 +R. Chattha et al. / Maturitas 59 (2008) 22–27 +Table 1 +Demographic data +Category +Number +Age (years) +48.03 ± 3.40 +Participants between ages 46 and 50 years +334 +Participants between ages 51 and 55 years +184 +Housewives +295 +Working women +Bankers +96 +Teachers +82 +Self-employed +45 +between his three factors. So, the direct oblimin method +of extracting factors was also used in the present anal- +ysis. Factors with eigenvalues greater than 1 were +extracted and only those items with a factor loading +greater than 0.4 were retained. This is consistent with +the procedure recommended by Greene [12]. However, +for reasons we explain below, we also present a factor +analysis using varimax rotation. +3. Results +Table 1 shows the demographic data. The mean age +of the subjects was 48.03 ± 3.40 years. Four factors +accounting for 53.6% of the variance were extracted. +However, the pattern matrix for the factors contained +only three factors after the criterion of factor loadings +greater than 0.4 was applied. The resulting factor struc- +ture accounts for 48.6% of the total variance and is +identical to the factor structure proposed by Greene +except that item 1 (“Heart beating quickly or strongly”) +does not contribute to any of the factors. The items +contributing to the three factors are: +Factor 1 (Psychological): Items 2–11 +Factor 2 (Somatic): Items 12–18 +Factor 3 (Vasomotor): Items 19–21 +Item 1, which does not appear in these three factors +had factor loadings of only 0.27 and 0.26 on factors 2 +and 3, respectively. By any reasonable criterion there- +fore, this item may be neglected. The factor loadings +of the individual items on the three factors are given in +Table 2. +The Kaiser–Meyer–Olkin (KMO) statistic, a mea- +sure of sampling adequacy, had a value of 0.918, +indicating that the pattern of correlations is adequate +Table 2 +Factor loadings using the direct oblimin method (pattern matrix) +Item +Factor 1 +Factor 2 +Factor 3 +Q2 +0.588 +Q3 +0.424 +Q4 +0.531 +Q5 +0.646 +Q6 +0.647 +Q7 +0.526 +Q8 +0.697 +Q9 +0.768 +Q10 +0.692 +Q11 +0.672 +Q12 +0.513 +Q13 +0.517 +Q14 +0.703 +Q15 +0.464 +Q16 +0.579 +Q17 +0.811 +Q18 +0.553 +Q19 +0.868 +Q20 +0.865 +Q21 +0.493 +for a factor analysis. It is also essential for a factor +analysis that there be some relationships between the +variables and so the sphericity of the data needs to be +checked. Bartlett’s test for sphericity for the data is +highly significant (p < 0.001) and so a factor analysis +is appropriate [19]. The component correlation matrix +which shows the correlations between the factors is +displayed in Table 3. The correlations are all signif- +icant at the 0.01 level of significance, justifying the +need for an oblique rotation rather than an orthogonal +rotation. Reliability of the data was also assessed. The +split-half reliability was 0.83 and Cronbach’s alpha was +0.91. +Table 4 shows the means and the standard deviations +of each sub-scale for the three factors of the oblique +rotation. The table also shows the correlations between +the sub-scales and the factor scores. The means for +our study are much lower than the means given by +Table 3 +The component correlation matrix (oblique rotation) +Psychological +Somatic +Vasomotor +Psychological +1 +0.48 +0.41 +Somatic +1 +0.36 +Vasomotor +1 +The correlations are all significant at the 0.01 level. +R. Chattha et al. / Maturitas 59 (2008) 22–27 +25 +Table 4 +Means, standard deviations and correlations +Factors +Mean +S.D. +Correlationa +Psychological +8.12 +5.87 +0.983 +Somatic +4.64 +3.73 +0.975 +Vasomotor +2.39 +2.10 +0.960 +a The correlation is between the sub-scales and the original factor +scores. +Greene [12]. This comparison and another compari- +son with an Ecuadorian population are displayed in +Table 5. +Indira [13,20] have previously conducted a similar +study on a sample of 105 Indian women in 1980. They +used the original 30-item questionnaire of Greene and +extracted eight factors with eigenvalues greater than +one. Of these, the first three are the ones obtained by +Greene. The method of factor extraction used by Indira +was varimax rotation. +Since the varimax method assumes no relationship +between the distinct factors to be extracted, it was also +of interest to us to examine this hypothesis and there- +fore to also use orthogonal (varimax) rotation instead +of oblique. The resulting analysis yielded four distinct +factors and showed that Greene’s psychological factor +(items 1–11) splits naturally into two distinct factors +which can be identified as anxiety (items 1–5 and 18) +and depression (items 2 and 6–11). These four fac- +tors together account for 53.6% of the total variance. +Our analysis also showed that item 2 (“Feeling tense +or nervous”) loads on both factors 1 (depression) and 3 +(anxiety). Table 6 gives the factor loadings for varimax +rotation. +Table 5 +Comparison of means for three studies +Factors +Indian +population +Sierra et al. +[21] +Greene [14]a +Psychological +8.28 ± 5.87 +8.84 ± 4.67 +19.62 ± 9.69 +Somatic +4.64 ± 3.73 +4.5 ± 2.74 +7.18 ± 4.57 +Vasomotor +2.39 ± 2.10 +3.82 ± 1.9b +6.46 ± 2.79 +Total +15.15 ± 10.01 +17.16 ± 8.45 +33.26c +a The means quoted for Greene are for the three scales in Greene’s +1976 study. +b The standard deviation of 1.9 is an estimate, since they have given +the data for item 21 separately. The mean of 3.82 is correct. +c It is not possible to give the standard deviation using the data as +given by Greene. +Table 6 +Factor loadings using the varimax method +Factor 1 +Factor 2 +Factor 3 +Factor 4 +Q1 +0.567 +Q2 +0.471 +0.543 +Q3 +0.529 +Q4 +0.601 +Q5 +0.600 +Q6 +0.550 +Q7 +0.637 +Q8 +0.665 +Q9 +0.711 +Q10 +0.608 +Q11 +0.664 +Q12 +0.469 +Q13 +0.521 +Q14 +0.661 +Q15 +0.496 +Q16 +0.644 +Q17 +0.740 +Q18 +0.495 +Q19 +0.823 +Q20 +0.814 +Q21 +0.477 +4. Discussion +Till the formulation of Greene’s Climacteric Scale +in 1998, there seemed to be no standard instrument +to assess the climacteric in women. The purpose of +this replicative study was to set up normative data in +the context of the menopause for the Indian popula- +tion (Table 4) using the GCS. We have shown that +Greene’s original model of three distinct factors (psy- +chological, somatic and vasomotor) constitute a good +representation of the factors associated with the cli- +macteric in Indian women. These three factors were +present in Indira’s earlier study [13], but were just three +out of eight factors. After the incorporation of some +changes in the original scale of Greene, there has been +noreplicativestudywhichconfirmsthefactorstructure. +Our study fills this gap. +For normative purposes, we have noted that the +study on an Ecuadorian population [21] using the GCS +also showed means for the sub-scales that are almost +the same as the ones we obtain (Table 5). It is inter- +esting to note that the means on each of the sub-scales +are much lower than the ones given by Greene [12] +(even after accounting for the fact that the items in that +study were slightly different). Another study that used +26 +R. Chattha et al. / Maturitas 59 (2008) 22–27 +the GCS on a Dutch population [22] gives a total score +on the GCS of 15.78 ± 9.09 which is almost the same +as the total scores for this study and the study on the +Ecuadorian population. +The hypothesis that the psychological scale should +have two distinct facets (anxiety and depression) is +shown to hold only when varimax (orthogonal) rotation +is used. The other difference we noted when varimax +rotation is used is that item 18 (“Breathing difficulties”) +is part of the anxiety factor rather than the somatic fac- +tor. However, both analyses show that the last item on +the scale (“Loss of interest in sex”) is clearly associated +with the vasomotor factor. +As there is still a limited amount of information +on the experience of menopausal symptoms and their +groupings in Asian women, the objectives of this +paper were to report the prevalence of symptoms in +Indian perimenopausal women and to construct symp- +tom groupings from reported symptoms. The findings +of this factor analysis may be used as normative data +for future studies. +Acknowledgment +We thank Prof. Subbakrishna for advice about factor +analysis. +Appendix A. The Greene Climacteric Scale +References +[1] International Menopausal Society. Available at: http://www. +imsociety.org/menopause perspectives around the world.html. +[2] WHO (World Health Organization Scientific Group): The +World Health Report. Shaping the Future. World Health Orga- +nization, Geneva; 2003. +[3] Sengupta A. The emergence of the menopause in India. Cli- +macteric 2003;6:92–5. +[4] Coulam CB. Age estrogens, and the psyche. Clin Obstet +Gynecol 1981;24:219–29. +[5] PadubidriVG,DaftarySN.Howkins&BourneShaw’stextbook +ofgynaecology.NewDelhi,India:ReedElsevierIndiaPvt.Ltd.; +2004. +[6] Blatt MH, Weisbader H, Kupperman HS. Vitamin E and cli- +macteric syndrome. Arch Intern Med 1953;91:792–9. +[7] Kupperman HS, Blatt MHG, Wiesbader H, Filler W. Com- +parative clinical evaluation of estrogen preparations by the +menopausal and amenorrhoea indices. J Clin Endocrinol +1953;13:688–703. +[8] Heinemann LA, Potthoff P, Schneider HP. International ver- +sions of the menopause rating scale (MRS). Health Qual Life +Outcomes 2003;1:28. +[9] Dennerstein L, Smith AM, Morse CA, et al. Menopausal symp- +toms in Australian women. Med J Aust 1993;159:232–6. +[10] Neugarten BL, Kraines R. Menopausal symptoms in women of +various ages. Psychosom Med 1965;27:266–73. +[11] Greene JG. Constructing a standard climacteric scale. Maturitas +1998;29:25–31. +[12] Greene JG. A factor analytic study of climacteric symptoms. J +Psychosom Res 1976;20:425–30. +[13] Indira SN, Murthy VN. A factor analytic study of menopausal +symptoms in middle aged women. Indian J Clin Psychol +1980;7:125–8. +R. Chattha et al. / Maturitas 59 (2008) 22–27 +27 +[14] Hunter M, Battersby R, Whitehead M. Relationships between +psychological symptoms, somatic complaints and menopausal +status. Maturitas 1986;8:217–28. +[15] Holte A, Mikkelsen A. The menopausal syndrome; a factor +analytic replication. Maturitas 1991;13:193–203. +[16] Kaufert P, Syrotuik J. Symptom reporting at the menopause. +Soc Sci Med 1981;15:173–84. +[17] Mikkelsen A, Holte A. A factor analytic study of climacteric +symptoms. Psychiatr Soc Sci 1982;2:35–9. +[18] Abe T, Suzuki M, Moritsuka T, Botan Y. Statistical factor +analysis and cluster analysis in the aetiology of climacteric +symptoms. Tohoku J Exp Med 1984;143:481–9. +[19] Andy F. Discovering statistics. London: Sage Publications; +2000. +[20] Indira SN. Psychosocial aspects in mid-life crisis, PhD thesis. +National Institute of Mental Health and Neurosciences, Banga- +lore; 1979. +[21] Sierra B, Hidalgo LA, Chedraui PA. Measuring climacteric +symptoms in an Ecuadorian population with the Greene Cli- +macteric Scale. Maturitas 2005;51:236–45. +[22] Barentsen R, van de Weijer PH, van Gend S, Foekema H. +Climacteric symptoms in a representative Dutch population +sample as measured with the Greene Climacteric Scale. Matu- +ritas 2001;38:123–8. diff --git a/subfolder_0/Frontal hemodynamic responses to high frequency yoga breathing in schizophrenia a functional near-infrared spectroscopy study.txt b/subfolder_0/Frontal hemodynamic responses to high frequency yoga breathing in schizophrenia a functional near-infrared spectroscopy study.txt new file mode 100644 index 0000000000000000000000000000000000000000..d0c010e0f0c69abd416a4dc4c30d117608900794 --- /dev/null +++ b/subfolder_0/Frontal hemodynamic responses to high frequency yoga breathing in schizophrenia a functional near-infrared spectroscopy study.txt @@ -0,0 +1,1038 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +PSY +CHIA +TRY +ORIGINAL RESEARCH ARTICLE +published: 24 March 2014 +doi: 10.3389/fpsyt.2014.00029 +Frontal hemodynamic responses to high frequency yoga +breathing in schizophrenia: a functional near-infrared +spectroscopy study +Hemant Bhargav 1*, H. R. Nagendra1, B. N. Gangadhar 2 and Raghuram Nagarathna1 +1 Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhan Samsthana, Bangalore, India +2 National Institute of Mental Health and Neurosciences, Bangalore, India +Edited by: +Shirley Telles, Patanjali Research +Foundation, India +Reviewed by: +Dusan Kolar, Queen’s University, +Canada +Tariq Munshi, Queen’s University, +Canada +*Correspondence: +Hemant Bhargav, Division of Yoga +and Life Sciences, Swami +Vivekananda Yoga Anusandhan +Samsthana, No. 19 Eknath Bhavan, +Gavipuram Circle, K.G. Nagar, +Bangalore 560019, Karnataka, India +e-mail: urs.aatmiya@gmail.com +Frontal hemodynamic responses to high frequency yoga breathing technique, Kapalabhati +(KB), were compared between patients of schizophrenia (n = 18; 14 males, 4 females) +and age, gender, and education matched healthy subjects (n = 18; 14 males, 4 females) +using functional near-infrared spectroscopy.The diagnosis was confirmed by a psychiatrist +using DSM-IV. All patients except one received atypical antipsychotics (one was on typi- +cal). They had obtained a stabilized state as evidenced by a steady unchanged medication +from their psychiatrist for the past 3 months or longer.They learned KB, among other yoga +procedures, in a yoga retreat. KB was practiced at the rate of 120 times/min for 1 min. +Healthy subjects who were freshly learning yoga too were taught KB. Both the groups +had no previous exposure to KB practice and the training was carried out over 2 weeks. A +chest pressure transducer was used to monitor the frequency and intensity of the prac- +tice objectively.The frontal hemodynamic response in terms of the oxygenated hemoglobin +(oxyHb), deoxygenated hemoglobin (deoxyHb), and total hemoglobin (totalHb) or blood vol- +ume concentration was tapped for 5 min before, 1 min during, and for 5 min after KB. This +was obtained in a quiet room using a 16-channel functional near-infrared system (FNIR100- +ACK-W, BIOPAC Systems, Inc., USA).The average of the eight channels for each side (right +and left frontals) was obtained for the three sessions. The changes in the levels of oxyHb, +deoxyHb, and blood volume for the three sessions were compared between the two groups +using independent samples t-test. Within group comparison showed that the increase in +bilateral oxyHb and totalHb from the baseline was highly significant in healthy controls dur- +ing KB (right oxyHb, p = 0.00; left oxyHb, p = 0.00 and right totalHb, p = 0.01; left totalHb, +p = 0.00), whereas schizophrenia patients did not show any significant changes in the same +on both the sides. On the other hand, schizophrenia patients showed significant reduction +in deoxyHb in the right pre-frontal cortex (right deoxyHb, p = 0.00). Comparison between +the groups showed that schizophrenia patients have reduced bilateral pre-frontal activa- +tion (right oxyHb, p = 0.01; left oxyHb, p = 0.03 and right total Hb, p = 0.03; left total Hb, +p = 0.04) during KB as compared to healthy controls. This hypo-frontality of schizophrenia +patients in response to KB may be used clinically to support the diagnosis of schizophrenia +in future. +Keywords: kapalabhati, schizophrenia, pre-frontal cortex, high frequency yoga breathing, fNIRS, optical topography, +cerebral blood flow, near-infrared spectroscopy +INTRODUCTION +Kap¯ +alabh¯ +ati kriy¯ +a (KB), also known as the breath of fire or the +skull shining breath, involves rapid breathing consisting of active +expiration with the help of abdominal muscles and passive auto- +matic inspiration taking place during relaxation (1). Experimental +data show that KB affects a broad scale of physiological processes +such as respiration and cardiovascular system (2), biochemical +parameters, (3) and central nervous activity (4, 5). Traditionally +also, KB practice is believed to increase the blood flow to the brain +(6). Immediately after the practice of KB the performance in a +cancelation task (7) and auditory P300 odd-ball paradigm task +(120 breaths/min for 1 min) improved (8). While performing KB, +the most advocated rate of breathing is 120 breaths/min, i.e., a +frequency of around 2 Hz (9). +Functional near-infrared spectroscopy (fNIRS) is a new non- +invasive optical method that can measure the real time change in +oxygenated hemoglobin (oxyHb) and deoxygenated hemoglobin +(deoxyHb) concentrations and their sum, i.e., total hemoglobin +(totalHb) or blood volume in the brain areas. Basics of the NIRS +device are described elsewhere (10). An fNIRS device has excel- +lent temporal resolution and the fNIRS results are physiologically +comparable to fMRI and PET results (11). Though fMRI is a more +commonly used neuro-imaging technique, we preferred fNIRS for +this study because: (a) there is no interference with the yogic +www.frontiersin.org +March 2014 | Volume 5 | Article 29 | 1 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +Bhargav et al. +Frontal hemodynamic responses to yoga breathing +practice as this device does not produce any noise, (b) fNIRS is +a simple to use light weight device, and (c) recordings are less +expensive. +A 16-channel fNIRS device is specifically designed to assess +hemodynamic responses in the bilateral pre-frontal cortices +(PFCs). Studies show that dorso-lateral PFC is involved in exec- +utive tasks and attention (12), and as mentioned above, the KB +practice has been used to enhance these cognitive functions; thus, +its effect on pre-frontal activation was assessed in this study using +fNIRS. Telles et al. (13) have recently used fNIRS device to assess +the effect of KB practice on pre-frontal hemodynamic responses +in 12 long term practitioners (8–36 months experience) of KB. +Studies have observed that PFC plays an important role in the +pathogenesis of schizophrenia. Several research groups have found +task-dependent abnormalities in frontal hemodynamics in schiz- +ophrenia (14, 15). Schizophrenia patients are being shown to have +functional deficits of PFC and impaired planning ability, e.g., a +study observed that during a cognitive task (tower of London) +schizophrenics show poorer performance and lesser pre-frontal +activationascomparedtonormalhealthyvolunteersonNIRS(16). +Reduced activation of frontal lobe during cognitive tasks (func- +tional hypo-frontality) has been one of the most consistent find- +ings in neuro-imaging studies of schizophrenia (17). But since this +functional hypo-frontality can be influenced by various clinical +factors such as psychological conditions (18, 19) and antipsy- +chotic treatment (20, 21), its clinical significance in the diagnosis +of schizophrenia has not been well established. In addition, since +most of the previous studies did not have control over the task +performance, a question was raised that whether the results of +these studies reflect only the reduced motivation in schizophre- +nia. The cognitive tasks that are used to assess activation of PFCs +in neuro-imaging studies have several other limitations, such as +they are time consuming, costly, and require trained staff and +equipment’s, which may interfere with the functioning of the +neuro-imaging device. Many neuro-psychological tasks are also +affected by regional and cultural factors and therefore they can- +not be used in patients who belong to different culture or who +are not familiar with the language in which the cognitive task is +developed. +KB practice has been shown to affect pre-frontal hemodynamic +responsesinhealthysubjectsusingfNIRS(13).KBisasimplephys- +ical breathing technique that does not require any equipment or +skilled staff, can be taught easily, can be administered in less than +1 min, and is cost effective. Since this practice does not involve any +word or symbol, it can be used on any individual who can learn +the breathing practice irrespective of his geographic, educational, +ethnic, or cultural background. +Thus, this study was planned with two major objectives: (1) to +assess the pre-frontal hemodynamic responses to KB practice per- +formed at 2 Hz frequency in healthy subjects and schizophrenia +patients and (2) to check whether schizophrenia patients differ in +their pre-frontal hemodynamic responses to KB from healthy age, +gender, and education matched controls. +MATERIALS AND METHODS +PARTICIPANTS +We enrolled 18 (14 males and 4 females) schizophrenia patients +and 18 (14 males and 4 females) healthy subjects, who had no gen- +eral medical disease, substance abuse, head injury, or diseases such +as hypertension, epilepsy and ischemic heart disease where KB is +contraindicated. The age of patients and controls was 28.9 ± 3.5 +[mean ± standard deviation (SD)] and 26.35 ± 3.53 years, respec- +tively, and the duration of education of patients and controls was +14.37 ± 3.8 and 15.5 ± 3.34 years, respectively (Table 1). There +were no significant differences between the two groups in age,gen- +der, and duration of education. All the subjects were right handed. +Patients were recruited from inpatients and outpatients of Holistic +Health Home – Arogyadhama, Bangalore, India and were diag- +nosed as having schizophrenia (14 paranoid, 2 disorganized, and +2 undifferentiated) according to DSM-IV criteria through clinical +interviews by two independent psychiatrists. All patients were on +antipsychotic medications by consultant psychiatrist. The dura- +tion of illness was 8.37 ± 5.6 years. All patients were medicated +with antipsychotics at the examination (17 atypical and 1 typical +antipsychotics) with mean chlorpromazine equivalent dosage of +289 ± 133 mg/day (22). Six out of 18 patients were medicated with +anticholinergics drugs (Table 1). Both schizophrenia patients and +healthy controls had no previous exposure to KB practice before +T +able 1 | Demographic and clinical characteristics of subjects. +S. no. +Healthy individuals +Schizophrenia patients +p Value +1 +n +18 +18 +2 +Sex +14 Males, 4 females +14 Males, 4 females +3 +Agea (years) +26.35 ± 3.53 (mean ± SD) +28.9 ± 3.5 +0.13 +4 +Handedness +All right handed +All right handed +4 +Educationa (years) +15.5 ± 3.34 +14.37 ± 3.8 +0.386 +5 +Mean age of onset of illness (years) +– +21.68 ± 2.36 +5 +Duration of illness (years) +– +8.37 ± 5.6 +6 +Medications +Nil +13 Patients on resperidone alone (2 on depot preparations); 2 on +resperidone plus quetiapine; 1 on aripirazole; 1 on clozapine and 1 +on flupenthixol; six patients were taking anticholinergics (Tab +trihexyphenidyl 2 mg BD) +aIndependent samples t-test; *p < 0.05. +Frontiers in Psychiatry | Affective Disorders and Psychosomatic Research +March 2014 | Volume 5 | Article 29 | 2 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +Bhargav et al. +Frontal hemodynamic responses to yoga breathing +(for more than a month in the last 1 year), all of them were trained +by a certified yoga trainer to perform KB till they could perform +it correctly (i.e., 120 ± 10 breaths/min for 1 min) and comfort- +ably. The training was given for a period of 10–15 days before the +assessments were taken. A chest pressure transducer was used to +monitor the frequency and intensity of the practice. Recordings +were taken only when the subject performed the practice correctly +andcomfortably.Allsubjectsgavewritteninformedconsentbefore +participating in the present study. The study was approved by the +ethics committee of SVYASA University, Bangalore, India. +fNIRS DEVICE +The system (FNIR100-ACK-W, BIOPAC Systems, Inc., USA) is +a continuous wave device, which measures changes in attenu- +ation at two wavelengths (730 and 850 ± 15 nm), sampling at +25 kHz, and hence allows for the differentiation of two dynamic +absorbers (oxyHb and deoxyHb). Equipped with 4 light emitting +and 10 detector probes, 16 channels can be measured quasi simul- +taneously. Concentration changes in oxyHb and deoxyHb were +calculated based on a modified Beer–Lambert approach (23).With +an optode probe set consisting of 10 photo-detectors and 4 light +emitters,16 channels were measured. The optodes were affixed to a +probe set with an inter-optode distance of 2.5 cm covering an area +of ~6 cm × 18 cm. The probe set was fastened to the participant’s +head bye elastic straps. For horizontal fixation, the lower edge of +the probe set was fixed 1 cm above the nasion. +PROCEDURE +The participants reported for the assessment at morning 7:00 a.m. +on different days. All recordings were taken in empty stomach, in a +dark room. The subjects wore a flexible headband over pre-frontal +region that contains an array of four photodiodes and 10 sen- +sors and covered with a black cloth. The raw data were acquired +from the probe, which is pre-filtered and processed in the data +processing unit. The data were then sent to a laptop computer +(with COBI software installed) to be digitized and read by the +computer. KB was practiced by the participants at a frequency of +120 ± 10 strokes/min for 1 min, continuous recordings were taken +before (5 min), during (1 min), and after (5 min) the practice. +STATISTICS +Sample size was calculated using G power (24).The waveforms +changes of oxyHb and deoxyHb in bilateral PFCs were acquired +from all the subjects in all 16 channels and the data were averaged +according to the task condition (pre, during, and post). Since spa- +tial resolution of fNIRS device is coarse, we took the average of +the oxyHb, deoxyHb, and totalHb levels on both right (channels +1–8) and left sides (channels 9–16) of the brain (13, 25). Thereby, +we got one mean value of each condition (pre, during, and post) +for each side of the brain (right and left) for each participant. The +data were analyzed by the statistician using Statistical Package for +Social Sciences version 16.0. Kolmogorov–Smirnov’s test was used +to check normality of the data. As the data were found to be nor- +mally distributed, paired samples t-test was used to measure the +changes in oxyHb, deoxyHb, and totalHb levels, respectively, dur- +ing and post KB practice from the baseline (pre) levels in both the +groups (schizophrenia patients and healthy controls). Indepen- +dent samples t-test was used to compare the values between the +groups. Alpha (p value) < 0.05 was considered to be statistically +significant. +RESULTS +oxyHb CHANGES +We observed a highly significant increase in bilateral oxyHb (in +micromoles per liter) from the baseline during the practice of KB +in normal healthy individuals; right side (p = 0.00) and left side +(p = 0.00). Whereas, no significant change was found in schizo- +phrenia patients on both the sides; right side (p = 0.92) and left +side (p = 0.62) (Table 2; Figures 1–4). +Betweengroup comparisonsshowedthatoxyHb levelsweresig- +nificantly higher in healthy controls as compared to schizophrenia +T +able 2 | Means and standard deviations of frontal hemodynamic responses before and during KB practice in patients and controls. +Variable +Group +Side +Pre (mean ± SD) +During (mean ± SD) +Effect size +pa Value +oxyHb (µmol/L) +Patient +Left +0.72 ± 6.17 +1.48 ± 8.62 +0.14 +0.62 +Control +0.11 ± 4.93 +9.87 ± 11.04 +0.88 +0.00** +Patient +Right +−0.82 ± 3.32 +−0.72 ± 5.20 +0.02 +0.92 +Control +0.21 ± 4.63 +12.48 ± 17 +.29 +0.78 +0.00** +deoxyHb (µmol/L) +Patient +Left +1.10 ± 8.39 +−0.69 ± 11.32 +0.16 +0.58 +Control +−1.36 ± 3.01 +−2.76 ± 7 +.79 +0.21 +0.39 +Patient +Right +−0.61 ± 3.04 +−3.29 ± 4.40 +1.22 +0.00** +Control +−1.67 ± 3.74 +−4.32 ± 8.12 +0.45 +0.09 +totalHb (µmol/L) +Patient +Left +1.83 ± 13.19 +−0.38 ± 13.40 +0.08 +0.77 +Control +−1.24 ± 5.01 +8.10 ± 11.07 +0.92 +0.00** +Patient +Right +−1.40 ± 4.06 +−4.02 ± 5.15 +0.60 +0.06 +Control +−1.46 ± 5.21 +8.16 ± 17 +.75 +0.66 +0.01* +oxyHb, oxygenated hemoglobin; deoxyHb, deoxygenated hemoglobin; totalHb, total hemoglobin. +aPaired samples t-test; *p < 0.05; **p < 0.01. +www.frontiersin.org +March 2014 | Volume 5 | Article 29 | 3 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +Bhargav et al. +Frontal hemodynamic responses to yoga breathing +FIGURE 1 | Oxygenated hemoglobin changes in healthy subjects and +schizophrenia patients in left pre-frontal cortex before (pre), during, +and after (post) KB practices. Abbreviations: oxyHb, oxygenated +hemoglobin; deoxyHb, deoxygenated hemoglobin; totalHb, total +hemoglobin; PFC, pre-frontal cortex. +FIGURE 2 | Oxygenated hemoglobin changes in healthy subjects and +schizophrenia patients in right pre-frontal cortex before (pre), during, +and after (post) KB practice. Abbreviations: oxyHb, oxygenated +hemoglobin; deoxyHb, deoxygenated hemoglobin; totalHb, total +hemoglobin; PFC, pre-frontal cortex. +patients during the practice of KB on both the sides; right side +(p = 0.01) and left side (p = 0.03) (Table 3). +deoxyHb CHANGES +Schizophrenia patients showed significant reduction in deoxyHb +(in micromoles per liter) during the practice of KB in right hemi- +sphere (p = 0.00),whereas healthy comparison subjects showed no +significant change (p = 0.09). No change was found in deoxyHb +levels on the left side of the brain in both healthy volunteers and +schizophrenia patients (Table 2; Figures 3 and 4). Between groups +comparison for deoxyHb changes did not show any significant dif- +ference between the two groups (control and patient) during the +practice of KB (Table 3). +totalHb CHANGES +Significant increase was seen in bilateral blood volume (totalHb in +micromoles per liter) from the baseline during the practice of KB +in healthy controls; right side (p = 0.01) and left side (p = 0.00). +On the contrary, totalHb levels reduced in schizophrenia patients +but did not reach the level of significance; right side (p = 0.06) and +left side (p = 0.77) (Table 2; Figures 3 and 4). +Between group comparisons showed that totalHb levels were +significantly higher in healthy controls as compared to schizophre- +nia patients during the practice of KB on both the sides; right side +(p = 0.03) and left side (p = 0.04) (Table 3). +DISCUSSION +We found that there was a highly significant increase in oxyHb +and totalHb in healthy subjects during the practice of KB, which +wasnotobservedinschizophreniapatients.Schizophreniapatients +showed reduction in deoxyHb in the right PFC within the group +(p = 0.01; Table 1) but it was not significant between the groups. +Frontal hemodynamic responses of schizophrenia patients to the +practice of KB were different as compared to healthy age, gender, +and education matched controls. Since, oxyHb is considered as +the most sensitive indicator of changes in regional cerebral blood +flow in NIRS measurements (26, 27), we observed that schizo- +phrenia patients had significantly lesser PFC activation or blood +flow as compared to healthy controls during the practice of KB +in terms of oxyHb changes. This suggests that the effect of KB on +pre-frontal hemodynamics is similar to that of a cognitive task, +which can activate this region of the brain. +Some significant immediate effects of KB practice on frontal +hemodynamics in long term yoga practitioners have already been +demonstrated recently (13). There was a reduction in bilateral +pre-frontal oxyHb and increase in deoxyHb during KB. These +findings appear contradictory to what we have found. But our +study differs from this study in terms of the experience of the +subjects in performing KB as well as the intensity and duration +of the KB practice that was administered. Study by Telles et al. +(13) involved long term practitioners of KB who had 8–36 months +experience of practicing KB whereas in our study we involved KB +naïve subjects. Secondly, in the study by Telles et al., KB was prac- +ticed at the rate of 60 breaths/min for a total duration of 18 min +in three epochs of 5 min separated by a gap of 3 min. And the +average of the three epochs was taken to assess the hemodynamic +responses during KB. Whereas, we administered KB for the dura- +tion of 1 min at double the frequency (120 breaths/min) and took +the average of 1 min. Thus,there may be two possible explanations +for the contradictory findings in the two studies: (1) subjects who +were experts and were practicing KB for a longer duration may +have got desensitized to this practice (similar to the practice effect +seen with repeated administration of neuro-psychological tests) +and thus were more relaxed during the practice thereby showing +PFC deactivation instead of activation,whereas those who are per- +forming this breathing for the first time may still remain sensitive; +(2) the intensity of practice given by Telles et al. (13) was not +sufficient to produce PFC activation. Pre-frontal hemodynamic +responses may have a threshold below which PFC activation may +not take place and this threshold may be somewhere between 60 +and 120 breaths/min. In future studies, it would be interesting to +Frontiers in Psychiatry | Affective Disorders and Psychosomatic Research +March 2014 | Volume 5 | Article 29 | 4 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +Bhargav et al. +Frontal hemodynamic responses to yoga breathing +FIGURE 3 | Frontal hemodynamic responses in schizophrenia patients before (pre), during, and after (post) KB through all the 16 voxels. Abbreviations: +oxyHb, oxygenated hemoglobin; deoxyHb, deoxygenated hemoglobin; totalHb, total hemoglobin; KB, kapalabhati. +FIGURE 4 | Frontal hemodynamic responses in schizophrenia patients before (pre), during, and after (post) KB through all the 16 voxels. Abbreviations: +oxyHb, oxygenated hemoglobin; deoxyHb, deoxygenated hemoglobin; totalHb, total hemoglobin; KB, kapalabhati. +T +able 3 | Means and standard deviations of frontal hemodynamic +responses in patients and controls during KB practice. +Variable +Side +Patient +(mean ± SD) +Control +(mean ± SD) +Effect +size +pa Value +oxyHb +(µmol/L) +Left +1.48 ± 8.62 +9.87 ± 11.04 +0.84 +0.03* +Right +−0.72 ± 5.20 +12.48 ± 17 +.29 +1.03 +0.01* +deoxyHb +(µmol/L) +Left +−0.69 ± 11.32 +−2.76 ± 7 +.79 +0.21 +0.57 +Right +−3.29 ± 4.40 +−4.32 ± 8.12 +0.15 +0.69 +totalHb +(µmol/L) +Left +−0.38 ± 13.40 +8.10 ± 11.07 +0.69 +0.04* +Right +−4.02 ± 5.15 +8.16 ± 17 +.75 +0.93 +0.03* +oxyHb, oxygenated hemoglobin; deoxyHb, deoxygenated hemoglobin; totalHb, +total hemoglobin. +aIndependent samples t-test; *p < 0.05. +assess hemodynamic responses in KB naïve subjects with gradually +increasing dosage (rate of breathing) of KB and try to generate a +dose–response curve along with the threshold point in oxyHb and +total Hb levels. +Detailed mechanism as to how the practice of KB affects frontal +hemodynamics and why schizophrenia patients respond differ- +ently from healthy subjects are yet to be understood, but as it is +known that PFCs are involved in the pathology of schizophre- +nia (14), we may hypothesize that because of the abnormality +in PFCs, schizophrenia patients have responded differently. All +schizophrenia patients were taking antipsychotic medications, +which make it difficult to disentangle drug effects from disease +effects. A review suggested that treatment with antipsychotic med- +ication seemed to normalize brain function and to make the brain +function of schizophrenia patients more similar to that of healthy +individuals (21). Therefore, the results of our study may be more +because of this disease rather than the medication, although we +cannot eliminate completely the medication effects. Future stud- +ies with drug naïve patients are required to discard the medication +effects and confirm the findings of this study. In future studies, +it would be interesting to assess and compare the hemodynamic +responses to KB in patients suffering from other neuro-psychiatric +disorders where PFCs are reported to be involved. +In the present study, we believe that the performance of KB +practice by schizophrenia patients was comparable to healthy con- +trols because, first, the practice was monitored objectively using +a chest pressure transducer for the frequency and depth, and +secondly, the patients have been adequately trained by a certi- +fied trainer and the recordings were taken only when the trainer +was satisfied that the schizophrenia patients performed the prac- +tice well enough to match healthy controls. Those patients who +could perform the practice as per the standards were only selected +in the study. Thus, assuming that schizophrenia patients per- +formed KB as correctly as the healthy controls, we found that +the increase in frontal lobe circulation during KB is not seen in +schizophrenia patients, which means that the effects of KB such +as increased attention and relaxation at the subjective level (7, 8) +may be lesser in schizophrenia patients as compared to healthy +individuals, which we did not check in the present study. We +should have assessed immediate effect of KB practice on clinical +parameters and cognitive performance in schizophrenia patients +simultaneously, which we plan to do in our future studies. Sec- +ondly, because of the limited number of channels, the area of +measurement in NIRS was restricted to the PFC. Simultaneous +measurements by NIRS and other neuro-imaging methodologies +www.frontiersin.org +March 2014 | Volume 5 | Article 29 | 5 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +Bhargav et al. +Frontal hemodynamic responses to yoga breathing +might be used to clarify the association of the PFC with other brain +regions (27). +Future studies should perform a diagnostic validity of KB tech- +nique in cases of schizophrenia. Future studies should also check +whether KB practice performed over a longer duration can modify +pre-frontal hemodynamic responses in schizophrenia patients and +whether this modification correlates with the clinical outcome. +CONCLUSION +This study uses fNIRS to demonstrate that schizophrenia patients +differ significantly from healthy individuals in terms of their bilat- +eral pre-frontal hemodynamic responses to Kap¯ +alabh¯ +ati kriy¯ +a. +Healthyindividualsshowsignificantlygreateractivationandschiz- +ophrenia patients show relative hypo-activation of bilateral PFCs +during KB. KB practice may serve as a potential diagnostic tool to +assess pre-frontal hemodynamic responses. Future studies should +assess diagnostic validity of KB in schizophrenia patients. +ACKNOWLEDGMENTS +We thank all subjects who participated in the study. Further, we +would like to thank Deepeshwar Singh and Varsha C. Shekhar for +supporting fNIRS technicalities. +REFERENCES +1. Bhole MV. 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Simultaneous recording of cerebral blood oxygenation changes during +human brain activation by magnetic resonance imaging and near-infrared spec- +troscopy.JCerebBloodFlowMetab (1996)16(5):817–26.doi:10.1097/00004647- +199609000-00006 +Conflict of Interest Statement: The authors declare that the research was conducted +in the absence of any commercial or financial relationships that could be construed +as a potential conflict of interest. +Received: 31 January 2014; accepted: 08 March 2014; published online: 24 March 2014. +Citation: Bhargav H,Nagendra HR,Gangadhar BN and Nagarathna R (2014) Frontal +hemodynamic responses to high frequency yoga breathing in schizophrenia: a functional +near-infrared spectroscopy study. Front. Psychiatry 5:29. doi: 10.3389/fpsyt.2014.00029 +This article was submitted to Affective Disorders and Psychosomatic Research, a section +of the journal Frontiers in Psychiatry. +Copyright © 2014 Bhargav, Nagendra, Gangadhar and Nagarathna. This is an open- +access article distributed under the terms of the Creative Commons Attribution License +(CC BY). The use, distribution or reproduction in other forums is permitted, provided +the original author(s) or licensor are credited and that the original publication in this +journal is cited, in accordance with accepted academic practice. No use, distribution or +reproduction is permitted which does not comply with these terms. +Frontiers in Psychiatry | Affective Disorders and Psychosomatic Research +March 2014 | Volume 5 | Article 29 | 6 diff --git a/subfolder_0/GYP & Wellness AcharyaGPM10.11772631454120979763[85].txt b/subfolder_0/GYP & Wellness AcharyaGPM10.11772631454120979763[85].txt new file mode 100644 index 0000000000000000000000000000000000000000..46e2391cf76ffcdd75ea1b906aec8f8517b4bffe --- /dev/null +++ b/subfolder_0/GYP & Wellness AcharyaGPM10.11772631454120979763[85].txt @@ -0,0 +1,701 @@ +NHRD Network Journal +1­ +–13 +© 2021 National HRD + +Network, Gurgaon +Reprints and permissions: +in.sagepub.com/journals-permissions-india +DOI: 10.1177/2631454120979763 +journals.sagepub.com/home/nhr +Article +Yoga and Wellness—Key Insights +from the Study on General Yoga +Programme +Rabindra Acharya1, Gopal P. Mahapatra2 and +Kadamibini Acharya1 +Abstract +Human beings have always strived towards excellence and progress since time immemorial. +Industrialisation, automation and technological disruptions have led to increased comfort and quality +of living of human beings and enhanced output, productivity and efficiency. Consequently, of late, +health and wellness are receiving increased attention globally. Stress and stress-related diseases and +workplace-related ailments have significantly increased over the last few decades and gained attention +from society and industrial organisations. In the recent past, in the Coronavirus pandemic context, +wellness has been focused upon in many countries, communities and organisations worldwide. Yoga +has been part of the Indian ethos for centuries. In this article, the authors discuss the General Yoga +Programme (GYP), its broad coverage, and the impact it has had on the participants in terms of their +wellness. With the help of a survey of the participants and linking it to relevant literature and research +in the field, the authors highlight how GYP is a useful tool for enhancing various wellness dimensions. +They recommend that GYP in its simplified form can be extended to the workplace; and also, HR +professionals can play a facilitative role in the process. +Keywords +Yoga, wellness, General Yoga Programme, HR +Introduction +Over the last four decades, globalisation has become a well-accepted term in society in general and the +world of professionals in particular. We live in an age where universal practices decide the more +significant part of social life, wherein national cultures, economies, national borders and regions dissolve +(Hirst et al., 2015). With rapid technological disruptions, and socio-economic and political changes, +1 Swami Vivekananda Yoga Anusandhana Samsthana, Jigani, Karnataka, India. +Corresponding author: +Gopal P. Mahapatra, Professor of Practice, OB &HRM, IIM Bangalore, Bengaluru, Karnataka 560076, India. +E-mail: gopal.mahapatra@iimb.ac.in +2 Professor of Practice, OB&HRM, IIM Bangalore, Bengaluru, Karnataka, India. +2 +NHRD Network Journal +globalisation has gained greater significance for economies in general and people in particular. It has +started impacting the economic situation and wellness of the people in various countries. +In 1990, the Human Development Index (HDI) was developed to assess all countries in terms of +‘human development’. It was created as an alternative to per capita GDP to measure economic and social +growth (Fukuda-Parr & Kumar, 2004). The HDI was used to evaluate development levels among +countries based on the three deficiency parameters: adult literacy, life expectancy and the logarithm of +purchasing power adjusted per capita GDP (McGillivray, 1991). Life expectancy, educational +achievement and average income give us a complete scenario of the overall health and socio-economic +position of the populations selected for the study, and how they have changed over the 1990s (Cooke et +al., 2007). +Globalisation and health is an important topic that focuses on the vital dimensions of our health, +wellness, and indeed planetary existence. Globalisation has had an impact on health through several +social pathways: from health facilities and economic changes to migrant flows and domestic displacement; +through trade and investment deals, labour market ‘flexibilisation’ and the spread of hazardous +commodities; or through the introduction of human rights and environmental security treaties and the +strengthening of health consultation efforts to build reasonable and sustainable global health results +(Labonté, 2018). +Wellness has emerged as an alternative to the conventional view of health as merely reducing illness. +This single indicator variable consists of a few interrelated areas that together make up wellness. For +instance, wellness can be an accessible score involving how people see themselves working and adjusting +to different life measurements (Harari et al., 2005). Wellness has many dimensions (Adams et al., 2000). +Wellness is described here as a multidimensional collection of states, both individual and socio- +cultural, which look for assistance from private health experience. Wellness varies from an ideal form of +‘high-level wellness’ to its harmful analogue ‘illness’. Illness is a person’s ‘disvalued’ condition of being +or a social functioning disease. It is a state of dysfunctionality or disorder. Measures of happiness, +overall wellness, symptoms list, emotional well-being, self-reported illness mechanisms and health +beliefs reflect various aspects of wellness. Wellness specifies the physiological, emotional, cognitive, +moral and social elements (Glik, 1986). +The Sanskrit word ‘Yoga’ derives from the term yug (to join) or yoke (to tie together or to concentrate). +Mainly, the term ‘Yoga’ describes the process of joining forces or a way of discipline: to align the body +with the mind and together connect with the self (the soul). Stated simply, it is the integration between +the physical person and the spiritual self. Yoga derives from an ancient eastern culture, in which education +was transferred from teachers to learners. In his classical work, the Indian sage Patanjali called ‘The +Master of Yoga’, put together this traditional practice. Yoga Sutras are 2,000-year-old scripts on Yoga +Philosophy. Yoga is ‘something which controls the process of thoughts and brings the mind to the state +of ultimate peace’. Ancient diviners adopted Yoga to discover the outer and inner worlds and eventually +gain the insight and knowledge of the religious Indian texts: the Vedas, Shastras and Upanishads +(Garfinkel & Schumacher, 2000). +Yoga has been practised for centuries in India. Nagendra (2008) has contributed significantly to Yoga +and wellness with many of his colleagues and co-researchers at Swami Vivekananda Yoga Anusandhana +Samsthana (SVYASA). According to him, Yoga is recognised as one among the six methods of +philosophy called as the Sat Darshanas—Nyaya, Vaisesika, SankhyaYoga, Purva Mimamsa and Uttara +Mimamsa. The true nature of Yoga is integration (Yujyate anena iti yoga). Swami Vivekananda widened +Yoga into four levels—Jnana Yoga, Karma Yoga, Bhakti Yoga and Raja Yoga, focused on realisation, +Acharya et al. +3 +being in tune and essentially integrating with the real world. Buddha named it excellence, real awareness, +Paramatma and nirvana. Patanjali portrayed it as Kaivalya and Moksha. Yoga is described in Uttara +Mimamsa as reality. The author Badarayana emphasises that Yoga facilitates the opportunity to choose +the way to attain complete freedom from all anxiety and stress, illness, pains and suffering, and move +towards positive wellness, leading to optimal health (Nagendra, 2008). +Yoga has many facets. Studies have shared multiple perspectives of Yoga from Eastern and Western +viewpoints in the following paragraphs. +With meditation, Yoga asanas and pranayama have become popular in the West, and Yoga has become +‘modernised’. The Hatha Yoga Pradipika is an authentic Hatha Yoga manual that reminds us that Hatha +Yoga is a medium for self-realisation. Yoga is a preventive measure for diseases and a reviving system +for the body, mind and spirit. Yoga therapy was designed to reinforce human physiology. Curative Yoga +is the practice of postures to cure health disorders (Garfinkel & Schumacher, 2000). Yoga could be a +discipline that may effectively influence the interpretation of the World Health Organization’s model of +health as a ‘condition of complete physical, emotional, and social well-being, and not solely the lack of +illness or susceptibility’ (Büssing et al., 2012). +Presently, the fundamental and familiar dimensions of Yoga practice involve various body postures +(asanas) and breathing exercises (pranayamas) that strive to guide one’s mind, gain relaxation and +improve an individual’s overall health. Studies have reported positive effects of Yoga on stress, reduced +anxiety and overall wellness. Yoga programmes and yogic breathing can improve the wellness of adult +participants and ensure normal health (Kjellgren et al., 2007). Supplementing the above, Collins (1998) +highlights how Yoga practice in daily routine enhances resilience, stamina and agility. It develops +friendliness, empathy and self-control while nurturing a sense of tranquillity and wellness. +Yoga has many practical dimensions. Yoga makes a person healthy, happy and wise by continuous +practice. Few researchers have highlighted the following. +Constant Yoga practice brings in improvements such as a change in outlook of life, improves self- +awareness and provides an increased sense of energy to pursue life positively (Atkinson & Permuth- +Levine, 2009; Desikachar et al., 2005). Furthering this, Arora and Bhattacharjee (2008) state how Yoga +practice generates a physiological response contrary to those of flight-or-fight stress response, which +produces stress reaction. Therefore, through Yoga, stability and integration can be achieved between the +body and mind. In many cases Yoga is known to have increased physical, emotional and spiritual +wellness, and bringing about some calmness in the patients; even suffering from life threatening diseases. +There are also other instances of practising Yoga regularly over a period of time can enhance mental +wellness and reduce depression and enhance positive emotions in life. +From a comprehensive wellness viewpoint, it appears that Yoga is a classic and balanced model of +wellness and healing. Although it does not succeed in the complete removal of physical diseases and +adverse conditions from the body, it provides a comprehensive healing course. Besides, Yoga brings +harmony to a person’s overall emotional and physical health and spiritual development and wellness. +Yoga is structured to achieve balanced well-being and remove distractions from the mind—therefore, it +makes our living better and reduces the suffering (Woodyard, 2011). +General Yoga Programme (GYP) is one of the Yoga practice techniques followed at the SVYASA, +Bengaluru. Other Yoga schools follow more or less similar procedures with the Hatha Yoga Pradipika or +Patanjali’s Yoga sutras as their base. +Yoga practised through a comprehensive GYP is summarised and depicted in Figure 1. +4 +NHRD Network Journal +Figure 1. General Yoga Programme. +Source: The authors. +Wellness and its Four Dimensions +In today’s dynamic environment, everybody wants to succeed. While achieving results and striving for +success, many people neglect their health and fitness. It is imperative to maintain an optimum balance +between body and mind. Not necessarily, we can assume that if an individual is physically fit and free +from illness, he or she has complete wellness. Being stress-free, fearless and happy is also essential for +human beings. Strong or weak wellness has a direct impact on an individual's action and linked emotions. +Therefore, optimum wellness is necessary to reduce stress and illness. There are many dimensions of +wellness that are essential for attaining overall wellness and happy life. After examining various studies, +the authors have identified four critical dimensions of wellness: (a) physical or physiological wellness, +(b) emotional or psychological wellness, (c) social wellness and (d) spiritual wellness. The four +dimensions are presented in Figure 2. +Figure 2. Four Dimensions of Wellness. +Source: The authors. +Acharya et al. +5 +Physical Wellness +Physiological wellness is related to our body and physical health. It is well-accepted that all the sub- +systems of our body, for example, the respiratory system, nervous system and immune system, should +function effectively. It is possible through the intake of healthy food with the right amount of nutrients +(i.e., vitamins, proteins and minerals), by doing physical exercise or workout, having adequate sleep and +avoiding stress and not so healthy habits (such as intake of alcohol, drugs or tobacco). +Psychological Wellness +Psychological or emotional wellness is related to one’s mental health, feelings, beliefs and emotions. It +is essential to maintain and nurture one’s emotional health and be aware of oneself and others’ feelings, +moods and emotions. Psychological wellness can successfully cope with stress, depression and frustration +and find solutions to encourage positive feelings, enthusiasm and a healthy attitude towards life. +In many articles, repetition of the syllable ‘Om’ has been considered one of the practical interventions +concerning wellness. In a recent study, Acharya et al. (2020) have highlighted how specific styles of +Mantra chanting improve the mindfulness and memory of cognitive variables directly associated with +psychological wellness. +Social Wellness +Social wellness relates to building and maintaining healthier connections and inter-personal relationships +with friends, family and other people in society at large. This dimension encourages people at work or at +home to interact, engage and maintain relationships with people and helps develop strong networks and +friendships with peers. Social wellness also increases motivation, sense of belongingness, productivity, +efficiency and collaboration. +Spiritual Wellness +Spiritual wellness is related to individuals who seek to find the purpose, meaning and value of his/her +life. Spiritual wellness is essential to establish inner peace, happiness and harmony in one’s life. It can +reshape the belief system and guide the actions of an individual. It is a powerful resource that directs +towards one’s purpose or life goals and helps to deal with daily life problems and find solutions to +achieve satisfaction and fulfilment. +Need for the Study and Why GYP +Yoga is a widely researched theme. Many studies have demonstrated the therapeutic and general health +effects of Yoga. Based on a literature review and a few recent studies, we believe that Yoga has an overall +impact on health. Wellness and wellbeing are well-researched areas though they are still evolving in their +respective fields. However, a critical review of the literature reveals that there are not many research +studies to determine the effect of Yoga and GYP in particular on overall wellness. Hence, given the +6 +NHRD Network Journal +significance of wellness in the twenty-first century and the increasing acceptance of Yoga, it was felt +necessary to study and find out the various benefits of Yoga. Specifically, we wanted to find out the +impact of Yoga on wellness in general and the four dimensions of wellness in particular. +Though Yoga has many components like postures (Asana), breathing practices (Pranayama), +concentration (Dharana), meditation (Dhyana) and the like, we find articles on specific techniques like +the asana or pranayama or meditation and their effects. GYP has many features, including loosening +exercises, postures, breathing exercises, focusing and defocusing practices, cleansing practices and +meditation with prayers. Each method has its speciality, but based on the current literature review and +significance of wellness, it was deemed necessary to study GYP, incorporating the above aspects of Yoga +for its impact on overall wellness. +Present Study +The study intends to determine the benefits of the General Yoga Programme, which has been practised by +the first author—a Yoga teacher and practitioner for over three decades. The authors conducted a pilot survey +with volunteer participants who have attended this Yoga programme over the last five years to determine the +benefits of improving wellness by practising Yoga. The study focuses on the four critical dimensions of +wellness, that is, physical or physiological wellness, emotional or psychological wellness, social wellness +and spiritual wellness, and evaluate their impact on overall wellness with general Yoga practices. +Methodology +This is an exploratory study. The methodology adopted both quantitative and qualitative techniques. We +designed the survey based on the literature, adopting from various domains of wellness literature. The +survey questionnaire (instrument) development is given below. +Instrument Design and Assessments Using Integrated Wellness Scale +To determine Yoga’s impact on overall wellness, the authors reviewed various tools based on the literature +on wellness and Yoga and their possible linkages. They have developed the Integrated Wellness Scale +(IWS) which includes the four domains of physical or physiological wellness, emotional or psychological +wellness, social wellness and spiritual wellness. +This scale has been adapted from a few globally well-accepted and specific tools to measure overall +wellness. We have attempted to create an evidence-based IWS. Each dimension has five elements, and it +is evaluated based on a 5-point Likert scale, varying from ‘Strongly Disagree’ to ‘Strongly Agree’ +(Radzyk, 2014; Reker & Wong, 1984). Quantitative data has been collected using the IWS. At the end of +the survey, we asked a few open-ended questions for collecting inputs on any additional benefits that the +participants have identified and their suggestions. This survey was conducted using Google form, and +the survey link was shared through WhatsApp with all the participants. The data was collected between +1 August and 1 September 2020. +Acharya et al. +7 + +Participants + +The IWS survey instrument was administered to 100 participants who were trained in the GYP. Out of +100 participants, 66 have responded. The participants consisted of people in business, homemakers, +employees from the central government, and large public sector enterprises. Both male and female +subjects were included within the age range of 25–60 years without any health complaints. The researchers +excluded participants suffering from various health conditions and those aged above 60 years. + + +Data Analysis and Findings + +For data analysis, MS Excel and percentage analysis were used. The researchers have evaluated each +dimension separately and measured the impact of each domain on wellness. The data received in the +form of four domains are presented in the following tables and graphs. + +Table 1 reflects the participants' responses to the physical wellness domain of the Integrated Wellness +Scale. + +We can observe ( +Table 1 +) that the physical wellness domain was studied using five questions. We can +identify that 68 per cent of the participants do not have many physical complaints, 83 per cent have not +suffered from any heart problems, and 91 per cent of respondents have a good appetite. However, few of +them are suffering from aches and pains, and 65 per cent of the participants believe that they are in good +shape physically ( +Figure 3 +). + + +Graphical Presentation of Data Across the Four Domains of Wellness + +The survey findings on the four dimensions of wellness are presented graphically as follows. + +0% +10% +20% +30% +40% +50% +60% +70% +Strongly +Agree +Agree +Neither agree +nor disagree +Disagree +Strongly +Disagree +Physical Wellness +I don’t have many physical complaints +I don’t think that I have a heart +condition/problem +I have a good appetite for food +I have aches and pains in my body +I am in good shape physically + +Figure 3. +Graph on Physical Wellness. + +Source: Based on survey data from respondents. +8 +NHRD Network Journal +Table 2 reflects the response to the psychological wellness domain of the Integrated Wellness Scale. +In the psychological wellness dimension, the researchers found that 91 per cent of people care about +their life, 69 per cent of the participants were busy with their commitments and work, 91 per cent of the +participants are excited that they are alive, and 90 per cent believe that their life is worthwhile. More +interestingly, 81 per cent of the participants expressed their enthusiasm to wake up every morning, to +learn and achieve their goals (Table 2 and Figure 4). +Table 1. Physical Wellness. +Statements/Response +Strongly +Agree +Agree +Neither Agree +nor Disagree +Disagree +Strongly +Disagree +I don’t have many physical complaints +17 (26%) +28 (42%) +9 (14%) +10 (15%) +2 (3%) +I don’t think that I have a heart condition/problem 30 (45%) +25 (38%) +4 (6%) +5 (8%) +2 (3%) +I have a good appetite +16 (24%) +44 (67%) +4 (6%) +2 (3%) +0 (0%) +I have aches and pains +2 (3%) +20 (30%) +16 (24%) +18 (27%) +10 (15%) +I am in good shape physically +8 (12%) +35 (53%) +14 (21%) +8 (12%) +1 (2%) +Source: Based on survey data from respondents. +Table 2. Psychological Wellness. +Statements/Response +Strongly +Agree +Agree +Neither Agree +nor Disagree +Disagree +Strongly +Disagree +No one really cares whether I am dead or alive +1 (2%) +2 (3%) +3 (5%) +26 (39%) +34 (52%) +I am often bored +0 (0%) +10 (15%) +10 (15%) +26 (39%) +20 (30%) +It is exciting to be alive +29 (44%) +31 (47%) +5 (8%) +0 (0%) +1 (2%) +Sometimes I wish that I never wake up +2 (3%) +6 (9%) +5 (8%) +19 (29%) +34 (52%) +I feel that life is worth living +32 (48%) +28 (42%) +1 (2%) +1 (2%) +4 (6%) +Source: Based on survey data from respondents. +0% +10% +20% +30% +40% +50% +60% +Strongly +Agree +Agree +Neither agree +nor disagree +Disagree +Strongly +Disagree +Psychological Wellness +No one really cares whether +I am dead or alive +I am often bored +It is exciting to be alive +Sometimes I wish that I never +wake up +I feel that life is worth living +Figure 4. Graph on Psychological Wellness. +Source: Based on survey data from respondents. +Acharya et al. +9 +Table 3 reflects the response to the social wellness domain of the Integrated Wellness Scale. +Researchers have analysed the social wellness dimension (Table 3). The survey reveals that 63 per +cent of the people never feel voidness, 79 per cent of the respondents believe that they are content with +their surroundings, 65 per cent of the participants have close connections and relationships with their +direct neighbours and 95 per cent believe that they feel pleasant at their home. Moreover, 83 per cent of +the respondents appreciate the importance of being a member of an association (Figure 5). +Table 4 reflects the response to the Spiritual Wellness domain of the Integrated Wellness Scale. +Similarly, spiritual wellness is explained in five essential items (Table 4); 77 per cent of the respondents +get satisfaction from private prayer to God to achieve spiritual wellness. Researchers found that increased +self-awareness is necessary for great happiness and wellness. From the survey response, it is evident that +most of the respondents were unaware of self, self-identity, and aim in life, which is required all the time, +especially in the present context of the pandemic. It is a cause of concern to the researchers. About 94 per +cent of the participants have faith in God and assume that God is everywhere and shows care and love to +his child and 66 per cent of people also believe that God is with us in every challenge and daily situations. +Moreover, 94 per cent of the participants have had positive experiences in their life (Figure 6). +The above data analysis has explained how all the four key dimensions of wellness are positively +impacted by the intervention of Yoga practices (GYP). +Table 3. Social Wellness. +Statements/Response +Strongly +Agree +Agree +Neither +Agree nor +Disagree +Disagree +Strongly +Disagree +I feel voidness +0 (0%) +10 (15%) +14 (21%) +20 (30%) +22 (33%) +I am content with my surrounding +12 (18%) +40 (61%) +9 (14%) +5 (8%) +0 (0%) +I have close contact with my direct +neighbours +11 (17%) +32 (48%) +12 (18%) +10 (15%) +1 (2%) +I feel pleasant in my home +32 (48%) +31 (47%) +3 (5%) +0 (0%) +0 (0%) +I think it’s important to be a member of +an association +16 (24%) +39 (59%) +7 (11%) +4 (6%) +0 (0%) +Source: Based on survey data from respondents. +Table 4. Spiritual Wellness. +Statements +Strongly +Agree +Agree +Neither Agree +nor Disagree +Disagree +Strongly +Disagree +I don’t find much satisfaction in +private prayer to God +1 (2%) +6 (9%) +8 (12%) +28 (42%) +23 (35%) +I don’t know who I am, where I came +from, or where I’m going +1 (2%) +18 (27%) +8 (12%) +22 (33%) +17 (26%) +I believe that God loves me and cares +about me +44 (67%) +18 (27%) +3 (5%) +1 (2%) +0 (0%) +I feel that life is a positive experience +38 (58%) +23 (35%) +5 (8%) +0 (0%) +0 (0%) +I believe that God is impersonal and +not interested in my daily situations +4 (6%) +9 (14%) +9 (14%) +26 (39%) +18 (27%) +Source: Based on survey data from respondents. +10 +NHRD Network Journal +0% +10% +20% +30% +40% +50% +60% +70% +Strongly +Agree +Agree +Neither agree +nor disagree +Disagree +Strongly +Disagree +Social Wellness +I feel voidness +I am content with my surrounding +I have close contact with my +direct neighbours +I feel pleasant in my home +I think it's important to be a +member of an association +Figure 5. Graph on Social Wellness. +Source: Based on survey data from respondents. +0% +10% +20% +30% +40% +50% +60% +70% +Strongly +Agree +Agree +Neither agree +nor disagree +Disagree +Strongly +Disagree +Spiritual Wellness +I don’t find much satisfaction in +private prayer with God +I don’t know who I am, where I came +from, or where I’m going +I believe that God loves me and cares +about me +I feel that life is a Positive Experience +I believe that God is impersonal and +not interested in my daily situations +Figure 6. Graph on Spiritual Wellness. +Source: Based on survey data from respondents. +Discussion +Many studies have been carried out to examine the efficacy of Yoga and the effects of loosening exercises, +asana, pranayama, meditation techniques and relaxation techniques on different aspects of wellness like +Acharya et al. +11 +physical, mental, emotional, social and spiritual. However, this exploratory study is an attempt to include +all the significant domains of wellness through the IWS survey and highlight the various effects of Yoga +practice through GYP. +One of the studies (Farinatti et al., 2014) on Yoga was compared to many other physical workout +groups, including aerobics and stretching exercise. In a research study on calisthenics, the author compares +a Yoga group with a calisthenics group, where they conducted three sessions a week. After one year, the +Yoga group displayed higher physical strength gains than the calisthenics group. Another research +evaluated the emotional wellness of college students after eight weeks of practising Vinyasa Yoga. The +college students showed increased positive affect scores and the negative effect score decreased. +It is evident from the results of the current survey that participants' responses are complementary to +each domain of wellness, which makes us infer that GYP could have an overall positive effect on +wellness. It is also observed that GYP results in positive responses to all aspects of wellness. Therefore, +we assume that a similar kind of improvement could be achieved in a larger population when Yoga is +practised under the able supervision of qualified Yoga teachers. +Conclusion +The world is changing fast in the era of digitisation and automation. Maintaining positive wellness is a +crucial aspect of an individual’s life and needs to be integrated into our lifestyle. To perform effectively +in the current environment and maintain wellness, Yoga has emerged as an essential facet in our lives. +The practice of Yoga can significantly enhance wellness and help us cope with the challenges in life. This +can help to achieve ultimate happiness, fulfilment, life satisfaction and overall wellness in our lives. +This exploratory study provides a solution to improve wellness by applying Yoga practices in our +daily routine. Yoga practice is beneficial to maintain four crucial aspects of wellness: physical or +physiological wellness, emotional or psychological wellness, social wellness, and spiritual wellness. The +study was an attempt by researchers to determine the impact of Yoga practices on enhancing an +individual’s wellness. After analysing both quantitative and qualitative results, researchers can conclude +that the General Yoga Practice approach leads to significant improvement in all four wellness domains +such as physical, psychological, mental and spiritual. Qualitative responses corroborate that Yoga (GYP) +improves physical strength and enhances flexibility and immune system of the body. It also strengthens +mental ability and emotions to deal with stress and frustration and builds strong connections and +relationships with friends, family and peers. Ultimately, it directs to discover self-identity and transform +thoughts into a positive outlook. Many respondents believe that Yoga helps them attain inner satisfaction +and keeps them relaxed, calm, and composed both physically and emotionally. They enjoyed the overall +process of Yoga and felt energetic and lively. It improved their resilience and enabled them to be more +agile to deal with the uncertainties of life. The GYP also helped to be self-aware and have clarity on the +purpose and priorities of their life. Overall, the participants appear to have been satisfied with GYP and +believe that their wellness has improved. +The authors also share their suggestions to improve the programme. Participants believe that regular +Yoga practice and consultation from time to time will boost their wellness. People could adopt it in their +lifestyle. This programme needs to be organised for people who suffer from stress, depression and +anxiety. This practice can also help people to deal with situations like COVID-19 pandemic. Hence, it +should be spread widely, and a large number of programmes should be organised for a large community +of people or employees in firms to benefit from it. +12 +NHRD Network Journal +Overall, this exploratory study strongly indicates the positive impact of the GYP and its effect on +wellness—in terms of physical, psychological, social and spiritual dimensions. Given the above benefits, +the authors firmly believe that, in its simplified form, GYP can be extended to the workplace. It will +provide multiple benefits to the employees and employers as well. The authors suggest that HR +professionals should play the role of a facilitator in the process of employees practising this GYP and +deriving benefits towards overall wellness. +Acknowledgements +The authors would like to thank Anant Gopal, PhD Scholar, Professor (Dr) Balram, at SVYASA, Amruta Londhe, +Research Associate, IIMB, for their valuable assistance in the research and Chitralekha, IIMB (R&P), for her +valuable editing support and the individual respondents who participated in this survey. +Declaration of Conflicting Interests +The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of +this article. +Funding +The authors received no financial support for the research, authorship and/or publication of this article. +References +Adams, T. B., Bezner, J. R., Drabbs, M. E., Zambarano, R. J., & Steinhardt, M. A. (2000). 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Validation of a new social well-being questionnaire (Bachelor’s thesis). University of Twente. +Reker, G. T., & Wong, P. T. P. (1984). Psychological and physical well-being in the elderly: The perceived well- +being scale (PWB). Canadian Journal on Aging/La Revue Canadienne Du Vieillissement, 3(1), 23–32. https:// +doi.org/10.1017/S0714980800006437 +Woodyard, C. (2011). Exploring the therapeutic effects of Yoga and its ability to increase the quality of life. +International Journal of Yoga, 4(2), 49. https://doi.org/10.4103/0973-6131.85485 +Bio-sketch +Rabindra Acharya is Deputy Director (Admin), Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA). +He is MSc and PhD in Yoga from SVYASA and has been active teacher, trainer and practitioner of Yoga, pranayama, +meditation for last >30 years. He has been part of large-scale research projects like Stop Diabetes Movement, +organised and co-ordinated a number of international and national conferences and conducted large number of +public and in-company programmes in the areas of Yoga, meditation, pranayama and other yogic practices for +government, private and public sector organisations and institutions. +Gopal P. Mahapatra is Professor of Practice, OB&HRM and Chairperson-MBA (Weekend), IIM Bangalore. He is +Doctorate (Fellow) in Management from IIMB and Post-Graduate in Personnel Management and IR from XISS. +Prior to this, he was a Professor of Practice, OB & HRM at IIM, Indore. He has >30 years of corporate, consulting +and academic experience in leading Strategic HR, Organisational Transformation, Leadership Development and +Executive Coaching. Prior to IIM, he was Director/Senior Director-HR (Orgn & Talent Dev.) Oracle India, RPG +Group Vice President-HR (Learning & OD), Managing Director, TVRLS, GM Corporate HR & Head HR, BPL +Head HR, CorpCommn & MS at Gujarat Gas and the like. He was the President, NHRDN, Bangalore, and is on +Academic Council of B-Schools. +Kadamibini Acharya is Assistant Professor Yoga & Centre Head, SVYASA, Delhi Centre. She is MSc and PhD +in Yoga from SVYASA and has been teaching and practising Yoga for last >20 years. She has been active teacher +in undergraduate and postgraduate courses in SVYASA, trainer and practitioner of Yoga, pranayama, meditation +over the years. She has organised and coordinated number of international conferences and conducted large number +of public and in-company programmes in the areas of Yoga, meditation, pranayama and other yogic practices for +government, private and public sector organisations. diff --git a/subfolder_0/Higher Perceived Stress and Poor Glycemic Changes in Prediabetics and Diabetics among Indian Population..txt b/subfolder_0/Higher Perceived Stress and Poor Glycemic Changes in Prediabetics and Diabetics among Indian Population..txt new file mode 100644 index 0000000000000000000000000000000000000000..3303c1f2d861d48e7454d6163bacfe7421407615 --- /dev/null +++ b/subfolder_0/Higher Perceived Stress and Poor Glycemic Changes in Prediabetics and Diabetics among Indian Population..txt @@ -0,0 +1,459 @@ +J Med Life. 2020 Apr-Jun; 13(2): 132–137. +doi: 10.25122/jml-2019-0055 +PMCID: PMC7378337 +PMID: 32742503 +Higher Perceived Stress and Poor Glycemic Changes in Prediabetics +and Diabetics Among Indian Population +Amit Mishra, Vivek Podder, Shweta Modgil, Radhika Khosla, Akshay Anand, + Raghuram Nagarathna, +Rama Malhotra, and Hongasandra Ramarao Nagendra +Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, +India +Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, India +Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and +Research, Chandigarh, India +Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India +* Corresponding Author: Dr Raghuram Nagaratna, Medical Director, Aarogyadhama, Swami Vivekananda +Yoga Anusandhana Samsthana, Prashanti Kutiram, Giddenahalli, Jigani Hobli, Anekal Taluk, Bengaluru - 560 +105, India. Email: rnagaratna@gmail.com +* Co-corresponding Author: Akshay Anand PhD, Professor, Neuroscience Research Lab, Department of +Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Phone: ++919815968102. E-mail: akshay1anand@rediffmail.com +Received 2019 Jun 13; Accepted 2020 Feb 4. +Copyright ©Carol Davila University Press +This article is distributed under the terms of the Creative Commons Attribution License +(http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use and redistribution provided that +the original author and source are credited. +Abstract +Diabetes mellitus (DM) is a chronic metabolic disorder with significant co-morbidities and healthcare +burdens. Many large studies have investigated the association between perceived stress and DM; +however, none investigated this in a larger Indian population. +We hypothesized stress as one of the reasons for the progression of people with prediabetes into DM. +The present study was, therefore, planned to report on associations between perceived stress and blood +glucose markers stratified by diabetic status. +The current descriptive study was a subset analysis of the nationwide cross-sectional survey, conducted +in all Indian zones under the National Multicentric Diabetes Control Program. The study examined the +perceived stress levels using a perceived stress scale (PSS-10) in people with prediabetes (n=649) and +DM (n=485) and then segregated them into three categories (minimum, moderate, and severe). Blood +glucose markers (fasting blood glucose, postprandial blood glucose, and HbA1c) were evaluated to +report their association with the perceived stress. The study revealed a significantly higher HbA1c level +in people with prediabetes, particularly those with severe perceived stress (6.12 ± 0.27) compared to +other categories. Those with DM had a higher fasting blood glucose level, particularly with severe +perceived stress (239.28 ± 99.52). An increased HbA1c level is noted in severely stressed people with +prediabetes, requiring a comprehensive analysis with a longitudinal study of the role of perceived stress +1 +2 +3 +3 +3,* +1,* +4 +1 +1. +2. +3. +4. +in the progression of prediabetes into DM. Additionally, higher fasting blood glucose levels in patients +with DM and severe perceived stress suggests the need for establishing comprehensive diabetic care +inclusive of stress management. +Keywords: Diabetes mellitus, perceived stress, HbA1c, prediabetes +Keywords: CCRYN (Central Council of Research in Yoga and Naturopathy, New Delhi); DM +(Diabetes mellitus); FBS (fasting blood sugar); HbA1c (glycated hemoglobin); HPA (hypothalamic- +pituitary-adrenal axis); IDRS (Indian Diabetes Risk score); IYN (Indian Yoga Association); NMB +(Niyantrita Madhumeha Bharata Abhiyaan); PPBS (postprandial blood sugar); PSS (Perceived Stress +Scale); WHO (World Health Organization) +Introduction +Diabetes mellitus (DM) is a chronic metabolic disorder with significant co-morbidities and healthcare +burdens. In a previous study conducted by SendhilKumar et al., the prevalence of DM in India was +reported to be 7.3% [1]. As per the current national survey, approximately 70 million Indians suffer +from DM with an anticipated rise to 120.5 million by 2040 [2]. +According to the World Health Organization (WHO) report, the global prevalence of DM was 4.0% in +1993, with developed countries being affected more. Among various countries, the Indian and Chinese +populations score higher [3]. This prevalence rate has drastically increased to 8.8% in 2015 [4]. A +multinational, large global estimation study for DM in 2016 found that there is a four-fold increase in +the number of people with DM between 1980 and 2014, with the age-standardized prevalence among +men and women increased by more than 50% [5]. The significant risk factors associated with DM +include non-modifiable (family history and age) and modifiable (obesity, sedentary lifestyle, lack of +physical exercise, and unbalanced diet) factors. India, being an overpopulated and developing country, +has more people in the age group of 60–79 years, thus increasing the DM risk in the population [6]. +Despite worldwide efforts to increase treatment, screening, and preventive programs, DM prevalence +continues to increase. +Factors like stress, anxiety, and depression play a crucial role in influencing this metabolic problem. +The stress levels are reported to be higher among the urban population due to longer working hours, +schedule complexities, social isolation, and lack of support at the professional or personal front [7]. In +India, the prevalence of DM was widely believed to be related to stress due to physical inactivity, +dietary changes, and unhealthy lifestyle conditions [1]. In this respect, the studies related to stress are +essential as it is often found associated with numerous chronic disorders [8]. +Psychological stress is believed to be an essential risk factor for DM, and stressful experiences may +affect the onset and metabolic control of DM. A large population-based survey of glucose tolerance +found an association between stressful experiences and the diagnosis of type 2 DM [9]. Previously, it +was found that stress-related factors, e.g., stressful workplace or traumatic life events, depression, type +A personality, mental health problems, can independently be responsible for DM. In recent years, the +potentially debilitating effects of stressful experiences on poor blood glucose control and the +development of diabetic complications have been studied. High emotional distress and depression are +also linked with DM [10]. This is a complex area with fewer studies being done in adults with type 2 +DM [11]. The chronic stress factors can over-activate the hypothalamic-pituitary-adrenal (HPA) axis, +resulting in an increased release of various insulin counter-regulatory hormones such as cortisol and +adrenaline [10] and eventual derangement in the metabolic control of DM. For example, elevated +plasma catecholamine levels and glucose intolerance have been found to be associated with stress even +in healthy individuals [12], suggesting that stress can lead to transient hyperglycemia in the non-DM +population as well. +In a previously published study, it was noted that psychological stress mobilizes glucose and lipid +release into the circulation with increased production of cytokine. Moreover, chronic or repeated +stressors can lead to dysregulated glucose metabolism, neuroendocrine function, and low-grade +inflammation. Furthermore, psychological stress can adversely affect health behaviors such as food +choice, medication adherence, physical activity, contributing to type 2 DM risk. Patients with +established DM were also found to have poor glycemic control and cardiovascular complications due +to depression and DM-related distress [13]. +Many studies point towards the peculiar features in Indian population that are responsible for +increasing the susceptibility to DM [14]. For example, the genetic susceptibility to DM is stronger in +Indian subjects, and it is thus essential to examine the role of stress in exacerbating DM. Twins from a +family of those with diabetes provide an interesting piece of evidence to show that stress indeed plays a +vital role in the pathogenesis of type 2 DM [15]. Therefore, it is crucial to examine further the +association of stress with DM using a larger population sample before any new public health +intervention is planned. The nationwide data in this respect is still lacking. The present study was, +therefore, planned to analyze the association between perceived stress category and blood glucose +markers stratified by diabetes staging. +Material and Methods +Study design +The current descriptive study was a subset analysis of the previously published nationwide cross- +sectional survey conducted on 16,368 participants, using a multilevel stratified cluster sampling +technique with random selection, among urban and rural populations covering all Indian zones of the +country. The study was conducted under the National Multicentric Diabetes Control Program, also +called the Niyantrita Madhumeha Bharata Abhiyaan (NMB). This was funded by the Central Council +of Research in Yoga and Naturopathy, New Delhi (CCRYN), and implemented by the Indian Yoga +Association (IYA). +Screening of participants +The Indian population was divided into seven major zones according to geographic distribution viz. +North, South, East, West, North East, North West and Central. In each zone, participants from both the +urban and rural regions were recruited. Participants were screened and selected from the general +population based on the defined inclusion criteria: participants with hypertension and obesity; and +exclusion criteria: participants with cardiovascular problems or who had undergone any major surgery. +Door to door screening was carried out through the Indian Diabetes Risk Score (IDRS) that is +comprised of questions related to the two modifiable (physical activity and waist circumference) and +two non-modifiable (age, family history) factors. Both male and female participants with an IDRS +score of above 50, who fall under the category of high risk for DM, were further called for registration. +In a previous study, Pawar et al. showed the sensitivity of IDRS as 73% and specificity 58.7% at a +cutoff of >50 [16]. DM patients who were recruited took standard antidiabetic drugs for their glycemic +control (Figure 1). +Registration and Recruitment +From the selected population, only those participants who had a higher IDRS score were enrolled. +Based on the self-declared DM status, they were subjected to a biochemical and psychological +assessment. The DM or prediabetic status was determined using a combination of both self-report and +biochemical results. The complete description of the research methodology, including study design, +sampling strategy, study methods and quality assurance, data collection, assessments, data compilation, +has been published previously in detail [17]. +Biochemical Assessment +The biochemical determinants of DM were estimated by an accredited diagnostic laboratory using +standard diagnostic procedures. Blood samples were collected at selected centers in seven zones +throughout the country. The glycated hemoglobin (HBA1c), fasting blood sugar (FBS), and +postprandial blood sugar (PPBS) were estimated. The diagnostic protocol for these tests was aligned to +and standardized across the centers as all tests were done by branches of a reputed diagnostic +laboratory. +Psychological Assessment (Stress Level Analysis): Perceived Stress Scale (PSS) +The Perceived Stress Scale (PSS) is a widely used instrument for measuring stress levels of the general +population with psychological disorders. It is a self-administered questionnaire with ten statements +where the participants were asked about feelings and thoughts about their own lives in the past month, +and they had to choose from 5 options (0-4), ranging from ‘never’ to ‘very often’. Of the ten questions, +six statements measured the stress level, and the other four statements measured counter stress, i.e., the +four counter stress questions assessed the level of confidence the person has while facing a stressful +situation, and these are scored in the reverse order. The maximum achievable score was 40, which was +divided into three categories (0-15: mild stress; 16-30: moderate stress; 30-40: severe stress). PSS-10 is +a revised version of the original scale comprising of 14 items (PSS-14) and was found to be +psychometrically comparable and as reliable as the original scale [18]. Data curation was ensured, and +only those individuals who had answered all the questions related to the PSS questionnaire were +included in the study. +Data Analysis +Data analysis was accomplished by applying the Pearson correlation test, paired sample t-test, chi- +square test, and one-way ANOVA by using SPSS (21.0). P≤0.05 was taken as statistically significant. +Ethical considerations +All subjects were informed about the aim of the research, and their written informed consent was +obtained. Ethical permission was obtained from the Institutional Ethics Committee (IEC) meeting held +at Morarji Desai National Institute of Yoga vide reference no. RES/IEC-IYA/001 dated 16th Dec 2016. +Results +Socio-demographic details +The current study analyzed a total of 1134 participants, from the previously published study with +prediabetes (n=649) and DM (n=485) in order to evaluate the association of perceived stress with their +glycemic changes [19]. +Association between blood glucose parameters and perceived stress in different populations +Based on the PSS score, people with DM and prediabetes were divided into a minimum, moderate, and +severely stressed population. FBS levels were found to be marginally (p=0.08) higher in the severely +stressed (109.80 ± 25.76) people with prediabetes, than moderately (99.24 ± 18.97) and minimally +stressed (99.49 ± 17.79) populations. Additionally, PPBS levels were found to be marginally (p=0.07) +higher in the severely stressed (155.5 ± 40.31) people with prediabetes than the moderately (121.57 ± +37.50) and minimally (121.23 ± 36.95) stressed population. Though alterations in FBS and PPBS levels +were not significant among the three categories, HBA1c levels were found to be significantly +(p=0.008) higher in the severely stressed (6.12 ± 0.27) people with prediabetes compared to moderately +(5.97 ± 0.21) and minimally stressed (5.95 ± 0.22) population (Table 1). +Table 1: +PSS score categorization into minimum, moderate and severe in people with prediabetes and its +association with glycemic parameters. +Blood Parameter +Stress Category +N +Mean +Std Deviation +p-value +FBS + +(mg/dl) +Minimum +307 +99.49 +17.79 +0.08 +Moderate +277 +99.24 +18.97 +Severe +10 +109.80 +25.76 +PPBS + +(mg/dl) +Minimum +174 +121.23 +36.95 +0.07 +Moderate +190 +121.57 +37.50 +Severe +4 +155.5 +40.31 +HbA1c + +(%) +Minimum +328 +5.95 +0.22 +0.008 +Moderate +308 +5.94 +0.21 +Severe +13 +6.12 +0.27 +Similarly, glycemic changes were also noted in the DM population. The mean FBS levels were found +to be significantly (p=0.02) higher in the severely stressed population (239.28 ± 99.52) than the +minimally (171.69 ± 76.78) and moderately (182.15 ± 72.35) stressed population. However, PPBS +(p=0.73) and HBA1c (p=0.19) levels did not show any significant difference between the different +categories (Table 2). +Table 2: +PSS score categorization into minimum, moderate and severe in the diabetic population and its +association with glycemic parameters. +Blood Parameter +Stress Category +N +Mean mg/dl +Std Deviation +p-value +FBS + +(mg/dl) +Minimum +247 +171.69 +76.78 +0.02 +Moderate +166 +182.15 +72.35 +Severe +7 +239.28 +99.52 +PPBS + +(mg/dl) +Minimum +164 +236.24 +101.35 +0.73 +Moderate +140 +264.20 +107.42 +Severe +3 +256.66 +44.65 +HbA1c + +(%) +Minimum +273 +8.55 +1.90 +0.19 +Moderate +204 +8.74 +1.98 +Severe +8 +9.46 +3.03 +Discussion +The current study provides a comprehensive comparison of the effects of perceived stress on the blood +glucose parameters among people with prediabetes and DM in the entire Indian population. Stress has +been studied in relation to various diseases and their course of progression and is found to be a risk +factor in many disorders. The present study has shown that people with prediabetes are under more +stress as compared to those with diabetes in India. Stress is believed to be closely related to DM +because both have common risk factors such as inadequate eating behaviors, sedentary lifestyle, +smoking, and alcohol abuse [20]. Also, chronic stress reactions and depression affect the hypothalamic- +pituitary-adrenal (HPA) axis leading to abdominal obesity, another risk factor of DM [21, 22]. Another +explanation for the correlation of stress with DM is evidenced by immune system alterations as a result +of stress. Pro-inflammatory cytokines and glucocorticoids such as cortisol have been found to be +elevated in response to chronic stress [23]. Stress and its correlation to the onset of DM have been +described earlier in which the retrospective analysis of 25 adult DM patients was reported to have a +history of antecedent stress [24]. In a follow-up study, it was found that stressed men, but not women, +were two times more likely to develop DM. Another intriguing finding of the study described that +participants who reported high levels of stress were less likely to quit smoking or drinking and +displayed an increased tendency for physical inactivity. Both these factors are known risk factors for +type-2 DM [20]. Interventions such as healthy lifestyle modifications have earlier been proved to be +effective in regulating DM progression. One hundred fifty minutes of physical workout per week +reduced the incidence of DM by 58% [25]. The Finnish Diabetes Prevention Study was the first +intervention study to prevent or postpone the occurrence of DM in high-risk individuals. The follow-up +studies reported that the intervention group underwent dietary and physical activity-related lifestyle +modifications and showed significantly greater improvement in weight reductions and glycemic index +[26]. +Another study in which medical conditions (DM and lifestyle factors) were self-reported by individuals +in the form of a questionnaire at the baseline, 5, and 10 years later, explored and proved the association +of perceived mental stress with the onset of DM [27]. Similarly, Toshihiro and co-workers, after a 3- +year follow-up, showed that impaired glucose metabolism (risk factor of DM) was related to stress +[28]. +A healthy individual under stress initially begins with a primary flight or fight response against the +stressor, but when the stress is prolonged, the body sets up a resistance phase resulting in hormonal, +metabolic, and physiological changes. In the people with prediabetes, the body appears to be in the +adaptation phase, physiologically. +Psychological stress is involved in the progression of multiple diseases. Severe types of psychological +stress affect both the nervous and peripheral systems. Much of experimental evidence suggests that the +severity of the disease depends upon the course and duration of stress. It has also been observed that +when the person encounters stress for the first time, it targets the nervous system with alteration in +pathophysiology and immune system [29]. Physiologically, stress activates the endocrine system, +which produces the primary effector (cortisol) regulating the vast range of physiological systems, +including the immune and cardiovascular systems, gluconeogenesis and protein, carbohydrate, and fat +metabolism [30]. +However, it is still debatable whether stress is responsible for the progression of systemic diseases or +disease progression leads to psychological stress or both [11]. There are studies that correlate stress +with DM, i.e., those with DM are more distressed because of the perception of complications they +anticipate. DM treatment or diagnosis can be one of the stressors as these patients have to keep up with +the sugar levels by following a strict diet regime [10]. Therefore, it is not very clearly understood +whether stress is a cause or a consequence of DM [31]. Our study does not provide any evidence in this +regard, and in order to test this discrepancy, large randomized controlled trials are required with a +longitudinal follow-up. +Conclusion +People with prediabetes and severe perceived stress have an increased HbA1c level, which calls for a +comprehensive analysis with a longitudinal study of the role of perceived stress in the progression of +prediabetes into DM. Additionally, higher FBS levels in patients with DM and severe perceived stress +suggests the need for establishing comprehensive diabetic care inclusive of stress management. +Acknowledgments +The authors would like to acknowledge the volunteers of Niyantrita Madhumeh Bharat for their help in +data collection, Dr. Rama Malhotra and Dr. Suchitra for data analysis. Abdul Ghani for data +digitization, CCRYN for providing support regarding human resources, MOHFW for providing +financial help for the cost of investigations, IYA for the overall project implementation, and Dr. Deepti, +Head of the English Department, Panjab University, for proofreading. +Source of Funding +This research work was supported by the Ministry of AYUSH, Government of India. +Conflict of interest +The authors declare that there is no conflict of interest. +References +1. Sendhilkumar M, Tripathy JP, Harries AD, Dongre AR, Deepa M, Vidyulatha A, et al. Factors +associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care +center, Chennai, Tamil Nadu, India. Indian J Endocrinol Metab. 2017 Jan-Feb;21(1):56–63. +[PMC free article] [PubMed] [Google Scholar] +2. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, Cavan D, +Shaw JE, Makaroff LE. 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[PubMed] [Google Scholar] +Articles from Journal of Medicine and Life are provided here courtesy of Carol Davila - University Press diff --git a/subfolder_0/Human immunodeficiency virusacquired immune deficiency syndrome A relook into the challenge from an integrated, yogic perspective.txt b/subfolder_0/Human immunodeficiency virusacquired immune deficiency syndrome A relook into the challenge from an integrated, yogic perspective.txt new file mode 100644 index 0000000000000000000000000000000000000000..fe0acfcd8e3ebe4e834ab06af282bf2ef85a5d72 --- /dev/null +++ b/subfolder_0/Human immunodeficiency virusacquired immune deficiency syndrome A relook into the challenge from an integrated, yogic perspective.txt @@ -0,0 +1,787 @@ +3 +© 2019 International Journal of Yoga - Philosophy, Psychology and Parapsychology | Published by Wolters Kluwer - Medknow +HIV/AIDS is said to be one of the deadliest disease of modern times, incurable. The +disease, is taking fortune out of the victims physically, mentally, psychologically, +socially and economically. Efforts are being made at global level to control the +deadly disease. In spite of all the efforts and the money spent, the disease is +still a challenging one. UNAIDS has strategized year 2030 to end HIV/AIDS. In +this background there is a need to relook the way the challenge of HIV/AIDS is +addressed. This paper relooks into the various issues both from preventive and +combating perspectives, by providing conceptual notes not well discussed among +the scientific community. Taking hints from Ayurvedic texts the paper discusses a +multidimensional approach involving food, sexual attitudes, condoms, behavioral, +education; all with yogic (yoga based) approach as the base to address the +challenge faster and better. +Keywords: Condoms, HIV/AIDS, ojas-kshaya, saptha-dhatus, yoga +Human Immunodeficiency Virus/Acquired Immune Deficiency +Syndrome: A Relook into the Challenge from an Integrated, Yogic +Perspective +BP Harichandra, Mavathur N Ramesh, HR Nagendra +Access this article online +Quick Response Code: +Website: www.ijoyppp.org +DOI: 10.4103/ijny.ijoyppp_8_18 +Address for correspondence: Prof. BP Harichandra, +C/O Dr. MN Ramesh, Ekanatha Bhavan, #19, +Kempegowdanagara, Bengaluru ‑ 560 019, Karnataka, India.  +E‑mail: ramesh.mavathur@svyasa.org +Montagnier opines that the immune system can take on +the HIV on its own,[6] world over  18.2 million people +are on ART as of June 2016, and globally, 35 million +people have died of AIDS‑related illnesses.[1] Further, it +is well known and well accepted that ART has a battery +of common and severe side effects. In this background, +the current article relooks into the various aspects +of HIV/AIDS, and proposes an integrative approach +considering yoga as a component, taking hints from +Ayurvedic texts to combat the challenge. +To present these, this article explores traditional texts +on medical sciences which are largely the Ayurvedic +texts, which explain about the immune system referred +to as vyādhikshamatva, the factors affecting them and +strategies for enhancing them, taking the concept of ojas +Review Article +Introduction +H +uman immunodeficiency virus  (HIV) that causes +acquired immune deficiency syndrome  (AIDS), +assaults the body’s immune system leading, over time, to +a situation where the body cannot fight the infections and +diseases.[1] HIV/AIDS is one of the biggest public health +challenges of the 20th century since its discovery in early +80s.[2] According to the United  Nations Programme on +HIV/AIDS (UNAIDS) statistics, at the end of 2015, 36.7 +million people globally and 2.1 million people in India +lived with HIV/AIDS.[1,3] UNAIDS strategizes making +2030 as the year to end AIDS epidemic,[4] which is about +one and a half decades away. Conventional approach to +combat HIV includes typically the “A‑B‑C; Abstinence, +Being faithful and use Condoms” strategy to prevent +HIV/AIDS and an antiretroviral therapy  (ART)‑based +medication for enhancing the immune system as well +as preventing vertical transmission. According to the +Montagnier, who shared the Nobel Prize for coinventing +the HIV, the virus is just like any other passerby virus, +and our body can be exposed to the virus any number +of times. If one has a strong immune system, the body +can overcome the virus in a matter of weeks.[5] Although +Department of Life Sciences, +S‑VYASA, Bengaluru, +Karnataka, India +Abstract +This is an open access journal, and articles are distributed under the terms of the +Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows +others to remix, tweak, and build upon the work non‑commercially, as long as +appropriate credit is given and the new creations are licensed under the identical +terms. +For reprints contact: reprints@medknow.com +How to cite this article: Harichandra BP, Ramesh MN, Nagendra HR. +Human immunodeficiency virus/acquired immune deficiency syndrome: +A relook into the challenge from an integrated, yogic perspective. Int J +Yoga - Philosop Psychol Parapsychol 2019;7:3-9. +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Harichandra, et al.: Yogic approach to address the HIV/AIDS challenge +4 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 1  ¦  January‑June 2019 +which is considered to be base of vyādhikshamatva. The +article also reviews the modern literature in the area +and briefly presents the views of modern Ayurvedic +researchers and Vaidyas on the issue. However, in order +to address the challenge, the article does not consider +the herbal or metal‑based Ayurvedic preparations, but +explains an integrated yogic perspective based on +enhancement of paṁcakośas, through the practice of +yoga as suggested by Maharshi Patanjali and other yogic +texts, which also includes lifestyle modification. Further, +the article addresses the challenge both in preventive +and combating modes. +Need for yogic approach +The basic premise based on which the concept is evolved +in this article is that HIV/AIDS primarily is a result +of bhogic  –  the materialistic approach to life. Simple +logic implies that the option for tackling it should be +the opposite of the bhogic, which is the yogic  –  the +spiritualistic approach to life. Thus far, the problem has +largely been addressed from physiological perspective. In +addition, an integrative approach accommodating yogic +and spiritual perspective could lead to better alleviation. +HIV/AIDS is also a significant social issue. Hence, +an approach with a lifestyle perspective, promoting +responsible social and ethical attitude toward life would +also be an advantage. An integrated approach provides all +these. An integrated approach considers an yogic approach +involving five cardinal principles, namely,  (1) physical +calming of the body by relaxation  (through practice of +various āsanās and deep relaxation technique, cyclic +meditation, and yoga nidrā), (2) slowing of the breath by +taming the breath to help better flow of energies (through +practice of different types of pranayāmās and prānic +energization technique), (3) mastering of the mind to help +calming it and thereby providing conducive environment +for channelizing the energy toward combating the +disease  (through techniques such as silence, observation +of breath, the Mind Sound Resonance Techniques),  (4) +lifestyle changes with a purpose of understanding oneself +and true purpose of life  (implemented through yogic +counseling), and  (5) overall energization of oneself +by taking precaution against loss of vital energy of the +body  (through practice of dhyāna). These principles +would help both in prevention mode and “supporting the +body to improve and combat HIV” mode. Traditional +and modern texts provide the practices to enhance each +of the paṁcakośas.[7] +Human immunodeficiency virus/acquired +immune deficiency syndrome – The yogic +dimension +The meaning of the word yoga is “union;” primarily, +the union of the body  (existence at physical state) +and the soul  (existence at consciousness state). +Primarily, in yoga, we add energy both to physical and +conscious levels. In the process of energization of the +soul, ojas  (dealt with in detail, later in this article) is +produced, which is the key to a strong immune system. +When the immune system is strong, the body is able to +take care of any attempt by disease‑causing agents that +cause infection. Reports of ability of yoga to increase +the CD4+  T‑cells in HIV‑positive adults[8] also adds +credence to examine its efficacy in mitigating AIDS and +complications arising out of it. +Mechanism of yoga +Working of yoga can be explained with the help of +“the principle of mutual convertibility,” which states +that matter and energy are interconvertible. In yoga, the +matter of the body is converted into energy of the soul. +With persistent practice of higher levels of yoga, matter +of the body, represented by the sapta dhātus, is converted +into higher state of matter, the ojas. It is worth noting +here that, although production of ojas happens naturally +during deep sleep when there is a conducive environment +in the body, it can be enhanced/assisted through yoga. +Fundamentally, the stages in which the production of +ojas happens can be explained using description from +Ayurvedic texts as follows: Sapta dhātus refer to the +seven body tissues, namely, the rasa (basic body fluids), +rakta (blood), māmsa (muscles), medas (fats and lipids), +asti  (bones), majje  (bone marrow), and śukra  (semen). +The sapta dhātus are produced in that order, and each +of the sapta dhātu becomes the source for the next +dhātu, starting from rasa to end with śukra.[9] The +last of the sapta dhātus, the semen is the highest state +of matter of all sapta dhātus, that is, a matter with +highest quantum of energy which is the key material for +production of ojas. Integrated yogic approach enhances +the production of ojas. The resulting higher energy +state, the ojas thus produced permeates all through the +body. Ojas is the energy of life and provides physical, +mental, and spiritual vitality. It is considered to be vital +in defense mechanism of the body[10] and a biological +determinant of bio‑strength and immune strength in an +individual.[11] The physical, mental, and spiritual strength +of an individual totally depends on ojas.[12] Further, ojas +is principally responsible for the immunity, referred to as +vyādhikshamatva, and its effect is referred to as ojabala +or bala. Ojas determines the capacity of an individual to +combat diseases, referred to as Vyadhi bala virodhitvam +and also resists virulence of a disease referred to as +Vyadhi utpadaka pratibandhakatvam.[13] The Ayurvedic +texts further explains that if ojas is affected, it leads to +a condition called ojas dushti, leading to pathogenesis, +which is further divided into three stages, namely, +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Harichandra, et al.: Yogic approach to address the HIV/AIDS challenge +5 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 1  ¦  January‑June 2019 +ojas‑vistramsa, ojas‑vyapat, and ojas‑kshaya. Ojas +vistramsa results in fatigue and weakness in the body, +and results in an environment in the body where disease +can easily get lodged in the body. Ojas vyapat results +in fluctuation of immunity leading to autoimmune +disorders, hypersensitivity, and allergic disorders. The +last stage, the ojas‑kshaya which refers largely to the +loss, absence or deficiency of ojas, causes wasting, +decay, degeneration, delirium, apoptosis, and thus +destruction of the body.[12,14‑16] The conditions of the +body with ojas‑kśaya are similar to that of an HIV +positive as explained below. +Similarities in symptoms of Ojas kshaya and +human immunodeficiency virus/acquired immune +deficiency syndrome +HIV/AIDS does not have unique symptoms but, +because of the weakened immune system, the victim +will be prone to several opportunistic infections. +A  similar condition described in the Ayurvedic texts, +which is said to be a result of ojas kshaya. There are +several references to this in Ayurvedic texts. Typically, +a few are mentioned here. Depletion of ojas shows +up through symptoms such as fear complex, constant +weakness, worry, affliction of sense organs with pain, +loss of complexion, cheerlessness, roughness, and +emaciation.[17,18] Further, it is explained that if the ojas +is destroyed, the human beings will also perish.[19] +Furthermore, according to the Ayurvedic texts, depletion +of ojas also leads to diabetes (ojomeha/madhumeha),[20,21] +anemia (pāndu roga),[22‑25] tuberculosis (rajayakshma),[26] +loss of immunity,[27] weight loss, and death.[13] Similar +conditions are also seen with reference to HIV/AIDS as +explained in the modern literature. It is also worth noting +that ojas is further subdivided into para ojas and apara +ojas. While para is the subtler ojas, apara is the grosser +ojas. In general, ojas‑kshaya means the deficiency of +apara ojas which leads to immune deficiency.[28] Para +ojas depletion being a more serious issue could lead +to faster death by disorders in cellular apoptosis.[15] +Perhaps, this would be a condition that could be called +AIDS. The typical symptoms along with references to +modern HIV/AIDS and that to ojas kshaya are listed in +Table 1. +Importance +of +ojas +in +managing +human +immunodeficiency +virus/acquired +immune +deficiency syndrome +Both production and preservation of ojas are important +in nurturing a person with HIV. There are two routes +leading to ojas kshaya  (1) deceiving the body of the +basic raw material required for the formation of sapta +dhātus, which is food; or in other words malnutrition +and (2) by rejection of the śukra itself due to indulgence +in unregulated, irresponsible sexual practices. Charaka +Samhita, a basic text of Ayurveda, also clearly explains +this.[18] While Harichandra and Ramesh have dealt with +the role of former separately in another study,[39] this +article emphasizes on the later as a factor leading to ojas +kshaya. +Preservation +of +śukra +requires +practice +of +brahmacharya  +(Sex +sublimation/Celibacy), +which +forms an integral part of yoga. As such, brahmacharya +is a part of the yama, the first stage of yoga +explained in the Patanjali Yoga Sutra  (PYS)  (Sutra +30, Sādhana Pāda) which reads as follows: “ahimsa +satya +asteya +brahmacharya +aparigraha +yamāha” +which means ahimsa‑  nonviolence, satya‑truthfulness, +asteya‑nonstealing, +brahmacharya‑celibacy, +and +aparigraha‑non +covetousness +are +the +Yamās‑the +restraints for yoga. Yama being the first stage of yoga, +brahmacharya, the part of yama becomes a fundamental +part of yoga. PYS 2–38 states “brahmacharya +pratiśṭāyam vīrya lābhaha” which means that when +brahmacharya is practiced, one acquires abundant +vitality and energy, which is required for an HIV victim +to combat the virus. Further, uncontrolled release of +semen throughout the life does contribute to premature +deterioration of vital capacities of brain, overburdens +the heart, and depletes the nervous system,[40] thus +affecting the overall well‑being. Swami Vivekananda +in the lessons on Raja yoga states so: “Ojas is most +easily made from that force which manifests itself +in the sexual powers. If the powers of the sexual +centers are not frittered away and their energies not +wasted  (action is only thought in a grosser state), they +can be manufactured into Ojas.”[41] Modern findings also +correlate the increased prevalence of hypogonadism in +HIV‑infected persons.[42,43] Reduction in the secretion +from gonads is what the authors are presenting here as +depleted śukra dhātu and thereby the ojas. Further, it is +observed that multimorbidities  (2+  comorbidities) are +Table 1: Similarity of symptoms between human +immunodeficiency virus/acquired immune deficiency +syndrome and ojas‑kshaya +Symptom/condition +References to +HIV/AIDS +References to +ojas‑kshaya +Madhumeha/diabetes +[20,21] +[29‑31] +Ojomeha/diabetes +[20,21] +[30,32] +Pandu roga/anemia +[22‑25] +[30,33] +Rajayakshma/tuberculosis +[26] +[34] +Reduced immunity and +inability to fight diseases +As the name itself +indicates there is +loss of immunity +[27] +Weight loss +[35,36] +[13] +Marana/death +[37,15,18] +[30,15,38] +HIV: Human immunodeficiency virus, AIDS: Acquired immune +deficiency syndrome +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Harichandra, et al.: Yogic approach to address the HIV/AIDS challenge +6 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 1  ¦  January‑June 2019 +high among HIV‑infected men with hypogonadism.[44] +It is also opined that early recognition of hypogonadism +can help improve the quality of life among HIV +positives.[42] Thus, it can be safely argued that preventing +loss of śukra would also help manage comorbidities +among HIV positives; perhaps, more so if śukra were +to be converted to ojas; thus preventing the ojas kshaya. +Another important thing that is worth noting here is +that the effect of ojas, the ojabala, is classified into +three categories: sahaja bala  (transferred generation to +generation), kālaja bala  (depending on environment), +and yuktikrut bala  (induced or gained by nutrition, +exercise, and healthy workouts).[12,45] Of these, sahaja +bala which is transferred generation to generation could +be safely attributed to be induced or developed in the +body well before the formation of zygote through the +sperm and ovum, and in the morula stage.[12] Hence, +enhanced sahaja bala could also help in preventing +mother‑to‑child transmission of HIV. Incidentally, +it is also reported that yoga helps in preventing +mother‑to‑child transmission.[46] +Both modern and traditional literature, based on yoga, +also provide clues on beneficial practices of yoga +for HIV positives. Some of them are highlighted +here. Practice of oli mudras which include vajroli, +sahajoli, and amaroli help sublimate sexual energy +into ojas.[40,47] Bhargav et  al. provide an integrative +approach‑based yoga module for HIV positives,[7] +which could be promising and worth studying. Further, +the factors that are responsible for ojas‑kshaya as +per +classical +texts, +namely, +Abhighata  +(trauma), +kshaya  (emaciation), kopa  (anger), shoka  (depression), +dhyana  +(worrying), +Sharma  +(excessive +physical +work), akshudha  (starvation), ativyayama  (excessive +exercise), atimadyapana (excessive alcohol intake), and +ativyaya  (excessive sex)[12,48] are all addressed in the +yogic approach explained in the astānga yoga  (eight +limbs yoga) explained by Maharshi Patanjali which +start right from yama and niyama, which are the aspects +requiring lifestyle modification, and are the first two +stages of yoga. +The Condoms Formula +Of all the precautionary measures for prevention +of HIV/AIDS, the highest importance is given to +promotion of condoms; “Use condoms‑Prevent AIDS” +is the major punch line in all awareness programs. This +could be construed as a good strategy for prevention, +but misleading for HIV positives. Indulgence in sexual +activity results in spending of the energy. Ojas being +a product of the semen/sexual energy, its loss bears +heavily on the HIV positive individual and repetition +of the behavior results in faster progression from HIV +positive state to the AIDS state. Thus, while condoms +use by HIV positives prevents HIV transfer, it promotes +AIDS. +The basic thought of emphasis on condom promotion +is based on the premise that its use will prevent HIV +from spreading; which addresses only half the problem. +Working on ideas to boost the immune system in the +infected individual, helping them to fight HIV better +would be a more beneficial strategy. To this effect, giving +a fillip to ojas is what the authors propose. Needless to +say, indulgence in sexual activity results in spending of +the energy, leading to ojas kshaya, resulting in faster +progression from HIV positive state to the AIDS state. +Thus, while condoms use by HIV positives prevent HIV +transfer, it promotes AIDS, thus is something like HIV +positives digging their own grave. Hence, it should be +strongly advised that a HIV positive individual abstain +from any kind of sexual activity. Just as some diet +would be prescribed for an ill person, who is basically +restraining the desires of the tongue; HIV positives +should be prescribed to restrain the desires of sex to +preserve their vitality. The HIV positives may resume +back to responsible sexual activities once the immune +system takes over the HIV. For agencies such as World +Health Organization, UNAIDS, National AIDS Control +Organization, it would be worthwhile to conduct a study, +to estimate the correlation between the frequencies +of indulgence in sexual activity to the progression +of disease. At this juncture, it is worth noting that +modifications in behavioral changes with reduction in +cases of people having 2+ nonregular sexual partners by +50%, 3+  nonregular sexual partners by over  90%, and +premarital sex by around 65% had a major role to play +in a successful prevention of HIV cases in Uganda.[49] +This establishes that behavioral correction with regard to +sex in general will go a long way in combating the HIV +epidemic. +Sex education +Educational programs to create awareness about AIDS +mainly focus on providing education on “safe sex.” +This can address or aggravate the problem depending +on the prevalent social ideology. This is required in +regions where premarital sex is accepted, but the +same can work to adverse effect in regions where +premarital sex is a taboo as it would result in curiosity +on sex‑related matters, possibly leading to irresponsible +sexual behavior. A  reflection of this can be seen in the +teen pregnancy data from the United States (US) which +indicates that out of all the babies born in 2014, 89% +of babies were to teenage parents  (numbering 249,078 +in 2014 and 273,105 in 2013).[50] Hence, sex education/ +condom awareness program plays an important role in +such countries where even the school girls becoming +pregnant is a major issue. The ideal way of resolving the +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Harichandra, et al.: Yogic approach to address the HIV/AIDS challenge +7 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 1  ¦  January‑June 2019 +problem of adolescents involving in free sex would be +to offer them an alternative in the way of realizing their +true potential and interests by proper introduction and +regular practice of yoga and meditation which would +also improve their academic performances. +Additional concerns +There are several other factors which are required to +be addressed for a wholesome approach to manage +HIV/AIDS. The following points are worth noting: +• Alcohol is known to reduce CD4+  cell count, +increase viral load, and result in faster progression +of HIV positive to AIDS.[51‑54] As also alcoholism is +known to affect ojas to a great extent[55,56] +• Use of drugs has played a major role in promoting +and spreading of AIDS. Appearance of AIDS in US +and Europe in drug users coincided with illicit drug +use[57] +• Researches have given clear indications about +the role of drugs  (prescribed drugs) in promoting +AIDS. The researches go to conclude that drug use +is necessary in HIV positive and sufficient in HIV +negatives for AIDS diseases.[57] Especially, in this +scenario, supplementation with safer complementary +and alternative approaches is important which could +help taper down drug use +• Malnutrition is considered to be a marker for poor +prognosis among HIV positives.[58] Proper nutrition is +a key to maintaining proper immune system and is +important for HIV positives.[39] Further, it is the basic +source of raw material for production of sapta dhātus +should be such that lesser effort is required to be put +by the body to assimilate it and it is conducive to +produce sapta dhātus. Such foods are traditionally +referred to as sātvik foods and help producing ojas.[59] +Such nutrition should be an integral part of any HIV +care system +• Yoga is proven to be helpful for HIV positives +in +reducing +psychological +distress,[60] +reducing +anxiety and depression,[61] improving the immune +system,[61] improving quality of life,[46] and also +in assisting the body to prevent the vertical +transmission (mother‑to‑child transmission) of HIV.[46] +Conclusions +Considering the discussions made in the article, the +following conclusions can be made: +1. HIV/AIDS has still been a challenge over  30  years. +A  relook into the way it is fought at is very much +essential +2. Ojas, the essence of sapta‑dhātus, is a key to health +and vitality. Increase of ojas is important to help +manage the HIV/AIDS +3. Factors provoking unnatural sexual behavior to be +checked to prevent HIV/AIDS +4. Condom promotion is harmful for HIV positives +since it promotes AIDS; although not HIV +5. Abstinence from sex is inevitable for HIV positives. +This would help both HIV positives and the society. +A  HIV positive could reserve the energies to fight +HIV positives. Society is at advantage since the major +route for HIV positive propagation is addressed +6. The promotion of “condom culture” in the name +of AIDS education should be checked. Implied +character education should replace sex education +7. Several other factors such as drugs, substance abuse, +and alcoholism helps disease progression, which +should be checked among HIV positives +8. Sātvik food conducive for production of sapta +dhātus should be an inevitable, integral part of HIV +management +9. Yoga is an indispensable tool for helping combat +HIV/AIDS. +Yoga, in general, promotes health and harmony in +the society. Finally, the following message of the +śvetāśvatara Upaniśad is worth noting; +na +tasya +rogo +na +jarā +na +vyādhiḥ +prāptsya +yogāgnimayaṁ śarīraṁ;[62] +…which proclaims, “diseases does not touch him, old +age does not bother him, death does not approach  (has +a wishful death) him who has ripened his body, with the +fire of Yoga.” +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +References +1. +UNAIDS. The Global HIV/AIDS Epidemic. UNAID; S2018. +Available +from: +https://www.hiv.gov/hiv‑basics/overview/ +data‑and‑trends/global‑statistics. [Last accessed on 2017 Aug 25]. +2. +Mills  EJ, Kanters  S, Ford  N. The comparative effectiveness of +antiretroviral therapies for HIV: Evidence to inform precision +public health. J Comp Eff Res 2017;6:85‑7. +3. +UNAIDS. HIV and AIDS Estimates; 2015. Available from: +http://www.unaids.org/en/regionscountries/countries/india/.  [Last +accessed on 2017 Jul 18]. +4. +UNAIDS. 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Sri +Ramakrishna Math Publications, Mysuru; 1994. p. 57. +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] diff --git a/subfolder_0/Hypoxia in CNS pathologies emerging role of mirna-based Neurotherapeutics and yoga based alternative therapies.txt b/subfolder_0/Hypoxia in CNS pathologies emerging role of mirna-based Neurotherapeutics and yoga based alternative therapies.txt new file mode 100644 index 0000000000000000000000000000000000000000..8f03eab6953fa46c18569374df2d9b32e708b02b --- /dev/null +++ b/subfolder_0/Hypoxia in CNS pathologies emerging role of mirna-based Neurotherapeutics and yoga based alternative therapies.txt @@ -0,0 +1,2233 @@ +REVIEW +published: 11 July 2017 +doi: 10.3389/fnins.2017.00386 +Frontiers in Neuroscience | www.frontiersin.org +1 +July 2017 | Volume 11 | Article 386 +Edited by: +Natalia N. Nalivaeva, +University of Leeds, United Kingdom +Reviewed by: +Aurel Popa-Wagner, +University of Rostock, Germany +Hermona Soreq, +Hebrew University of Jerusalem, Israel +*Correspondence: +Akshay Anand +akshay2anand@gmail.com +†These authors have contributed +equally to this work. +Specialty section: +This article was submitted to +Neurodegeneration, +a section of the journal +Frontiers in Neuroscience +Received: 04 September 2016 +Accepted: 20 June 2017 +Published: 11 July 2017 +Citation: +Minhas G, Mathur D, +Ragavendrasamy B, Sharma NK, +Paanu V and Anand A (2017) Hypoxia +in CNS Pathologies: Emerging Role of +miRNA-Based Neurotherapeutics and +Yoga Based Alternative Therapies. +Front. Neurosci. 11:386. +doi: 10.3389/fnins.2017.00386 +Hypoxia in CNS Pathologies: +Emerging Role of miRNA-Based +Neurotherapeutics and Yoga Based +Alternative Therapies +Gillipsie Minhas 1 †, Deepali Mathur 2 †, Balakrishnan Ragavendrasamy 3, Neel K. Sharma 4, +Viraaj Paanu 5 and Akshay Anand 1* +1 Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, +Chandigarh, India, 2 Faculty of Biological Sciences, University of Valencia, Valencia, Spain, 3 Molecular Biosciences +Laboratory, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, India, 4 Armed Forces Radiobiology +Research Institute, Bethesda, MD, United States, 5 Government Medical College and Hospital, Chandigarh, India +Cellular respiration is a vital process for the existence of life. Any condition that +results in deprivation of oxygen (also termed as hypoxia) may eventually lead to +deleterious effects on the functioning of tissues. Brain being the highest consumer of +oxygen is prone to increased risk of hypoxia-induced neurological insults. This in turn +has been associated with many diseases of central nervous system (CNS) such as +stroke, Alzheimer’s, encephalopathy etc. Although several studies have investigated +the pathophysiological mechanisms underlying ischemic/hypoxic CNS diseases, the +knowledge about protective therapeutic strategies to ameliorate the affected neuronal +cells is meager. This has augmented the need to improve our understanding of the +hypoxic and ischemic events occurring in the brain and identify novel and alternate +treatment modalities for such insults. MicroRNA (miRNAs), small non-coding RNA +molecules, have recently emerged as potential neuroprotective agents as well as targets, +under hypoxic conditions. These 18–22 nucleotide long RNA molecules are profusely +present in brain and other organs and function as gene regulators by cleaving and +silencing the gene expression. In brain, these are known to be involved in neuronal +differentiation and plasticity. Therefore, targeting miRNA expression represents a novel +therapeutic approach to intercede against hypoxic and ischemic brain injury. In the first +part of this review, we will discuss the neurophysiological changes caused as a result +of hypoxia, followed by the contribution of hypoxia in the neurodegenerative diseases. +Secondly, we will provide recent updates and insights into the roles of miRNA in the +regulation of genes in oxygen and glucose deprived brain in association with circadian +rhythms and how these can be targeted as neuroprotective agents for CNS injuries. +Finally, we will emphasize on alternate breathing or yogic interventions to overcome +the hypoxia associated anomalies that could ultimately lead to improvement in cerebral +perfusion. +Keywords: hypoxia, ischemia, microRNA, yoga, breathing exercise, neuroprotection +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +INTRODUCTION +Mammalian brain lacks fuel reservoirs and hence needs a +constant supply of glucose for ATP generation, cell survival, and +production of neurotransmitters. Although it constitutes only 2% +of body weight, it consumes nearly a quarter of total body glucose +(∼5.6 mg glucose per 100 g human brain tissue per minute) +(Erbslöh et al., 1958). Under physiological aerobic conditions, +glucose is completely metabolized into carbon dioxide and water +resulting in the formation of ATP. Any hindrance in the oxygen +supply to the brain may cause catastrophic effects to brain +cells. In this review we will first discuss the pathophysiological +effects caused due to hypoxia, which has been associated +with different neurodegenerative diseases and consecutively, we +will discuss miRNA based therapeutic approach to target the +hypoxia-associated CNS injuries along with alternate therapies +for management of hypoxia. +PATHOPHYSIOLOGICAL RESPONSES TO +HYPOXIA +Oxygen is an essential element for cell survival. It acts as a final +electron acceptor in oxidative phosphorylation, which ultimately +leads to the production of energy in the form of ATP. However, +under hypoxia, a cell undergoes prolonged energy deprivation +that results in irreversible cellular dysfunction and ultimately +leads to cellular demise (Gutierrez, 1991; López-Barneo et al., +2001; Hardie, 2003). Hypoxia may occur in both basal conditions +as well as diseased conditions (Brahimi-Horn et al., 2007; +Brahimi-Horn and Pouysségur, 2007; Sluimer et al., 2008; Li Z. +et al., 2009). +In response to hypoxia, a cell triggers a plethora of reactions, +which include disturbance in ion channel homeostasis, energy +failure, free radical production, etc. It has been estimated +that 60% of ATP is consumed by ATPases, such as the +Na+/K+ ATPase, and Ca2+ATPase under normal conditions +(Zauner et al., 2002). During hypoxia, there is a reduction +in the intracellular ATP/ADP ratios, which disrupts the ion +concentration gradients by causing an increased efflux of K+ +ions and influx of Na+ and Ca2+ ions. Eventually, membrane +depolarization takes place and the accumulated Ca2+ ions +activate the proteases, which leads to membrane damage, +disturbance in mitochondrial metabolism, and generation +of reactive oxygen species (ROS) (Boutilier, 2001). Under +prolonged exposure to hypoxia, hypoxia-inducible factor (HIF) +is upregulated, which is a well-studied transcription factor and +serves as a potential endogenous marker for hypoxia. HIF-1 +transcriptional complex, a ubiquitously expressed protein made +up of two subunits namely HIF-1α and HIF-1β which binds +to DNA at hypoxia response elements (HRE) of target genes +(Semenza et al., 1994; Semenza, 1999; Kemp and Peers, 2007). +More than 200 target genes have been known to be regulated +by the HIF complex, which further “turns on” factors involved +in erythropoiesis, pro-inflammatory gene expression, energy +metabolism or apoptosis, angiogenesis, and cellular survival +and proliferation (Kaur et al., 2005; Lundgren et al., 2007; +Loor and Schumacker, 2008). Age is a major risk factor for +hypoxia and associated clinical outcomes. The vulnerability to +hypoxia-induced diseases increases many-fold with age. It has +become more evident that with age the oxygen pressure falls +which along with a lower cerebral perfusion results in microglial +activation and neuroinflammation (Buga et al., 2013; Popa- +Wagner et al., 2014; Sandu et al., 2015). Age-related changes +in HIF have also been established that have been associated +with increased susceptibility toward stroke (Katschinski, 2006). +Frenkel-Denkberg et al. observed a difference in DNA-binding +efficiency of HIF when compared between young and old mice +that were exposed to hypoxia (Frenkel-Denkberg et al., 1999). +Different studies have demonstrated that the aging theories +of telomere shortening and free-radical generation, both are +dependent on the availability of oxygen (Nishi et al., 2004). +It has been seen that by conducting aerobic exercise processes +including yoga, there is an increase in the expression of brain- +derived neurotrophic factor (BDNF) in the body. BDNF is +an important mediator of neurogenesis as well as neuronal +plasticity. It promotes growth in various areas of the brain such +as the hippocampus, the dorsal root ganglions as well as cortical +neurons. These levels decrease with age, however an increase in +all age groups which performed aerobic exercises, in this case +yoga, was observed (Pal et al., 2014). Aerobic exercises increasing +blood oxygen levels and thus promoting cerebral perfusion have +shown to have a direct impact in the reduction of Sympathetic +Adrenal Medulla axis (SAM). Activation of SAM causes an +increased release of catecholamines from the adrenal medulla. +In acute scenarios, these catecholamines are of great importance. +However, if chronically raised they can lead to increased vascular +resistance, which in turn can lead to decreased perfusion of +organs including cerebral perfusion (Arora and Bhattacharjee, +2008). +Literature indicates that cell differentiation is promoted upon +hypoxia in different cell types. It has been demonstrated that +molecules playing a critical role in cell differentiation such as +Notch, MYC, and Oct-4 in conjunction with hypoxia and HIFs +are associated with each other (Simon and Keith, 2008). However, +the molecular mechanism and pathways by which hypoxia +induces cell differentiation is poorly understood (Gustafsson +et al., 2005; Samanta et al., 2017). It is also reported that +hypoxia directly regulates the Notch signaling pathway activity +in the cell differentiation process (Gustafsson et al., 2005). +Additional molecules which are directly influenced by HIF- +2α include OCT4 and MYC transcription factors (Dang et al., +2008; Simon and Keith, 2008). By modifying cell growth, cells +respond to oxygen deprivation metabolism by activation of +hypoxia induced genes. In various cell types the role of HIF1α +and hypoxia has been investigated in cellular proliferation. +Under hypoxic conditions Notch signaling is also increased so +as to maintain progenitor/stem cell state, which is dependent +on HIF-1α accumulation (Pear and Simon, 2005). Hypoxia +leads to increased Notch1 signaling which further leads to +differential expression of regulatory cell cycle proteins and +increased proliferation of cells. However, how HIF-1α leads to +the activation of these transcription factors are poorly understood +and needs further investigations. +Frontiers in Neuroscience | www.frontiersin.org +2 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +Moreover, hypoxia has also been shown to have an impact on +circadian rhythms for temperature and oxygen levels. A study +by Mortala et al. has demonstrated disruption in temperature +rhythms in rats exposed to different levels of oxygen under 12 +h light-dark (LD) cycle vs. those under constant light regimen, +suggesting a connection between hypoxia and circadian rhythms +(Mortola and Seifert, 2000). Likewise, it has also been noted in +conditions increasing oxygen transport to the brain such as in +aerobic exercise and controlled breathing exercises that there is +an increase in alpha wave activity as well as a decreased galvanic +skin response. Both of these parameters facilitate a more steady +and consistent circadian rhythm, which in turn maintain a more +steady oscillation of temperature and oxygen levels (Kumar and +Joshi, 2009). +A number of studies have also demonstrated that both pre- +and post-hypoxic conditioning could offer protective effects to +the tissue and hence may function as a novel therapeutic strategy. +Hypoxic/ischemic preconditioning is performed by exposing +the tissue to hypoxia/ischemia below dangerous levels for a +considerable number of times so that tissue becomes resistant +to subsequent insult. This process protects the tissue from +further injury. Similarly, post-hypoxic conditioning shields the +tissue from damage as it develops tolerance against hypoxia +through repeated inductions but is applied after the injury has +occurred. The therapeutic effects and mechanisms of hypoxic +preconditioning were reported in the 1960s much earlier +than cerebral ischemic preconditioning was studied but were +not emphasized to that extent as the latter one (Lu, 1963; +Dahl and Balfour, 1964). Later, Schurr et al. studied hypoxic +preconditioning and brain tolerance in rat hippocampal slices +(Schurr et al., 1986). Numerous other in vitro models of hypoxic +preconditioning have been studied such as primary neuronal +cultures, hippocampal slices, olfactory cortex, and transient +ischemic attacks in humans showing tolerance effects against the +pathological state (Kirino et al., 1996; Perez-Pinzon et al., 1996; +Arthur et al., 2004; Steiger and Hanggi, 2007; Obrenovitch, 2008; +Shpargel et al., 2008; Bickler and Fahlman, 2009; Gidday et al., +2013). +Hypobaric hypoxia is another means of inducing hypoxic +preconditioning and its neuroprotective potential and other +beneficial health related effects have already been demonstrated +(Meerson, 1984; Meerson et al., 1996; Gong et al., 2012; Millet +et al., 2013; Zhen et al., 2014). Rybnikova et al. employed +this technique (Samoilov et al., 2001; Rybnikova et al., 2005, +2006) to investigate its mechanisms and therapeutic potential. +Recently, same group of investigators used this model in rats +and found that both early and delayed applications of the +post-conditioning augmented recovery and mitigated neuronal +injury caused as a result of hypoxia (Rybnikova et al., 2012). +Similarly, Gamdzyk et al. found neuroprotective potential of this +technique in the rat model (Gamdzyk et al., 2014). Ischemic +post-conditioning is also proven to protect heart and brain +tissues (Zhao et al., 2003; Zhao, 2007). All these data suggest the +therapeutic potential of hypoxic pre- and post-conditioning and +need further investigation. Consequently, the complex nature +of pathophysiology associated with hypoxia provides numerous +check-points that could be targeted as therapeutic targets. +HYPOXIA/ISCHEMIA IN CNS +PATHOLOGIES +The reduced blood supply also deprives the tissue from oxygen +and nutrients leading to tissue damage and cell death in a +prolonged hypoxic state. Under normal scenario, the body +has its own mechanisms to sense oxygen deprivation and +to overcome from this. However, permanent damage and +pathological outcome may arise in conditions where the tissue +under hypoxia is unable to reverse the deficiency. Brain, as +it is well-known, has a very high metabolic demand and is +completely dependent on oxygen supply for glucose metabolism. +Any small disruption in oxygen supply, even for a few +seconds, can cause sudden and irreversible damage in the +functioning of the brain. Hypoxia in CNS tissues can initiate +a series of pathophysiological events that can exert their own +impact. +Furthermore, hypoxic injury has been associated with +many clinical CNS anomalies including stroke, encephalopathy, +ischemic retinopathies, and Alzheimer’s (Peers et al., 2007; Zhang +and Le, 2010). However, previous studies related to hypoxia and +Alzheimer’s disease (AD) are meager. With recent investigations +it has come into light that the pathology of AD shares common +links with hypoxia/ischemia (Peers et al., 2007; Lanteaume +et al., 2016; Liu et al., 2016). Studies have demonstrated that +hypoxia induces up-regulation of beta-secretase 1 (BACE1) +gene expression both in vitro and in vivo, thereby contributes +to the pathology of Alzheimer’s disease (AD) (Sun et al., +2006). A recent finding also demonstrates that hypoxia induces +epigenetic alteration in AD and suggests that it can acerbate +AD progression through demethylation of genes encoding γ- +secretase enzyme (Liu et al., 2016). This study revealed that +hypoxia exaggerated the neurological outcome and memory +dysfunction in AD mice. Patients suffering from stroke or +cardiovascular disease have been shown to be more susceptible +to cognitive impairment and dementia, such as Alzheimer’s (de +La Torre, 2008). Zhang et al. demonstrated recently that miR- +124 regulates the expression of BACE1 in the hippocampus +under chronic cerebral hypoperfusion (Zhang et al., 2017). +In case of cerebral ischemia, the susceptibility toward AD +was shown to increase (Jendroska et al., 1995; Altieri et al., +2004). Hypoxia can also induce formation of amyloid β plaques +on prolonged exposure. Studies conducted in different cell +lines exposed to hypoxic conditions demonstrate increase in +production of amyloid regardless of the cell line being tested +(Wang et al., 2006; Li L. et al., 2009; Muche et al., 2015). The +mechanism behind the pathogenesis of AD being linked with +hypoxia/ischemia is still unknown. Nonetheless, it has been +revealed that the pathways of calcium homeostasis and calcium +channel signaling are the connecting link between the AD +prognosis and hypoxia (Green and Peers, 2001; Bai et al., 2015). +Apart from increasing the production of amyloid β plaques, it +has been shown that hypoxia also leads to other pathological +hallmarks associated with AD, such as tau phosphorylation, +decreasing the degradation, and clearance of plaques (Burkhart +et al., 1998; Fang et al., 2010; Zhang and Le, 2010; Zhang et al., +2014). +Frontiers in Neuroscience | www.frontiersin.org +3 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +Recently, Ashok et al. demonstrated that hypoxia-inducible +factors may be neuroprotective in Alzheimer’s disease (Ashok +et al., 2017). Furthermore, hypoxia and ischemia activates +processing of amyloid precursor protein and plays a crucial +role in the pathogenesis of AD (Salminen et al., 2017). Several +investigations using cellular models and in vivo studies have +revealed that expression and activity of neprilysin (NEP), which +is an Aβ-degrading enzyme, declines with age and also under +hypoxic/ischemic conditions. This may result in accumulation +of Aβ plaques and eventually development of AD pathology +(Nalivaevaa et al., 2004; Caccamo et al., 2005; Wang et al., 2005; +Fisk et al., 2007; Nalivaeva et al., 2011, 2012; Zhuravin et al., +2011). Furthermore, the levels of caspases such as caspase 3, 8, +and 9 are markedly increased in human neuroblastoma NB7 cells, +which can cleave APP intracellular domain (Kerridge et al., 2015). +These findings indicate that NEP levels in hypoxic/ischaemic +brain might be regulated by stimulation of caspases, which may +result in loss of Aβ clearance and related to development of AD. +In case of encephalopathy, an obstruction in cerebral blood +flow leads to oxygen/glucose shortage in an infant’s brain +and eventually primary energy failure (Shalak and Perlman, +2004). Simultaneously there is an increase in the production of +lactate due to a switch from aerobic to anaerobic metabolism +(Hanrahan et al., 1996). A cascade of reactions antecede this event +such as disturbance in sodium/potassium (Na+/K+) pumps, +Ca2+ influx, membrane depolarization, glutamate release, and +subsequently cellular death (Johnston et al., 2009). Both apoptotic +and necrotic cell death have been visualized in primary and +secondary energy failure during neuronal injury with the later +most prominently seen with primary energy failure (Cotten +and Shankaran, 2010). Moreover, during the injury immune +infiltrates penetrate the blood-brain barrier (BBB) and enhances +neuronal injury but the mechanism remains elusive (Ferriero, +2004). Palmer et al. documented that neutrophils invade the BBB +in the initial phase and causes brain edema (Palmer et al., 2004). +Therefore, involvement of hypoxia in neuronal degeneration +insists the need to explore the therapeutic targets that will target +common pathological hallmarks and consequently will help in +ameliorating these hypoxia-induced disease conditions. +DEVELOPMENT OF NOVEL THERAPEUTIC +INTERVENTION: MIRNA IN +NEUROPROTECTION +Hypoxia associated CNS anomalies, such as stroke, Alzheimer’s, +ischemic retinopathy, and encephalopathy are all linked with +some common pathophysiological attributes that could be +targeted for therapeutics. With discovery of miRNA-mediated +regulation of gene expression, many studies have investigated +the miRNA as interventions for human diseases, with few +studies now being conducted at preclinical and clinical levels +(Christopher et al., 2016). +Over the last 10 years, miRNA have been identified as the +18–25 nucleotides long non-coding RNA molecules responsible +behind the translation regulation. These have been observed +in organisms from Drosophila to humans (Bartel, 2004). In +human genome miRNA have been shown to control various +physiological and pathophysiological processes. A functional +miRNA is formed in a two-step process, from a primary +miRNA or pre-miRNA, which is transcribed through RNA +polymerase II. It is then further processed into a hairpin structure +(70–100 nucleotide long) by ribonuclease III Drosha that is +complexed with RNA binding protein Pasha. Ultimately this +hairpin structure is transported to cytoplasm, where it is acted +upon by Dicer to form the mature 18–25 nucleotide long miRNA +(Lee et al., 2003, 2004). How these miRNAs work to regulate gene +expression is a complex process with still many aspects unknown. +Mostly these miRNA exert their action through the formation of +RNA-induced silencing complex (RISC). Typically the miRNA +exert their effect by binding through RISC to the target genes +at their 3′ UTR sites and regulating the levels of proteins, either +by mRNA degradation, translation repression, or decapping +of mRNA (Macfarlane and Murphy, 2010). These negatively +regulate the post-transcriptional expression of their target genes +either through blocking the translation of concerned mRNA or +by degrading them (Ivan et al., 2008). Another aspect essential +for the miRNA to function is the sequence complementarity +between the miRNA and the mRNA, which decides the fate and +mechanism for mRNA regulation. Moreover, a single miRNA +can control multiple targets and vice versa, multiple miRNA +molecules can collectively regulate a single target mRNA (Bartel, +2004). +miRNAs play a crucial part in development and functioning +of brain (Meza-Sosa et al., 2012; Davis et al., 2015). Several brain- +specific miRNA have been identified in mouse as well as humans, +which include miR9, miR124a, miR124b, miR135, miR153, and +others (Sempere et al., 2004). miRNAs serve as vital regulators in +the central nervous system (CNS) and are implicated in various +neurological diseases (Cao et al., 2016). Indeed, atypical levels +of miRNA have been observed in many neurological disorders +including those that are hypoxia induced. A few these miRNA +that have been identified to play an important role in ischemic +injury, include miRNA 15, miRNA 21, miRNA 29, miRNA 124, +miRNA 145, miRNA 181, miRNA 200 family, miRNA 497, and +others (Xiao et al., 2015). miRNA profiling studies in different +animal models of ischemia along with human patients have been +conducted, which have revealed patterns of miRNA expression at +different time-points post-injury (Jeyaseelan et al., 2008; Tan K. +S. et al., 2009). miRNA 210 is one that has shown conservation +throughout the evolution. It is expressed in hypoxic tissues and +is activated by HIF1α, a hypoxia inducible transcription factor +(Chan and Loscalzo, 2010). The expression has also been revealed +in middle cerebral artery occlusion (MCAO) model in rat brain +as well as blood (Zeng et al., 2011). +Since the role of miRNA has been implicated in neuronal +development as well as disease pathogenesis, it becomes +necessary to explore the miRNA-associated regulation as a +potential to develop novel clinical biomarkers and therapeutics. +Recent studies have identified miRNA derivatives, anti-miRNA +oligonucleotides and locked nucleic acids, as therapeutic targets +to be tested in clinical scenario (Weiler et al., 2006; Love +et al., 2008; Nampoothiri et al., 2016). Qiu et al. established the +neuroprotective role of miRNA 210 in hypoxia-ischemia injury, +Frontiers in Neuroscience | www.frontiersin.org +4 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +where the carotid artery in rats was permanently ligated at post- +natal day 7, followed by exposure to hypoxia for 2 h. miRNA +210 is known to decrease the apoptosis of neuronal cells along +with inhibition of caspases (Qiu et al., 2013). miRNA such as +these can be targeted as novel therapeutics for ischemic injury. +Hu et al. tested the delivery of miRNA 210 through a non-viral +vector in ischemic heart injury and demonstrated a decrease in +apoptosis (Hu et al., 2010). In different studies it has also been +shown that it easily crosses the BBB. Moreover, investigations +have also revealed miRNAs that have been implicated to confer +neuroprotection in Alzheimer’s disease (Liu et al., 2012; Yang +et al., 2015). The development of neurodegenerative diseases is +associated with the differential expression of miRNAs. Earlier +investigations have revealed that ischemic stroke can trigger +variations in the miRNA expression (Kocerha et al., 2009; Tan K. +S. et al., 2009). A study investigating changes in miRNA profiling +showed that 138 miRNAs were upregulated and 19 miRNAs were +downregulated in stroke patients (Cao et al., 2012). In addition, +miRNAs including hsa-let-7f, miR-126, −1259, −142-3p, -15b, +-186, -519e, and -768-5p were found to be downregulated in +different subtypes of stroke. Likewise, miRNAs including hsa- +let-7e, miR-1184, −1246, −1261, −1275, −1285, −1290, −181a, +−25∗, −513a-5p, −550, −602, −665, −891a, −933, −939, and +−923 showed upregulated expression in the stroke patients (Tan +et al., 2013). +An interesting study showed that miRNA expression is +sex-specific in ischemic stroke patients (Siegel et al., 2011). +A significantly elevated expression of miR-23a was found in +females whereas reduced expression was observed in males’ post- +ischemic event. Furthermore, upregulated expression of miR- +223 confers neuroprotection in stroke patients by reducing the +expression of the glutamate receptor subunits (Harraz et al., +2012). Alternatively, its decreased expression may aggravate +neuronal cell death by elevating glutamate receptor subunits +levels thereby indicating that it can prevent neuronal injury +by regulating the expression profiles of glutamate receptor +subunits. In addition, reduced expression of miR-145 may also +prevent neuronal cell death by increasing superoxide dismutase- +2 levels (Dharap et al., 2009). Let7f and miR1 was shown +to subdue neuroprotection by controlling insulin-like growth +factor 1, which protects neurons endogenously (Selvamani et al., +2012). Conversely, treatment with anti-miR1 and anti-Let7f are +known to significantly reduce the infarct volume and protect +neurons from cell death post-stroke. The findings of Buller +et al. (2010) showed that expression of miR-21 is enhanced +by three-folds following stroke in vivo. miR-21 overexpression +inhibits apoptosis and mediates neuroprotection in vitro. A +study reported that miR-181 expression changes in stroke, +and reduced expression of miR-181 confers neuroprotection by +manipulating glucose-regulated protein-78 (GRP78) (Ouyang +et al., 2012). In addition, miR-124a, miR-210, miR-125b, and +anti-inflammatory (miR-26a, miR-34a, miR-145, and let-7b) +miRNA show altered expression profiles in stroke patients (Liu +et al., 2011; Rink and Khanna, 2011; Zeng et al., 2011). In +Alzheimer’s disease, expression profiles of several miRNAs have +been found to be altered in both the human AD tissue and +diseased model (Cogswell et al., 2008; Hebert et al., 2008; Lukiw +et al., 2008; Patel et al., 2008; Wang et al., 2008; Croce et al., +2013) suggesting that dysregulated miRNAs are associated with +AD pathogenesis. Table 1 summarizes different miRNA shown +to regulate hypoxia/ischemia and thus, their neuroprotective +potential in CNS injuries. +Moreover, the function of miRNA as a master regulator of +gene expression has made it a potential for clinical translation. +For instance, the first clinical trial was with miR 122 antagonists +against Hepatitis C virus is under Phase II trial (www. +clinicaltrials.gov/NCT01200420) (Gebert et al., 2013). Another +clinical trial registered at ClinicalTrials.gov is for miR 34 +in hepatic cancers (www.clinicaltrials.gov/NCT01829971). In +Alzheimer’s disease, a clinical trial investigating correlation +between miR 107 and BACE1 levels has been initiated (www. +clinicaltrials.gov/NCT01819545). Apart from these, anti-miRNA +drugs have also been developed for cardiac as well as muscular +disorders (Hydbring and Badalian-Very, 2013). All these clinical +trials and drugs have paved way for much more clinical +translation to come in near future. +Nonetheless +there +are +some +issues +that +need +more +investigations such as route of delivery, effects that can be +off-target and safety and can be resolved before translation to +clinics. +miRNA in Inflammation and Angiogenesis +Hypoxia/ischemia is a complex phenomenon, with multiple +events that play a role in the pathogenesis including energy +failure, ROS generation, inflammation, and angiogenesis. It has +been seen that conditions increasing cerebral perfusion as in +aerobic exercises, such as yoga, practiced over a long period +of time actually reduce serum IL-6 levels, a pro-inflammatory +cytokine found in the body. There was also an increased +presence found of C-reactive protein, another inflammatory +species in the body, in those who did not perform these aerobic +exercises (Kiecolt-Glaser et al., 2010). The two pathways that +can be mainly targeted through regulation of miRNA includes +angiogenesis and inflammation (Ouyang et al., 2015). Bonauer +et al. investigated the role of miR 92a in angiogenesis in +vitro in endothelial cells as well as in vivo using a mouse +model of hind-limb ischemia and revealed that overexpressing +the miR 92a under ischemic conditions inhibits angiogenesis, +therefore, administration of an inhibitor could enhance the blood +vessel growth and assist in recovery from ischemia (Bonauer +et al., 2009). miRNA-210 is another one that is known to +induce angiogenesis in cerebral ischemia. Lou et al. revealed +increased expression of miRNA-210 in endothelial cells in a rat +model of cerebral ischemia, which was shown to be through +Notch 1 signaling, thus, indicating angiogenesis. In another +study, overexpressing miR-210 lead to angiogenesis as well as +neurogenesis in a mouse brain. miR-210 expression in neuronal +cells demonstrated their role in proliferation of endothelial cells +and formation of new vascular microvessels (Lou et al., 2012; +Zeng et al., 2014). miRNAs are overexpressed in endothelial +cells and they have been demonstrated to modulate angiogenesis +and endothelial cell function. Angiogenesis is a process in +which new blood vessels emanate from preexisting vessels. It +has been reported by several studies that Dicer enzyme, if +inactivated may result in abnormal endothelial cell function +and blood vessel formation. Dicer is an enzyme involved in +Frontiers in Neuroscience | www.frontiersin.org +5 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +TABLE 1 | Different miRNA known to regulate hypoxia/ischemia associated genes and how these can play a neuroprotective role in CNS pathologies. +miRNA +Associated target/Role in CNS injury +Neuroprotective role +References +miR 21 +Blocks Fas ligand; increased after +ischemia +Increases neuronal survival post ischemia +Buller et al., 2010 +miR 30a, miR 383, +miR 320a +Aquaporin proteins; downregulated in +ischemia +Overexpression can modulate cerebral edema +Jeyaseelan et al., 2008 +miR-106 +Regulates the transporter ABCA1 involved +in ApoE production +In AD patients downregulated in the temporal cortex +Kim et al., 2012 +miR-107 +Up regulation of BACE1 +Downregulated in temporal cortex of AD patients which could +impact upon Aβ production +Goodall et al., 2013 +miR-124 +Regulates the Expression of BACE1 +In the hippocampus under chronic cerebral hypoperfusion +Long et al., 2014 +miR-125b +Cell cycle regulator +Glial cell and astroglial proliferation +Pogue et al., 2010 +miR 126, miR 130a, +miR 296, miR 424 +Promote angiogenesis +Modulation can increase angiogenesis after ischemia and +maintain vascular integrity +Würdinger et al., 2008; +Ghosh et al., 2010; Caporali +and Emanueli, 2012 +miR-134 +Heat-shock proteins; increased in +ischemia +Downregulation can decrease apoptosis and cellular damage, +improve neurological outcomes +Chi et al., 2014 +miR-142 -3p +Promotes the IL-1β-dependent glutamate +dysfunction +Upregulated in the CSF of MS patients and in experimentl +autoimmune encephalomyelitis cerebellum +Mandolesi et al., 2017 +miR-145 +Targets SOD2; Upregulated after ischemia +Antagonists can increase SOD2 expression and decrease +ROS +Dharap et al., 2009 +miR-146a +Complement activation repressor +Altered innate immune response and neuroinflammation +Alexandrov et al., 2011 +miR-146a +Transmembrane protein; regulator of βAPP +cleavage +Aberrant βAPP processing and amyloidogenesis +Yanez-Mo et al., 2011 +miR 181 +Glucose-regulated protein 78 (GRP78); +increased in ischemic injury +Reduction can increase neuronal survival +Ouyang et al., 2012 +miR 155 +Regulates inflammation +Regulates CD4+ and CD8+ T cell accumulation, NK cell +maturation and expansion, T cell cytokine production, CD8+ +T cell-mediated cytotoxicity, astrogliosis, macrophage +polarization, expression of receptors necessary for viral entry, +and expression of viral proteins +Dickey et al., 2017 +miR 210 +Decreased in ischemic stroke +Overexpression induces angiogenesis +Fasanaro et al., 2008; Zeng +et al., 2011; Lou et al., +2012; Ma et al., 2016 +miR-339-5p +Regulates BACE1 expression and is most +likely dysregulated in AD patients +Triggers the amyloidogenic pathway +Long et al., 2014 +miR 497 +Anti-apoptotic genes—Bcl2; upregulated +in ischemia +Inhibition increases neurological function and decreases +infarcts +Yin et al., 2010 +miRNA biogenesis and functions in regulation of vascular +development (Yang et al., 2005; Kuehbacher et al., 2007; Suarez +et al., 2007, 2008). Yang et al. showed that mice hypomorphic +for Dicer die after few days and possess abnormal blood +vessel formation suggesting that Dicer is required for normal +mouse development (Yang et al., 2005). Several other groups +observed profound consequences resulted by knockdown of +Dicer, and concluded that molecule is necessary for normal +mouse development (Bernstein et al., 2003). Giraldez et al. found +that there were significant abnormalities in gastrulation phase, +brain development, and blood circulation in zebrafish offspring +model which was deprived of both maternal and zygotic Dicer +(Giraldez et al., 2005). +It +has +been +seen +that +angiogenic +regulators +such +as +angiopoietin-2 receptor, Tie-1, VEGF, and its receptors VEGFR1 +and VEGFR2, are differentially expressed and linked with +abnormal Dicer ex1/2 embryos and yolk sacs (Yang et al., 2005; +Suarez and Sessa, 2009). Several other in vitro studies have +determined the significant role of miRNAs in endothelial cells +(Otsuka et al., 2007, 2008). Knockdown of Dicer in human +endothelial cells lead to the formation of defective capillary- +like structures and stunted cell growth (Kuehbacher et al., +2007; Suarez et al., 2007, 2008). In addition, expression of Tie- +2/TEK, VEGFR2, endothelial nitric oxide synthase, IL-8, and +angiopoietin-like 4 regulator proteins is found to be altered in +Dicer silenced endothelial cells (Suarez et al., 2007). Interetingly, +the expression of thrombospondin-1 remained elevated in these +cells (Kuehbacher et al., 2007; Suarez et al., 2008). +Numerous in vivo studies demonstrated the crucial role +of Dicer in postnatal angiogenesis. Findings of Kuehbacher +et al. (2007) showed sprout formation was abridged when +nude mice was subcutaneously injected for Dicer silencing in +HUVECs (suspended in a Matrigel plug). Similarly, Suarez +et al. (2008) generated two Dicer knockout mouse cell lines, +which were endothelial specific (Suarez et al., 2008). These +findings suggest that the role of miRNA in modulation of +Frontiers in Neuroscience | www.frontiersin.org +6 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +distinct aspects of angiogenesis might prove to be worthwhile in +many human pathological diseases, especially those involving the +vasculature. +Inflammation is an important impact as well as a cause +in ischemia-reperfusion injury. Eisenhardt et al. in their study +investigated the role of miRNA-155 in a mouse model of +myocardial ischemia-reperfusion and revealed its involvement in +exacerbation of inflammation as well as ROS generation post- +injury (Eisenhardt et al., 2015). miRNAs play a crucial role +in regulating both innate and adaptive immunity (Lu et al., +2009; Dalal and Kwon, 2010). Innate immunity is the first +line of defense and protects the organism from invasion of +foreign pathogens. On the contrary, adaptive immune system +is highly specific to a particular antigen and elicits B and +T lymphocytes to combat microbes. The former immune +response neutralizes the effect of pathogens through the pathogen +associated molecular patterns (PAMPs), recognition process by +the toll-like receptors, or TLRs (Takeda and Akira, 2015). TLRs +are transmembrane proteins expressed by cells participating in +innate immune system, which recognize invading microbes and +induce downstream signaling pathways that triggers immune +responses to kill foreign pathogens. +It is well-documented that miRNAs are implicated in +regulating inflammation and immune responses. A number +of miRNAs have been induced by lipopolysaccharide (LPS) +mediated TLR signaling such as miR-146a, miR-155, and miR- +132 (Taganov et al., 2006). Studies have shown that cytokines +like interleukin-1β, LPS, and tumor necrosis factor (TNF-α) +stimulates the expression of miR-146a. Consecutively, miR- +146a, suppresses the expression of IL-1 receptor associated +kinase and TNF receptor-associated factor-6, components of +the TLR4 signaling pathway (Taganov et al., 2006). Hence +miR-146a negatively controls TLR signaling pathway. Similarly, +interferon-β, and LPS induces the expression of miR-155 in +murine macrophages (O’connell et al., 2007; Tili et al., 2007). +Once miR-155 are activated, cytokines such as interleukin- +6 (IL-6) and tumor necrosis factor-α (TNF-α) are triggered +(Tili et al., 2007). miR-155 regulates suppressor of cytokine +signaling (SOCS)-1 demonstrating its involvement in regulation +of innate immune system (Rodriguez et al., 2007; Tili et al., +2007; Lu et al., 2009). Ceppi et al. showed that silencing of +miR-155 in dendritic cells derived from human myeloid cells +significantly elevated protein levels of the pro-inflammatory +cytokine interleukin1 (IL-1) (Ceppi et al., 2009). In addition, +miR-155 knockdown in these antigen-presenting cells directly +suppressed pro-inflammatory TAK1-binding protein 2 levels, +indicating its anti-inflammatory property (Ceppi et al., 2009). +On the contrary, several studies have reported that miR-155 +can augment inflammation. Overproduction of miR-155 in +mouse bone marrow results in a myeloproliferative phenotype +(O’connell et al., 2007). +While the expression of both miR-146 and miR-155 is elevated +in macrophages in response to LPS stimulation, the expression of +miR-125b is decreased. Tili and colleagues showed that reduced +expression of miR-125b results in increased expression of TNF- +α and eventually augments inflammation (Tili et al., 2007). +Several other miRNAs such as miR-9, miR-21, and miR-147 +are induced by TLR signaling and are expressed considerably +and hence regulate immune responses in response to microbial +invasion (Bazzoni et al., 2009; Liu et al., 2009; Sheedy et al., +2010). +Similarly, miRNAs are implicated in adaptive immune system +by regulating the development of both T cell and B cell +lymphocytes. Numerous studies have shown the involvement of +miRNAs in controlling signaling networks in T cells (Monticelli +et al., 2005; Wu et al., 2007; Merkerova et al., 2008). Wu et al. +demonstrated that some overexpressed miRNAs are dynamically +regulated during antigen-specific T-cell differentiation when +miRNA profiling was performed in naive, effector and memory +CD8+ T cells (Wu et al., 2007). Other studies showed that there +were abnormally developed and fewer mature T-cells in Dicer +deficient mice as compared to normal mice (Cobb et al., 2005; +Muljo et al., 2005). +Reports have revealed the involvement of both miR-17 and +miR-92 in T cell development (Xiao et al., 2008). Lately, +it has been reported that miRNAs are also involved in the +differentiation of T cells into distinct effector T helper cells. Du +et al. reported that miR-326 regulates differentiation of TH17 +cells both in vitro and in vivo (Du et al., 2009). Other miRNAs +such as miR-181a can facilitate the intensity of T cell receptor +signaling (Li et al., 2007) whereas miR-155 is implicated in +regulatory T (Treg) cell formation and function (Zheng et al., +2007; Chong et al., 2008; Liston et al., 2008; Zhou et al., 2008). +Furthermore, role of several miRNAs such as miR-150, miR- +155, and miR-34a has also been described in humoral immunity +involving B-lymphocytes (Chen et al., 2004; Monticelli et al., +2005; Vigorito et al., 2007; Xiao et al., 2007; Zhou et al., 2007; +Basso et al., 2009; Tan L. P. et al., 2009; Xiao and Rajewsky, 2009; +Rao et al., 2010). +Studies have indicated toward miRs that could regulate the +immunological processes as well as nervous system, which have +been termed as NeurimmiRs. NeurimmiRs such as miR 132 and +miR 124 have shown to play a role in cross-talk between the two, +at both local and peripheral levels. Furthermore, investigating +such miRs that regulate the neuroimmunological processes could +lead to exploring their potential as therapeutics (Soreq and Wolf, +2011). +miRNA and Circadian Rhythms in +Hypoxia/Ischemia +Superchiasmatic +nucleus +(SCN) +located +in +the +anterior +hypothalamus of a mammalian brain is the central switch for +circadian rhythms. Apart from SCN, it has been demonstrated +that each cell in the body has its own clock which controls +the molecular and cellular functions. The proteins associated +with the molecular clock include, Brain, Muscle ARNT-Like +protein 1 (Bmal1), Period (Per1, Per2), Cryptochrome (Cry), and +Circadian Locomotor Output Cycles Kaput (CLOCK) (Shearman +et al., 1997; Zylka et al., 1998). All these proteins belong to the +bHLH-PAS protein family which is characterized by the presence +of basic helix-loop-helix domain. The members of this protein +family are known to play an important role in response to low +oxygen as well as diurnal changes in light. Another protein that +Frontiers in Neuroscience | www.frontiersin.org +7 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +belong to this same family includes HIF1α that is involved in the +maintenance of oxygen homeostasis. Another new proteins have +been recently identified, MOP3 and MOP9, which are associated +with both the pathways, i.e., circadian and hypoxia (Bunger et al., +2000; Hogenesch et al., 2000). +The variables that display circadian patterns include body +temperature, metabolic rate etc. Any condition that causes +prolonged hypoxia ultimately disturbs the oscillations of these +essential parameters and their associated body functions. Under +normal physiological conditions, these events follow well-defined +oscillations which help in maintenance of homeostasis. Studies +have demonstrated the existence of a cross-talk between these +two pathways (Ghorbel et al., 2003). Chilov et al. in their study +observed increase in the level of PER1 and CLOCK along with +co-immunoprecipitation of HIF1α with PER1 under hypoxia in +mice (Chilov et al., 2001). +Circadian rhythms have also been associated with stroke +occurrence in humans with the temporal and seasonal pattern +of occurrence (Marler et al., 1989; Argentino et al., 1990; Elliott, +1998; Raj et al., 2015). Higher risk for hemorrhagic stroke has +been reported in evening (Elliott, 1998). In another study, higher +frequency of ischemic stroke was noted in 6 a.m. to noon quarter +as compared to other quarters of the day (Argentino et al., +1990). These studies show that the circadian variation in time of +occurrence can depend on the sub-type, which can also help in +planning therapeutics. +miRNA regulation of circadian rhythms has also been +implicated through different studies (Chen and Rosbash, 2016; +Gao et al., 2016). It binds to 3′ UTR region of the target genes +and control different processes such as its mRNA stability and/or +translation. The miRNA that control the circadian rhythms, +such as miR219, miR132, also show rhythmic expression in +SCN. Cheng et al. in their study have demonstrated increase +in rhythmicity as an outcome of administration of antagonists +against these miRs (Cheng et al., 2007). In another study by +Shende et al. investigated the miRNAs that target the clock gene, +Bmal1, in mouse which were exposed to 12 h LD cycles. The +authors identified miR 152, miR 494, which showed bimodal +pattern of expression, following diurnal oscillations along with +the levels of Bmal1. These miRs were also shown to interact with +Clock (Shende et al., 2011). +Many physiological features, especially cardiovascular, follow +defined circadian cycles. Therefore, the circulating levels of +miRNA play an important role in circadian control associated +with different pathology. The different identified miRNAs +can also act as targets as well as biomarkers for any +disturbances from normal physiology. The knowledge about +the miRNA involved in the clock genes is still limited and +needs further detailed investigations for their translation to +clinics. +OVERCOMING HYPOXIA WITH YOGA +BASED ALTERNATE THERAPIES +With increasing evidence in the past years, Yoga is gaining +recognition as a therapeutic intervention in the management of +non-communicable diseases like hypertension, coronary artery +disease (Cramer et al., 2014), diabetes (Innes and Vincent, 2007), +obesity, back pain (Cramer et al., 2013), and also as an adjunct +in the management of cancer. The reduction in respiratory +rate, heart rate, vagal predominance as a general response +following yoga practices possess a considerable role in managing +hypoxia and its associated pathophysiological responses. This +understanding might be beneficial in its application as a targeted +therapy. While meditation’s any effect on Alzheimer disease (AD) +is hypothetical, meditation has received significant consideration +as a tool that possibly will have positive medical and psychological +benefits. Studies indicate improvement in cognitive functions in +elders with dementia (Oken et al., 2006). Kirtan Kriya (KK), a +type of meditation was also investigated in subjects with memory +impairment, Newberg et al. demonstrated positive effects of KK +on cerebral blood flow and cognitive function. A difference in the +activation of the anterior cingulate gyrus and prefrontal cortex, +was seen in the subjects who practiced KK (Newberg et al., 2010). +Neuroimaging studies following Yoga practices in individuals +with mild cognitive impairment suggest increased memory +performance. Enhanced memory performance was correlated +with increased neuronal connectivity between default mode +networks and frontal medial cortex, pregenual anterior cingulate +cortex, right middle frontal cortex, posterior cingulate cortex, and +left lateral occipital cortex suggesting that yoga might be helpful +in enhancing memory recall, specifically visual memory encoding +(Eyre et al., 2016). Meditation improves sleep and sleep problem +is also a risk factor for AD (Devore et al., 2014; Innes and Selfe, +2014). Froeliger et al. revealed that upon conducting controlled +breathing exercises such as pranayama and meditation, there +was a significant decrease in cognitive failures as evaluated by +Voxel-Based Morphometric analysis, which showed a positive +co-relation with increased GMV (Gray matter volume) in the +regions of cerebellar, temporal, occipital, limbic, and frontal lobe +of the brain. There was also a positive correlation seen with +the amount of increase in GMV and the duration of practice +of the breathing exercises and meditation (Froeliger et al., +2012). Long term meditation practice is associated with larger +overall gray matter volume and increased regional enlargement +of areas associated with sustained attention, introspection, and +autonomic function surveillance, indicating the possible role of +Yoga practices in facilitating neuroplasticity (Hernández et al., +2016). It has also been seen in studies that upon activities +that increase cerebral perfusion as well as increase oxygen +inhalation, such as performing yogic asanas (yogic poses) and +pranayama (yogic breathing exercises), there is an increase in +the amplitude in the P3 wave evoked potential (Tripathi and +Bharadwaj, 2013). This escalation in P3 amplitude means that +there is an increased neuronal pool recruitment, which can be +seen as increased attention as well as memory updating. The +study revealed that those who took part in activities which, +increased cerebral perfusion showed a significantly improved +functioning in comparison to the control group which was +only on oral Alzheimer medications. Sutton et al. first of all +identified the P3 wave in 1965 and since then it has been +used extensively in the area of event-related potentials (ERPs) +(Sutton et al., 1965). ERPs are electrophysiological responses +Frontiers in Neuroscience | www.frontiersin.org +8 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +produced in the brain as a result of specific events or stimuli +(Blackwood and Muir, 1990). The latency range for most adults +for auditory stimuli is 250–400 ms. The latency is generally +explained on the basis of the speed of stimulus of one event from +another. Shorter latencies signify exceptional mental execution +compared to longer ones. The P300 can be employed as a +diagnostic tool to discriminate dementias of different origin and +can be elicited by a wide variety of sensory or motor events. +In addition, P300 is used to evaluate and monitor Alzheimer’s +disease (AD). Lengthening of latency is the most pronounced +variation in the auditory modality in AD and other cortical +dementias, which is related to debilitated memory (Polich et al., +1990). Latency lengthening is also observed in AD with visual +modality stimulation and in the auditory modality in healthy +individuals with increased risk of having AD. This may be +used in early monitoring for this disease (Saito et al., 2001). In +related investigation by Caravaglios et al. it was revealed that +P300 latency was higher in AD elderly subjects as compared +to controls (Caravaglios et al., 2008). A similar study found +significant differences in P300 latency between AD subjects +and control (O’mahony et al., 1996). Lai et al. determined +P300 latency as well as amplitude in AD group, group with +mild cognitive impairment, and the control group (Lai et al., +2010). The authors found that P300 latency was higher in +AD group followed by those with cognitive involvement as +compared to controls, while no difference in P300 amplitude +was observed among the three groups. Similarly in another +study Yamaguchi et al. compared P300 latency and amplitude +in Alzheimers’ with vascular dementia and the controls and +found that both the diseased groups had a higher latency as +compared to the control group (Yamaguchi et al., 2000). Several +other studies evaluated P300 latency and its subcomponents, +called P3a and P3b in AD patients and compared them with +controls and found significantly higher latency in patients +compared to controls (Frodl et al., 2002; Bennys et al., 2007; +Juckel et al., 2008). Telles et al. assessed whether practicing +alternate nostril yoga breathing (nadisuddhi pranayama) has +any influence on P300 auditory evoked potentials and found +a dramatic elevation in the P300 peak amplitudes suggesting +that it unequivocally affects intellectual processes (Telles et al., +2013; Mccaffrey et al., 2014), conducted a study and found +the possibility of older adults with AD to complete the Sit +“N” Fit Chair Yoga Program with positive changes across each +physical process (Mccaffrey et al., 2014). In healthy individuals, +controlled breathing at a rate of 5.5 breaths per minute evoked +activity at the brainstem, across the dorsal length of pons, +in hypothalamus, hippocampus, lateral cortices and regions +of striatum. Interestingly, studies on meditation techniques +(Cyclic Meditation and Transcendental Meditation) in healthy +regular practitioners demonstrated hypometabolic states with +significant reductions in oxygen consumption (Wallace, 1970; +Telles et al., 2013). Long-term Yoga practices are independently +associated with decreased chemoreflex hypoxic and hypercapnic +responses and better baroreflex sensitivity (Spicuzza et al., +2000). This might be achieved as a result of adaptation of +peripheral and central chemoreceptors and pulmonary stretch +receptors to the regular practice of slow breathing during +yoga practices, followed by a decrease in the vagal afferent +discharge to the bulbopontine centers. Hypometabolic state in +yoga practitioners could enable tolerating hypoxic conditions. +Another study designed to understand the efficacy of Yoga +practices in promoting physiological recovery showed that Yoga +practitioners with 2 years of experience practicing yoga atleast +twice a week produced 41% less lipopolysaccharide stimulated +IL-6 in response to the laboratory stressor than novices (Kiecolt- +Glaser et al., 2010). Investigations are required to understand +the regulatory role of Yoga on miRNA. However, based on the +literature available, we speculate that miRNA associated in the +process of inflammation, angiogenesis and stress response might +be differentially regulated in long term practitioners, whereas, the +same is expected be the process through which the therapeutic +effects are moderated by Yoga. Therefore, Yoga practices might +be a promising tool to understand the inherent ability of the body +in managing hypoxia induced CNS injuries and also as a possible +therapeutic tool. +FUTURE DIRECTIONS +With advancement in awareness about the profiling and +expression +patterns +of +different +miRNA +associated +with +hypoxia/ischemia-induced CNS injuries, it has led to translation +of this information in clinical set-ups. The miRNA levels could +now be utilized as clinical biomarkers for ischemia. Moreover, +since a single miRNA could regulate a whole network with +multiple targets, controlling the levels of individual miRNA +species could assist in designing therapeutics for complex +diseases. Unlike other exercises, Yoga practices appear to be +unique and the present day findings indicate that yoga can restore +or maintain homeostasis. However, the underlying mechanisms +need to be understood in detail. Further investigations pertaining +to miRNAs linked with ischemic injuries and the role of Yoga +practices in regulating them could benefit in management and +therapy for CNS pathologies in future. +AUTHOR CONTRIBUTIONS +GM +wrote +the +manuscript +and +contributed +in +writing +content related to hypoxia in CNS pathologies, miRNA in +neuroprotection, +and +circadian +rhythms +in +hypoxia +etc.; +DM +contributed +in +writing +content +related +to +hypoxia +pathophysiological responses and the role of miRNA in +inflammation, +angiogenesis, +and +neuroprotection; +BR +contributed content for the Yoga based therapeutics; VP +added yoga related information in the manuscript; NS added +information related to correlation between cerebrovasculature +and AD pathogenesis, yoga related studies, and hypoxia in +promoting cell differentiation; AA conceptualized, designed, and +edited the manuscript. +Frontiers in Neuroscience | www.frontiersin.org +9 +July 2017 | Volume 11 | Article 386 +Minhas et al. +miRNA and Yoga-Based Neurotherapeutics +REFERENCES +Alexandrov, P. 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No use, distribution or reproduction is permitted which does not comply +with these terms. +Frontiers in Neuroscience | www.frontiersin.org +15 +July 2017 | Volume 11 | Article 386 diff --git a/subfolder_0/INCREASE IN VOLUNTARY PULSE RATE REDUCTION ACHIEVED FOLLOWING YOGA TRAINING.txt b/subfolder_0/INCREASE IN VOLUNTARY PULSE RATE REDUCTION ACHIEVED FOLLOWING YOGA TRAINING.txt new file mode 100644 index 0000000000000000000000000000000000000000..355db41b1e5965a8e637a0f53753ffecc8adfe9a --- /dev/null +++ b/subfolder_0/INCREASE IN VOLUNTARY PULSE RATE REDUCTION ACHIEVED FOLLOWING YOGA TRAINING.txt @@ -0,0 +1,29 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/Immediate Effect of Specific Nostril Manipulating Yoga Breathing Practices on Autonomic and Respiratory Variables.txt b/subfolder_0/Immediate Effect of Specific Nostril Manipulating Yoga Breathing Practices on Autonomic and Respiratory Variables.txt new file mode 100644 index 0000000000000000000000000000000000000000..d5209a0fda51417e16ea1ed92f85ced685d172f2 --- /dev/null +++ b/subfolder_0/Immediate Effect of Specific Nostril Manipulating Yoga Breathing Practices on Autonomic and Respiratory Variables.txt @@ -0,0 +1,1436 @@ +Immediate Effect of Specific Nostril Manipulating Yoga Breathing +Practices on Autonomic and Respiratory Variables +P. Raghuraj Æ Shirley Telles + Springer Science+Business Media, LLC 2008 +Abstract +The effect of right, left, and alternate nostril +yoga breathing (i.e., RNYB, LNYB, and ANYB, respec- +tively) were compared with breath awareness (BAW) and +normal breathing (CTL). Autonomic and respiratory vari- +ables were studied in 21 male volunteers with ages between +18 and 45 years and experience in the yoga breathing +practices between 3 and 48 months. Subjects were assessed +in five experimental sessions on five separate days. The +sessions were in fixed possible sequences and subjects were +assigned to a sequence randomly. Each session was for +40 min; 30 min for the breathing practice, preceded and +followed by 5 min of quiet sitting. Assessments included +heart rate variability, skin conductance, finger plethysmo- +gram amplitude, breath rate, and blood pressure. Following +RNYB there was a significant increase in systolic, diastolic +and mean pressure. In contrast, the systolic and diastolic +pressure decreased after ANYB and the systolic and mean +pressure were lower after LNYB. Hence, unilateral nostril +yoga breathing practices appear to influence the blood +pressure in different ways. These effects suggest possible +therapeutic applications. +Keywords +Right nostril yoga breathing  Left nostril +yoga breathing  Alternate nostril yoga breathing  +Unilateral nostril yoga breathing  Autonomic +and respiratory variables +Introduction +In 1895 Kayser first described ‘changes in the amount of +blood flowing through the cavernous tissues of the nasal +conchae’. This has come to be called the nasal cycle. The +cycle was considered an ultradian rhythm during which the +patency and efficiency of the right and left nostrils changed +alternately +with +varying +periodicity +(Stoksted +1953). +However the earlier accepted view that 80% of healthy +individuals have a regular nasal cycle was re-examined by +a study which used numerical measures of reciprocity and +quantified the division of airflow between the nasal pas- +sages over time (Flanagan and Eccles 1997). Hourly +measurements of unilateral nasal airflow were made for 8 h +in 52 volunteers. A numerical definition of the nasal cycle +was derived based on (i) the correlation between unilateral +airflows and (ii) an airflow distribution ratio between the +two nasal airways. Only 11 of the 52 volunteers had pat- +terns of nasal airflow which met this definition. This was +21% of the volunteers studied. This suggested that earlier +descriptions of the nasal cycle as being a regular cyclical +phenomenon in most healthy individuals required further +understanding. +In a different kind of investigation, the time periods of +multiple systems during sleep and waking rest were studied +in three healthy adults, assessing ten variables which +included the nasal cycle (Shannahoff-Khalsa and Yates +2000). Time series analysis detected periods at 115–145, +70–100 and 40–65 min across all variables. Hence at +present the concept of spontaneous changes in nasal +patency in humans remains a possibility, though the +physiological mechanisms underlying this cycle are not +clear (Okhi et al. 2005). It is recognized that nasal blood +vessels influence nasal airflow and hence nasal airflow is +regulated by autonomic and central controls (Eccles 2000). +P. Raghuraj  S. Telles +Swami Vivekananda Yoga Research Foundation, +Bangalore, India +S. Telles (&) +Patanjali Yogpeeth, Bahadrabad, Haridwar, Uttarakhand +249402, India +e-mail: shirleytelles@gmail.com +123 +Appl Psychophysiol Biofeedback +DOI 10.1007/s10484-008-9055-0 +This is related to the fact that sympathetic nerves supplying +the nose are regulated by the hypothalamus and vasomotor +areas of the brainstem. Despite this need for clarity in +understanding the nasal cycle there is an interest in +understanding the physiological changes associated with +spontaneous changes in nasal patency and those associated +with unilateral forced nostril breathing. +For example unilateral forced nostril breathing (UFNB) +through the right nostril significantly increased blood glu- +cose while left nostril breathing lowered it (Backon 1988). +In a single subject it was seen that right UFNB reduced the +involuntary blink rate whereas left UFNB increased +involuntary blink rates (Backon and Kullock 1989). Also, +right UFNB decreased the intraocular pressure whereas left +UFNB increased it. +These findings suggested that right unilateral forced +nostril breathing is associated with a generalized increase +in sympathetic tone, and can hence be correlated with the +‘active phase’ of the basic rest activity cycle (Werntz et al. +1983). Another study examined the effects of UFNB on the +functioning of the heart (Shannahoff-Khalsa and Kennedy +1993). This involved three experiments. For two of them +the subjects breathed at the rate of 6 breaths per minute and +for the third their breath rate was rapid (i.e., 2–3 breaths/s). +Using impedance cardiography it was shown that at a +breath rate of 6 per minute, right UFNB increased the heart +rate compared to left UFNB, which lowered the heart rate. +Also the stroke volume was higher with left UFNB and left +UFNB also increased the end diastolic volume. +Apart from the lateralized effects on the autonomic ner- +vous system, recordings of the electroencephalogram (EEG) +suggested that nasal patency was inversely coupled to +alternating dominance of activity in the two cerebral +hemispheres, mediated through the autonomic nervous +system (Werntz et al. 1983). However this was not seen in +another study. In ten untrained subjects nasal decongestion +was altered by having the subjects lie in the lateral recum- +bent position, occluding the contralateral nostril (Velikonja +et al. 1993). Cortical activation and laterality were esti- +mated based on ratios of low beta and high alpha +bandwidths, relative to each other and between hemi- +spheres. The study did not support the hypothesis of +hemispheric activation correlated with nasal patency in +subjects untrained in breathing techniques. Similarly, as for +unilateral forced nostril breathing, a study on the immediate +effects of uninostril yoga breathing related to the perfor- +mance in a hemisphere-specific task, also did not support the +description of nasal patency being coupled with lateraliza- +tion of cerebral function. Hence the effects of nostril patency +on cerebral hemispheric activation remain unresolved. +In addition to spontaneous shifts in nostril patency and +unilateral forced nostril breathing, changes in nostril +patency have been induced through yoga practice. The +ancient Indian science of Yoga uses voluntary regulation of +the breathing to make breathing rhythmic, facilitate relax- +ation and induce a state of mental calmness (Swami +Vivekananda 1973). Some of these breathing techniques +involve inhalation and exhalation through one nostril +selectively (Swami Muktibodhananda 1999). These yoga +breathing techniques allow the effects of selective nostril +breathing to be studied, when carried out presumably +without effort, for specified periods. +One month of right nostril yoga breathing practiced for a +few minutes at a time, four times a day, increased the +baseline oxygen consumption by 37% (Telles et al. 1994). +Left nostril yoga breathing and alternate nostril yoga +breathing also increased baseline oxygen consumption, but +the magnitude of change was lesser than for right nostril +yoga breathing (i.e., 24 and 18%, respectively). Left nostril +yoga breathing also increased the volar galvanic skin +resistance (suggestive of a decrease in sympathetic activ- +ity). The immediate effects of 45 min of right nostril yoga +breathing were compared to those of an equal duration of +normal breathing, in another study (Telles et al. 1996). +Right nostril yoga breathing increased systolic blood +pressure by 9.4 mm Hg, increased oxygen consumption by +17%, and decreased digit pulse volume (suggestive of an +increase in vasomotor sympathetic activity) by 45%. +There has been no study comparing the immediate +effects of right, left and alternate nostril yoga breathing +practiced by the same individuals on different occasions. +Hence, the present study was planned to study the effects of +these three yoga breathing practices, compared to breath +awareness and normal breathing, on autonomic and respi- +ratory variables in normal volunteers. +Methods +Participants +Twenty-one male volunteers with ages ranging between 18 +to 45 years (group mean ± SD, 27.5 ± 6.3 years) partici- +pated in the study. Autonomic and respiratory variables +have been shown to vary with the phases of the menstrual +cycle (Yildirir et al. 2002), hence the study was restricted +to males. The participants were undergoing training at a +yoga center. They had experience of practicing the three +yoga breathing techniques (i.e., right nostril yoga breath- +ing, left nostril yoga breathing and alternate nostril yoga +breathing) ranging between 3 and 48 months (group +mean ± SD, 14.6 ± 10.7 months). All of them had com- +pleted a residential training course in yoga which was for 3 +months During the three months the training was intensive, +i.e., for 8 h each day and included training in yoga postures +(asanas), voluntarily regulated breathing (pranayamas), +Appl Psychophysiol Biofeedback +123 +meditation, and yoga philosophy. It also included the +practice of the yoga breathing techniques mentioned here +(viz., RNYB, LNYB, ANYB and BAW), as well as +instruction on the theory of yoga breathing and descriptions +from traditional texts about the effects of the practices +based on experiences of yoga practitioners. The 3 month +training also included a single session of 60 min of theory +on the physiological effects of different yoga practices +citing published research. +Following the 3 months of intensive training participants +continued to stay at the yoga center to receive training in +philosophical aspects of yoga. They continued to practice +yoga unsupervised and reported practicing yoga breathing +practices other than those reported here for approximately +10 min a day, at least 3 times in a week. In addition to this +all the participants included in the study were given a +month of training in the breathing practices assessed in the +present study for 30 min each day for a month before the +study began as a refresher course. This one month of +supervised practice was to attempt to reduce the differences +between subjects due to their wide range of experience in +yoga practice. +All of them were in normal health based on a routine +clinical examination and none of them had a history of +smoking or respiratory ailments including nasopharyngeal +abnormalities. They were all right handed dominant based +on their response to the Edinburgh handedness inventory +(Oldfield 1971). Handedness was assessed as there is a +report supporting a handedness by nostril interaction +(Searleman et al. 2005). Also none of them were taking +medication and they did not use any other wellness strat- +egy. The variables to be recorded and the study design +were described to the participants after which their signed +consent to participate in the study was obtained. None of +them was aware of the hypothesis of the study. The project +had the approval of the Institutional Review Board. +Design +The participants were assigned to five sessions as five +possible sequences. These were (i) Sequence 1: right nostril +yoga breathing, left nostril yoga breathing, alternate nostril +yoga breathing, breath awareness, and normal breathing; +(ii) Sequence 2: left nostril yoga breathing, alternate nostril +yoga breathing, breath awareness, normal breathing, and +right nostril yoga breathing; (iii) Sequence 3: alternate +nostril yoga breathing, breath awareness, normal breathing, +right nostril yoga breathing, and left nostril yoga breathing; +(iv) Sequence 4: breath awareness, normal breathing, right +nostril yoga breathing, left nostril yoga breathing, and +alternate nostril yoga breathing, and (v) Sequence 5: normal +breathing, right nostril yoga breathing, left nostril yoga +breathing, alternate nostril breathing, and breath awareness. +For each sequence the five sessions (of 40 min each) +were conducted on five different days. Each 40 min session +consisted of 30 min during which subjects practiced any +one of the four breathing techniques (RNYB, LNYB, +ANYB, and BAW) or did not do any breath manipulation +(in the control session). The 30 min period was preceded +and followed by 5 min periods which were ‘rest periods’ +without breath manipulation. Hence each subject had a 40 +min session each day. This was for 5 days keeping the time +of the day constant for each subject. In the 30 min seg- +ments during which subjects practiced different breathing +techniques, there were four 7.5 min epochs. +Participants were randomly assigned to these five pos- +sible sequences using a random number table. Hence, each +participant was assessed in five sessions on five different +days at the same time of the day, with the assignment of +participants to different session-sequences being random. +Assessments were done throughout a session. HRV data +were recorded in Epoch 3 and Epoch 4, each of 7.5 min +duration. Five minutes of each epoch were analyzed for +HRV. In each epoch of 7.5 min, HRV data were recorded +in the last 5 min, hence the first 2.5 min of each epoch were +not included for analysis. Each session lasted for 40 min of +which 30 min was spent in the respective breathing prac- +tices, preceded and followed by 5 min of sitting quiet. This +30-min ‘during’ period was considered as four epochs +(Epoch 1–4), of 7 min 30 s each. The assessments’ sche- +dule during a session has been presented schematically in +Fig. 1. +Assessments +Autonomic and respiratory variables were acquired using a +four channel polygraph (Medicaid, Chandigarh, India). The +EKG was acquired using Ag/AgCl electrodes with con- +ducting gel (Electrode Gel, Medicaid Systems, Chandigarh, +India), fixed at mid-clavicular points bilaterally and with a +third electrode 1 cm above the left lower costal margin. +These three positions were selected to simulate standard +electrode positions to record the three limb leads with +minimal risk of movement artifact (Thakur and Webster +1985). This precaution was needed as participants used +their right hand to manipulate the nostrils. The EKG was +digitized using a 12 bit analog-to-digital converter (ADC) +at a sampling rate of 1,024 Hz and was analyzed off-line to +obtain the heart rate variability (HRV) spectrum. The skin +conductance level was recorded with two contoured silver +electrodes in contact with the volar pads of the distal +phalanges of the index and middle fingers of the left hand. +Using a low level DC amplifier a current of 0.5 V was +passed through the electrodes. The finger plethysmogram +was recorded using a photoelectric transducer kept at the +base of the nail of the left thumb. The respiration was +Appl Psychophysiol Biofeedback +123 +recorded using a stethograph connected to an AC amplifier +and fixed around the trunk approximately 8 cm below the +lower costal margin as the participants sat erect (Telles +et al. 1996). The blood pressure was recorded before and +after each session with a standard mercury sphygmoma- +nometer, auscultating over the right brachial artery. The +diastolic pressure was noted as the reading at which the +Korotkoff sounds appeared muffled. The mean pressure +was derived as follows: mean pressure = diastolic pres- +sure + 1/3 X Pulse pressure, where the pulse pressure is +the difference between the systolic and diastolic pressure +(Ganong 1999). +Yoga Breathing Practices +There were three yoga breathing (pranayama) sessions and +two control sessions one of breath awareness (BAW) and +the other of normal breathing (CTL) given to each subject. +The sessions were for 30 min on five separate days at the +same time of the day. The five practices are described +below. (1) Right nostril yoga breathing (RNYB) or Sur- +yanuloma viloma pranayama practice involves breathing +exclusively in and out through the right nostril while the +left nostril is gently occluded. (2) Left nostril yoga +breathing (LNYB) or Chandra anuloma viloma pranayama +practice involves breathing through the left nostril exclu- +sively while the right nostril is occluded. (3) Alternate +nostril yoga breathing (ANYB) or Nadisuddhi pranayama +practice involves breathing through left and right nostrils +alternately. Throughout these practices the awareness is +directed to the breath and breathing. During breath +awareness, the participants maintained awareness of the +breath without manipulation of the nostrils (Visweswaraiah +and Telles 2004). During the normal breathing session the +participants sat at ease without specific instructions about +their breathing. In the three nostril manipulating pranaya- +mas the thumb and the ring finger of the right hand were +used to manipulate or occlude the nostrils. This is a char- +acteristic +yoga +gesture +(nasika +mudra +in +Sanskrit) +prescribed during pranayama practice to manipulate the +nostrils with ease (Swami Niranjananda Saraswathi 1994). +During the different practices (except for the normal +breathing session) the participants were asked to remain in +a mental state characterized by relaxation and internal +awareness. This is the mental state adopted during +meditation and voluntary regulated yoga breathing (pra- +nayama). Also, the participants’ attention was directed to +the movement of air into and out of their nostrils. They also +attempted to be aware of the air as it moved through their +nasal passage. +Data Extraction +The following data were extracted from the polygraph +records. The heart rate in beats per minute (bpm) was +obtained by continuously counting the QRS complexes in +successive 60 s periods. The breath rate (in cycles per +minute) was calculated by counting the breath cycles in +60 s epochs, continuously. The skin conductance level (in +micro Siemens) and finger plethysmogram amplitude (in +cm) were sampled at 30 s intervals. +Frequency domain analysis of the heart rate variability +data was carried out for 5 min recordings, in the following +5-min epochs for each of the five sessions: pre, epoch 3 +(E3), epoch 4 (E4), and post. The EKG data were visually +inspected offline and those EKG records which had arti- +facts were not included for analysis. In the records of eight +participants the EKG record in the first during state (i.e., +‘epoch 1’) had muscle artifact. This was also seen in the +second during state (i.e., ‘epoch 2’ in another three sub- +jects. The third and fourth during states (i.e., ‘epoch 3’ and +‘epoch 4’) were noise-free in all subjects and hence were +used for analysis. Fourier analysis of the R-R interval series +was done using the HRV analysis software version 1.1 +developed by the Biomedical Signal Analysis Group, +University of Kuopio, Finland (Niskanen et al. 2004). +Hence, the HRV was sampled in two ‘during’ epochs, +i.e., E3 and E4. The energy in the HRV series in the fol- +lowing specific frequency bands was studied viz., the very +low frequency band (0.0–0.05 Hz), low frequency band +(0.05–0.15 Hz), and high frequency band (0.15–0.50 Hz). +The low frequency and high frequency band values were + All variables sampled continuously +HRV data in 5 min epochs continuously + Blood Pressure +Pre +5 min +During 1 +7.5 min +During 2 +7.5 min +During 3 +7.5 min +During 4 +7.5 min +Post +5 min +Fig. 1 Schematic presentation +of the timing of assessments +during a session +Appl Psychophysiol Biofeedback +123 +expressed as normalized units (Task force of the European +Society of Cardiology and the North American Society of +Pacing and Electrophysiology 1996). +Data Analysis +Statistical analysis was done using SPSS (Version 10.0) +package. +Repeated +measures +analyses +of +variance +(ANOVA) were performed with two Within Subjects fac- +tors, i.e., (i) Sessions with five levels; right nostril yoga +breathing, left nostril yoga breathing, alternate nostril yoga +breathing, breath awareness, and normal breathing and (ii) +States with six levels; i.e., pre, epoch 1 (E1), epoch 2 (E2), +epoch 3 (E3), epoch 4 (E4), and post. For variables such as +low frequency (LF) power, high frequency (HF) power and +LF/HF ratio of the HRV spectrum the Within Subjects +factor (States) had four levels; i.e., pre, epoch 3 (E3), epoch +4 (E4) and post. For systolic blood pressure, diastolic +pressure and mean pressure the Within Subjects factor +(States) had two levels; i.e., pre and post. +Post-hoc tests with Bonferroni adjustment for multiple +comparisons were used to detect significant differences +between mean values. +Results +The groups mean values ± SD for heart rate, skin con- +ductance level, finger plethysmogram amplitude and breath +rate for all five sessions are given in Table 1. The groups +mean values ± SD for low frequency (LF) power, high +frequency (HF) power, and ratio of low frequency to high +frequency (LF/HF) power for all five sessions are given in +Table 2, and for systolic blood pressure, diastolic blood +pressure and mean pressure for all five sessions are given in +Table 3. In addition, for greater clarity the HRV (along +with breath rate data for comparison) are provided as line +graphs in Fig. 2 and the systolic, diastolic and mean +pressure values are given as bar graphs in Fig. 3. +There was a significant difference between Sessions for +(i) heart rate [F = 3.47, for df = 3.74, 74.74, p \ .05, +Huynh-Feldt e = .934]; (ii) breath rate [F = 16.70, for +df = 3.30, 66.02, p \ .001, Huynh-Feldt e = .825]; (iii) +systolic blood pressure [F = 11.93, for df = 3.39, 67.74, +p \ .001, Huynh-Feldt e = .847]; (iv) diastolic blood +pressure [F = 5.21, for df = 3.04, 60.77, p \ .01, Huynh- +Feldt e = .760]; and (v) mean pressure [F = 9.98, for +df = 3.41, 68.18, p \ .001, Huynh-Feldt e = .852]. +Table 1 Heart rate, skin conductance level, finger plethysmogram amplitude and breath rate in all five sessions +Variables +Sessions States +Pre +Epoch 1 +Epoch 2 +Epoch 3 +Epoch 4 +Post +Heart rate (bpm) +RNYB +74.20 ± 9.69 76.85 ± 9.51 +77.01 ± 10.55 +78.18 ± 9.83 +77.87 ± 9.52 +77.20 ± 11.04 +LNYB +73.50 ± 8.25 75.66 ± 8.16 +76.60 ± 8.45 +77.19 ± 8.75 +76.90 ± 8.75 +77.76 ± 11.05* +ANYB +75.78 ± 9.11 78.96 ± 9.55** +79.67 ± 8.77*** 78.89 ± 12.54 +80.51 ± 9.36** +80.61 ± 10.61* +BAW +72.98 ± 9.01 71.07 ± 7.12 +72.84 ± 8.01 +73.02 ± 8.02 +73.52 ± 7.97 +74.98 ± 8.12 +CTL +78.13 ± 8.48 74.36 ± 7.53 +74.27 ± 7.65 +75.50 ± 7.63 +75.68 ± 7.92 +77.30 ± 7.35 +Skin conductance +level (lS) +RNYB +1.58 ± 1.89 +2.08 ± 2.23 +2.34 ± 2.40 +2.35 ± 2.43 +2.43 ± 2.44 +2.74 ± 2.85* +LNYB +2.89 ± 3.29 +2.56 ± 2.71 +2.00 ± 2.39 +2.30 ± 2.61 +2.40 ± 2.59 +2.66 ± 2.97 +ANYB +1.85 ± 2.47 +2.32 ± 2.86 +2.55 ± 2.88 +2.59 ± 2.80 +2.79 ± 2.93 +3.11 ± 2.85* +BAW +1.18 ± 1.43 +1.26 ± 1.42 +1.21 ± 1.47 +1.30 ± 1.67 +1.35 ± 1.67 +1.62 ± 1.82 +CTL +1.57 ± 2.03 +1.44 ± 1.89 +1.54 ± 2.14 +1.49 ± 1.98 +1.71 ± 2.44 +1.87 ± 2.68 +Finger plethysmogram +amplitude (cm) +RNYB +0.59 ± 0.29 +0.46 ± 0.22* +0.45 ± 0.22 +0.41 ± 0.19* +0.38 ± 0.20** +0.33 ± 0.14*** +LNYB +0.59 ± 0.31 +0.56 ± 0.30 +0.50 ± 0.24 +0.46 ± 0.22 +0.51 ± 0.28 +0.48 ± 0.29 +ANYB +0.53 ± 0.29 +0.47 ± 0.25 +0.49 ± 0.24 +0.42 ± 0.22 +0.38 ± 0.17* +0.41 ± 0.21 +BAW +0.66 ± 0.31 +0.56 ± 0.31 +0.48 ± 0.25*** +0.49 ± 0.38 +0.46 ± 0.31* +0.36 ± 0.18*** +CTL +0.67 ± 0.41 +0.57 ± 0.30 +0.53 ± 0.28* +0.51 ± 0.26* +0.43 ± 0.25** +0.43 ± 0.23* +Breath rate (cpm) +RNYB +17.28 ± 2.85 12.29 ± 4.94** +12.41 ± 5.55** +12.23 ± 5.04*** 12.07 ± 4.99*** 16.03 ± 3.86 +LNYB +17.02 ± 3.21 11.11 ± 4.93** +11.39 ± 5.28** +11.71 ± 5.51** +11.85 ± 5.45** +15.67 ± 3.85 +ANYB +17.19 ± 4.04 +9.08 ± 3.09*** +9.33 ± 2.86*** +9.45 ± 3.52*** +9.49 ± 3.21* +13.98 ± 4.73* +BAW +16.45 ± 3.69 16.26 ± 3.37 +16.32 ± 3.63 +16.25 ± 3.73 +16.10 ± 4.02 +15.90 ± 3.54 +CTL +16.75 ± 3.79 16.95 ± 3.79 +17.14 ± 3.63 +16.97 ± 3.87 +17.00 ± 3.69 +16.83 ± 3.97 +Values are group mean ± SD +* p \ .05, ** p \ .01, *** p \ .001, post-hoc tests with Bonferroni adjustment, compared with respective ‘Pre’ values +Appl Psychophysiol Biofeedback +123 +There was a significant difference between States for (i) +heart rate [F = 9.59, for df = 3.35, 67.13, p \ .001, Hu- +ynh-Feldt e = .671]; (ii) skin conductance level [F = 7.65, +for df = 56.62, p \ .001, Huynh-Feldt e = .566]; (iii) +finger +plethysmogram +amplitude +[F = 20.04, +for +df = 78.59, p \ .001, Huynh-Feldt e = .547]; (iv) breath +rate [F = 37.69, for df = 2.74, 54.69, p \ .001, Huynh- +Feldt e = .547; (v) LF power [F = 3.81, for df = 53.32, +p \ .05, Huynh-Feldt e = .935]; (vi) HF power [F = 4.31, +for df = 57.00, p \ .01]; (iv) LF/HF ratio [F = 5.63, for +df = 46.64, p \ .01, Huynh-Feldt e = .815]. +There was a significant interaction between Sessions and +States for (i) skin conductance level [F = 2.25, for +df = 5.80, 116.01, p \ .05, Huynh-Feldt e = .290]; (ii) +breath rate [F = 11.09, for df = 7.84, 156.82, p \ .001, +Huynh-Feldt +e = .392]; +(iii) +systolic +blood +pressure +[F = 40.12, for df = 2.72, 54.36, p \ .001, Huynh-Feldt +e = .679]; (iv) diastolic blood pressure [F = 23.83, for +df = 3.08, 61.64, p \ .001, Huynh-Feldt e = .770]; and +(v) mean pressure [F = 14.61, for df = 1.64, 32.85, +p \ .001, Huynh-Feldt e = .411]. This suggested that for +all the above mentioned variables the Sessions and States +were not independent of each other (Zar 1999). +Post-hoc tests for multiple comparisons were per- +formed with Bonferroni adjustment. All comparisons +were made with respective ‘pre’ states. In the right nostril +yoga breathing session there was a significant decrease in +the +finger +plethysmogram +amplitude +during +the +E1 +(p \ .05), E3 (p \ .05), and E4 (p \ .01) phases and +after the practice (p \ .001). The skin conductance level +was increased significantly after the practice (p \ .05). +Both systolic and diastolic blood pressure and mean +pressure increased significantly following the practice +(p \ .001, +p \ .001, +and +p \ .01, +respectively). +The +breath +rate +was +significantly +lower +during +the +E1 +Table 2 LF power, HF power, LF/HF ratio of the HRV spectrum in all five sessions +Variables +Sessions +States +Pre +Epoch 3 +Epoch 4 +Post +Low frequency (LF) power (n.u.) +RNYB +39.87 ± 6.18 +45.22 ± 9.88 +44.38 ± 11.68 +40.21 ± 10.18 +LNYB +39.94 ± 3.19 +43.42 ± 8.85 +40.74 ± 7.13 +39.82 ± 8.62 +ANYB +40.07 ± 5.66 +45.23 ± 11.37 +47.23 ± 10.57* +41.56 ± 8.50 +BAW +40.57 ± 5.02 +43.03 ± 6.91 +38.88 ± 8.39 +42.04 ± 7.19 +CTL +40.49 ± 14.27 +38.43 ± 6.46 +41.62 ± 9.38 +41.64 ± 10.23 +High frequency (HF) power (n.u.) +RNYB +60.15 ± 6.15 +56.49 ± 10.72 +58.52 ± 8.28 +59.84 ± 10.11 +LNYB +61.12 ± 9.49 +55.26 ± 8.98 +54.94 ± 7.96 +59.30 ± 8.38 +ANYB +59.93 ± 5.66 +56.35 ± 15.13 +52.01 ± 12.93* +58.44 ± 8.50 +BAW +59.73 ± 5.37 +57.77 ± 7.65 +59.15 ± 10.92 +57.89 ± 7.20 +CTL +62.01 ± 7.53 +61.13 ± 6.63 +58.82 ± 9.95 +58.36 ± 10.23 +LF/HF ratio +RNYB +0.67 ± 0.18 +0.83 ± 0.36 +0.74 ± 0.28 +0.74 ± 0.45 +LNYB +0.68 ± 0.37 +0.86 ± 0.32 +0.85 ± 0.27 +0.70 ± 0.28 +ANYB +0.68 ± 0.17 +0.77 ± 0.38 +1.11 ± 0.64* +0.73 ± 0.32 +BAW +0.69 ± 0.16 +0.76 ± 0.25 +0.77 ± 0.47 +0.76 ± 0.25 +CTL +0.64 ± 0.22 +0.66 ± 0.19 +0.77 ± 0.43 +0.78 ± 0.39 +Values are group mean ± SD +* p \ .05, post-hoc tests with Bonferroni adjustment, compared with respective ‘Pre’ values +Table 3 Systolic and diastolic blood pressure and mean pressure in +all five sessions +Variables +Sessions States +Pre +Post +Systolic blood +pressure (mm Hg) +RNYB +110.57 ± 6.52 116.67 ± 5.41*** +LNYB +110.38 ± 6.53 106.19 ± 6.51** +ANYB +109.81 ± 6.19 108.67 ± 6.43* +BAW +111.33 ± 5.88 111.24 ± 6.23 +CTL +112.48 ± 6.84 112.19 ± 6.60 +Diastolic blood +pressure (mm Hg) +RNYB +72.67 ± 5.30 +76.00 ± 5.02*** +LNYB +72.76 ± 4.88 +71.62 ± 4.67 +ANYB +73.05 ± 4.27 +72.38 ± 3.98* +BAW +72.67 ± 4.49 +72.48 ± 4.51 +CTL +73.05 ± 4.59 +72.19 ± 4.47* +Mean pressure +(mm Hg) +RNYB +85.30 ± 5.31 +89.42 ± 4.63** +LNYB +85.30 ± 4.87 +83.14 ± 4.64** +ANYB +85.30 ± 4.29 +84.47 ± 4.26 +BAW +85.55 ± 4.36 +85.39 ± 4.47 +CTL +86.19 ± 4.86 +85.52 ± 4.71* +Values are group mean ± SD +* p \ .05, ** p \ .01, *** p \ .001, post-hoc tests with Bonferroni +adjustment, compared with respective ‘Pre’ values +Appl Psychophysiol Biofeedback +123 +(p \ .01), E2 (p \ .01), E3 (p \ .001), and E4 (p \ .001) +phases of the practice. +In the left nostril yoga breathing session there was a sig- +nificant increase in the heart rate after the practice (p \ .05). +The systolic blood pressure and mean pressure reduced +significantly after the practice (p \ .01, respectively). The +breath rate decreased significantly during the E1, E2, E3, and +E4 phases of the practice (p \ .01, respectively). +The alternate nostril yoga breathing session resulted in a +significant increase in the heart rate during the E1 +(p \ .01), E2 (p \ .001), and E4 (p \ .01) phases and after +the practice (p \ .05). There was a significant increase in +both LF power and LF/HF ratio of the HRV spectrum +during the E4 phase of the practice (p \ .05, respectively). +In contrast there was a significant decrease in the HF power +of the HRV spectrum during the E4 phase of the practice +(p \ .05). The skin conductance level was increased sig- +nificantly +after +the +practice +(p \ .05). +The +finger +plethysmogram amplitude was reduced significantly during +the E4 phase of the practice (p \ .05). There was a sig- +nificant reduction in both systolic and diastolic blood +pressure (p \ .05, respectively) after the practice. The +breath rate was decreased significantly during the E1 +(p \ .001), E2 (p \ .001), E3 (p \ .001), and E4 (p \ .05) +phases, and after the practice (p \ .05). +In the breath awareness session there was a significant +decrease in the finger plethysmogram amplitude during the +E2 (p \ .001) and E4 (p \ .05) phases and after (p \ .001) +the practice. +In the normal breathing session there was a significant +decrease in the finger plethysmogram amplitude during the +E2 (p \ .05), E3 (p \ .05) and E4 (p \ .01) phases and +after (p \ .05) the practice. There was also a significant +reduction in the diastolic blood pressure and mean pressure +after the session (p \ .05, respectively). +Discussion +The present study evaluated the changes in autonomic and +respiratory variables during and after right, left, and alter- +nate nostril yoga breathing compared to an equal duration +of breath awareness and normal breathing. +Some of the autonomic variables which were assessed in +the present study directly indicate the level of activity in +different subdivisions of the sympathetic nervous system +whereas others indicate autonomic balance. The heart rate +for example, is regulated by dual innervation (sympathetic +and vagal) as well as humoral factors (Andreassi 2000). +This also applies to the heart rate variability (HRV) com- +ponents. The low frequency (LF) band of the HRV is +mainly related to sympathetic modulation when expressed +in normalized units (Task force of the European Society of +Cardiology and the North American Society of Pacing and +Electrophysiology 1996) while the efferent vagal activity is +a major contributor to the high frequency (HF) band. The +LF/HF ratio is correlated with the sympathovagal balance +(Malliani et al. 1991). +A decrease in finger plethysmogram amplitude is cor- +related +with +increased +noradrenergic +vasomotor +sympathetic control of the cutaneous blood vessels (Delius +and Kellerova +´ 1971). The skin conductance level is an +indicator of the level of activity in the cholinergic sudo- +motor sympathetic nerves supplying the eccrine sweat +glands (Shields et al. 1987), which is believed to be the +major contributor to changes in the spontaneous electro- +dermal activity (Fowles 1986). The blood pressure depends +on two main factors viz., the cardiac output and the +peripheral vascular resistance. The systolic blood pressure +varies more within a short period than the diastolic blood +pressure. Also the systolic blood pressure is usually +determined by the cardiac output while the diastolic blood +Low Frequency Power +0 +10 +20 +30 +40 +50 +Pre +Epoch 3 +Epoch 4 +Post +Pre +Epoch 3 +Epoch 4 +Post +Pre +Epoch 3 +Epoch 4 +Post +States +Pre +Epoch 3 +Epoch 4 +Post +States +normalized units +RNYB +LNYB +ANYB +BAW +CTL +High Frequency Power +46 +48 +50 +52 +54 +56 +58 +60 +62 +64 +States +normalized units +RNYB +LNYB +ANYB +BAW +CTL +Breath Rate +0 +5 +10 +15 +20 +cycles per minute +LF/HF Ratio +0 +0.2 +0.4 +0.6 +0.8 +1 +1.2 +States +RNYB +LNYB +ANYB +BAW +CTL +RNYB +LNYB +ANYB +BAW +CTL +Fig. 2 Low frequency power, +high frequency power and LF/ +HF ratio of heart rate variability +spectrum and breath rate in all +five sessions +Appl Psychophysiol Biofeedback +123 +pressure is more closely related to the peripheral vascular +resistance (Franklin 2004) and the mean pressure signifies +the average pressure throughout the cardiac cycle (Ganong +1999). Unlike these variables, it is well established that the +breath rate depends upon numerous factors ranging from +physical activity to psychological stressors (Stevenson and +Ripley 1952). +A summary of inferences for the three experimental +interventions i.e., right nostril yoga breathing, left nostril +yoga breathing, and alternate nostril yoga breathing and the +two control sessions +(breath awareness, and normal +breathing) is given below. +Right nostril yoga breathing practice increased the skin +conductance level and in contrast reduced the finger ple- +thysmogram amplitude. This may be mediated by an +increase in sympathetic activity in the sudomotor and +cutaneous vasomotor subdivisions, respectively. However +these findings could have been influenced by the slower rate +of breathing during RNYB described below as well as other +confounding factors such as the fixed session sequence, +which has also been described below. There was also an +increase in blood pressure (both systolic and diastolic blood +pressure). The increase in blood pressure following right +nostril yoga breathing may be related to peripheral vaso- +constriction as the finger plethysmogram amplitude was +lower. These results suggest that right nostril yoga breathing +practice increases sympathetic tone in some subdivisions of +activity. However the skin conductance ‘pre’ values for the +right nostril yoga breathing session differed from the ‘pre’ +SC values of the left nostril yoga breathing session. Though +the difference was not statistically significant these differ- +ences in ‘pre’ values, and the fact that ‘post’ heart rate data, +(also of right nostril yoga breathing and of left nostril yoga +breathing sessions), were not different, make it difficult to +state that right nostril yoga breathing increased sympathetic +activity. However earlier studies have shown a trend of +sympathetic activation following breathing exclusively +through the right nostril. +Right unilateral forced nostril breathing increased the +heart rate compared with left unilateral forced nostril +breathing (Shannahoff-Khalsa and Kennedy 1993) sug- +gesting an increase in cardio-sympathetic activity. Previous +studies on right nostril yoga breathing have also showed +similar results. A month of right nostril yoga breathing +practice compared to alternate nostril yoga breathing +resulted in a significant increase in the heart rate and oxygen +consumption and a decrease in the body weight (Telles +et al. 1994). Another study which compared the immediate +effects of right nostril yoga breathing with normal breath- +ing, both practiced for 45 minutes, showed a reduction in +skin resistance, digit pulse volume (45%) and an increase in +systolic blood pressure (9.1 mm Hg) following right nostril +breathing (Telles et al. 1996). In the present study also, the +finger plethysmogram amplitude reduced and systolic blood +pressure increased following the practice. +Left nostril yoga breathing practice resulted in a sig- +nificant reduction in both systolic blood pressure and mean +pressure, and possibly increased activity in some other +subdivisions of sympathetic nervous system activity. The +reduction in systolic blood pressure following left nostril +yoga breathing may be related to a combination of effects +such as changes in cardiac output, peripheral vascular +resistance, and humoral factors. +The practice of alternate nostril yoga breathing resulted +in more changes than either uninostril yoga breathing. +There was a decrease in both systolic and diastolic blood +pressures and in the finger plethysmogram amplitude. In +contrast, there was an increase in the heart rate, skin con- +ductance level, LF power and LF/HF ratio of the HRV +spectrum. The changes in heart rate and HRV, skin con- +ductance level and finger plethysmogram amplitude could +have been influenced by the slower breath rate during +alternate nostril yoga breathing. +Systolic Blood Pressure +100 +102 +104 +106 +108 +110 +112 +114 +116 +118 +RNYB +LNYB +ANYB +BAW +CTL +RNYB +LNYB +ANYB +BAW +CTL +RNYB +LNYB +ANYB +BAW +CTL +Sessions +mm Hg +Pre +Post +Pre +Post +Pre +Post +Diastolic Blood Pressure +69 +70 +71 +72 +73 +74 +75 +76 +77 +Sessions +mm Hg +Mean Pressure +80 +82 +84 +86 +88 +90 +Sessions +mm Hg +*** +** +* +*** +* +* +** +** +* +Fig. 3 Systolic, diastolic and mean blood pressure before and after +the five sessions +Appl Psychophysiol Biofeedback +123 +During all three nostril manipulating yoga breathing +practices there was a significant decrease in the breath rate. +This may be related to consciously regulating and slowing +down +the +breathing +while +practicing +the +respective +breathing techniques. However after alternate nostril yoga +breathing practice the breath rate further reduced compared +to the baseline. This may be due to breathing through both +nostrils alternately. +The breath rate was considerably slower during ANYB +(approximately 9 cpm) compared with RNYB and LNYB. +During all three of them the respiratory rates were slower +than spontaneous breathing at rest (approximately 17 cpm). +Also throughout LNYB the breath rate was lower than in +RNYB (ranging from 0.2 to 1.2 cpm). Given the fact that a +reduction in breath rate is associated with reduced arousal, +the lower breath rates in these yoga breathing practices +could be expected to have influenced most, if not all +variables as described below, with the possible exception +of the blood pressure. +In order to prevent changes in breath rate influencing the +outcome it would have been ideal to have had the subjects +breathe at predetermined rates in all sessions. However in +order to study the effect of the pranayama techniques +practiced as naturally as possible, subjects were not given +specific instructions about the breath rate as such instruc- +tions are not a part of the traditional descriptions of the +yoga techniques studied here. The disadvantage of this is +that the increase in the LF power of the HRV during +alternate nostril yoga breathing could have been related to +the slower breath rate. This does not permit an interpreta- +tion of the changes in the heart rate variability as being due +to shifts in autonomic balance. This is related to a link +between respiration and heart rate variability. It was shown +that biofeedback training to increase the amplitude of +respiratory sinus arrhythmia maximally, increases the +amplitude of heart rate oscillations only at approximately +0.1 Hz. (Lehrer et al. 2000). To achieve this, breathing is +slowed to a point at which resonance occurs between +respiratory induced oscillations and oscillations that natu- +rally occur at this rate. Also, in another study it has been +shown that any changes in breathing frequency that almost +coincide with spontaneous Mayers wave frequency (6 +breath per mintue) such as regulated slow breathing or +chanting Ave Maria or yoga mantra enhances heart rate +variablity and baroreflex sensitivity by synchronising +inherent cardiovascular rhythms (Bernardi et al. 2001). +This may explain the changes in increase in heart rate and +heart rate variablity components which occurred during the +practice of RNYB, LNYB or ANYB practice when the rate +of breathing was slower. +The very low frequency power (VLF) did not change +significantly during or after the breathing techniques, or in +the control session. The VLF accounts for more than 90% +of the total power in the 24 h heart rate power spectrum, +however the physiological mechanisms underlying the +VLF power have not been determined. The VLF power +partially reflects thermoregulatory mechanisms, fluctuation +in activity of the renin–angiotensin system, and the func- +tion of peripheral chemoreceptors (Malliani et al. 1991; +Parati et al. 1995). Also both the respiratory pattern and +level of physical activity modulate VLF power. Hence +there are several possible physiological mechanisms for the +VLF power which is the reason why the VLF power values +have not been detailed in the present study. +The changes in the normal breathing session were a +decrease +in +finger +plethysmogram +amplitude +and +a +decrease in blood pressure, which are contrary to each +other. In this session, the participants were asked to sit at +ease without specific instructions about breathing. These +changes could be related to the fact that the participants +might have felt a sense of monotony and boredom. It has +been shown that such a state influences changes in +autonomic indices resulting in increased sympathetic +activity (Ohsuga et al. 2001). However, it is difficult to +explain the reduction in the diastolic blood pressure and +mean pressure while there was a simultaneous reduction +in the finger plethysmogram amplitude indicative of +peripheral vasoconstriction. +The effects of uninostril breathing have been described +in ancient Indian yoga texts, where the flow of air through +the nostrils is in the form of energy and is called swara +(=sound in Sanskrit) (Swami Muktibodhananda 1999). +Hence, Swara Yoga explains how the flow of subtle energy +through the nostril changes at regular intervals and also +describes its’ importance. When the breath flows through +the left nostril (lunar swara), it is said that the energy is +flowing through the left subtle energy channel (ida nadi), +while when breathing through the right nostril (solar +swara), it flows through the subtle energy channel on the +right (pingala nadi), and when breathing through both +nostrils, it flows through the middle channel (sushumna). +These subtle energy channels (nadis) are not anatomically +distinct entities but were described based on experiential +observations of the ancient sages. Energy flow through ida +is supposed to be ‘heat dissipating (cooling)’ whereas +energy flow through pingala is ‘heat generating’. Swara +Yoga specifically mentions that when the breath flows +through ida, one should carry out ‘passive activities’, such +as rendering service and performing religious rites (Shiva +Swarodaya, V: 102–113). When the breath flows through +pingala, one should perform ‘energetic’ activities, such as +studying scriptures, hunting and controlling an elephant, +horse or chariot (Shiva Swarodaya, V: 114–123). When the +breath flows through both nostrils (sushumna), it has been +mentioned to avoid activity and remain relaxed (Shiva +Swarodaya, V: 128) (Raghuraj and Telles 2003). +Appl Psychophysiol Biofeedback +123 +The way in which unilateral breathing influences the +central nervous system and other systems has not been +conclusively proven. It seems possible that mechanical +receptors in the nasal mucosa are activated with airflow +into the nostril, and this signal is unilaterally transmitted to +the hypothalamus (Shannahoff-Khalsa 1991). The hypo- +thalamus is considered the highest center for autonomic +regulation. A similar mechanism may explain the effects +seen here. +The present study suggests that breathing through the +right, left or through both nostrils alternately produces +distinct autonomic changes. However there are certain +methodological limitations to the study which do not allow +definite inferences to be made. One of the main drawbacks +is the method of randomization. Participants were ran- +domly assigned to five possible sequences, with the five +sessions on separate days. At the time the fixed sequences +were planned so as to follow the order in which the yoga +breathing techniques (i.e., right nostril yoga breathing, left +nostril yoga breathing, alternate nostril yoga breathing, or +breath awareness) are taught during a typical yoga session. +Due to these fixed-session sequences there is an inherent +confounding bias in the results so that changes which occur +in a preceding session could possibly have carryover +effects to the session which follows it. +Other limitations of the study are related to the practice +of yoga breathing techniques. Since all participants were +right hand dominant they all used their right hand to +manipulate the nostrils. For this reason, recordings of skin +conductance and finger plethysmogram amplitude were +from the left hand. There is a possibility that there may be +differences between the two hands in levels of skin resis- +tance and blood volume pulse. Kennedy et al. (1986) +showed widely differing sympathetic tonus between the +two sides of the body. Autecubital venous blood was +sampled in both arms simultaneously every 7.5 min for +periods of 3 to 6 h and assayed for epinephrine, nonepi- +nephrine and dopamine levels. Fluctuations in the nasal +cycle were shown to correlate significantly with the alter- +nating levels of nor-epinephrine. +Also, it could be expected that using the right hand to +do all the manipulations may have contributed to the +changes observed during the three yoga breathing tech- +niques. There was no attempt to control for this. Also, +since the participants had received theory and practical +instruction about the effects of the pranayama practices, +they may have been aware about what effects to expect +by practicing the yoga techniques, even though they were +not told the hypothesis of the study. It is possible that by +knowing the effects they were able to induce them +inadvertently, since experience in yoga has been shown to +facilitate control over functions earlier considered to be +involuntary. Further studies controlling for these factors +would be worthwhile given the possible therapeutic +applications of these practices. +Clinical studies have been conducted to understand the +efficacy of unilateral nostril breathing. In 1948, Friedell +reported the first clinical trial using alternative nostril +breathing for symptoms of angina pectoris on 11 patients. It +was shown that ‘diaphragmatic breathing with attention to +both phases of respiration and the intervening pauses’ cou- +pled with ‘alternately closing one nostril while inhaling +slowly through the other’ had profound effects on relieving +symptoms of angina pectoris and eventually the patients +were able to curtail the use of nitroglycerin. It was speculated +that alternate nostril breathing directly affects the lateralized +sympathetic and vagal input to the heart, hence inducing a +balance in autonomic nervous system activity. More +recently, a study was conducted to evaluate the comparative +effects of yogic and conventional treatment in diarrhea- +predominant irritable bowel syndrome (IBS) in a random- +ized control design(Taneja et al. 2004). 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London: Prentice-Hall. +Appl Psychophysiol Biofeedback +123 diff --git a/subfolder_0/Immediate effects of cyclic meditation on state mindfulness in normal healthy volunteers.txt b/subfolder_0/Immediate effects of cyclic meditation on state mindfulness in normal healthy volunteers.txt new file mode 100644 index 0000000000000000000000000000000000000000..b4165c8760d118446e41f60e5a8f0e58ae954a7f --- /dev/null +++ b/subfolder_0/Immediate effects of cyclic meditation on state mindfulness in normal healthy volunteers.txt @@ -0,0 +1,372 @@ +See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/273439006 +Immediate effects of Cyclic Meditation on State +mindfulness in Normal Healthy volunteers: A +controlled study +Article · January 2014 +READS +189 +4 authors, including: +Suhas Vinchurkar +Electrical Geodesics Incorporated +10 PUBLICATIONS 11 CITATIONS +SEE PROFILE +Deepeshwar Singh +SVYASA Yoga University +14 PUBLICATIONS 17 CITATIONS +SEE PROFILE +Available from: Deepeshwar Singh +Retrieved on: 27 July 2016 +Meditation is known to influence higher mental functions by inducing a state of low physiological arousal and +alertful rest. Improvements in cognitive functions following meditation are being expressed as a result of enhanced +mindfulness in meditators. We evaluated the immediate impact of meditation practice on state mindfulness using a +short Mindfulness Attention Awareness Scale (MAAS). Ninety participants with ages ranging from 21-34 years +(group mean age ± SD; 24.2 ± 7.2 years) were randomly assigned to a meditation group (n=44) and a control group +(n=46). MAAS was administered anonymously in a classroom setup and two of the project coordinators were +present to supervise the administration and to assist the participants where necessary. We executeda matched +controlled design with assessment performed before and after the practice of meditation. Participants had no prior +experience of meditation practice. Data were analyzed using IBM SPSS 20. The data were checked for normality. +Paired samples t-test was applied for pre-post comparisons for both the groups. State MAAS scores were +significantly higher following the practice of meditation as compared to control group. A single session ofCyclic +Meditation calms the mind and helps to develop a better level of mindfulness. This signifies the individuals +heightened attention on body, breath andmind, whichis known to further enhance the higher mental functions. +Keywords: state mindfulness, meditation, yoga, cyclic meditation, attention +Visweswaraiah, 2014). +Meditation is a profound inward attention as practiced in many +traditions. Meditation techniques such as mindfulness meditation or +One of the various forms of mindfulness is the practice of a unique +transcendental meditation include specific postures, focused +technique called Cyclic Mediation (CM). CM is a moving +attention, or an open attitude toward distractions defined by National +meditation practice derived from an ancient Indian text, Mandukya +Center for Complementary and Alternative Medicine (NCCAM), +Upanishad (Nagendra & Nagrathana, 1997).It was fundamentally +USA. Regular practice enhances calmness and relaxation, improve +designed for novice practitioners and combines the practice of yoga +psychological balance, cope with illness, or enhance overall health +postures with guided meditation. CM is known to induce a quiet +and well-being (NCCAM, 2010). +state of mind, which is compatible with the description of meditation +(dhyana or effortless expansion), according to Sage Patanjali +Mindfulness meditation involves paying heightened awareness to +(Subramanya & Telles, 2009a). Although this moving meditation +the present-moment and non-judgmentally focusing on all that we +differs from the classic description of meditation, in which the +possess to a greater or lesser extent. It is an intrinsic state that all +practitioners remain seated, keeping as still as possible, the mental +humans can cultivate through a long-term practice of meditation, +state in both practices (moving meditation and seated practices) is +which enhances mindfulness skills and in turn these skills promote +supposed to be comparable(Subramanya & Telles, 2009b). An +psychological well-being (Soler et al., 2014). There are two- +essential part of the practice of CM is being aware of sensations +component models of mindfulness, i.e., sustained attention in the +arising in the body (Nagendra & Nagrathana, 1997) which +present moment and the open, curious, and accepting attitude(Lutz, +emphasize the mindful component. +Slagter, Dunne, & Davidson, 2008). Recently, mindfulness has been +Several studies have demonstrated the beneficial effects of Cyclic +proposed to remediate a range of clinical problems (e.g., depression, +anxiety, stress) and to impact core aspects of social cognition (e.g., +Meditation on behavioral and cognitive domains. In a previous +metacognition, self-referential thought, cognitive behavior, rather +study conducted on middle managers, CM program decreased +than physiological, paradigm for meditation. Following the guided +occupational stress levels and baseline autonomic arousal in 26 +asymptomatic, male, middle managers (Vempati & Telles, 2000). +meditation like focusing on sensation in the body, sound, thoughts +Studies conducted to determine the effects of CM practice reported a +and emotions (longer formal practices) or shorter formal practices +decreased oxygen consumption indicating physiological relaxation +(MBCT, Vipassana) and informal meditation practices (Cyclic +as in mindfulness (Sarang & Telles, 2006). Few other studies on +Meditation, Transcendental Meditation or mindfulness in daily life +immediate effects of CM concluded that it improves attention, +activities), or both, there are definitive changes in higher mental +cognition, enhances slow wave sleep and reduces anxiety (Patra & +functions of such practitioners (Crane et al., 2014). These practices +Telles, 2009; Sarang & Telles, 2006, 2007; Subramanya & Telles, +certainly effect the mindfulness of individuals whether practiced +2009b).Mindful yoga practices (like CM) may generate the state of +long term or even a single session(Vinchurkar, Singh, & +mindfulness, which, when evoked recurrently through repeated +practice, may accrue into trait or dispositional mindfulness +(Chambers, Gullone, & Allen, 2009; Garland et al., 2010).A recent +study on the effective practice of mindfulness to explore the +relationship of meditation on mindfulness skills and psychological +health demonstrated a significant improvement in both the variables +Immediate effects of cyclic meditation on state mindfulness +in normal healthy volunteers: A controlled study +Correspondence should be sent to Suhas Ashok Vinchurkar +B.N.Y.S., PhD Scholar, ANVESANA Research Laboratories +Department of Yoga and Life Sciences, Swami Vivekananda +Yoga Research Foundation, Bangalore +Indian Journal of Positive Psychology +2014, 5(4), 400-403 +http://www.iahrw.com/index.php/home/journal_detail/19#list +© 2014 Indian Association of Health, Research and Welfare +ISSN-p-2229-4937e-2321-368X +Suhas Ashok Vinchurkar, Singh Deepeshwar, Naveen Kalkuni Visweswaraiah and H. R. Nagendra +ANVESANA Research Laboratories, Department of Yoga and Life Sciences, Swami Vivekananda Yoga Research Foundation +(Deepeshwar, Suhas, Naveen, & Nagendra, 2014). A previous study +Assessments +on long term CM practitioners showed that meditators had higher +We assessed state mindfulness using the popular short Mindfulness +levels of mindfulness and positively correlated to the experience of +Attention Awareness scale. The state MAAS is a 5-item scale +practice and level of mindfulness (Vinchurkar et al., 2014). +designed to assess the short-term or current expression of a core +With this background, we aimed at finding if a single session of +characteristic of mindfulness, namely, a receptive state of mind in +CM practice would influence mindfulness in novice practitioners. +which attention, informed by a sensitive awareness of what is +Therefore, the current study was designed to evaluate the immediate +occurring in the present, simply observes what is taking place. This +effect of CM practice on state mindfulness as assessed by a +is in contrast to the conceptually driven mode of processing, in +Mindfulness Attention Awareness Scale (MAAS) state version. +which events and experiences are filtered through cognitive +appraisals, evaluations, memories, beliefs, and other forms of +Method +cognitive manipulation. The state MAAS draws items drawn from +We identified a congruent group of 100 healthy volunteers from a +the trait form of the MAAS (e.g., “I'm finding it difficult to stay +University school who had no prior experience of yoga or meditation +focused on what's happening in the present”). Though not as +practice. A routine clinical examination was carried out to rule out +frequently used as the trait MAAS, the state MAAS has shown +any disorder, which could limit their practice of CM or also the +excellent psychometric properties (e.g., Cronbach's alpha = .92; +ability to comprehend the MAAS state test. The participants' ages +Brown & Ryan, 2003). Trait MAAS scores have been shown to +ranged from 21-34 years (group mean age ± SD; 24.2 ± 7.2 years) and +predict state MAAS scores, and state scores have been related to +were randomly assigned to a meditation group (n=44; 21.6 ± 5.1 +psychological well- being outcomes (Brown & Ryan, 2003), both of +years) and a control group (n=46; 23± 4.6 years). This was a group of +these findings providing evidence for the construct validity of the +students belonging to the same class and therefore were matched for +state measure. Trait and state MAAS scores have been shown to +age, education and routines. None of the participants had exposure to +have independent effects on well-being outcomes, suggesting that +any meditation practice and were unaware of the aims of the study. +the state measure has incremental validity in relation to the trait +Subjects with cognitive deficits ruled out by routine clinical +scale. +examination were excluded from the study. The effect size for control +The MAAS has been validated in various samples of students (α = +group was r= 0.09 whereas for meditation group r= 0.52. The +.82) and adults from the general community (α = .87)(Brown & +Institutional ethics committee approved this study and a signed +Ryan, 2003). +informed consent was obtained from all the subjects following +Data extraction +explanation of the study. +The questionnaire was administered in a classroom setup (for +The questionnaire was scored by computing a mean of the 5 items in +approximately 15 minutes) and two of the project coordinators were +the questionnaire. The data was tabulated for each subject to be +present to supervise the administration and to assist the participants +subjected for analysis. +where necessary. The questionnaire was administered to 100 +Data analysis +participants. All the participants filled out the questionnaire, but for +Data were analyzed using IBM SPSS 20.The data was checked for +whom more than 20% of the items were missing or whose reports +normality and then a Paired samples t-testswas performed to +were considered unreliable (i.e., consistently rated the highest or the +investigate statistically significant difference in state MAAS scores +lowest scores on all items), were excluded from the analyses (n = 10, +of meditation group (before and after CM), and control group +6 in meditation group and 4 in the control group; 10%). +(before and after SR). +Research design +For all the analysis, we present 95% confidence intervals and +We executed a matched controlled design comprising two groups +considered p < 0.05 as significant. +pre-post assessments using the short Mindfulness Attention +Results +Awareness Scale (MAAS) before and after cyclic mediation(CM) for +the meditation group and similarly, before and after equal duration of +State MAAS scores were significantly higher in the meditation +supine rest (SR) in the Control group. A schematic presentation of the +group following the practice of cyclic meditation(Pairedsamples t- +design is presented in Figure 1. +test, t = -4,05, p < 0.01). The control group (Supine Rest) showed no +significant changes following the practice of Supine Rest (Paired +samples t-test, t = -0,66, p =0.57). +Group mean values ± S. D. and paired sample t-testare given in Table 1. +Table 1: Means and standard deviations, Paired Samples t-test, and +paired sample correlations (between Pre and Post) for MAAS scores +for meditator and control groups +Groups +Pre +Post +t-value +P-value +Cohen's d +Meditators +3.31 ± 0.88 +4.20 ± 0.85** +-4.05 +0.01 +-1.22 +(n=44) +Control +3.23 ± 0.92 +3.58 ± 0.80 +-0.66 +0.57 +-0.19 +(n-46) +*p< 0.05, **p < 0.01, paired samples t-test +meditation, which is known to be associated with attention, +Discussion +concentration, and emotion regulation. +In the present study, we investigated whether immediate effect of +Collectively, these findings suggest that a single session of cyclic +cyclic meditation or supine restis associated with any change in the +meditation practice can lead to the development of higher levels of +state mindfulness of novice practitioners. We found that the +state mindfulness while improving overall psychological wellbeing +meditation group demonstrated higher levels of state mindfulness +in healthy individuals. Mindfulness attention is associated with +against those practicing supine rest in a single session of practice. +motivational and attitudinal components which explore the impact +The findings of the present study showed higher scores in the +that this form of awareness has on psychological wellbeing. Further +meditation group on the single factor of mindfulness, which is known +studies are warranted in all age groups and conditions to ascertain +to be associated with lower mood disturbance and stress (Brown & +this immediate effect of Cyclic Meditation. +Ryan, 2003). The practice of cyclic meditation comprises physical +postures (asanas), breath work, physical and mental awareness +Acknowledgment +together leading to a state of meditation(Nagendra & Nagrathana, +The grant from Department of Science and Technology under the +1997). Earlier studies looking at the immediate effect of cyclic +Cognitive Science Research Initiative (DST-CSI) is greatly +meditation have shown improved performance in all age groups on +acknowledged [Project No. SR/CSI/22/2009]. +tasks like Six Letter Cancellation Test, which are known to assess +selective attention and visual scanning abilities (Pradhan & +References +Nagendra, 2010; Sarang & Telles, 2007). Similar study assessing the +immediate effect of CM, assessed individuals for their memory, state +anxiety, attention and concentration using a Wechsler memory scale, +Spielberg's State Anxiety Inventory and a Digit Span test +respectibely. The results indicated heightened memory scores, +attention, concentration and a significant reduction in state anxiety of +the individuals following CM session(Subramanya & Telles, +2009).The results of our study are in conformity of these earlier +findings. Increased state mindfulness is indicative of better +performance in attentional and memory tasks as demonstrated +earlier. +Several other meditation studies highlight their effects on trait +mindfulness and must be studied for their state effects too. A study on +highly experienced Zen meditators reported parallel trends where +levels of mindfulness were found to have strong positive correlation +to the years of meditation experience(Brown & Ryan, 2003). Eight +weeks of MBSR, showed improved levels of mindfulness and +lowered mood disturbances and symptoms of stress with cancer +patients (Garland, Tamagawa, Todd, Speca, & Carlson, 2013). +Another study showed similar trends that meditation improves the +levels of mindfulness regardless of the meditation +technique(Schoormans & Nyklíček, 2011). The correlation of the +MAAS with various well-being measures reported that mindfulness +meditation is associated with greater wellbeing and moreover +MAAS was related to lower neuroticism, anxiety, depression, +unpleasant affect, and negative affectivity. On the contrary, the +MAAS was associated with higher pleasant affect, positive +affectivity, vitality, life satisfaction, self-esteem, optimism, and self- +actualization (Brown & Ryan, 2003). +The underlying mechanisms of development of state mindfulness +still remain unknown. 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Psychometric proprieties of Spanish version of mindful attention awareness diff --git a/subfolder_0/Impact of yoga on psychopathologies and quality of life in persons with HIV a randomized controlled study.txt b/subfolder_0/Impact of yoga on psychopathologies and quality of life in persons with HIV a randomized controlled study.txt new file mode 100644 index 0000000000000000000000000000000000000000..7f3820986e1dbeb48ef66b1c65875046e502d568 --- /dev/null +++ b/subfolder_0/Impact of yoga on psychopathologies and quality of life in persons with HIV a randomized controlled study.txt @@ -0,0 +1,1168 @@ +See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/328557453 +Impact of yoga on psychopathologies and QoLin persons with HIV: A +randomized controlled study +Article  in  Journal of Bodywork and Movement Therapies · October 2018 +DOI: 10.1016/j.jbmt.2018.10.005 +CITATIONS +4 +READS +127 +3 authors, including: +Some of the authors of this publication are also working on these related projects: +Yoga for Mental Health among patients with HTN View project +Yoga for Addiction View project +Kashinath Metri +Central University of Rajasthan +48 PUBLICATIONS   168 CITATIONS    +SEE PROFILE +All content following this page was uploaded by Kashinath Metri on 31 October 2018. +The user has requested enhancement of the downloaded file. +Accepted Manuscript +Impact of yoga on psychopathologies and QoLin persons with HIV: A randomized +controlled study +Asha Kiloor, Sonykumari, Kashinath Metri +PII: +S1360-8592(18)30446-7 +DOI: +https://doi.org/10.1016/j.jbmt.2018.10.005 +Reference: +YJBMT 1733 +To appear in: +Journal of Bodywork & Movement Therapies +Received Date: 22 June 2017 +Revised Date: +12 March 2018 +Accepted Date: 28 July 2018 +Please cite this article as: Kiloor, A., Sonykumari, Metri, K., Impact of yoga on psychopathologies and +QoLin persons with HIV: A randomized controlled study, Journal of Bodywork & Movement Therapies, +https://doi.org/10.1016/j.jbmt.2018.10.005. +This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to +our customers we are providing this early version of the manuscript. The manuscript will undergo +copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please +note that during the production process errors may be discovered which could affect the content, and all +legal disclaimers that apply to the journal pertain. +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +1 + +Title: Impact of yoga on psychopathologies and QoLin +persons with HIV: A randomized controlled study + +Authors: +Asha Kiloor1, Msc (Yoga) +Yoga Therapist, SVYASA University, Bengaluru +Dr Sonykumari1, PhD +Associate Professor, SVYASA University, Bengaluru +*Dr Kashinath Metri1, MD, PhD +Assistant Professor, SVYASA University, Bengaluru + +*Corresponding author: Dr Kashinath G Metri +Email: kgmhetre@gmail.com + + Mobile: +01 9035257626 +1Affiliation: Division of Yoga and Life Sciences, Sami Vivekananda Yoga +Anusandhana Samsthan (SVYASA – A deemed to be a University), # 1 Eknath +Bhavan Gavipuram Circle K G Nagar, Bengaluru-560019, India. + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +2 + +ABSTRACT +Background: Evidence suggests that individuals with human immunodeficiency +virus (HIV) positive, often exhibit poor physical and mental health, which +contributes to a reduced Quality of Life (QoL). Yoga is a form of alternative +therapy that has positive influences on general health and QoL. +Objectives: This study examined the effects of yoga on i) anxiety, depression +and psychological well-being, and ii) Quality of Life (QoL), among individual +with HIV positive. +Methodology: Sixty individuals with HIV-positive (aged30–50 years) from +rehabilitation centres across Bangalore were randomly assigned to the yoga +intervention group (n=30; 11 men) or the wait-listed control group (n=30; 10 +men). Participants in the yoga group underwent 8 weeks of intense yoga +practice, performed an hour a day, for 5 days a week. The yoga practice +consisted of physical postures, breathing practices, relaxation techniques, and +meditation. Participants in the wait-listed control group followed their normal +routine. Anxiety, fatigue, depression, and QoL were assessed twice for all +subjects in each group – once at the start of the study to establish a baseline +and once more at the end of the2month study period to assess any changes. +Data analysis was performed on the assessments using SPSS software version 10. +Results: In the yoga group, a significant reduction in anxiety (p<0.001), +depression (p<0.001), and fatigue (p<0.001) was observed, associated with +significant improvements in well-being (p<0.001) and all domains of QoL +(p<0.001). However, in the control group, an increase in anxiety, fatigue, and +depression was observed, associated with a significant decrease in well-being +and QoL. +Conclusion: This study clearly indicates that yoga intervention improves the +psychological health and QoL of individuals with HIV-positive. Therefore, based +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +3 + +on these findings, yoga is strongly recommended as a complementary therapy +to enhance conventional HIV care. +Keywords: HIV, Yoga, Fatigue, Anxiety, Depression, Quality of Life. + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +4 + +INTRODUCTION +Approximately, +40 +million +people +worldwide +are +living +with +human +immunodeficiency virus (HIV) infection (Alter et al 2006). Country-wise, India +records the second-highest number of HIV-infected persons, approximately 3–4 +million (Go et al 2004). HIV is an infectious disease that affects an individual’s +immunity, thus increasing vulnerability to various opportunistic infections. +Pharmacological treatments such as Anti-Retroviral Therapy (ART) are presently +used to increase life expectancy and control HIV progression. But, the ART +intervention is frequently associated with various side effects (Antoni et al 2002; +Hartmann et al 2006). +However, despite ART intervention, several psychological issues associated with +HIV, continue to persist among persons with HIV-positive (Green & Smith 2004; +Rodger et al 2013; Rosenfield et al 1996). +Additionally, individuals with HIV-positive experience social stigmas, feelings of +guilt, uncertainty about the future, feelings of isolation, lack of social +reinforcement, and worry about frequent infections, thus making them prone to +chronic psychological problems such as anxiety disorder and depression (Bogart +LM et al 2000; Vogl et al 1999). Several cross-sectional studies have +demonstrated a high prevalence of anxiety disorder and depression among +individuals HIV-positive, with the risk of depression being four times more as +compared to normal individual. The prevalence rate of depression among HIV- +infected individuals ranges from 5% to 45%, and the prevalence rate of anxiety +disorder is up to 38% (Bogart LM et al 2000; Elliott A et al 1998). Also, individuals +with HIV positive have depression have higher suicidal tendency than non-HIV +depressed individuals (Chandra P et al 1998; Cluver et al 2007; Penzak et al +2000). +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +5 + +Further studies have shown that the presence of depression in HIV-infected +individuals is associated with a decreased CD4 cell count, an increased viral +load, and reduced compliance with ART (Yun LW et al 2005). +Apart from frequent infections, weight loss and fatigue are observed +prominently among individuals with HIV-positive. Such symptoms affect daily +work and lead to more disability and dependency in the persons with HIV +(Cleary PD et al 1993; Low et al 2011; Ferrando et al 1998; Breitbart et al 1998). +Collectively, these issues such as anxiety, depression, poor immunity, and HIV- +associated +symptoms +lead +to +reduced +psychological +well-being +and +significantly affect quality of life (QoL) among individuals with HIV-positive +people (Adewuya et al 2008; AminiLari et al 2013; Aranda et al 2004). +Non-drug interventions such as yoga, meditation, tai chi, or Cognitive +Behavioural Therapy (CBT) have been found to be effective in improving several +physical and psychological symptoms associated with chronic health +conditions, including HIV (Antoni et al 2002; Naoroibam et al 2016; Bhargav et al +2016; Ferrando et al 2004; Taylor et al 1995). +Yoga +Yoga is a form of mind–body intervention consisting of physical practices, +breathing techniques, and meditation. The science of Yoga is considered to be +approximately more than 5000 years old (Keley et al 2010). Spiritually, the +practise of yoga aims to achieve the highest goal of life called Moksha, which +refers to liberation (Siddiqui et al 2016). Scientific investigations have noted the +many physiological and psychological benefits of yoga practice in both clinical +and nonclinical populations (Yang et al 2007; Raju et al 1986). +The practise of yoga has disease preventive effects and beneficial effects on +wellness. Scientific evidences have confirmed the various wellness benefits of +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +6 + +yoga for various health conditions, such as diabetes mellitus (Hemmer et al 2008; +Mahapure et al 2008), cardiovascular disease (Ashish et al 2015), neurological +disorders (Sharma, 2015), gastrointestinal disorders (Kaswal et al 2013; ), and +many psychological troubles. A significant portion of yoga research has focused +on studying its impact on psychological health and well-being. Yoga and +meditation intervention studies show reduction in anger (Bhushan & Sinha 2001), +anxiety (Eppley et al 1989), and depression (Krishnamurthy & Telles 2007; Woolery +et al 2004), as well as increase in well-being (Netz & Lidor 2003). The potential of +yoga to increase psychological well-being, including improved energy, and +overall QoL has been demonstrated in older adults (Oken B et al 2006).Yoga +practice reduces depression symptoms in pregnant woman (Mitchell, +2012).Yoga can be considered an ancillary treatment option for people with +depressive disorders and individuals with elevated levels of depression (Cramer +& Langhorst 2013).Yoga practice results in a significant decrease in anxiety levels +and a positive change in subjective well-being among students (Jadhav & +Havalappanavar 2009).Yoga practice reduces anxiety and blood pressure and +improves +QoL +more +significantly +than +physical +exercise +(Marefat +& +Peymanzad2011). +Hence, the present study intended to assess the impact of a 2-month integrated +yoga intervention on psychological health, QoL, and well-being among HIV- +infected persons, when compared with a matched wait-list control group. +Methods and materials +Participants +HIV-infected people aged 30–50 years on ART were recruited in this +study.We considered the participants within this age range because, after the +age of 50, people with HIV usually experience severe weight loss, and co- +morbid conditions such as tuberculosis, hepatitis B, fatigue syndrome etc. +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +7 + +rendering them unable to perform yoga. Also, the lower age limit is chosen as +30, as any HIV person below 30 years of age is usually in less advanced stages of +disease. +We approached two HIV rehabilitation centres located in Bengaluru city, India. +A total of 88 participants was approached for participation, and they were +screened for eligibility criteria. +Among 88 participants, 63 were found to be eligible for the study. Of 63 +potential participants, 2 declined to participate in the study. Finally, we selected +60 potential participants for the study. For the equal distribution of subjects +across both groups, we did not consider the data of one subject from yoga +group, although he received IY (See Flow Chant 1). None of the participants +had CD4 count<300 indicating AIDS. +Randomization +Participants’ names were fixed up in alphabetical order and then listed in serial +order from 1 to 60. Using a computer-based random number generator, two +groups were formed. The groups were named 'A' and 'B'. Group A was selected +as intervention group and B as a wait-list group using tossing method. + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +8 + + + +Flow Chart 1 + +Figure 1: Participant recruitment + + + + +Eligible +subjects = 63 +Subjects screened = 88 + 60 subjects +Drop outs=2 Due +personal reasons +Control group = 30 subjects +Pre assessment n=30 +Post assessment n=30 +2 Months yoga + ART +Post assessment n=30 + ART only +Yoga group = 30 subjects +Pre assessment n=30 +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +9 + + + + +Inclusion criteria +• HIV-positive and within the age range of30–50 years +• Willing to participate in the study +• Participants of Both genders +Exclusion criteria +• Prior exposure to yoga +• Physical handicap or Severe disability +• Recent surgery +• Acute respiratory infections +• History of psychiatric illness or usage of antipsychotic medication +• Drug addiction +Ethical consideration +Participants were informed about the study protocol in their respective mother +tongue, +and +written +informed +consent +was +obtained +before +the +commencement of the study. +This study was approved by an Institutional Review Board (IRB) of Directorate of +Distance Education, SVYASA University, Bengaluru, India. +Intervention +All subjects in the yoga group performed2 months of yoga practice consisting of +loosening practices, Suryanamaskara, breathing practices, Asanas, Pranayama, +meditation, and relaxation techniques (See Table:1), which were performed +daily for 1hour, 5 days a week. The subjects in the control group followed their +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +10 + +normal routine activity. Regular attendance was monitored by maintaining an +attendance register and subjects who attended <70% of the sessions were +excluded from analysis. A total of 95% of the subjects attended all sessions, none +of the subjects had attendance less than 70%. +The yoga module used in the study by Rosy et al (2015) was applied in this study. +(Please add Table 1 Here) +Table 1: List of practices performed by the yoga group +Sl.No. +Name of Practices +Number of rounds +Duration + +Starting Prayer +2 min +Shithilikarana practices +1 +Forward and backward bending +5 rounds +2 min +2 +Twisting +5 rounds +2 min +3 +Side bending +5 rounds +2 min +Suryanamaskara +6 rounds +8 min +Quick Relaxation Technique +3 min +Breathing Practices +1 +Hands in and out breathing +5 rounds +2 min +2 +Ankle stretch breathing +5 rounds +2 min +3 +Bhujangasanabreathing +5 rounds +2 min +4 +Straight leg- raise breathing +5 rounds +2 min +Asanas +1 +Ardhakatichakrasana +1 round +2min +2 +Ushtrasana +1 round +1 min +3 +Paschimothanasana +1 round +1 min +4 +Bhujangasana +1 round +1 min +5 +Shalabhasana +1 round +1 min +6 +Setubandasana +1 round +1min +7 +Vipareetakarani +1 round +2 min +Quick Relaxation Technique +3 min +Pranayama +1 +Kapalabhati +60–80 rounds/min +2 min +2 +Sectional Breathing +5 rounds +5 min +3 +Nadishudhi +10 rounds +5 min +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +11 + +4 +Seetkari/Seetali/Sadanta +5 rounds +2 min +5 +Bhramari +10 rounds +5 min +Meditation +1 +Nadanusandhana +9 ×4 +5 min +Deep Relaxation Technique +10 min +Closing Prayer +2 min + +Assessments and tools +Primary outcome measures +WHO Quality of Life- HIV Brief (WHOQOL-HIV BREF) +Both groups were administered WHOQOL-HIV BREF before and after 2 months of +(Hsiung PC et al 2011). +The WHOQOL-HIV BREF is considered to be a valid &a reliable tool to assess +different domains of QoL among HIV infected persons. It comprises of 31 items, +each using a 5-point Likert scale ( 5 most 1 least?). The 31 items are distributed +across six domains. The six domains of QoL are as follows: physical health, +psychological health, level of independence, social relationships, environment, +and spirituality/religion/personal beliefs. The physical health domain measures +pain and discomfort, energy and fatigue, and sleep and rest. The psychological +health domain measures positive feelings, thinking, learning, memory and +concentration, self-esteem, body image and appearance, and negative +feelings. The level of independence domain measures mobility, daily life +activities, dependence on medications or treatments, and work capacity. The +social relationships domain includes personal relationships, social support, and +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +12 + +sexual activity. The environment domain measures physical safety and security, +home environment, financial resources, health and social care, accessibility and +quality, opportunities for acquiring new information and skills, participation in +and opportunities for recreation and leisure activities, and physical environment +(pollution, noise, traffic, climate, and transport) (Fatiregun, 2009). +Secondary outcome measures +Hospital Anxiety and Depression Scale +Anxiety and depression were assessed using the Hospital Anxiety and Depression +Scale. +The Hospital Anxiety and Depression Scale (HADS) is a valid tool to assess +symptom severity and anxiety disorders and depression in both individuals under +somatic, psychiatric, and primary care as well as those in the general +population. The scale contains a total of 14 items, of which 7 items assess +subjective anxiety and 7 assess depressions. (Zigmond AS; Snaith et al RP 1983) +Fatigue +For both groups, subjective fatigue was assessed using the Fatigue Severity Scale +(FSS) before and after 2 months. +Fatigue Severity Scale +The FSS is a valid tool to assess subjective fatigue. For both groups, the FSS was +administered before and after 2 months. The FSS is a method of evaluating the +impact of fatigue (Valko P et al 2008). + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +13 + +WHO (Five) Well-Being Index (1998 version) +Both groups were administered WHO (Five) Well-Being Index (1998 version) +before and after 2 months of the yoga intervention (Huen & Bonsiqnore M 2001). +It is a valid &reliable tool to assess the subjective well-being of individual +(Saipanish, 2009; Heun et al 2001). +Data analysis +Data analysis was performed using SPSS version 10 (IBM, Chicago, USA). +Data was subjected tothe Shapiro–Wilk test normality test and all variables were +found to be normally distributed. Descriptive statistics were presented as mean +and standard deviation. Paired sample t test and the independent sample t test +were used to compare the characteristics within-group and between-group, +respectively. +P value (significance) more than 0.05 was considered to depict a statistically +significant change. +Results +Demographic characteristics of participants did not differ between the two +groups; hence, the groups were comparable at baseline (Table 2). +Table 2: Comparison of demographics between the groups at baseline +Variable +Yoga group, +(n=30; 10 men; 20 +women) +[Mean±SD] +Control group, +(n=30; 11 men; 19 +women) +[Mean±SD] +p value +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +14 + +Age (years) +41.90±7.02 +42.1±7.32 +0.13 +History of HIV infection +(years) +6.82±1.83 +6.65±1.36 +0.15 +Fatigue +47.87±4.47 +48.42±1.18 +0.51 +Psychological well- +being +11.26±3.52 +9.87±1.54 +0.51 +Anxiety +11.29±2.15 +11.45±2.17 +0.71 +Depression +9.16±2.15 +9.19±2.04 +0.92 +Physical QoL +10.71±1.16 +10.77±1.15 +0.81 +Psychological QoL +10.27±0.85 +10.01±1.01 +0.50 +Overall QoL &General +health +12.39 ± 1.41 +12.32 ± 1.17 +0.81 +Social relations +9.58 ± 0.81 +9.48 ± 0.63 +0.60 +Environmental +11.58 ± 0.98 +11.47 ± 0.89 +0.84 +Spirituality +11.68 ± 1.25 +11.26 ± 1.12 +0.17 + +The yoga group consisted of 30 participants (11 men and 19 women), and the +wait-listed control group consisted of 30 participants (10 men and 20 women). +The intervention was found to be feasible, which is evidenced by a regular +attendance rate ofmore than 90%. +Shapiro-Wilk Test: Data was subjected to Shapiro-Wilk test and all the variables +found to be normally distributed with p value more than 0.05. Hence we used +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +15 + +the paired sample t-test to assess the changes within each group before and +after 2 months and the independent sample t-test were used to compare the +differences between the groups. + +Yoga group (Table 3) +In the yoga group, we noted significant improvement in depression (p <0.001), +anxiety (p <0.001), psychological well-being (p <0.001), fatigue (p <0.001), and +all domains of QoL after2 months of yoga intervention when compared with +those at baseline (Table 3). +Control group (Table 3) +In contrast to the yoga group, we observed a significant increase in anxiety (p +<0.001), depression (p <0.001), and fatigue (p <0.005), along with asignificant +decrease in all domains of QoL and well-being (p <0.001), after 2 months +compared with those at baseline in the control group (See Table 3). +Table 3: Pre–post comparison of variables of yoga and wait-listed control groups +Group +Yoga group +Control group + +Pre M ± SD +Post M ± SD +p +value +% +change +Pre M ± SD +Post M ± SD +p value +% +change +Between- +group +compariso +n p value +Fatigue +47.87 ± 4.47 +22.77 ± 2.51 +<0.001 +−52 +48.42 ± 1.18 +49 ± 35 +0.005 +2 +<0.001 +Well-being +11.26 ± 3.52 +19.03 ± 1.97 +<0.001 +69 +9.87 ± 1.54 +8.61 ± 2.56 +0.001 +−13 +<0.001 +Anxiety +11.29 ± 2.15 +5.45 ± 1.34 +<0.001 +−52 +11.45 ± 2.17 +12.48 ± 2.20 +<0.001 +9 +< 0.001 +Depression +9.16 ± 2.15 +4.74 ± 1.12 +<0.001 +−48 +9.19 ± 2.04 +10.23 ± 1.93 +<0.001 +11 +<0.001 +QOL +PH +10.71 ± 1.16 +15.77 ± 1.12 +<0.001 +47 +10.77 ± 1.15 +9.84 ± 1.1 +<0.001 +−9 +<0.001 +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +16 + +Psy +10.27 ± 0.85 +14.94 ± 0.84 +<0.001 +45 +10.01±1.01 +9.08±0.91 +<0.001 +−9 +<0.001 +LOInd +12.39±1.41 +15.68±1.17 +<0.001 +27 +12.32±1.17 +10.97±1.49 +<0.001 +−11 +<0.001 +SRln +9.58±0.81 +13.29±0.59 +<0.001 +39 +9.48±0.63 +9.26±0.58 +0.03 +−2 +<0.001 +Envmt +11.58±0.98 +15.71±0.57 +<0.001 +36 +11.47±0.89 +10.87±0.67 +0.002 +−5 +<0.001 +PBlfs + +11.68±1.25 +15.94±0.96 +<0.001 +36 +11.26±1.12 +10.84±1.07 +0.11 +−4 +<0.001 +Abbreviations: “<” values are p values’ Fatg, Fatigue;WBng, Well-being;Anx, Anxiety;Dpr, Depression;QOL +Ph, QOL Physical;QOLPsy, QOL Psychological. QOL LOInd, QOL Level of Independence;QOL SRln, QOL Social +Relation;QOL Envmt, QOL Environment; QOL PBlfs, QOL Personal Beliefs +Between-group comparison +The yoga group showed a higher improvement in anxiety (p <0.001), depression +(p <0.001), fatigue (p <0.001), psychological well-being (p <0.001), and all +domains of QoL. Thus, we found significant differences between theyoga and +control groups (Table 3). +Discussion +In this study, we found a significant improvement in depression, anxiety, fatigue, +well-being, and QoL following 2 months of the yoga intervention in HIV-infected +participants. In contrast to the yoga group, a significant increase in depression, +anxiety, and fatigue and the deterioration of QoL and well-being were +observed in the control group. Worsening of the control group characteristics +may be attributed to the progression of the disease. Previously ssurveys have +shown that the natural advancement of disease involves worsening of anxiety +and depression symptoms along with reduction of CD4 counts in HIV patients. +Both these factors are known to have are reciprocities spiraling effect on each +other, resulting in a vicious cycle. Addition of yoga may break this cycle by +preventing or retarding progression of psychopathology (Marry et al 2002). Rosy +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +17 + +et al 2016 also observed that there was an increase in anxiety and depression in +HIV positive patients on ART after one month of routine conventional treatment +as compared to the baseline. +This study suggests that yoga practice enhances the mental health by improving +the well-being and reducing anxiety, depression and fatigue. Further, these +findings suggest the importance of yoga as an alternative intervention in +conventional HIV care. This study also showed the significance of the yoga +intervention as an add-on therapy to ART in HIV care. +Few studies have shown the potential use of the yoga intervention in HIV- +infected persons. +Another randomized controlled trial by Mawar et al 2015 reported significant +improvement in the health related QoL domains (12% in physical health; 9% in +level of independence; 11% in psychological health) (Mawar et al 2015) +In a randomized controlled trial, Rosy et al (2016) reported significant +improvement in depression scores (p=0.04, −13.39%) and a non-significant +reduction in anxiety scores (p=0.13, −8.2%) following 1 month of an integrated +yoga intervention in persons with HIV; in contrast to the yoga group, the control +group showed a significant increase in anxiety and depression over the same +period. The findings of our study are consistent with this previous study by Rosy et +al (2016) with a notable difference being the longer duration of 2 months. The +longer duration in our study may explain the comparatively higher improvement +in depression (48%) and anxiety (52%) in the yoga intervention group. Similarly, +asignificant increase in anxiety and depression in the control group was +observed at post-assessment; which may be attributed to HIV-associated +depression and anxiety. +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +18 + +In another randomized controlled trial, Ram et al (2016) reported significant +improvement in QoL domains following 4 months of the yoga intervention in HIV +persons with cocaine addiction (Agarwal et al 2015). Consistent with this study, +our study also found significant improvement in QoL domains following 2 months +of yoga intervention. However, the frequency of the yoga intervention in our +study was 5 days per week, as compared to 1 session per week in the previous +study. Also the type of yoga module differed from the previous study. These +variations could explain the greater improvement in QoL domains observed in +our study, +Our findings are also supported by a pilot RCT study by Menon et al 2013 in +which significant improvement in physical health, psychological well-being and +CD4 count following 10 weeks of yoga intervention among the adolescents with +HIV positive (Menon et al 2013). +The exact mechanism action of yoga is not known. However, based on earlier +findings, we can hypothesize that yoga practice leads to decreased stress +response through down-regulation of the HPA (hypothalamus-pituitary-adrenal +axis) (Ross et al 2009), which could have contributed to a reduction in anxiety. +Most of the yoga postures involve active stretching, which might have +contributed to increased parasympathetic activity and enhanced secretion of +positive Neuro-hormones such as serotonin, oxytocin which have anti- +depressant action (Sharma et al 2005). Decreased anxiety and depression is +shown to improve QoL (Chandwani et al 2009). +This study has a few limitations such as a small sample size, with no sample size +calculation done prior to the study. Additionally, the control-group has not had +any type of intervention, while the yoga group is a short term intervention. +Conclusion +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +19 + +This study clearly indicates that yoga intervention improves the psychological +health and QoL of individuals infected with HIV. Therefore, based on these +findings, yoga is strongly recommended as a complementary therapy to +enhance conventional HIV care. + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +20 + +Conflict of Interest +Authors declare no conflict of interest. +Acknowledgement + +We are grateful for the constant support we received from the HIV Centres +throughout the study. + + + + + + + + + + + + + + +MANUSCRIPT + +ACCEPTED +ACCEPTED MANUSCRIPT + +21 + +Reference +• Adewuya, A. 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Acta psychiatricascandinavica, 67(6), 361-370. + + + + +View publication stats +View publication stats diff --git a/subfolder_0/Indian PM_s evidence-based wellness approach inspires politico-scientific activism.txt b/subfolder_0/Indian PM_s evidence-based wellness approach inspires politico-scientific activism.txt new file mode 100644 index 0000000000000000000000000000000000000000..b3c7670ae164d1b4cea9e0fe5a7e5ec32b018a0f --- /dev/null +++ b/subfolder_0/Indian PM_s evidence-based wellness approach inspires politico-scientific activism.txt @@ -0,0 +1,94 @@ +ANNALS +COMMENTARY +3 +www.annalsofneurosciences.org +ANNALS OF NEUROSCIENCES VOLUME 26 NUMBER 1 JANUARY 2019 +Indian PM’s evidence based wellness approach inspires +politico-scientific activism +H R Nagendraa, Akshay Anandb* +a SVYASA, Bangalore +b Neuroscience Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh +*Correspondence Author: +Akshay Anand, Professor +Neuroscience Research Lab +Department of Neurology, +PGIMER, Chandigarh, India, 160012 +Contact no: +91 9914209090 +E-mail: akshay1anand@rediffmail.com +The Indian health knowledge generation programs and pol- +icies are dominated by studies initiated either by the scien- +tists, Physicians or the funding agencies and often remain +limited to labs. Recently, the Indian PM reset this method- +ological approach by himself prioritizing evidence based + +approach to wellness over the pharma driven health research. +On the 2nd International Yoga Day, he publically role mod- +elled for the Common Yoga Protocol developed by Ministry +of AYUSH (Ayurveda, Yoga, Unani, Sidha and Homeopathy), +along with 50,000 local Yoga enthusiasts. This was widely +televised in the country. He also appealed to the health poli- +cy makers to study if Yoga based intervention can prevent +the increasing cost and disease burden of Diabetes. The India + +Yoga Association (IYA) quickly took cue from this appeal +and formulated a customized Diabetic Yoga Protocol (DYP) +as population based intervention plan, promptly funded by +the Ministry of AYUSH. The said protocol was evolved by the +eminent Yoga scholars from various schools, for primary +prevention of Diabetes. It included 1 hour of daily exercises +which included specific postures, breathing and meditation +techniques which could be beneficial for alleviating muscle +resistance to insulin and prevention of stress. The accept- +ability and cost effectiveness of Yoga in Indian health scenar- +io was the basis for IYA to swiftly recruit about 1200 Yoga +practitioners, rechristened as Yoga Volunteers for Diabetes +Management (YVDM). The national survey for prevalence of +old and new Diabetics was completed by the trained YVDMs +within a record time of 2 months, surpassing the earlier + +national effort which had taken 7 years. The entire lifestyle in- +tervention project was executed within 10 months with alacrity +and enthusiasm of YVDMs. About 2, 40,000 individuals across +64 Indian districts were screened through house to house visits +in anticipation of the statistical sample of 24,000 Pre-diabetics +and Diabetics. This was based on Indian Diabetes Risk Score +(IDRS), conversion rate and incidence of disease. The resulting +pre-diabetics were enrolled nationwide in the study and were +physically monitored continuously for compliance to DYP for +3 months for any possible halt of conversion of Pre-diabetes +into Diabetes. This was analyzed by blood sampling, stress +and ­ +demographic questionnaire pre and post DYP interven- +tion. The Yoga academics are upbeat at the prospect of pub- +lishing the outcome of intervention of Yoga protocol as well as +awareness generated in the process. For this a randomization +methodology consisting of two locations in each village and a +city of a district were randomly selected, with each alternative +location, separated by 6 kms, serving as waitlisted control for +Yoga intervention. The execution of the project was aided by IT +professionals who developed Apps for collection and collation +of data from subjects who underwent 3 months of Yoga. The +Senior Research Fellows who coordinated the YVDMs through +free whatsapp, also evaluated stress before and after 3 months, +and additionally, collected information about substance abuse, +BMI and disenchantment with use of medicines. The trial was +registered in the Clinical Trial Registry of India. +The stupendous success of the deployment of non- +governmental, non-medical human resources, their training +and the intervention of the yoga module, in such a short time, +bears testimony to political expediency and quality assur- +ance in installing Integrative Medicine in India. Preliminary +results have revealed the efficacy of the customized protocol +in halting conversion of pre-Diabetics into Diabetics. Much +like China, India needs to overcome the reluctance shown by +successive Govts in integrating modern medicine with popu- +lar traditional approaches. The quality of methodology also +promises brighter prospects for implementation of ‘Ayushman +Bharat’, the flagship program of Govt of India aimed to provide +record health insurance cover to about 500 million poor In- +dians. Despite growing resistance of Indian Medical Associa- +tion to integrate traditional medicine with modern medicine, +Govt appears unfazed not only in promoting wellness centers +across the country but also in consolidating Yoga skills through +popular accreditation system for quality Yoga intervention. +doi : 10.5214/ans.0972.7531.260102 diff --git a/subfolder_0/Infl uence of yoga on postoperative outcomes and wound.txt b/subfolder_0/Infl uence of yoga on postoperative outcomes and wound.txt new file mode 100644 index 0000000000000000000000000000000000000000..69966c3bc470b34f3c099ce650f4da0a4ec152b8 --- /dev/null +++ b/subfolder_0/Infl uence of yoga on postoperative outcomes and wound.txt @@ -0,0 +1,1187 @@ +33 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Infl + uence of yoga on postoperative outcomes and wound +healing in early operable breast cancer patients undergoing +surgery +Raghavendra M Rao, Nagendra H R, Nagarathna Raghuram, Vinay C, Chandrashekara S1, +Gopinath K. S.2, Srinath B. S.2 +Department of Yoga Research, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India. +1Department of Clinical Immunology, M.S Ramaiah Medical Teaching Hospital, Bangalore, India. +2Department of Surgical Oncology, Bangalore Institute of Oncology, Bangalore, India. +Original Article +Correspondence to: Dr. Nagarathna Raghuram +No. 19, Eknath Bhavan, +Gavipuram Circle, KG Nagar, +Bangalore – 560 019, India. +E-mail: rn44@rediffmail.com +Context: Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from +surgery. +Objective: The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing +in early operable breast cancer patients undergoing surgery. +Methods: Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled +trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes +and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. +Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were +collected for estimation of plasma cytokines—soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha +and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture +removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann +Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to +determine predictors for postoperative outcomes. +Results: Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a +signifi + cant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal +(P = 0.03) in the yoga group as compared to the controls. There was also a signifi + cant decrease in plasma TNF alpha levels +following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes +showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. +Conclusion: The results suggest possible benefi + ts of yoga in reducing postoperative complications in breast cancer +patients. +Key words: Cancer; immunity; surgery; wound healing; yoga. +ABSTRACT +After surgery, breast cancer patients experience particularly +high levels of distress[1-4] manifested as anxiety, depression +and anger due to the effects of surgery and the disease +itself on life expectancy, physical appearance and sexual +identity.[5] Furthermore, concerns regarding one’s physical +condition, postoperative recovery, hospital admissions, +anticipating painful procedures, image problems, +confronting cancer diagnosis and worries about survival +and recovery can contribute to the already prevailing +distress and psychological reactions.[6] Numerous studies +have shown that such preoperative distress is known +to affect postoperative outcomes and delay recovery in +both cancer and noncancer population.[7] In general, high +preoperative stress or anxiety is predictive of greater +pain intensity, longer hospital stays, more postoperative +complications and poorer treatment compliance.[8,9] +Apart from this, distress is also known to impede wound +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +34 +healing in early phases of wound repair through its effect +on glucocorticoids and proinflammatory cytokines in +blood such as TNF-alpha and IL-1.[10-12] Wound healing +is important in this current context of breast surgery as +exaggerated inflammation, infections and collection of +seroma at the wound site lengthen hospital stay, warrant +more medical attention, cause distress[13,14] and lead to +delayed wound closure.[15] Although the use of anesthetics +and opioids for effective postoperative pain management +has been shown to reduce plasma cortisol levels[16] +related to poorer wound healing, they nevertheless cause +distressing side effects such as headache, nausea and +gastrointestinal distress and are not cost-effective.[17] +Evidence suggests that in clinical practice, interventions +to reduce the patient’s psychological stress level may +improve both wound repair and recovery following +surgery.[18,19] +There is evidence to show that interventions that alter +appraisal, coping and/or mood may also modulate +immune and endocrine function, thereby enhancing +surgical recovery.[20,21] Even modest interventions that +have relatively small consequences for psychological +distress such as educating the patient about surgery[18] +and improving the ambience in the wards[22] are known +to influence the recovery process. Several meta-analyses +of presurgical intervention studies have argued that +association between presurgical intervention and +clinical outcome is clinically meaningful.[19] Depending +on the meta-analysis, two thirds to three quarters of +intervention patients had better outcomes than control +subjects (patients who have undergone surgery but not +intervention) with the size of improvement ranging +from 20–28%.[19] These stress reduction and behavioral +interventions apart from reducing distress, hospital stays +and medication are also known to affect recovery from +surgery and are cost-effective.[18,19,23] +Yoga is one such psychotherapeutic intervention that +has been used in numerous health care concerns where +stress was believed to play a role. It consists of a series +of breathing exercises or Pranayama (regulated nostril +breathing), postures, relaxation and meditative techniques. +These techniques are known to alter certain physiological +functions that are known to reduce the effects of stress. +These functional alterations include bringing about a +stable autonomic balance,[24] improvement of physical +efficiency,[25] increase in cardiopulmonary functions,[26] +improved immunological tolerance,[27] improved neuro- +endocronine functions,[28-30] improved mood states[31-33] +and a tranquil state of mind to combat stress.[34] This +could be particularly useful in the current context where +apart from reducing psychological distress, yoga could be +used to alter endocrine and immune function to lower the +risk of infections and enhance wound healing. Distress +could also impede recovery by reducing compliance, for +example, it is known that breathing exercises reduce the +risk of pneumonia following surgery[35] and incorporating +yoga interventions that use breathing, stretching and +relaxation interventions could help hasten the recovery +process following breast surgery. We hypothesize that yoga +interventions would help improve postoperative outcomes +and recovery and improve wound healing in early operable +breast cancer patients undergoing surgery. +SUBJECTS AND METHODS +Described here is a single center, randomized controlled +trial that recruited ninety-eight recently diagnosed women +with stage II and III operable breast cancer who were +awaiting breast cancer surgery. This study evaluated +the effects of yoga intervention vs a supportive therapy +with exercise rehabilitation in early stage II and III breast +cancer patients undergoing breast cancer surgery. The +selected women were recently diagnosed with breast +cancer, with time following diagnosis ranging from 1–4 +weeks. Subjects were recruited from January 2000 to June +2004 at a comprehensive cancer care center in Bangalore. +The study was approved by the ethical committee of the +recruiting cancer center. Patients were included if they met +the following criteria: i) women with recently diagnosed +operable breast cancer, ii) age between 30 to 70 years, iii) +Zubrod’s, performance status 0–2 (ambulatory > 50% +of time), iv) high school education, iv) willingness to +participate, v) Surgery as a primary treatment. Patients +were excluded if they had i) a concurrent medical +condition likely to interfere with the treatment, ii) any +major psychiatric, neurological illness or autoimmune +disorders, iii) secondary malignancy, iv) presented with +infections or history of recent infections in the past month. +The details of the study were explained to the participants +and their informed consent was obtained. +Baseline assessments were done on 98 patients on the +day prior to their surgery. Sixty-nine patients contributed +data to the current analyses at the second assessment +(four weeks after surgery). The reasons for dropouts +were attributed to migration to other hospitals, use of +other complementary therapies (e.g., Homeopathy or +Ayurveda), lack of interest, time constraints and other +concurrent illness. +Demographic information, medical history, clinical data, +intake of medications and investigative notes were taken +during their initial hospital visit before randomization. +About 12 ml of blood sample was collected in vacuettes +under sterile conditions on the day of the surgery. Blood +samples were collected between 7 a.m. to 11 a.m. for +all participants to reduce diurnal variability. Follow- +up assessments were done at four weeks following +Rao R M, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +35 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +surgery and before the commencement of any adjuvant +treatment. +Randomization +Subjects consenting to participate in this study were +randomly allocated to receive either yoga (intervention) +or supportive therapy plus exercise therapy prior to their +surgery using random numbers generated by a random +number table. Randomization was performed using +opaque envelopes with group assignments, which were +opened sequentially in the order of assignment during +recruitment. These envelopes had names and registration +numbers written on their covers. It was not possible to +mask the yoga intervention from the subjects as yoga is +a popular practice. However, the investigators (treating +surgical oncologists) were blind to the intervention. +Measures +Postoperative outcome measures +Breast cancer subjects in our study underwent surgery +as a primary treatment. They underwent either breast +conservation surgery (lumpectomy with axillary +dissection) or (mastectomy with axillary dissection). +We assessed the following postoperative outcomes: i) +Number of days of drain retention following surgery— +this is indicative of seroma collection at the wound site +and is known to delay wound healing.[14] The criteria +for drain removal followed in the hospital was drain +fluid < 50 ml in 48 hours for all breast cancer surgery +patients. ii) Duration of hospital stay (number of days in +hospitalization) —patients were discharged if they were +ambulatory, their general condition was good and did not +have any postoperative complications. iii) Postoperative +duration (interval between surgery and the start of +any other adjuvant treatment). iv) Interval for suture +removal (number of days from the day of surgery to the +day of suture removal)—the suture was removed when +the approximated margins of the wound were closed +(when primary union was facilitated). v) Presence of +postoperative complications such as infections, secondary +suturing, seroma, discharge, uncontrollable pain etc. +Immune outcome measures +i) Plasma levels of cytokines — TNF-alpha, IFN-gamma +and soluble IL-2R alpha. +Quantifications of cytokines — sIL-2R, TNF-alpha and +IFN-gamma: Two milliliters of blood samples were +collected in sodium citrate vacuettes and plasma isolated +for cytokine measurements. +Plasma was analyzed for cytokines using double sandwich +ELISA techniques with Duoset ELISA Development kits +from R & D Systems, USA. The test samples were run +in duplicate and readings taken on a microplate reader +(Organon Technica, USA). The test was calibrated using +varying concentrations of a set of standards given along +with the kit. The plates were read at 450 nm and standard +curves plotted for each run with the log of cytokine +concentrations on the y-axis and the log of the optical +density (O.D.) readings on the x-axis; the best fit lines were +determined by regression analyses. The concentrations +were then extrapolated by using the mean O.D readings +of the duplicate wells. The sensitivity of the tests was in +the range of 15.7–998 15.8–950 and 31.5–2000 pg/ml for +TNF-alpha, IFN-gamma and sIL-2 Rα′ respectively. +Interventions +The intervention group underwent an “integrated yoga +program” and the control group received “supportive +counseling and postoperative exercise rehabilitation.” +While the goals of yoga intervention were stress reduction +and improvement in shoulder mobility, the goals of the +control intervention was to reinforce social support +and prevent shoulder restriction. The yoga intervention +consisted of a set of breathing exercises or Pranayama +(voluntarily regulated nostril breathing) and yogic +relaxation techniques. These practices were based on the +principles of attention diversion and relaxation to cope +with day-to-day stressful experiences. +Supportive counseling sessions as control intervention +included two important components: “i) education and +reinforcing social support and ii) shoulder exercise for +postoperative rehabilitation”. We used this as a control +intervention mainly because it has been used earlier +to hasten recovery from surgery[18,19] and to control for +the nonspecific effects of the yoga program that may be +associated with adjustment such as attention, support and +a sense of control. +Subjects and their caretakers were invited to participate in +an introductory session lasting 60 minutes before surgery +where they were given information about surgery and the +management of its related side effects, taught shoulder +exercises and mobilization by the physiotherapist and +provided the answers to a variety of common questions. +Both the interventions were imparted at the patient’s +bedside by trained personnel during the pre- and +postoperative periods and subjects underwent four +such in-person sessions in the hospital. Following their +discharge, subjects were asked to practise their respective +interventions at home daily (for half an hour) during the +next three weeks. Subjects’ interventions were monitored +on a weekly basis by telephone calls. Subjects were also +provided audiotapes of these practices for home practice +Yoga and postoperative outcomes +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +36 +using an instructor’s voice so that a familiar voice could +be heard on the cassette. Subjects were also encouraged +to maintain a daily log listing the yoga practices done, +use of audio-visual aids for practice, duration of practice, +experience of distressful symptoms, intake of medication +and diet history. +Data analysis +Data was analyzed using SPSS 10.0 for Windows. Data was +tested for normality and homogeneity. An independent +samples t test was done to assess postoperative outcomes +between groups. The values of TNF-alpha were not +normally distributed, hence, a nonparametric Mann +Whitney U test was done on the change scores (pre- and +postsurgery) to compare groups. A Chi Square test was +done to analyze the difference in proportions among +category variables across groups. +A multiple hierarchical regression analysis was done to +examine the variance in dependent variables explained +by independent variables. The dependent variables in +this analysis were the number of days of drain retention, +interval for suture removal, duration of hospital stay, +postoperative duration (interval between surgery and +adjuvant therapy). The independent prognostic variables +entered into the analysis were age in years, type of surgery, +size of tumor, postoperative surgery complications +(presence or absence) and intervention. All models used +the same set of five independent variables except for +postsurgery TNF-alpha levels where a presurgery TNF- +alpha level was added as an additional predictor. The ratio +of subjects to the number of variables was 13.8 in the final +model. For each equation, the probability of F-to-enter an +independent variable was set at P < 0.10 and F- to-remove +was set at P < 0.25. Probabilities were set at these levels +so as to allow only for a small number of potential strong +predictors to be selected in the models. The regression +analysis was done using the entry method. +RESULTS +The age, stages of disease, grade and node status were +similar in the yoga and supportive therapy (control) +groups. The Chi square test on all sociodemographic and +medical characteristics of study sample did not show any +significant differences in the proportions across groups +[Table 1]. The mean years of education of the study sample +was 12.49 ± 2.67 years with a minimum of seven years and +a maximum of 17 years of education. The mean overall age +of the subjects was 49.2 ± 9.6 years in both groups. +Effects of group on postoperative outcomes +Independent samples ‘t’ test was done to assess the +effects of groups on postoperative outcomes. There was +a decrease in the number of days of drain retention (95% +confidence interval, CI (0.74 to 2.8)) following surgery. +There was a rapid healing of the surgery wound as +evidenced by shorter intervals for suture removal (95% +CI (0.23 to 4.6)) and a decrease in the duration of hospital +stay (95% CI (0.44 to 2.1)) following surgery in the yoga +group as compared to controls [Table 2]. +Effects of groups on postoperative outcomes in subjects +undergoing only mastectomy: +Independent samples ‘t’ test was done to assess the +effects of groups on postoperative outcomes. There was a +decrease in the number of days of drain retention (95% CI +(0.8 to 3.1)) following surgery. There was a rapid healing +of the surgery wound as evidenced by shorter intervals +for suture removal (95% CI (0.23 to 5.5)) and a decrease +in the duration of hospital stay (95% CI (0.32 to 2.2)) +following mastectomy in the yoga group as compared to +controls [Table 3]. +Effects of type of surgery on postoperative outcomes +As subjects in both groups received either breast +conservation surgery or mastectomy, we evaluated the +effects of these two surgical procedures on postoperative +outcomes. Independent samples ‘t’ test done to assess +the effects of type of surgery on postoperative outcomes +showed significant decreases in the interval for suture +removal (95% CI (0.78 to 5.4)) and the duration of hospital +stay (95% CI (0.09 to 1.9)) in subjects who underwent +breast conservation surgery as compared to mastectomy +[Table 4]. +Postsurgery complications +Postsurgery complications were assessed in both the +groups based on consultants’ notes (blind to intervention) +during the postoperative follow-up period. The presence +or absence of such complications following surgery in +each subject was noted as a category variable. Although +there was a decrease in the number of postoperative +complications in the yoga group, the independent +samples’ nonparametric Chi square test did not show +any significant difference in the proportion of presence/ +absence of postoperative complications across the +groups. There was also no significant difference in the +postoperative complications between breast conservation +vs mastectomy [Table 5]. +Cytokines +There was no significant change in soluble IL-2r alpha +and IFN-gamma levels following surgery between the +groups (results not shown). Wicoxon Signed rank test +Rao R M, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +37 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Table 2: Independent samples t test to compare postoperative outcomes between yoga and control groups +Postoperative outcomes +Control group +Yoga group +t value (df) +P value +Number of days of drain retention +6.44 ± 2.5 +4.7 ± 1.6 +3.46 (67) +0.001 +Postoperative duration +24.6 ± 10.9 +21.7±9.4 +1.16 (62.7) +0.25 +(in days) +Interval for suture removal +12.7 ± 5.2 +10.3 ± 3.6 +2.21 (60.2) +0.031 +(in days) +Duration of Hospital stay (in days) +6.2 ± 2.1 +4.9 ± 1.2 +3.07 (67) +0.003 +Table 1: Demographic characteristics + +All Subjects +Yoga group +Control group +Chi Square and + + + + +(Chi square + + + + +significance value) + +n +(%) +n +(%) +n +(%) +Stage of Breast Cancer + + + + + + + II +31 +45 +17 +54.8 +14 +45.2 +1.1 (3.84) + III +38 +55 +16 +42.1 +22 +57.9 +Grade of Breast Cancer + + + + + + + I +1 +1 +1 +100 +0 +0 +3.94 (5.99) + II +8 +12 +6 +75 +2 +25 + III +60 +87 +26 +43 +34 +57 +Menopausal status + + + + + + + Pre +33 +48 +20 +61 +13 +39 +6.03 (7.82) + Post +33 +48 +11 +33 +22 +67 + Peri +1 +1 +1 +100 +0 +0 + postHysterectomy +2 +3 +1 +50 +1 +50 +Type of surgery + + + + + + + Mastectomy +52 +75.4 +24 +53.8 +28 +46.2 + 0.24 (3.84) + Breast conservation +17 +24.6 +9 +47.1 +8 +52.9 +Stressful life events since +past 2 years + Yes +19 +28 +8 +42 +11 +58 +0.34 (3.84) + No +50 +72 +25 +50 +25 +50 +Control group: supportive therapy group. +Chi square significance values at P < 0.05 level. +showed a significant increase in the TNF-alpha levels +following surgery in the control group alone (P = 0.049). +There was a significant decrease in TNF-alpha following +surgery in the yoga group (P < 0.001) as compared to the +controls in the Mann Whitney U test indicative of better +wound healing in the yoga group at four weeks following +surgery [Table 6]. +Regression on postoperative outcomes +A multiple hierarchical regression analysis was done to +examine the variance in dependent variables (postoperative +outcomes) explained by independent variables such as age +in years, type of surgery, size of tumor, postoperative surgery +complications (presence or absence), presurgery TNF-alpha +levels (for postsurgery TNF-alpha as a dependent variable +only) and intervention. Number of days of drain retention +was explained by the combined effects of yoga intervention +(95% CI (0.32 to 2.4)), presence of surgery complications +(95% CI (0.001 to 2.93)) that was responsible for 27.4% of the +variance in the model. The interval for suture removal was +explained by the combined effects of surgery complications +(95% CI (2.8 to 8.6)) and the type of surgery (95% CI (0.37 to +5.6)) that accounted for 33.8% of the variance in the model. +Duration of hospital stay was explained by intervention +alone (95% CI (0.21 to 1.9)) and accounted for 21.1% of the +variance in the model. None of the predictors explained +variance in the postoperative duration. Lastly, postsurgery +TNF-alpha levels were explained by the combined effect +of presurgery TNF-alpha levels (95% CI (0.63 to 0.72)), +intervention (95% CI (9.7 to 20.4)), age (95% CI (0.14 to +0.74)) and the type of surgery (95% CI (0.46 to 13.5)) that +predicted 94.2% variance in the model [Table 7]. +DISCUSSION +The results suggest that yoga intervention helped reduce +the length of hospital stay and improved wound healing +by shortening the interval period for suture removal +and reduced plasma TNF-alpha levels significantly +as compared to the support and exercise intervention +group following surgery. The results did not differ when +postoperative outcomes were analyzed in only the +mastectomy group. Regression analysis on postoperative +outcomes showed intervention to affect the duration of +drain retention and hospital stay and TNF-alpha levels. +Yoga and postoperative outcomes +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +38 +Table 3: Independent samples t test to compare postoperative outcomes between yoga and control groups in +subjects receiving only mastectomy +Postoperative outcomes +Control group +Yoga group +t value (df) +P value +Number of days of drain retention +6.79 ± 2.4 +4.8 ± 1.5 +3.5 (45.9) +0.001 +Postoperative duration (in days) +24.6 ± 10.9 +21.7±9.4 +0.24 (48) +0.81 +Interval for suture removal (in days) +13.7 ± 5.3 +10.8 ± 3.3 +2.19 (48) +0.03 +Duration of hospital stay (in days) +6.4 ± 2.1 +5.1 ± 1.2 +2.7 (44.5) +0.01 +Table 4: Independent samples t test to compare postoperative outcomes between types of surgery (Mastectomy vs +Breast conservation surgery) + +Mastectomy +Breast conservation +Postoperative outcomes +group +group +t value (df) +P value +Number of days of drain retention +5.88 ± 2.3 +4.8 ± 2.1 +1.81 (67) +0.076 +Postoperative duration (in days) +23.7 ± 10.1 +21.2 ± 10.5 +0.87 (64) +0.39 +Interval for suture removal (in days) +12.4 ± 4.7 +9.3 ± 3.8 +2.46 (65) +0.017 +Duration of hospital stay (in days) +5.8 ± 1.9 +4.8 ± 1.5 +1.997 (67) +0.05 +The interval for suture removal was explained by surgery +complications and the type of surgery. +Sustained elevated levels of TNF-alpha at four weeks +following surgery is indicative of stress and delayed +wound healing. This could be attributed to stress-induced +increase in cortisol levels in the pre- and immediate +postoperative period damping inflammation or infections +in the postoperative period.[36] The results showed that +our intervention was effective in reducing postoperative +complications. The type of surgery (mastectomy vs breast +conservation) did not affect postoperative outcomes in our +study which is consistent with earlier findings.[37] +In our study, there was a decrease of TNF-alpha levels +following four weeks of surgery in the intervention group +indicating that our intervention helped reduce risk factors +in the pre- / postoperative period that could have delayed +wound healing. However, an earlier study with relaxation +training for breast cancer patients undergoing radiotherapy +did not show any significant reductions in TNF-alpha +levels.[38] This could be because radiation therapy has been +shown to induce proinflammatory cytokine levels in earlier +studies irrespective of stress levels possibly confounding +the effects of stress reduction intervention. +Stress response can have an impact on wound healing +as it is regulated by inflammatory mediators. Depression +and stress are associated with enhanced production of +proinflammatory cytokines.[39] Results from animal models +show that stress stimulates proinflammatory genes, delays +wound contraction and myofibroblast differentiation +leading to delayed wound closure by > 25% and +decreases immune / inflammatory responses required for +bacterial clearance leading to infection in the host.[40-42] +Given the substantial contribution of stress for wound +repair and immune changes associated with distress, +even small alterations in anxiety could have substantial +clinical implications both directly through physiological +mechanisms and indirectly through increased pain and +decreased compliance.[7,43] +Our findings are consistent with earlier studies using +behavioral and relaxation approaches to improve +postoperative outcomes. A variety of hypnotic-relaxation +interventions appear to shorten hospital stays, decrease +pain and promote faster recovery following surgery.[44] +For example, 241 patients undergoing a stressful medical +procedure were randomized to receive perioperative +standard care, structured attention or self-hypnotic +relaxation. The self-hypnotic relaxation patients showed +lower pain and anxiety, lower use of self-administered +pain medication, shorter procedure times and less +hemodynamic instability than the other two groups. +[45] Others such as relaxation with guided imagery and +exercise have demonstrated stress-relieving outcomes +closely associated with wound healing.[46,47] +We propose several mechanisms for action for our yoga +intervention. The internal awareness and relaxation +associated with these practices are known to alter +perceptible thoughts and emotions and reduce reactivity +to stressful situations or stimuli thereby altering stress +responses and reducing distress.[48] The effects could be +attributed primarily to the reduction in distress in the +immediate postoperative period that could have buffered +the effects of stress hormones, facilitated recruitment of +inflammatory cells at the wound site and reduced the +rate of infections and the sustained elevated levels of +proinflammatory cytokines at a later period. Secondly, +various yogic breathing practices are known to increase +oxygen consumption[49-51] that could hasten wound +repair.[52] Lastly, our intervention also helped facilitate +compliance to treatment such as the use of breathing +exercises that are known to reduce risks of pulmonary +infections following surgery.[35] We compared our +intervention with standard physiotherapy rehabilitation +and supportive therapy that has earlier shown beneficial +Rao R M, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +39 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Table 5: Comparison of postoperative complications +between groups and types of surgeries using non- +parametric Chi Square test +Postsurgery +Yoga, +Control +Mastectomy +Breast +complications +n = 33 +n = 36 +n = 52 +conservation + +n (%) +n (%) +n (%) +n =17 + + + + +n (%) +Yes +2 (6.1) +8 (22.2) +9 (17.3) +1 (5.9) +No +31 (93.9) +27 (75) +42 (80.8) +16 (94.1) +Observed Chi +Square value +3.82 + +1.41 +Chi square +values of +significance at +P < 0.05 level +3.84 + +3.84 +Table 6: Comparison of mean scores and changes in +plasma TNF-alpha levels in yoga and control groups +before and after surgery + +TNF-alpha levels (pg/ml) +Outcome +Pre +Post +Change +Z scores on +measures +surgery +surgery +pre-to post- Wilcoxons + + + + +test +Control, n = 36 + + + +Mean ± S.D +18.5 ±52.1 26 ± 53.5* -7.5± 14.9 +-1.97 a* +Yoga, n = 33 +Mean ± S.D +11.7 +8.5 + +±13.3 +±7.2 +3.2±10.1 +-0.914 +Z scores for +Mann Whitney Test +– +– +-3.52 + – +†P value +(Two tailed) +– +– +< 0.001 +– +* P < 0.05, P value for non parametric Wilcoxons Signed rank test +† P value for non parametric Mann Whitney U test. +Table 7: Regression analysis on postoperative outcomes using predictors: age in years, type of surgery, size of +tumor, postsurgery complications and presurgery plasma TNF-alpha levels +Model for +Predictor variables +R2 +Beta +F +P value +Number of days of +drain retention +Interventiona + +0.298 + +Surgery a complications +0.27 +0.232 +4.59 +0.001 +Interval for suture +removal +Surgerya + +0.44 + +complications Size +0.33 +0.27 +6.12 +< 0.001 +Duration of hospital stay +Interventiona +0.21 +0.296 +3.25 +0.01 +Postoperative duration +– +0.09 +0.245 +1.287 +0.282 +Postsurgery +TNF-alpha levels +Presurgery TNF-alpha levels + +0.963 + +Interventiona + +0.191 + +Age in years +0.942 +0.107 +152.6 +< 0.001 + +Type of surgerya + +0.077 +a - Category variables with two levels. +effects with respect to postoperative and wound healing +outcomes.[53] This study supports the hypotheses that +adding an active stress reduction component (yoga-based +relaxation and breathing exercises) to these interventions +would hasten the recovery process. +Our study however, has several limitations: i) We assessed +only one cytokine TNF-alpha in our study; other cytokines +and biological determinants (IL-1, IL-10, transforming +growth factor beta (TGF β), fibroblast growth factor +(FGF), vascular endothelial growth factor (VEGF)) that +are known to impact wound healing at various stages +and intervals following surgery were not assessed.[36] +ii) We assessed plasma TNF-alpha levels only after four +weeks of surgery and not immediately afterwards; an +immediate postoperative TNF-alpha level would have +helped determine if changes were occurring due to +perioperative or postoperative factors. Also, assessing +these levels immediately following surgery and after +subsequent intervals thereafter, would have provided +more valuable information on the dynamics of wound +healing. iii) The results of this study are also limited by +the fact that there was 29% attrition in the study on follow- +up assessments, further affecting the power of our study. +iv) Differences in the preoperative nutritional status of +the subjects could have confounded the observations in +this study. However, it may be pointed out that although +a detailed nutritional assessment of each subject was not +done, all subjects were evaluated for any clinical signs +of malnutrition and hemoglobin levels before surgery. +All subjects were moderately built and did not show any +clinical signs of malnutrition or abnormal hemoglobin +levels. We did not assess serum albumin levels as none +of the subjects showed any clinical signs of malnutrition. +This measure could have been used to assess differences +in nutritional status across subjects. +However, our results support the beneficial effects of yoga +intervention on both postsurgery outcomes and wound +healing. Further studies on the dynamics of wound repair +processes using more relevant and advanced biological +determinants of stress and wound repair are warranted. +Future studies should evaluate the mechanisms of action +of yoga intervention through possible neuroendocrine +and immune markers. +Yoga and postoperative outcomes +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +40 +Rao R M, et al. +ACKNOWLEDGMENTS +This research was supported by a grant from the Central Council +for Research in Yoga and Naturopathy, Ministry of Health and +Family Welfare, Govt. of India. 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Brain Behav Immun 2005;19: +207-16. +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] +41 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Yoga and postoperative outcomes +Source(s) of support: Central Council for Research in yoga and +Naturopathy, Ministry of Health, Govt of India +Presentation at a meeting: 39th Annual ASCO Meeting +Organisation: American Society for Clinical Oncology Place: Chicago +Date: June 2nd 2003 +43. Kiecolt-Glaser JK, Marucha PT, Malarkey WB, Mercado +AM, Glaser R. Slowing +of wound healing by psychological stress. Lancet 1995;346:1194-6. +44. Blankfi + eld RP. Suggestion, relaxation and hypnosis as adjuncts in the care +of surgery patients: A review of the literature. Am J Clin Hypn 1991;33: +172-86. +45. Lang EV, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum +KS, et al. Adjunctive non-pharmacological analgesia for invasive medical +procedures: A randomized trial. Lancet 2000;355:1486-90. +46. Holden-Lund C. Effects of relaxation with guided imagery on surgical stress +and wound healing. Res Nurs Health 1988;11:235-44. +47. Emery CF, Kiecolt-Glaser JK, Glaser R, Malarkey WB, Frid DJ. Exercise +accelerates wound healing among healthy older adults: A preliminary +investigation. J Gerontol A Biol Sci Med Sci 2005;60:1432-6. +48. Kabat-Zinn J. Full Catastrophe Living: Using the wisdom of your body and +mind to face stress, pain and illness. Delacorte Press: New York; 1990. +49. Chen MA, Davidson TM. Scar management: Prevention and treatment +strategies. Curr Opin Otolaryngol Head Neck Surg 2005;13:242-7. +50. Telles S, Desiraju T. Oxygen consumption during pranayamic type of very +slow-rate breathing. Indian J Med Res 1991;94:357-63. +51. Jerath R, Edry JW, Barnes VA, Jerath V. Physiology of long pranayamic +breathing: Neural respiratory elements may provide a mechanism that +explains how slow deep breathing shifts the autonomic nervous system. Med +Hypotheses 2006;67:566-71. +52. Gajendrareddy PK, Sen CK, Horan MP, Marucha PT. Hyperbaric oxygen +therapy ameliorates stress-impaired dermal wound healing. Brain Behav +Immun 2005;19:217-22. +53. McAnaw MB, Harris KW. The role of physical therapy in the rehabilitation +of patients with mastectomy and breast reconstruction. Breast Dis +2002;16:163-74. +[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009] diff --git a/subfolder_0/Influence of yoga on mood states, distress, quality of life.txt b/subfolder_0/Influence of yoga on mood states, distress, quality of life.txt new file mode 100644 index 0000000000000000000000000000000000000000..ba843d3fea5ecd6082f1511fbd526f951db4ba08 --- /dev/null +++ b/subfolder_0/Influence of yoga on mood states, distress, quality of life.txt @@ -0,0 +1,1260 @@ +11 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Infl + uence of yoga on mood states, distress, quality of life +and immune outcomes in early stage breast cancer patients +undergoing surgery +Raghavendra M Rao, Nagendra H R, Nagarathna Raghuram, Vinay C, Chandrashekara S1, Gopinath K S2, Srinath B S2 +Department of Yoga Research, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India, 1Department of Clinical +Immunology, M.S Ramiah Medical Teaching Hospital, Bangalore, India, 2Department of Surgical Oncology, Bangalore Institute of Oncology, +Bangalore, India. +Context: Breast cancer patients awaiting surgery experience heightened distress that could affect postoperative outcomes. +Aims: The aim of our study was to evaluate the effects of yoga intervention on mood states, treatment-related symptoms, +quality of life and immune outcomes in breast cancer patients undergoing surgery. +Settings and Design: Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited for a randomized +controlled trial comparing the effects of a yoga program with supportive therapy plus exercise rehabilitation on postoperative +outcomes following surgery. +Materials and Methods: Subjects were assessed prior to surgery and four weeks thereafter. Psychometric instruments were +used to assess self-reported anxiety, depression, treatment-related distress and quality of life. Blood samples were collected +for enumeration of T lymphocyte subsets (CD4 %, CD8 % and natural killer (NK) cell % counts) and serum immunoglobulins +(IgG, IgA and IgM). +Statistical Analysis Used: We used analysis of covariance to compare interventions postoperatively. +Results: Sixty-nine patients contributed data to the current analysis (yoga n = 33, control n = 36). The results suggest +a signifi + cant decrease in the state (P = 0.04) and trait (P = 0.004) of anxiety, depression (P = 0.01), symptom severity +(P = 0.01), distress (P < 0.01) and improvement in quality of life (P = 0.01) in the yoga group as compared to the controls. +There was also a signifi + cantly lesser decrease in CD 56% (P = 0.02) and lower levels of serum IgA (P = 0.001) in the yoga +group as compared to controls following surgery. +Conclusions: The results suggest possible benefi + ts for yoga in reducing postoperative distress and preventing immune +suppression following surgery. +Key words: Cancer; immunity; mood; surgery; yoga. +Original Article +Correspondence to: Dr. Nagarathna Raghuram +No.19, Eknath Bhavan, Gavipuram Circle, +K. G. Nagar, Bangalore – 560 019. India. +E-mail: rn44@rediffmail.com +ABSTRACT +Awaiting surgery is a distressing experience for most +breast cancer patients.[1-3] It has been described as a acute, +short-term stressor with multiple stressful components +such as concerns regarding one’s physical condition, +postoperative recovery, hospital admissions, anticipating +painful procedures, image problems, confronting cancer +diagnosis and worries about survival and recovery.[4] It is +known that such concerns evoke strong emotional and +psychological reactions in the subjects further heightening +preoperative distress. Such heightened preoperative +distress has been found to be related to longer hospital +stays, delayed recovery, more postoperative complications, +pain and increased need for medications.[4,5] These +distressing symptoms are also known to impair local and +systemic immune responses leading to delayed wound +repair[6,7] and postoperative infections.[8,9] Apart from +direct effects on endocrine and immune function, greater +pain sensitivity and distress of more anxious patients +may affect recovery because of reduced compliance; for +example, breathing exercises reduce the risk of pneumonia +following surgery.[10] Patients may become more cautious +about following recommendations for walking, breathing +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +12 +or coughing because of pain and distress further affecting +the process of recovery.[5] +A multitude of factors seem to affect antitumor and innate +immune responses collectively during surgical recovery +such as mood, perceived stress, anti-inflammatory +analgesics and anesthesia. Medications that reduce +pain and distress such as analgesics,[11] corticosteroids, +morphine[12] and anesthetics[13,14] following surgery can +directly help reduce treatment-related distress, improve +functional well being and reduce consequent immune +suppression. However, such medications are not +always cost-effective and have side effects ranging from +gastrointestinal distress, nausea and, sleep disturbances[10] +and also excessive use can dampen both innate and +anti-tumor immune responses.[4] For example, marked +suppression of NK cell activity and count is observed +following surgical procedures that often last for an +extended period inspite of the use of anti-inflammatory +and anesthetic medications.[15] This transitory dysfunction +of NK cells may create a favourable milieu for metastases. +This has been attributed to loss of control over dormant +micrometastases or from an inability to destroy tumor cells +released perioperatively.[16] Moreover, changes in NK cell +activity and number seem to be affected by mood states +with decreased NK cell numbers seen with depressed +mood[17,18] and decreased NK cell activity is related to +anxiety states.[19] +There is evidence to show that interventions that alter +appraisal, coping and/or mood may also modulate +immune and endocrine function, thereby enhancing +surgical recovery.[20,21] Even modest interventions that +have relatively small consequences for psychological +distress such as educating the patient about surgery[22] +and improving the ambience in the wards[23] are known +to influence the recovery process. Several meta-analyses +of presurgical intervention studies have argued that +association between presurgical intervention and clinical +outcome is clinically meaningful.[24] Depending on the +meta-analysis, two thirds to three quarters of intervention +patients had better outcomes than control subjects with +the size of improvement ranging from 20–28%.[24] These +stress reduction and behavioral interventions apart from +reducing distress, are also known to affect immune +responses in general.[25,26] +Yoga is one such psychotherapeutic intervention, +which, has been used effectively in numerous health +care conditions where stress was believed to play a role. +General effects of yoga in promoting health are due +to its ability to establish stable autonomic balance,[27] +development of hypometabolic states,[28] improvement of +physical efficiency,[29] improvement of thermoregulatory +efficiency,[30] increase in cardiopulmory functions,[31] +improved immunological tolerance,[32] neuro-endocronine +functions,[33-35] improved mood states[36-38] and a tranquil +state of mind to combat stress.[39] These physiological +benefits possibly explain the rationale for using yoga +intervention to reduce distress and improve immune +outcomes in cancer subjects undergoing surgery. Moreover, +various techniques of yoga have shown to improve mood +states, reduce stress, improve quality of life and, adjustment +in cancer patients.[40] In an earlier study, we have shown +yoga to reduce treatment-related distress and symptoms in +breast cancer patients undergoing chemotherapy.[41] This +may have implications in the current context wherein +high psychological distress is seen preoperatively. We +hypothesize that yoga interventions would help reduce +psychological distress and improve anti-tumor immune +responses in breast cancer patients following surgery. +SUBJECTS AND METHODS +This is a single center, randomized controlled trial which +recruited ninety-eight recently diagnosed stage II and III +operable female breast cancer patients to evaluate the +effects of yoga intervention versus a supportive therapy +and exercise rehabilitation. Time following diagnosis +ranged from 1–4 weeks. Cancer staging was done using +the international union against cancer staging system. +Participants were recruited between January 2000 to June +2004 in a comprehensive cancer care center in Bangalore. +The study was approved by the ethical committee of the +recruiting cancer center. Patients were included if they +met the following criteria: i) women recently diagnosed +with operable breast cancer, ii) age between 30 to 70 +years, iii) Zubrod’s, performance status 0–2 (ambulatory +> 50% of time), iv) high school education iv) willingness +to participate v) primary treatment as surgery. Patients +were excluded if they had i) a concurrent medical +condition likely to interfere with treatment, ii) any major +psychiatric, neurological illness or autoimmune disorders, +iii) secondary malignancy iv) presenting with infections or +history of recent infections in the past month. The details +of the study were explained to the participants and their +informed consent was obtained. +Baseline assessments were done on 98 patients prior to +their surgery. Sixty-nine patients contributed data to the +current analyses at the second assessment (postsurgery +four weeks after surgery). The reasons for dropout were +attributed to migration to other hospitals, use of other +complementary therapies (e.g. Homeopathy or Ayurveda), +lack of interest, time constraints and other concurrent +illness [Figure 1]. +At the initial visit before randomization, investigative +notes and standard self-report questionnaires assessing +anxiety, depression and quality of life were used to get +Rao R M, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +13 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +174 paents screened +44 refused +32 not eligible +98 randomized +12 disconnued +17 disconnued +2 shied to another hospital +2 other CAM therapies + +3 lack of interest +5 me constraints + + +8 shied to another hospital +3 other CAM therapies + +3 lack of interest + +4 me constraints +1 due to illness +Surgery +Postsurgery 33 completed +/analyzed +Postsurgery 36 completed +/analyzed +Yoga +n = 45 +Supporve therapy +n = 53 +Reasons for +Dropouts +Figure 1: Trial profi + le +demographic information, medical history, clinical data, +intake of medications during their hospital visit. About +12 ml of blood samples were collected in vacuettes under +sterile conditions on the day of their surgery. Blood +samples were collected between 8 a.m. to 12 p.m. for +all participants to reduce diurnal variability. Follow-up +assessments were done at four weeks following surgery +before the commencement of any adjuvant treatment. +Randomization +Subjects consenting to participate in this study were +randomly allocated to receive either yoga (intervention) +or supportive therapy plus exercise therapy prior to their +surgery using random numbers generated by a random +number table. Randomization was performed using +opaque envelopes with group assignments, which were +opened sequentially in the order of assignment during +recruitment with names and registration numbers written +on their covers. Yoga being a popular intervention, it +was not possible to mask the yoga intervention from the +subjects although they were initially told that they would +be participating in a postoperative rehabilitation program. +However, the investigators (treating surgical oncologists) +were blind to the intervention. +Measures of stress +Stress was assessed using standard self-report +questionnaires such as the State Trait Anxiety Inventory +(STAI)[42] for anxiety and Beck’s Depression Inventory +(BDI)[43] for depression. +STAI consists of separate self-report scales for measuring +two distinct anxiety concepts: state anxiety and trait +anxiety, each having twenty statements. The respondents +are required to rate themselves on a four point scale: +‘not at all to very much so’ on various anxiety-related +symptoms which they experience. This has been used +widely in earlier studies on cancer populations and with +a concurrent validity ranging from 0.75 to 0.80 with other +tests. +Beck’s Depression Inventory is a self-report measure +used to assess behavioral manifestations of depression. +The inventory is composed of 21 categories of symptoms +and attitudes, each with a graded series of 4–5 evaluation +statements ranked to indicate the range of severity +Yoga in breast cancer surgery +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +14 +of symptoms from neutral to maximal severity. This +instrument has a reliability of 0.48–0.86 and validity of +0.67 with the Diagnostic and Statistical Manual of Mental +Disorders (DSM) diagnostic criteria for depression. +Measures of quality of life and stress symptoms +Quality of life of study participants was ascertained using +the Functional Living Index of Cancer (FLIC).[44] This scale +is a self-administered measure of the global quality of life +for cancer patients having a high correlation (0.44–0.75) +with other scales. +A subjective symptom checklist was developed during +the pilot phase to assess stress, treatment-related side +effects, problems with sexuality and image and relevant +psychological and somatic symptoms related to breast +cancer. The checklist consisted of 31 such items, each +evaluated on two dimensions, the severity graded from +“none to very severe (0–4)” and distress from “not at all to +very much (0–4)”. This scale measured the total number +of symptoms experienced, total and mean severity and +distress score and was evaluated previously in a similar +breast cancer population.[45] +Immune assays +Blood samples were collected in three separate +vaccutainers: 7 ml of each blood sample was collected in +a heparinized vacuette for the separation of peripheral +blood lymphocytes, 2 ml in a sodium citrate vacuette for +plasma and 2 ml in a plain vacuette for serum. +Blood cell separation: Peripheral Blood Lymphocytes +were isolated from 7 ml of heparinized blood using ficoll +gradients (Histopaque 1077 R, Sigma Inc.). The isolated +lymphocytes were then washed in phosphate-buffered +saline (PBS), treated with 4% glacial acetic acid to lyse +the red blood cells (RBCs) and again washed with PBS. +The lymphocytes were then counted on a hemocytometer/ +coulter counter and diluted at concentration of 50,000 +cells/ml in Tris-buffered saline (TBS). Thereafter, the +cell suspension was centrifuged and the cells fixed on +the slides using an acetone-methanol medium. The NK +Cell count was determined by immunohistochemistry +using the standard Alkaline Phosphatase Anti-Alkaline +Phosphatase technique (APAAP). Briefly, the cells fixed +on the slides were treated with an anti-CD56 antibody +(DAKO Cytomation) and then with a secondary antibody +conjugated with APAAP +. Cells with the CD56 surface +antigen bound to these antibodies and took up the fast red +stain giving a red glow over the periphery. The cells were +counterstained with hematoxylin. Only those cells which +took up the fast red stain and had pink to red stained +edges were counted as CD56-positive cells as against +others, which took up only hematoxylin and appeared +blue. The cells were counted in two hundred fields and +the mean percentage of CD56-positive cells per hundred +fields extrapolated. Serum Immunoglobulins (IgG, IgM +and IgA) were assessed using an Immunoturbidometry +assay with an autoanalyzer. +Interventions +The intervention group received an “integrated yoga +program” and the control group received “supportive +counseling and exercise rehabilitation.” While the +goals of the yoga intervention were stress reduction +and improvement in shoulder mobility, the goals of the +control intervention were to reinforce social support +and prevent shoulder restriction. The yoga intervention +consisted of a set of breathing exercises, pranayama +(voluntarily regulated nostril breathing) and yogic +relaxation techniques. These practices were based on the +principles of attention diversion and relaxation to cope +with day-to-day stressful experiences. These sessions were +administered by an instructor at the subjects’ bedside prior +to surgery and during their postoperative recuperation +in the hospital. Following their discharge, subjects were +asked to practise at home for the next four weeks. Subjects +were also provided audiotapes of an instructor’s voice to +help them practise at home so that a familiar voice could +be heard on the cassette. Their practice was monitored on +a day-to-day basis by their instructor through telephone +calls once a week. Subjects were encouraged to maintain +a daily log listing the yoga practices done, use of audio- +visual aids for practice, duration of practice, experience +of distressing symptoms, intake of medication and diet +history. +Supportive counseling sessions as control intervention +included two important components: “i) education and +reinforcing social support and ii) shoulder exercise for +postoperative rehabilitation.” We chose to have this as +a control intervention to prevent shoulder restriction +and to control for any nonspecific effects of the yoga +program that may be associated with adjustment such as +attention, support and a sense of control. Moreover, these +interventions have been shown to hasten recovery from +surgery in earlier studies.[22,24] +Subjects and their caretakers were invited to participate in +an introductory session lasting 60 minutes before surgery +where they were given information about surgery and +management of its related side effects, taught shoulder +exercises and mobilization by the physiotherapist +and provided information about a variety of common +questions. The interventions were imparted at the +patient’s bedside and subjects were asked to perform the +shoulder exercises at their home following their discharge +Rao R M, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +15 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Table 1: Demographic characteristics + +All subjects +Yoga group +Control group + +n +(%) +n +(%) +n +(%) +Stage of breast cancer + + + + + +II +31 +45 +17 +54.83 +14 +45.16 +III +38 +55 +16 +42.1 +22 +57.89 +Grade of breast cancer + + + + + +I +1 +1 +1 +100 +0 +0 +II +8 +12 +6 +75 +2 +25 +III +60 +87 +26 +43 +34 +57 +Menopausal status + + + + + +Pre +33 +48 +20 +61 +13 +39 +Post +33 +48 +11 +33 +22 +67 +Peri +1 +1 +1 +100 +0 +0 +Posthysterectomy +2 +3 +1 +50 +1 +50 +Type of surgery + + + + + +Mastectomy +52 +75.4 +24 +53.8 +28 +46.2 +Breast conservation +17 +24.6 +9 +47.1 +8 +52.9 +Stressful life events in the past two years +Yes +19 +28 +8 +42 +11 +58 +No +50 +72 +25 +50 +25 +50 +Control group: supportive therapy group +until they receive adjuvant therapy. Both groups received +four such in-person sessions of intervention during their +hospital stay. +Data analysis +Data was analyzed using SPSS 10.0 for windows. Data +was tested for normality and homogeneity. An analysis +of covariance was done on all assessments 3–4 weeks +postsurgery using their respective baseline (presurgery) +measures as covariates. The within-groups effects was +analyzed using a paired t test. +RESULTS +The age, stages of disease, grade and node status were +similar in the yoga and supportive therapy (control) groups +[Table 1]. The mean years of education of the study sample +was 12.49 ± 2.67 years, with a minimum of seven years and +a maximum of 17 years of education. The mean overall +age of the subjects was 49.2 ± 9.6 years in both groups. All +subjects had adequate nutritional status with the majority +of them having a body mass index (BMI) between 19–25 +(57%) and the rest above 25 (43%). +Psychological outcomes +Measures of mood [Table 2] +Participants reported high levels of anxiety at baseline +(before surgery). A paired samples t test done to assess the +changes in anxiety state following surgery within groups +showed a significant decrease in anxiety state following +surgery in both control [t (35) = 6.69, P < 0.001,95% +confidence interval, CI (4.9 to 10.6)] and yoga groups +[t (32) = 6.41, P < 0.001, 95% CI (7.6 to 14.3]. Analysis +of covariance using baseline anxiety states as a covariate +showed a significant decrease in anxiety states following +surgery [F (66) = 4.22, P = 0.04, 95%CI (-5.6 to -0.3)], in +the yoga group as compared to controls. STAI trait scores +were initially high in the period between diagnosis and +surgery. A paired samples t test done to assess the changes +in the anxiety trait following surgery within groups +showed a significant decrease in the anxiety trait following +surgery in both control [t (35) = 5.50, P < 0.001, 95% CI +(4.9 to 10.6) ] and yoga groups [t (32) = 6.1, P < 0.001, +95% CI (5.8 to 11.7) ]. ANCOVA using baseline anxiety +trait score showed significant decrease in the anxiety trait +scores following surgery, [F (66) = 9.8, P = 0.002, 95% +CI (-7.2 to -1.7)]. There was no significant within-group +differences following surgery in the depression scores. +Analysis of covariance using baseline depression scores +as a covariate showed a significant decrease in depression +following surgery [F (66) = 7.6, P = 0.008, 95% CI (-4.6 +to -0.73)]. +Measures of quality of life and stress symptoms [Table 3] +A paired samples t test showed a significant decrease +in distress in the yoga group alone following surgery +[t (32) = 2.1, P = 0.05, 95% CI (0.006 to 5.7)]. There was +a significant decrease in symptom severity [F (66) = 12.8, +P = 0.001, 95% CI (-5.1 to 1.4)] and distress [F (66) = +13.6, P < 0.01, 95% CI (-6.3 to -1.8)] in the yoga group as +compared to the controls following surgery. There was +no significant within-group differences following surgery +in the quality of life scores. Analysis of covariance using +baseline quality of life scores as a covariate showed +significant improvements in quality of life following +Yoga in breast cancer surgery +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +16 +Table 3: Comparison of number, severity and distress +of symptoms on symptom checklist in yoga and control +groups following surgery using paired t test and ANCOVA +Outcome measures +Presurgery +Postsurgery + +Y (n = 33), + +C (n = 36) +Number of Symptoms +Yoga +Mean ± (S.D) +8.2 ± 3.5 +7.5 ± 2 +Control +Mean ± (S.D) +9.1 ± 4.2 +8.8 ± 2.5 +⇕Adjusted mean (y-c) +(95% CI) +-2.79 +-5.5 to 0.079 +Severity of symptoms +Yoga +Mean± (S.D) +11.7 ± 6.7 +10.8 ± 3.6 +Control +Mean± (S.D) +15.6 ± 8.6 +15.3 ± 5.1 +⇕Adjusted mean (y-c) +(95% CI) + +-4.24** + + +-7.0 to -1.4 +Symptom distress +Yoga +Mean (S.D) +14.4 ± 8.7 +11.5 ± 4.2* +Control +Mean (S.D) +16.9 ± 9.8 +16.3 ± 6.0 +⇕ Adjusted mean (y-c) + +-2.63** +(95% CI) + +-4.6 to -0.65 +*P < 0.05, ** P < 0.01, *** P < 0.001, y = Yoga, c = Control / +Supportive therapy group +P values for paired t test in yoga and control groups +⇕ Posttest scores (y-c) adjusted for their baseline scores between yoga and +control groups with 95% CI and using ANCOVA for P values. +Table 2: Comparison of anxiety state and trait, +depression and quality of life scores in yoga and control +groups following surgery using paired t test and ANCOVA +Outcome measures +Presurgery +Postsurgery + +Y (n = 33), + +C (n = 36) +STAI-Anxiety state Scores +Yoga +Mean ± SD (standard deviation) 44.2 ± 10.9 +34.0 ± 3.9** +Control +Mean ± SD +49.6 ± 12.0 +38.4 ± 8.1 +⇕Adjusted mean (y-c) + +-2.79 +(95% CI) + +-5.5 to 0.079 +STAI-Anxiety Trait Scores +Yoga +Mean ± SD +42.8 ± 9.8 +33.4 ± 4.4** +Control +Mean ± SD +47.4 ± 11.6 +40.3 ± 8.7 +⇕Adjusted mean (y-c) + +-4.24** +(95% CI) + +-7.0 to -1.4 +Beck’s Depression Scores +Yoga +Mean ± S.D +12.1 ± 6.4 +11.6 ± 4.5 +Control +Mean ± S.D +15.1 ± 7.3 +15.1 ± 5.3 +⇕Adjusted mean (y-c) + +-2.63** +(95% CI) + +-4.6 to -0.65 +FLIC Quality of Life Scores +Yoga +Mean ± S.D +109.8 ± 21.5 107.6 ± 13.1** +Control +Mean ± S.D +100.7 ± 17.4 +92.7 ± 17 +⇕Adjusted mean (y-c) +(95% CI) + +11.82*** + + +5.1 to 18.5 +*P < 0.05, **P < 0.01, ***P < 0.001, y = Yoga, c = Control/ Supportive +therapy group +P values for paired t test in yoga and control groups +⇕ Posttest scores (y-c) adjusted for their baseline scores between yoga and +control groups with 95% CI and using ANCOVA for P values +surgery [F(66) = 12.34, P = 0.01, 95% CI (4.7 to 19.8)] in +the yoga group as compared to the controls. +Immune measures +Serum immunoglobulins [Table 4] +Subjects’ serum samples were assessed for Immunoglobulins +G, M and A at baseline following surgery. A paired +samples t test showed a significant increase in IgA levels +following surgery in the control group [t (32) = -3.2, P = +0.005, 95% CI (-1.1 to -0.21] but no significant changes +in the yoga group. Analysis of covariance using the +baseline presurgery measure as a covariate also showed a +significant decrease in IgA levels following surgery in the +yoga group [F (62)=10.21, P =0.001] as compared to the +controls. There was no significant within- and between- +group changes in IgM and IgG levels. +Lymphocyte subsets [Table 5] +T Lymphocyte subsets such as CD4+, CD8+ and CD56+ +% were assessed before and after four weeks after surgery. +A paired samples t test done to assess the changes in CD56 +% following surgery within groups showed a significant +decrease in CD56 % following surgery in the control group +[t (32) = 3.57, P = 0.001), 95% CI (1.85 to 6.76)] but not +in the yoga group. Analysis of variance done on these +post- measures using the baseline measure of CD56 % as +a covariate showed significantly higher levels of CD56 +% in the yoga group following surgery [F (62) = 5.78, +P = 0.019] as compared to the controls. A paired samples +t test done to assess the changes in CD4 % following +surgery within groups showed a significant decrease in +CD4 % counts following surgery in the control group +[t (35)= 3.31, P = 0.002, 95% CI (1.62 to 6.72)] but not in +the yoga group. Analysis of variance on post- measures +using baseline measures of CD4 % as a covariate did not +show any significant changes between groups following +surgery. A paired samples t test done to assess the changes +in CD8 % following surgery within groups showed a +significant decrease in CD8 % following surgery in the +control group [t (34) = 3.46, P = 0.001, 95% CI (1.64 to +Rao R M, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +17 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Table 5: Comparison of Lymphocyte subsets CD4, CD8 +and CD56 % populations in yoga and control groups +following surgery using paired t test and ANCOVA +Outcome measures +Lymphocyte subsets in % +Presurgery +Postsurgery +CD4+ counts in % +Yoga mean ± (S.D) +38.9 ± 6.1 +35.3 ± 6.4* +Control mean ± (S.D) +38.3 ± 6 +34.8 ± 5.1* +⇕Adjusted mean change scores (y-c) +(95% CI) + +0.5 ± 1.4 + + +-2.3 to 3.3 +CD8+ counts in % +Yoga mean ± (S.D) +35 ± 5.9 +33.1 ± 4.7 +Control mean ± (S.D) +35.8 ± 6.6 +32.1 ± 5.1** +⇕Adjusted mean change scores (y-c) +(95% CI) + +1.3 ± 1.2 + + +-1.1 to 3.6 +CD56+ counts in % +Yoga mean (S.D) +19.7 ± 6.8 +20.4 ± 4.9 +Control mean (S.D) +21.8 ± 8.4 +17.5 ± 4.3** +⇕ Adjusted mean change scores (y-c) + +2.8 ± 1.2 * +(95% CI) + +0.4 to 5.1 +*P < 0.05, **P < 0.01, ***P < 0.001, y = Yoga, c = Control/Supportive +therapy group +P values for paired t test in yoga and control groups +⇕ Posttest scores (y-c) adjusted for their baseline scores between yoga and +control groups with 95% CI and using ANCOVA for P values. +Table 4: Comparison of serum immunoglobulins IgG, +IgA and IgM levels (g/L) in yoga and control groups +following surgery using paired t test and ANCOVA +Outcome measures +Presurgery +Postsurgery +Serum immunoglobulin G +Yoga mean ± (S.D) +5.6 ± 3.6 +5.9 ± 3.8 +Control mean ± (S.D) +5.1 ± 2.9 +7.3 ± 5.2* +⇕Adjusted mean change scores (y-c) +(95% CI) + +-1.5 ± 1.1 + + +-3.6 to 0.69 +Serum immunoglobulin M +Yoga mean ± (S.D) +0.8 ± 0.5 +0.9 ± 0.7 +Control mean ± (S.D) +0.8 ± 0.5 +1.0 ± 0.7 +⇕Adjusted mean change scores (y-c) + (95% CI) + +-0.2 ± 0.2 + + +-0.5 to 0.2 +Serum immunoglobulin A +Yoga 33 mean ± (S.D) +1.1 ± 0.95 +1.13 ± 0.7 +Control 32 mean ± (S.D) +1.2 ± 1.05 +1.84 ± 1.23** +⇕Adjusted mean change scores (y-c) +(95% CI) + +-0.765 ± 0.24** + + +-1.24 to -0.29 +*P < 0.05, **P < 0.01, ***P < 0.001, y = Yoga, c = Control/Supportive +therapy group +P values for paired t test in yoga and control groups +⇕ Posttest scores (y-c) adjusted for their baseline scores between yoga and +control groups with 95% CI and using ANCOVA for P values. +6.30)] but not in the yoga group. Analysis of variance on +this post- measure using the baseline measure of CD8 % as +a covariate did not show any significant changes between +groups following surgery. +DISCUSSION +The results suggest a significant decrease in psychological +morbidity such as anxiety state and trait, depression, +treatment-related symptoms and improvement in the +quality of life in the yoga group as compared to the +controls following surgery. There was also a significantly +lower decrease in CD56 % in the yoga group as compared +to the controls and lower levels of serum IgA in the yoga +group as compared to controls postoperatively. However, +there was a significant decrease in CD4, CD8 and CD56 +% in the control group alone following surgery. +Although studies have shown various stress reduction +interventions to modulate serum IgA levels and lymphocyte +subsets in individuals, the fact that yoga helped decrease +IgA levels postoperatively could be confounded by the +heterogeneity in the extent of disease, type of surgery and +disease stage among the groups. This is because earlier +studies have shown that the tumor load is directly related +to the serum IgA levels in breast cancer patients.[46] On +the contrary, it can also be argued that yoga also helped +reduce stress and improved anti-tumor immune responses +that could have facilitated this change. +Although there is a dearth of literature using yoga +interventions postsurgery, the beneficial effects conferred +by similar stress reduction interventions nevertheless +support our findings.[25,47] Psychotherapeutic intervention +studies have used a number of diverse strategies which +have positively affected immune function including +hypnosis, relaxation, exercise, classical conditioning, +self-disclosure, exposure to a phobic stressor to enhance +perceived coping self-efficacy and cognitive-behavioral +therapies.[20] A variety of hypnotic-relaxation intervention +appear to shorten hospital stays, decrease pain and +promote faster recovery following surgery[48] and most +are brief, often single sessions and many involve taped +suggestions. For example, 241 patients undergoing a +stressful medical procedure were randomized to receive +peri-operative standard care, structured attention or self- +hypnotic relaxation. Self-hypnotic relaxation patients +showed decreased pain and anxiety, lower use of self- +administered pain medication, shorter procedure times +and less hemodynamic instability than the other two +groups.[49] These group differences were particularly +impressive in view of the brevity of the intervention and +the presumed heterogeneity of the patients’ hypnotizable +abilities. Another study showed that greater increases in +relaxation in response to the intervention were associated +with higher NK cell numbers and activity in healthy +students taking medical exams.[50] +In contrast to the above relatively mild and predictable +stress of examinations, breast cancer surgery is a high- +Yoga in breast cancer surgery +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +18 +Rao R M, et al. +stakes stressor with possible consequences that include +death, pain, disfigurement, economic losses, alteration +in social roles and uncertainty about the outcome.[24] +Similar to other studies,[51] patients in our study displayed +heightened anxiety prior to surgery and heightened +distress persisting in the postoperative period. Studies +have shown that if these stressors are perceived as +uncontrollable and unpredictable, they can continue to +be associated with elevated stress hormones.[52] Studies in +both animal models and humans have shown elevations +in plasma levels of epinephrine and cortisol to reflect +sympathetic nervous system activation and hypothalamo- +pituitary axis activation.[53,54] Coincidentally, such +activation is also known to suppress NK cell activity,[15] +reduce lymphocyte proliferative responses to mitogens and +bring about changes in lymphocyte subpopulations such +as NK cell counts.[55] Such immune suppression following +surgery in cancer patients has also been implicated in +the promotion of metastasis via numerous mechanisms +including the suppression of natural killer cell activity and +counts by stress hormones.[16,56] The ability to “unwind” +after stressful encounters, i.e., a quicker return to one’s +neuroendocrine baseline, influences the total burden +that the stressors place on the individual.[57] Earlier +studies have advocated that interventions promoting +early adaptation can produce substantial benefits for +mental and physical health.[53] Our intervention was +helpful in reducing postoperative distress and anxiety +and also helped improve immune responses in terms +of changes in lymphocyte subpopulations such as CD4 +and CD8% and NK cell counts postoperatively indicating +that it helped promote adaptation to this stressor. The +changes in lymphocyte subpopulations seen with yoga +interventions could be attributed to stress reduction +effects and adaptation to the stress of surgery that could +have facilitated a decrease in postoperative distress +and consequent improvement in immune outcomes. +Catecholamines and glucocorticoids have been shown to +rapidly and markedly affect the distribution of NK cells +among different immune compartments (e.g., spleen, +liver, lungs, circulating blood, marginating pool of blood, +etc)[58,59] and it may be hypothesized that changes in these +hormone levels could be one of the mechanisms of action +of our intervention. +Our study however, has several limitations: i) we assessed +only NK cell number and T lymphocyte subsets and +not NK cell function or T lymphocyte function, thereby +studying the effect of stress on immune cell trafficking +rather than immune cell function. ii) We assessed CD4, +CD8 and NK cell % by immunohistochemistry as opposed +to fluorescence-activated cell sorting (FACS) and this is +a major limitation of our study. The tests were run in +duplicate by a single observer and quality control was +maintained by cross-verifying the NK cell counts with +FACS for standardization purposes. Our values of NK cells +in % are similar to earlier findings.[60,61] iii) As patients in +this study were those who were enrolled to participate in +a trial using yoga and supportive therapy intervention, it +will be worthwhile to speculate that cancer patients who +seek psychosocial interventions and care are different +from those who don’t in terms of psychological distress +and immune outcomes.[62] Consequently, meta-analyses +has shown that these groups would also benefit more from +such interventions,[63] thereby limiting the generalizability +of our findings. +The stress reduction and immune-enhancing benefits +conferred by our intervention could have implications +for breast cancer patients who have to endure long-term +treatments that could cause more distress and immune +suppression.[64] Although studies support the fact that +even brief stress reduction interventions can have possible +clinical benefits,[22] it remains to be seen if these benefits +can be sustained significantly over a period. Although our +study did not show any functional changes in immune +responses (lymphocyte proliferation in response to +antigens or NK cell activity), it nevertheless supports a +trend for the prevention of immune suppression in terms +of cell trafficking and counts. However, larger controlled +trials with more advanced measures of immune function +are needed to study the immediate effects of yoga +intervention on surgery outcomes. +ACKNOWLEDGMENTS +This research was supported by a grant from the Central Council +for Research in Yoga and Naturopathy, Ministry of Health and +Family Welfare, Govt. of India. We are thankful to Dr. Jayashree and +Mrs. Anupama for imparting the yoga intervention. +REFERENCES +1. +Deane KA, Degner LF. Information needs, uncertainty and anxiety in women +who had a breast biopsy with benign outcome. Cancer Nursing 1998;21: +117-26. +2. +Hughson AV, Cooper AF, McArdle CS, Smith DC. Psychosocial morbidity +in patients awaiting breast biopsy. 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Is the wish to participate +Rao R M, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] diff --git a/subfolder_0/Integrated yoga therapy for mastalgia.txt b/subfolder_0/Integrated yoga therapy for mastalgia.txt new file mode 100644 index 0000000000000000000000000000000000000000..276a14a4571e374f2ec304f0bb534b0ce310a41c --- /dev/null +++ b/subfolder_0/Integrated yoga therapy for mastalgia.txt @@ -0,0 +1,1171 @@ +International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 +162 +Access this article online +Website: http://www.ijmsph.com +Quick Response Code: +DOI: 10.5455/ijmsph.2016.18122015291 +Review Article +Integrated yoga therapy for mastalgia +Raghunath Sukanya1, Raghuram Nagarathna1, Ravi Sandhya2, Hongasandra Ramarao Nagendra1 +1Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, (SVYASA), Bengaluru, Karnataka, India. +2Prameya wellness centre, Bengaluru, Karnataka, India. +Correspondence to: Raghunath Sukanya, E-mail: rnagaratna@gmail.com +Received December 18, 2015. Accepted December 28, 2015 +Mastalgia has neither an organic etiology nor any definitive treatment, which affects women’s quality of life during their +reproductive lives. Considering mastalgia as one of the psychosomatic disorder, mind–body interventions such as yoga +would play an important role. This review is an effort to give a yogic concept in understanding the anatomy and physiol­ +ogy of the subtle aspects of human mind–body system that helps us to understand the imbalances that lead to evolution +of chronic lifestyle-related diseases and their pathophysiology in a totally different perspective, which can help modern +science to unravel some of the mysteries behind lifestyle problems. +KEY WORDS: Yoga therapy, mastalgia, quality of life +Abstract +International Journal of Medical Science and Public Health Online 2016. © 2016 Raghunath Sukanya. This is an Open Access article distributed under the terms of the Creative + +Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format +and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. +of estrogen, progestin, and prolactin. Acyclic mastalgia (ACM) +is more recurrent or severe, hampers daily activities, and + +accounts for about 30% of BP.[4] Little is known about the cause +of ACM. BP with or without a tender palpable swelling and nod­ +ularity (fibrocystic disease) seeks greater attention because of +the anxiety and fear about the risk of getting breast cancer.[4] +It is important to study its high prevalence and its potential to +become benign to malignant.[4] +Prevalence of Mastalgia and Fibrocystic +Disease of the Breast: India and Global +The prevalence of mastalgia happens to differ extensively + +in various countries. In the United Studies, two studies on +adult people recorded prevalence rates of 68%[5] and 11% for +CM.[6] However, in Canada and United Kingdom, it is recorded +as 51.5% and 32%, respectively.[7] The prevelance rates in +India happen to be identical, with a recorded prevelance of +51%[8] to 54%[9] in an adult urban population. +Etiology +Although the etiology of mastalgia is not clearly understood, +several contributory factors have been reported. Imbalance + +in estrogen and progesterone hormones, prolactin,[10] thyroid- +stimulating hormone,[11] abnormalities of lipid metabolism,[12] +age,[2] premenstrual syndrome,[5] stress (anxiety, depression, +and childhood abuse),[13] duct ecstasies,[14] smoking,[15] and +caffeine[16] have all been implicated [Figure 1]. +Introduction +Mastalgia or breast pain (BP) is a common breast disorder +with highly variable prevalence estimates ranging from 41% +to 79%. Mastalgia is generally nonthreatening, but the anxiety + +of underlying breast cancer is the cause for women to + +approach evaluation. A thorough clinical evaluation is required +to assess the cause.[1,2] +Mastalgia in young women is associated with anxiety and +depression, thereby brings down the quality of life (QOL). + +We get the description of mastalgia (BP) in medical history +from 1829. +Most of the women experience various breast symptoms, +i.e., swelling and tenderness, nodularity, pain, palpable lumps, +nipple discharge, or breast infections and inflammation; most +of the cases will be benign. +Cyclical mastalgia (CM) or mastodynia typically occurs +every month before the start of the menstrual period and is +relieved within 7 days of the onset of menses.[3] Approximately +40%–70% of BP is cyclic and is related to hormonal cycling +International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 +Sukanya et al.: Integrated yoga therapy for mastalgia +163 +Pathophysiology of Mastalgia +Mastalgia: a Psychoneuroendocrine Disorder +Increased sensitivity to catecholamines and pituitary hyper­ +prolactinemia owing to inappropriate dopaminergic tone + +(decreased baseline dopamine levels in blood was found in +studies) results in BP [Figure 2]. +Mastalgia may be associated with an upward change in +the circadian prolactin profile, a probable downward change +in menstrual profiles, and loss of seasonal deviations. In addi­ +tion, patients with mastalgia reveal a intensified prolactin + +secretion in response to thyrotrophic-releasing hormone anti­ +dopaminergic drugs and may sequester iodine in an active +manner in their breast tissue owing to a change in prolactin + +control [Figure 1]. In addition, stress can cause a rise in prol­ +actin response.[17] +Stress and Mastalgia +It is well established that psychological stress plays a major + +role in the cause of mastalgia,[18,19] and severe mastalgia is rela­ +ted to increased levels of psychological distress.[20] Psychological +stress causes mastalgia and, in turn, affects the patients’ QOL + +negatively. Depression and anxiety are the other important + +psychological disturbances in patients with mastalgia.[18] +Studies have shown that acute stressors may have a +stimul­ +ating effect on the immune system, while in the case +of chronic stress (and, in particular, in depression), the imm­ +une system may be downregulated.[21] It is assumed that the +stress-induced neuroendocrine hormones cause immune + +deregulation. +Recently proposed theories suggested that stressors induce +cognitive and affective responses activating the sympathetic + +nervous system and endocrine variations (corticotrophin- +releasing hormone, epinephrine, norepinephrine, adrenaline +among others), which could result in troubled physiological +functions through the hypothalamic–pituitary (HP)–adrenal, + +sympathoadrenal–medullary, and HP–gonadal axes.[22] +Normal breast function is a balance between estrogen and +progesterone, which is a part of the neuroendocrine control +exerted by the HP-gonadal axis. Normally, estrogen induces + +prolactin release by increasing the dopaminergic tone centrally. + +But, it is postulated that this tone is impaired in patients +with mastalgia. Decreased baseline dopamine levels and + +increased catecholamines have been seen in studies in + +patients with CM and ACM. Catecholamines may be released +owing to dietary factors or stress, resulting in altered abnor­ +mal sensitivity of the breast tissue. Recent studies point to +a prolactin (PRL) secretary hypersensitivity for estradiol in + +patients with CM. +Studies suggest that there is a subtle hormonal imbalance +in the HP axis. The hypothalamus–pituitary component is the +major governing part of the whole endocrine system. Normal +breast function is a balance between estrogen and progesterone + +levels, which is a part of the neuroendocrine control exerted +by the HP-gonadal axis. +Management of Mastalgia +Treatment strategies have varied from hormonal to nonhor­ +monal, from reassurance[23] or relaxation therapies to other non­ +drug therapies such as vitamin E, vitamin B6, evening primrose +oil (EPO),[24] phytoestrogens, and herbs. +Drug Therapies +Drugs +such +as +progesterone +creams, +NSAIDs, +tamoxifen,[25,28] +danazol,[26] bromocriptine[27] and centchroman,[18–22], goserelin, + +gonadotropin-releasing hormone agonists,[30] and centchro­ +man,[24,26,31] have all been tried. Usage of all these drugs has +been shown to exert minor or major side effects. +Mind–Body Interventions for Mastalgia +As there is no known organic etiology for mastalgia and +the main cause appears to be psychosomatic, it appears that + +mind–body interventions would play an important role. It is + +reported that cognitive behavioral therapy remarkably decreases +the complaints of majority of the mastalgia patients.[13] +Need for the Study +Yoga has been extensively used as one of the mind–body +interventions and has shown beneficial effects in reducing +pain,[32] anxiety,[33] and depression.[34] It can be hypothesized + +that it would lead to a reduction/normalization of sympathetic +nervous system/HP axis activation. In a systematic review + +that looked at the role of yoga in pain management, nine rand­ +omized-controlled trials (RCTs) have shown yoga intervention +exhibits beneficial effects in reducing pain in any part of the +body when compared with the control interventions.[35] Yoga is +also found to reduce back pain,[36–38] headache, abdominal pain +during menstruation and other premenstrual symptoms,[39] +and different gynecological problems.[35,40,41] Pointing to the +benefits achieved by mind management techniques of yoga, it +has been found to be useful in decreasing stress,[42–45] stress, +and inflammation[44] and in increasing self-esteem,[46] positive +affect, and wellness.[47] +Yoga as a Therapy +Yoga, which is known to be an effective mind–body inter­ +vention for stress management,[33,34,41,42,44,48–50] has not been +tried in women with mastalgia. +Literature Review of Published Works Related +to CAM therapies in Mastalgia +Summary of studies done in the past decade on different +complementary and alternative therapies including supplements, + +herbal, diet, acupuncture, and psychoeducation in treating +mastalgia is tabulated in Table 1. +Sukanya et al.: Integrated yoga therapy for mastalgia +International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 +164 +The effects of yoga on psychological aspects (anxiety, + +depression, stress, and QOL) have been studied from past +several years. Summary of a few recent studies has been given +in Table 2. +Studies including RCTs over a past decade have shown +that yoga practices can result in improving psychological +aspects, lowering the anxiety, depression, and stress level, +improving QOL, lowering the sympathetic and inflammatory +activities, and increasing parasympathetic tone. Hence, we +have strong evidence that yoga helps in the management of + +stress. Studies have revealed that yoga alters the physiological +responses to stressors by enhancing autonomic stability with +better parasympathetic tone in normal adults.[51] +It is proved that CM results owing to a dormant stress- +induced hormonal imbalance as specified by hyperprolac­ +tinemia.[52] It is observed that patients with CM and ACM show +increased catecholamines and decreased baseline dopamine +level, which suggests that catecholamines may be released +owing to stress, resulting in altered abnormal sensitivity of the + +breast tissue.[53] Yoga may improve the QOL by promoting + +voluntary reduction in violence and aggressiveness.[54] Mastery +over the emotional responses of anxiety[21] or depression[55] +is attained via relaxing awareness during all the practices in +general and meditation in particular.[56] Kundalini yoga is found + +to be beneficial in cases of depression. It stimulates the various +autonomic nerve plexus (chakras) and activates pineal organ, +which in turn brings homeostasis between sympathetic and + +parasympathetic activities.[57] This mastery over emotional + +surges leads to controlled and need-based physiological +responses that may reduce the overtones of HP–adrenalin + +axis[58] during chronic pain. Yoga has an influence on the + +HP–adrenalin axis as evidenced by a reduction in cortisol levels +in normal[59] and sick individuals.[49,50] +This article has given a flow chart of how stress is corr­ +ected based on yogic concepts. Ancient Indian manuscripts +courting back to about 5,000 years (Rig Veda, Patañjali +Yoga Sutra, and ayurveda) offer a extremely evolved the­ +oretical basis for the etiopathogenesis of disease and its +management. +Literature Review of Yogic Texts and Yoga +Studies +Integrated Approach of Yoga Therapy (IAYT) for Mastalgia +The IAYT repairs and restores the system into balance at + +all five levels of one’s existence. The Pancakośa concept given +in the Taittirīya Upaniṣad forms a model of the total structure +of a human being [Figure 2]. It brings a deep understanding +of the relationship between a human being and all aspects of +his or her experience. This theme of relationship is fitting as +we glimpse into the fifth layer of the five bodies, Änandamaya +kosha, to gain an understanding of its properties in relation to +health. Understanding the mechanisms behind such reversal +by yoga requires considering the subject in the terminology +specified in the field of study. +Yoga therapy techniques are based on the principle of + +mind–body medicine that includes: (a) the concept of five + +aspects of one’s personality, called the Pañcakoça viveka +(Taitriya Upaniṣad), (b) yogic definition of stress (Bhagavad-Gita) + +as kleças (Patañjali Yoga Sutra), and (c) progression of a +mind–body illness from mind to the body as vyādhi or disease +through intermediation of prāņa (Yoga Vāsiṣtha). +The Pañcakoça viveka explains the anatomy and physi­ +ology of the subtle aspects of human mind–body system that +helps us to understand the imbalances that lead to evolution +of chronic lifestyle-related diseases and their pathophysiology + +in a totally different perspective, which can help modern science +to unravel some of the mysteries behind lifestyle problems. + +These five aspects are: (a) Annamaya Kosha (sheath of + +physical body that is composed of all the molecules of gross +elements); (b) Pränamaya Kosha (the subtle energy that is +at the base of all cellular activities); (c) Manomaya Kosha +(sheath of mind/emotion), (d) Vigïänamaya Kosha (sheath of +intellect); and (e) Änandamaya Kosha (sheath of bliss). +The Origin and Scope of Yoga +Yoga is a rich traditional contribution from India to humanity, + +which starts with introspection/inner mindfulness.[47] Yoga + +includes diverse practices, such as physical postures (asanas), + +regulated breathing (Prāņāyāma), meditation, and several + +concepts for cognitive change.[47] The benefits of yoga in impro­ +ving muscle strength, flexibility, blood circulation and oxygen + +intake and hormone functions at the gross level are well + +documented.[46] Meditation has been defined as teaching in +consciousness that induces definite alterations in perception, + +attention, and cognition[59] and, thus, aid in decreasing stress,[44] +depression,[60] and anxiety.[33] +Yoga, which is a way of life, is the need of the hour in +all fields of human endeavor. The scope of yoga is extended +to bring about changes in the lifestyle, which is at the base +of prevention and treatment of noncommunicable diseases. +Yoga for promotion of positive health is being nurtured by +many who do not want to be the victims of modern ailments. +The term “Yoga” comes from a Sanskrit word “Yuj” meaning + +“to join.” Yoga is a technique of joining the individual con­ +sciousness with universal consciousness,[61] which expands +the limited view of the world around. +The Concept of Stress, According to Modern +Science and Yogic Scriptures +According to modern science, stress is defined as + +“a phylogenetic, nonspecific, conventional basic response +pattern to any demanding situation.”[62] Several physiological +changes occur when exposed to life-threatening physically +demanding situations that help the system for fight or flight. + +Although this does cause a temporary imbalance in the metabolic +processes that may drain out the useful chemicals and generate + +International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 +Sukanya et al.: Integrated yoga therapy for mastalgia +165 +many endotoxins, the system has enormous capacity to + +restore the balance by detoxification, repair, and rejuvenation. +The responses are similar when the demanding situations are +physical or emotional, and the system can restore to normalcy +over a period of time. But, when the situations become chronic +and does not give time for restoring normalcy before taking +up the next challenge, the system is forced to reset itself at a +different level, the imbalance continues, and normalcy is lost; +this long-standing imbalance leads to an illness through accu­ +mulation of endotoxins (free radicals, etc.). Thus, disease is a +habituated disturbed pattern of response.[63] +Yoga, a science of introspection/internal awareness/mind­ +fulness, takes us one more step to analyze the mental pro­ +cesses during stress response. All stress responses begin in +the mind as intense fear, anger, or depression; all are intense +emotional surges; in all these emotional surges, the thoughts + +in the mind go on rewinding at uncontrollable speed; this gathers +enough energy to bring about all the physiological changes. +Thus, stress according to yoga is “persistent uncontrolled +speeded up repetitive thoughts in the mind.” Yoga teaches +the process of slowing down the flow of thoughts, which is the +technique to manage stress. +Mechanism of Mind–Body Disease (Ādhija +Vyādhi) According to Yoga (Vāsiṣtha Model) +In accordance with the yoga manuscript, Yoga Vāsiṣtha, +“all diseases can be classified as ādhija or Anādhija. Ādhija +Vyādhi (stress/mind born disease) is due to ādhi (stress); it +begins as an internal by disturbances at the mind level. On +the other hand, the Anādhija vyādhi is not due to ādhi (stress); +they are caused by external causes such as infections, toxins, +injuries etc.” +Although the etiology of mastalgia is unclear, it is clear that +this is not owing to any infection, injury, or toxins (not Anādhija +Vyadhi) and, hence, can be considered to be Ādhija Vyādhi +(noncommunicable lifestyle disease) [Figure 3]. +The root cause, the wrong lifestyle, results in stress that +begins in the Manomaya kośa (instinctual mental layer of human + +Table 1: List of literature review of CAM therapies in treating mastalgia +Citation details +Subjects and design +Intervention; assessments +Conclusion and critical analysis +Studies on supplements for mastalgia +1 +Goyal[27] +24 systematic reviews and RCTs +Evening primrose oil; low-fat, +high-carbohydrate diet, lisuride, or +vitamin E +Less efficacy; license banned in +USA; do not know the efficacy; very +few studies +2 +Carmichael[52] +Review RCTs, non-RCTs, cohort, +N = 1,992 (total) +Vitex agnus castus; Questionnaire: +VAS, HAM-D, DSR CGI-SI, and +DMS III-R +Effective in cyclical mastalgia; safe +side effect profile and can be used +3 +Romualdo et al[71] +91 subjects with cyclic mastalgia +900-mg borage oil capsules; +assessed by VAS +Scores of both the mean mastalgia +and most severe mastalgia showed +significant (p < 0.0001) reduction +4 +Saeed et al.[24] +Quasi-experimental, purposive; +N = 50: 25 danazol and 25 primrose +oil +Evening primrose oil assessment: +Cardiff Breast pain scale at 8, 12, +and 24 weeks +Danazol was more effective than +evening primrose oil +5 +Vaziri et al.; Int J +Fam Med 2014 +Three armed RCT; 61, flax seed +as bread; 60, omega-3 fatty acids +as pearl; and 60, wheat bread for +women +VAS after two menstrual cycles +Flax seed was more effective than +omega 3 fatty acid (p < 0.001) +6 +Allen and +Froberg[16] +Three armed RCT; single blind, +N = 56 with mastalgia. Experimen­ +tal, caffeine-free diet; control, no +dietary restriction; placebo, choles­ +terol-free diet +Caffeine-free diet +Decreased caffeine consumption did +not result in a significant reduction +of palpable breast nodules or in a +lessening of breast pain/tenderness +Nonpharmacological studies +7 +Lori[70] +N = 37; a pilot study, acupunc­ +ture. Treatment consisted of four +acupuncture sessions over 2 weeks, +with 3 months of follow-up +Reduction in pain intensity and pain +interference was demonstrated with­ +in one cycle through acupuncture +A randomized-controlled trial may +be warranted to evaluate the effect +of acupuncture on noncyclic breast +pain and the optimal frequency of +acupuncture treatments +8 +Yarkin; Appl Res +Qual Life 2013 +N = 98; mastalgia without organic +etiology. 66, psychoeducation PEG; +32, no psychoeducation +SF36 Health-Related Quality of +Life scale; VAS at baseline and 2 +months later +Psychoeducation was effective in +reducing pain and increasing the +quality of life +Sukanya et al.: Integrated yoga therapy for mastalgia +International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 +166 +Table 2: Summary of published articles in yoga and stress +S. No +Author +Design, subjects, and inter­ +vention +Results +Conclusion +1. +Vedamurthachar et al. +2006 +Subjects: 60 alcoholic +subjects—30, Sudarshan Kriya +Yoga (SKY); 30, control subjects; +60-min sessions, alternate days; +2 weeks +SKY group showed reduced +depression (BDI), plasma cortisol, +and ACTH more than control +subjects. Depression correlated +with cortisol in SKY group. +SKY reduces depression and +stress-hormone levels (cortisol +and ACTH) in alcoholic subjects +2. +Jiang et al. 2009 +Yoga, 3 times weekly (n = 30), +Yoga, once weekly (n = 30), and +control subjects (n = 30) female +college students; 8-week inter­ +vention; lgG level measured +Yoga increased IgG levels more +prominent in 3 times/week group +Yoga influences the immunity +(IgG levels) +3. +Gopal et al. 2011 +Yoga (n = 30), control subjects +(n = 30); first-year medical +students for 12 weeks. Heart +rate, respiratory rate, blood +pressure, stress, anxiety, serum +cortisol, IL-4, and IFN-g were +measured +Physiological measures increased +in control group but did not in +yoga group. Psychological stress +was very high in control group +but moderately high in yoga +group. Serum cortisol increased +and IFN-γ decreased less in +yoga group than in the control +group. Both groups showed +increased IL-4. +Yoga resists autonomic changes +and impairment of cellular +immunity seen during examination +stress +4. +Kariya et al. 2010 +Yoga (n = 255) for 16 weeks, +symptoms check list, physical +self-perception; serum immuno­ +globulin was measured +Somatization, personal relation­ +ship, and hostility decreased; +compulsion, anxiety, depression, +fear, and psychosis decreased; +serum IgM decreased +Yoga improves social health and +promotes immune changes +5. +Kumar and Pandya +2012 +Yoga (n = 80), control subjects +(n = 30); PG students 30 min/day +for 6 months; ESR was measured +ESR was lower in yoga group for +both male and female subjects +Yoga Nidra: nonspecific +inflammation +6. +Nidhi et al.[33] +RCT, N = 90, 12 weeks of yoga; +physical exercise for control +subjects. Anxiety level was +measured +Trait anxiety was significantly +lower +Anxiety reduced in yoga group. +p = 0.002 +7. +Kinser et al.[60] +N = 12, 8 weeks of gentle yoga. +Interpretive phenomenological +study. RCT mixed method study +Major depressive disorder (MDD) +came down. The main reason +was stress +Yoga served as a self-care +technique in MDD +8. +Rani et al.[42] +N = 50, enumeration sampling +technique +Modified stress assessment +scale +9. +Kiecolt-Glaser et al.[44] +N = 50, hatha yoga and treadmill +walk, to measure potential stress +reduction benefits and inflamma­ +tory and endocrine response +Novices’ average serum IL-6 +levels were 41% higher than +those of experts +Yoga significantly reduces cortisol +and inflammation +10. +Kiecolt-Glaser 2014 +Patients from 0 to III stage BC. +Yoga, n = 53; stretching, n = 54 +Improved QOL. Depression, +sleep quality, and fatigue meas­ +ured at 1, 3, and 6 months later +Yoga improved QOL and physio­ +logical changes associated with +XRT beyond the benefits of +simple stestching exercises +11. +Vadiraja et al.[49] +N = 88; 44 = yoga, 44 = supportive + +therapy. Stages II and III BC +patients undergoing radiotherapy +Reduction in anxiety, depression, +and stress level in yoga group +Yoga helps in reducing stress in +BC patients +International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 +Sukanya et al.: Integrated yoga therapy for mastalgia +167 +system). The persistent uncontrolled repetitive thoughts in the +mind during these chronic emotional surges of stress activate +the physiological responses at the body level. The texts say +that prāņa is the mediator that transfers the imbalances from +the mind to the body. Prāņa is the vital energy (vital force/ +bioenergy/subtle energy/life energy/chi) that carries out all + +activities in the physical body (annamaya kosha). When the mind +picks up enormous speed (Vega–udvega—the uncontrolled + +speed in upward direction), more prāna is activated to promote +heightened activity in all organs. Persistent excessive prāna + +flow to an organ causes tissue damage, which could be + +inflammation or early degeneration. Inflammation without +any external onslaught by a germ or a toxin is Ādhija Vyādhi. + +The text goes on to describe two factors that decide where + +the Ādhija Vyādhi manifests. These are: (a) a genetic predis­ +position to a particular disease and/or (b) an inherent weak­ +ness or vulnerability of the organ in the particular individual.[47] +Let Us Look at Mastalgia as Ādhija Vyādhi—Mind–Body +Disease +The problem begins as responses that are persistent +long-standing emotions (recognizable or unrecognizable/ +suppressed or expressed), which could be anxiety or depression; +this invariably draws too much prāna to carry out the stress +responses; over a period of time, the habituated excessive + +prāna activity localizes to the breast as pain; pain is uncontrolled +excessive activity in the sensory nervous system, which is the +result of hormonal (estrogen, progesterone, prolactin, etc.) +imbalance. In summary, the yogic model theorizes that the + +whole complication is owing to repetitive attack by uncontrolled +thoughts (suppressed emotions) at the mind level (Manomaya +kośa), which results in extreme prāna activity and establishes +as violence (inflammation) that leads to an imbalance (endo­ +crine/nervous) at Annamaya kośa to show up as BP. +Diagram of pathophysiology of stress and mechanism of +psychosomatic nature of mastalgia as a yogic model can be +seen in Figure 4. +ādhija Vyādhi +(Stress born) +Anādhija Vyādhi +( non +-stress born ) +Sāra (Essential) +conginital birth +defects (self +Realization) +Sāmānya +(Psychosomatic +ailments) +Remedy : Life +style changes +Injury, infection +and Toxins . +Remedy : +Medicines, +Surgery +Adhi-Vyadhi +Figure 4: Mechanism of psychosomatic nature of mastalgia—a yogic +model. +Mastalgia +Eastrogen +Progesterone +imbalance +Stress +Prolactin +TSH +Pre menstrual +syndrome +Anxiety +Depression +Smoking +Abnormal lipid +metabolism +Figure 1: Stress and mastalgia.[17] +Annam ayaKośa +Prā am ayaKośa +Man +n +om ayaKośa +Vijnānam ayaKośa +Panchakosha Viveka +Taittirèya Upanisad +Man has 5 major aspects of existence +Figure 2: Concept of pañcakoça (five-layered existence). +Affects HPA +Speed at manomaya +kosha +Psycho- Neuro- +Endocrine Imbalance +Stress +Results in Mastalgia +Cyclical +A-cyclical +MASTALGIA +Releases Stress +hormones +Imbalance in +FSH secretion +anxiety, +depression, +E +Estrogen- +projesterone, +prolactine +Imbalance +Speed and +imbalance at +Prānamaya Kosha +Speed & imbalance +at Annamaya Kosha +R +Figure 3: Mechanism of mind body disease (Ādhija Vyādhi) according +to yoga (Vāsiṣtha model). +Sukanya et al.: Integrated yoga therapy for mastalgia +International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 02 +168 +Reversal of the Disease (Mastalgia) by the Correction of +the Five Layers with Yogic Lifestyle +Yoga is defined as “mastery over the modifications of the +mind” by sage Patañjali,[64] which is the goal of the integrated +yoga program. The modules of IAYT used in this study are + +techniques that help to repair and restore the system into + +balance at all five levels of one’s existence. +Annamaya Kosha Practices +The practices used at annamaya kosha include yogic diet, +kriyas (cleansing techniques) and asanas, and relaxation +practices. Annamaya kosha may be regarded as the focus of +modern medicine. +IA +YT recommends simple wholesome vegetarian (sātvik) +diet that helps to keep the mind calm and controlled; it also +recommends moderation in eating habits, sleep, and behavior. +Āsanas, which form the major component of IAYT, help +in improving lymphatic flow through repetitive stretches of +the arms, chest, back, neck, and the thoracic region during + +different postures. +Kriyās, known as cleansing techniques, may help in clearing +the endotoxins, the accumulated free radicals in the breast +area.[65] Āyurveda, yoga, and naturopathy describe that toxins +(āma) are formed within the gut owing to disturbed digestion +that results from uncontrolled surge of suppressed emotions. +This morbid matter (āma) blocks the subtle energy channels +(srotas or nādis) or meridians (Chinese medicine) in differ­ +ent areas and causes local imbalances in prāņa flow to local +organs. Kriyās are recommended to help in detoxifying and +achieving voluntary mastery (Rāja Yoga. Kolkata: Ch2 v49; +Advaithāshrama). [66] +Prāņāmaya Kosha Practices +Prāņāyāma is a very useful tool to calm down the mind + +through voluntary slowing down of the breathing rate. Slowing +down the rate of inhalation and exhalation is pranāyāma. + +Several types of pranāyāma help in channelizing and balan­ +cing the prāna (chi and vital energy) flow to different organs +in general and to the breast region, in particular in cases of +mastalgia. +Manomaya Kosha Practices +Meditation +Pratyāhara (withdrawal of senses from the objects of +perception), dhāraṇa (binding the mind to a single thought + +space), dhyāna (effortless flow of a single thought), and + +sāmadhi (merging of the knower with the object of meditation) +are the components of meditation described by Patañjali. + +Meditation helps to remove the restlessness wandering + +uncontrolled surge of negative disturbing thoughts and helps +in channelizing them to the desirable positive thought on the +background of what remains as inner calmness and bliss. +Thus, these practices are the recommended techniques to +achieve voluntary mastery over the modifications of the mind, +the definition of yoga.[67] +Vijnānāmaya and Ānadāmaya Kosha Practices +Theory Classes and Yogic Counseling Using Jnāna Yoga, +Bhakti Yoga, and Karma Yoga +The theory lectures that explain the unique concepts from +scriptures on mind body disease (ādhi and vyādhi), happi­ +ness analysis, yama (do’s), niyama (don’ts), working without +building stresses (karma yoga), and emotion culture through +devotional practices (bhakti yoga) help in changing the loop +of intrusive stress responses such as anxiety or depression +and promote positive feeling by unfolding the divinity within. +Yogic counselling in which the therapist goes into the life +problems of the individual and helps the participant to change +the perception of the problem itself goes a long way to bring +about the required cognitive change. This also prepares the +participant to face any stressfully demanding situation that +may trigger the unwanted uncontrolled surges of emotions + +such as anxiety or depression or tension or fear. The impro­ +ved confidence and will power helps in improving the feeling +of wellness and, thus, the QOL. Thus, the lectures from the +scriptures and yogic counselling helps in improving interper­ +sonal relationships,[68,69] adjusting to environmental changes +and ups and downs of life. Thus, there occurs an introspective +cognitive change by recognising the psychological freedom +“to react, not to react or change the habituated patterns of +reaction to situations” as highlighted in yoga texts.[47] +Conclusion +This is an effort to give a brief synthesis of the rich tradi­ +tional knowledge of yoga, which has explained a problem and + +a solution to mastalgia through the Indian scriptures and + +yogic lifestyle, which has been implemented in our RCT with +6-month follow-up (CTRI/2014/08/004911), an hour of yogic + +practices for 12 weeks, has given a highly significant result + +in alleviating mastalgia and depression and anxiety, thereby +improving QOL and removing/ruling out the fear of getting +breast cancer. +References +1.  +Nasreen N, Sohail S, Memon MA. Utility of breast imaging in +mastalgia. JLUMHS 2010;9:12–6. +2.  +Murshid KR. A review of mastalgia in patients with fibrocystic +breast changes and the non-surgical treatment options. 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Int J Med +Sci Public Health 2016;5:162-170 +Source of Support: Nil, Conflict of Interest: None declared. diff --git a/subfolder_0/Integrating Yoga in Rehabilitation of Spinal Cord Injury to Improve Benefits of Stem Cell Therapies.txt b/subfolder_0/Integrating Yoga in Rehabilitation of Spinal Cord Injury to Improve Benefits of Stem Cell Therapies.txt new file mode 100644 index 0000000000000000000000000000000000000000..8213e1b859f60878fa1021104d888fa431760d1a --- /dev/null +++ b/subfolder_0/Integrating Yoga in Rehabilitation of Spinal Cord Injury to Improve Benefits of Stem Cell Therapies.txt @@ -0,0 +1,955 @@ +Journal of Stem Cells +ISSN: 1556-8539 +Volume 13, Number 4 +© Nova Science Publishers, Inc. + + + + +Integrating Yoga in Rehabilitation of Spinal Cord Injury +to Improve Benefits of Stem Cell Therapies + + + +Monali Madhusmita1,, John Ebnezar2, +Thaiyar Madabusi Srinivasan3, +Kashinath G Metri4, +and Patita Pabana Mohanty +1PhD Scholar, Division of Yoga and Life Sciences, +S-VYASA University, Bangalore, India +2Head of the Department, Department of Orthopedics, +Ebnezar Orthopaedic Centre, Parimala Specialty +Hospital, Bangalore, India +3Visiting Professor, Division of Yoga & Physical +Sciences, S-VYASA University, Bangalore, India +4Associate Professor, Division of Yoga and Life +Sciences, S-VYASA University, Bangalore, India +5Head of the Department, Associate Professor, +Department of Physiotherapy, SVNIRTAR, +Odisha, India + + + Corresponding Author: Monali Madhusmita, +S-VYASA University, Bangalore, Karnataka, India. +E-mail: monaliyoga@gmail.com +Abstract + +Spinal cord injury (SCI) leads to severe disability +contributing to poor quality of life. Cell-based or cell- +related therapies have emerged as breakthrough therapies, +both in regeneration of spinal cord and enhanced functional +recovery. This review aims to discuss the therapeutic +benefits of yoga in the rehabilitation of SCI in enhancing +neural plasticity and emerging as an important add-on to +support stem cell therapies. Conventional treatment for SCI +does not bring out full recovery of loss of function. Chronic +systemic inflammation prevailing years after injury is +one of the obstacles in sensory and motor function +improvement. Recurrence of secondary infections, risk of +neural tissue death and depression disorders leading to poor +quality of life are some of the factors which are barriers to +recovery of SCI. Cell replacement strategies provide +cells that can replace the lost function. They provide a +regenerative pathway for injured adult neurons, which +would then promote the regeneration of adult neurons. +Transplantation of cells mostly leads to the rejection of + the donor material due to a combination of humoral +and cellular immune responses. Evidences how that +yoga modulates immune function which is otherwise +compromised by stress. It can promote neurogenesis and +angiogenesis resulting from increase production of +neurotrophins. Yoga as an immune modulator can thus +enhance the acceptance of implanted stem cells leading to +the regeneration of the spinal cord circuitry and restore +function after injury. It is thus hypothesized that yoga’s +therapeutic benefits may prove as an approach to alleviate +the barriers of cellular therapies if necessary evidences are +generated. + + +Keywords: spinal cord injury (SCI), stem cells, stem cell +therapy, yoga, neuroplasticity, neurotrophins, neurogenesis, +angiogenesis. + + + + + +Monali Madhusmita, John Ebnezar, Thaiyar Madabusi Srinivasan et al. +204 +Introduction + +Spinal Cord Injury Pathophysiology + +Spinal cord injury (SCI) is a disastrous condition, +with sudden loss of sensory, motor and autonomic +functions distal to the level of trauma. The primary +effects of the trauma are necrosis, edema, haemo- +rrhage, and vasospasm. An avalanche of secondary +patho-physiology includes: i) ischemia, ii) apoptosis, +iii) fluid and electrolyte disturbances, iv) excito- +toxicity, v) lipid peroxidation, vi) production of free +radicals, and vii) an inflammatory response, resulting +in further catastrophe due to swelling and blood flow +reduction. Finally, a large fluid filled cavity or cyst +forms in the center of the cord, surrounded by a +subpial rim containing some preserved axons, mostly +demyelinated. Hypertrophic astrocytes, macrophages, +and other cells secrete extracellular matrix and +inhibitory molecules to form glial scar, culminating in +a physical and chemical barrier to regeneration. +Although there are major advances in the medical and +surgical care of SCI patients, still no effective +treatment exists for the neurological deficits resulting +from SCI. These damages result in serious disability +and multiple secondary health conditions (SHCs; +multi-morbidity due to co-morbidities/complications) +that require progressing management.[19] Further, it +is said, “Persons with SCI have a specific constel- +lation of ongoing health problems that are not being +addressed by the mainstream health care system, and +that demand the attention of the health services +research community”.[4] +Multimorbidity associated with SCI makes it a +very costly condition and it costs around $21,450 per +annum, to care for 1 person with chronic SCI in the +United States.[5] Generally, men are at higher risk of +SCI than women; the gender ratio ranged from 0.99:1 +in Taipei, Taiwan to 13.5:1 in India.[19] Employment +of emergency services includes treatment for urinary +tract infections, pneumonia, and other SHCs such as +pressure ulcers and depression.[10] But 17% of these +health care service utilization could be categorized +under “preventable” .[7] +‘Divergent’ antipsychotic medications and drugs +used in some neurological disorders such as SCI are +associated with metabolic side effects such as weight +gain, diabetes, and dyslipidemias. [38] First and +second generation antidepressants are linked to +cardiovascular and sexual dysfunction complications. +The therapeutic use of these medications is also +partial. Thus, there is a clear demand for complemen- +tary non-psycho-pharmacological intervention for +psychiatric, neurological and various other dis-orders. +[18] Many studies suggest that yoga acts as a +preventive measure and helps in patient's psychol- +ogical healing process [23]. + + +Current Therapeutic Strategies for Spinal +Cord Injury + +Surgical Decompression +Urgent surgical decompression within 24 h after +injury significantly increased post- operative motor +and sensory functions according to American Spinal +Injury Association (ASIA) score. Although early +decompression reduces the risk of respiratory failure +and sepsis, neurological surgery for the treatment of +SCI is still associated with complications such as +incidental durotomy or meningitis. + +Therapeutic Hypothermia +Beneficial effects of modest (32–34 _C) systemic +hypothermia induced by intravascular cooling catheter +and difference between the temperature at the spinal +cord lesion and core body temperature have been +successfully resolved by localized cooling of the +injury site during surgical decompression. Systemic +hypothermia as well as local cooling attenuate main +patho-physiological processes during SCI including +neuronal metabolism, neuro- inflammation, oxidative +stress, excitotoxicity, and apoptosis. At the same +time, decreased temperature protects the spinal cord +from further injury by preserving the blood- +spinal cord barrier (BSCB) and reducing edema, and +induces neuro-repair by enhancing angiogenesis and +neurogenesis. + +Pharmacotherapy +Because of their anti-inflammatory effects and +capacity to reduce oxidative stress and excitotoxicity, +corticosteroids are used in many preclinical and +clinical studies as therapeutic agents for the treatment +of SCI. Use of methyl prednisolone in patients with +SCI has become controversial, because of high rate of +Integration of Yoga and Stem Cell Therapy in Rehabilitation of Spinal Cord Injury +205 +complications such as sepsis, pulmonary embolism, +and gastrointestinal hemorrhage [47]. + + +Barriers in Neuronal Regeneration/Functional +Recovery in SCI + +Inflammation +Inflammation leads to apoptosis of neurons and +oligodendrocytes, scar formation and finally in the +reduction of neuronal function. Managing inflamm- +ation will decrease secondary degeneration and the +functional deficit after SCI [51]. + +Secondary Infections +Urinary tract infection, pressure ulcers, pulm- +onary and cardiovascular problems are some SCI +complications which cause psychosocial distress for +patients and delay of integration with society [49]. + +Chronic Pain Syndrome +Chronic pain in SCI is mostly referred to as +‘central pain’ and is very debilitating in nature and +results in poor rehabilitation outcomes [54]. + +Respiratory Failure and Fatigue +Respiratory complications remain the most +common cause of mortality following SCI [49]. + + +Yoga as a Therapeutic Tool + +Yoga is a promising mind-body intervention for +improving health and well- being in a number of able- +bodied and clinical populations.[40] It is an ancient +Indian physical, mental and spiritual practice and the +word “yoga” comes from Sanskrit, “yuj,” meaning +“yoke” or “union”.[18] Yoga has been observed to +treat symptoms of some neurological and psychiatric +disorders through an array of physiological mecha- +nisms pertinent to either the aerobic factors of yoga +(the changing sequel of asanas) or the breathing and +meditative components of yoga (pranayama and +dhyana). The aerobic components of yoga augment +mental health through a variety of pathways such as +stimulating the central nervous system for the release +of endorphins monoamines, and brain-derived neuro- +trophic factor (BDNF) in the hippocampus.[33] The +meditative part consists of controlled breathing, +relaxation, and meditation techniques and works +with multiple possible mechanisms which lead to +a decrement in sympathetic and increase in para- +sympathetic tone, which further has been linked with +emotional regulation and empathic response. [18] +Secondly, there may be increase in heart-rate +variability (HRV) and respiratory sinus arrhythmia +(RSA). The reduction in these parameters has been +associated with anxiety, panic disorder, depression, +irritable bowel syndrome, early Alzheimer’s, and +obesity. Finally, meditative practices lead to increases +in EEG synchrony and coherence, which are associ- +ated with improved integrated brain functioning and +problem-solving. +Various studies show that meditation increases +the levels of Brain-derived neurotrophic factor +(BDNF).[41] Other consequences include increase in +vagal tone, down-regulation of the hypothalamic- +pituitary-adrenal axis and decrease in serum cortisol, +increase in gamma-aminobutyric acid (GABA) levels +and serum prolactin. Upgrading of frontal electro- +encephalogram (EEG) alpha wave activity improves +relaxation [11], [12], [30]. +Some studies have linked an increase in +melatonin and a decrease in cortisol, to the meditative +components of yoga.[3] Increases in melatonin +impacts promotion of sleep, stimulates the immune +system by acting as a powerful antioxidant, and +decreases blood pressure. Further, Tooley et al. +observed higher levels of plasma melatonin in patients +immediately after yogic meditation sessions, as +compared with control [36]. They hypothesized two +possible mechanisms: First, meditation reduces +blood flow to the liver, slowing the metabolism of +melatonin. Secondly, these practices increase the +levels of serotonin, which is converted to melatonin in +the pineal gland. Harinath et al. also observed an +increase in melatonin levels after a 3-month practice +of asanas, pranayama, and meditation [8]. Meditation +has also been associated with reduction in levels of +cortisol. Studies have found a significant positive +correlation between levels of cortisol, negative affect, +and depression. Vagal or parasympathetic activity is +responsible for calming the body’s stress response +systems, and is associated with decreased levels of +cortisol. Thus, components of yoga apart from aerobic +exercise, such as controlled breathing and meditation +Monali Madhusmita, John Ebnezar, Thaiyar Madabusi Srinivasan et al. +206 +techniques, is known to decrease cortisol levels [13], +[24]. +More active practices followed by relaxing ones +lead to deeper relaxation than relaxing practices alone, +documented by research from Swami Vivekananda +Yoga University, Bangalore, India and possibility +of neural plasticity bringing changes in the hypo- +pituitary–pancreatic axis [2]. + + +Rehabilitation of SCI Patients: +Potential of Yoga + +Severed spinal cord due to SCI leads to disruption +of communication in parts that are innervated at or +below the lesion. Neuroprotective drugs such as +methylprednisolone are being used for the treatment +for spinal injuries and may prevent cell death. SCI is +followed by several complications for which there +is a need for rehabilitation [44]. Teams of nurses, +physicians, physical and occupational therapists, +psychologists, and social workers, avail inter-disci- +plinary health care services for rehabilitation of SCI +patients. Yoga as a therapy is a holistic approach, +which is believed to stimulate neural pathways and +neurotransmitters. Thus, different yogic techniques +may act as a valuable healing tool, with proper +modification and supervised facilitation, leading to +regeneration of nerve fibers in SCI patients [30]. + + +Iyengar Yoga for SCI Patients + +Evidences shows that special form of yoga known +as Iyenger yoga using props and other innovative +modalities is able to handle special challenges of SCI +patients.[45] With guided assistance this form of yoga +develops strength, flexibility, and physical balance +through proper stretching of muscles and building up +symmetric and asymmetric postures. Enhancement of +body awareness through integration of pranayama into +these postures and focus on time and weight +management of muscle contraction and relaxation is +the mainstay of this form of yoga. Literature review +reveals that specific forms and different limbs of yoga +helps in alleviating dysfunctions such as bowel, +bladder, sexual, pain and depression in individuals +with SCI [10]. +Integrated Yoga for Traumatic SCI Patients + +Another recent study conducted at a rehabilitation +centre in Odisha, India, indicated that the addition of +integrated yoga intervention to physiotherapy has +beneficial effects in terms of improving pain, inflame- +mation, gait, and spasticity among patients with +paraplegia. Further, it also suggested the integration of +yoga practices in conventional rehabilitation programs +for traumatic spinal injury patients [46]. + + +Effect of Yoga on Neurotrophins +and Neurotransmitters + +A review elaborates the effect of yoga on various +neurotransmitters and neurotrophins.[36] Endogenous +dopamine production was raised during Yoga Nidra +meditation, as demonstrated by a PET study and +increase in brain GABA levels following 60-min yoga +session as compared to controls performing a 60-min +reading, as demonstrated by another study.[15], [32] +Furthermore, other evidences revealed that yogic +practice daily for one hour for a period of 3 months +helps in lowering ACTH and cortisol, while elevating +serotonin, dopamine, and BDNF in healthy active men +[23]. + + +Stem Cell Therapy +Stem cells are defined as cells that have the +capacity to recreate themselves perpetually and +possess pluripotent ability to differentiate into +many cell types. Mammalian pluripotent stem cells +which have been identified are of two types: +embryonic stem cells (ESCs) derived from the inner +cell mass of blastocysts and embryonic germ cells +(EGCs) obtained from post implantation embryos. +These stem cells give rise to various organs and +tissues [5], [27], [36]. Currently, there is identification +of generation of a new class of pluripotent stem cells +known as induced pluripotent cells (iPS cells) from +adult somatic cells such as skin fibroblasts by +introduction of embryogenesis‐related genes [22], +[33], [43]. As an addendum to ESCs and iPS cells, +tissue‐specific stem cells have been isolated from +various tissues such as hematopoietic stem cells, bone +marrow mesenchymal stem cells, adipose tissue +Integration of Yoga and Stem Cell Therapy in Rehabilitation of Spinal Cord Injury +207 +derived stem cells, amniotic fluid stem cells, and +neural stem cells. Multipotent neural stem cells +(NSCs) found in developing or adult mammalian +brain which has attribute of indefinite growth and +multipotent potential. They differentiate into three +major Central Nervous System (CNS) cell types: +neurons, astrocytes, and oligodendrocytes [8], [13], +[17], [38]. Recently, it is evident that stem cells which +were thought to be responsible for generation of +mature differentiated cells of one organ may have the +ability to also differentiate across lineages and +contribute to generation of other types of tissues. For +instance, hematopoietic stem cells can differentiate +into neuronal tissue, suggesting that easily accessible +stem cells sources may one day be useful in the +therapy of ischemic (stroke) and other degenerative +diseases of CNS [26.] +Stem cell therapy despite of its various challenges +is a very promising treatment modality for treating the +spinal cord injury and recovering functional ability. +The ability of stem cells to differentiate into various +other cell types and producing substances such as +cytokine, growth factor, and trophic factor, in turn +promote neuroprotection and regeneration. Schwann +cells, embryonic stem cells, mesenchymal stem +cells/bone marrow stem cells, olfactory ensheathing +cells and neural stem cells are various types of stem +cells used for implantation in SCI. Among various +types of stem cells, bone marrow derived mesen- +chymal stem cells is highly used in SCI. Research +showed that direct intra-medullary injection to the +injured spinal cord site in sub-acute phase is most +effective [45]. +In a recent study, CD34C cells from human UCB +(Umbilical Cord Blood) were ingrained into immune- +compromised animals that had undergone a stroke +48 hours earlier. There were reports of neo-vascu- +larization in the ischemic zone, leading to neuronal +regeneration, mainly owing to endogenous neuro- +genesis [32]. Similar results have been observed for +animals that were treated with granulocyte colony +stimulating factor (G-CSF), an agent that mobilizes +hematopoietic progenitors from the bone marrow into +the blood [28]. +Many in vivo studies shows that non-neural stem +cells also has significant functional impact in the +clinical management of stroke and spinal cord injury, +and other neurodegenerative disorders by inducing +angiogenesis, recruiting endogenous stem cells, +guiding axons or secreting neurotrophic factors. As +already demonstrated in animal models and in clinical +studies in ischemic heart disorders [1], [5], [39] these +results have clinical significance, despite the fact that +the injected cell population did not itself generate +neural cells. A large number of studies in last 5–10 +years have showed that non-neural stem cells are +competent of generating neurons or glia in vitro and in +vivo [25]. +Spinal cord injury is a devastating condition +in humans leading to significant disability with +immense loss of quality of life and economic output. +Till date there is no adequate clinical cure and overall +prognosis is mostly poor. Research in the last +two decades shows that cellular or cell-related +therapies have unlatched exhilarating therapeutic +possibilities. +For spinal cord regeneration, stem cell trans- +plantation still holds the best future and amongst +them, human embryonic stem cells (hESC) and +olfactory ensheathing cells (OEC) are presently the +leading prospects [14]. Inflammation after traumatic +SCI is non-resolving and it will be present in chronic +injury stages also. It plays a key role in the +pathophysiology of SCI, and it has been associated +with further neurodegeneration and development +of neuropathic pain. Neuropathic pain is a huge +challenge, and cellular or cell-related therapies +are rapidly gathering momentum to combat it. +These therapies aspires to attain analgesic effects +from different perspectives such as preventing +neuronal damage due to inflammation, cell cycling, +or dysfunctional regeneration; inducting biological +minipumps using adrenal medullary chromaffin +tissues, engineered cell lines, or astrocytes; and +lastly, regulating the internal milieu using trans- +plant of bone marrow of bone marrow mesenchymal +stem cells .[15] Neural precursor cells (NPCs) +have been shown to reduce acute and sub-acute +inflammatory responses after SCI.[24] The role +of yoga practices in stem cell regeneration and +regulation is under investigation, and as this study +implies, it is possible that targeted exercises and +pranayama could stimulate stem cell organization in +SCI. More on this is presented later. + +Monali Madhusmita, John Ebnezar, Thaiyar Madabusi Srinivasan et al. +208 +Barriers in Stem Cell Therapy for SCI + +Immune Response +Transplantation of cells may leads to the rejection +of the stem cells due to a combination of humoral and +cellular immune responses [53]. + +Reduced Angiogenesis +Reduced angiogenesis leads to failure in neural +plasticity. [52] + +Reduced Neurogenesis +Insignificant neurogenesis due to various reasons +may lead to failure in neural regeneration and +functional recovery in SCI. [52] + +Decreased Level of Growth Factors +Different types of growth factors helps in +directing differentiation of neural stem cells and +their deficiency acts as a barrier to stem cell therapy +[50]. + + +Neuroplasticity + +Brain plasticity is seen to be influenced +by several factors including neurotrophic factors, +neurotransmitters, endocrines, cytoskeleton proteins +and neuronal electrical activity to name a few. +Practice of yoga produces brain plasticity leading +to improvement in cognitive function and alleviation +of symptoms such as depression, anxiety etc. [23]. +It has great potentials in treating neurological diseases +as well. Neurotrophic factors are key molecules which +are involved in the development and differentiation +of the nervous system and play a major role in +neuronal plasticity. Synaptic neuroplasticity induced +by neurotrophins like BDNF or VEGF may be +responsible for the therapeutic benefit of yoga in +various psychiatric and neuro-degenerative diseases. +A study in patients with depression has shown +reduction in cortisol level along with increased +blood +plasma +BDNF +content +following +yoga +practice [22]. Figure 1 illustrates the possible +mechanism of impact of integrating yoga therapy +in rehabilitation SCI to improve benefits of stem +cell therapies. + +Conclusion + +This study concludes that yoga is an immune- +modulator and can be instrumental in overcoming +barriers of conventional treatment and stem cell +therapy to achieve functional recovery in SCI. Yoga is +an emerging therapy having potential to enhance stem +cell therapy by increasing production of neurotrophins +and other neurotransmitters, decreasing systemic +inflammation, enhancing neurogenesis and angio- +genesis; thus, it may also help in minimizing the +barriers of stem cell therapy. All these potential +beneficial effects of yoga may help in improving the +benefits of stem cell therapy out come in patients with +SCI. +Management of SCI is challenging and also +incurs huge economic burden on the individual, +family and care- takers and the health care system of +the state. Loss of man-power due to SCI is a serious +issue to be addressed with the rise in road traffic +accidents (RTA). Yoga has shown promising results +to combat the deleterious aftereffects of SCI and +in alleviating secondary complications. Quality of +life enhancement resulting from adaptation of +yogic lifestyle is a boon for individuals with SCI. +Yoga therapy practice is also known to enhance +neural plasticity by promoting expression of neuro- +transmitters and neurotrophins in the CNS. Increase in +levels of neurotrophins in blood plasma resulting +from yogic practices induces neurogenesis and +angiogenesis further enhancing synaptic plasticity. +Cellular therapies such as stem cell therapies are +emerging as promising therapeutic tools, leading SCI +management towards a more satisfactory clinical cure. +However till date, the success rate of such cell-based +therapies is minimal and associated with many +shortcomings. Success rate of stem cell therapy in +acute or fresh spinal cord injuries of few weeks is +very high with acceptance of grafted tissue and +translation of its effect to neurological recovery. But +in chronic phase following SCI, the problem of tissue +rejection and administration of immunosuppressant +drugs after stem cell therapy, makes prognosis poor. +Incorporation of yoga therapy into rehabilitation +programs of SCI patients can possibly enhance +the likelihood of acceptance of induced stem cells +by the body, lowering the possibility of tissue +rejection and intake of immunosuppressant drugs +Integration of Yoga and Stem Cell Therapy in Rehabilitation of Spinal Cord Injury +209 +leading to significant functional recovery. Stem cell +therapy works by inducing angiogenesis, recruiting +endogenous stem cells, guiding axons and secreting +neurotrophic factors etc. Yoga therapy could contrib- +ute hugely for successful implementation of stem cell +therapy as a breakthrough treatment for SCI patients’ +rehabilitation. Scientific literature also indicates that +the state of brief intermittent hypoxia produced during +practice of pranayama might stimulate migration of +the stem cells from their milieu to the site of injury +and +facilitate +neuronal +regeneration.[33] Thus, +integration of yoga therapy into rehabilitation of +SCI may be one of the approaches to alleviate the +limitations of cellular therapies. + + +The above flow chart shows the impact of integrating yoga therapy in the rehabilitation of SCI to improve the outcome of +cell -based strategies by enhancing neuro-glial plasticity with reduction of inflammation and increase production of +neurotrophins leading to neurogenesis, angiogenesis and increase production of stem-cells. + + +Reference + +[1] +Noonan VK, Fallah N, Park SE, Dumont FS, Leblond J, +Cobb J, et al. Health care utilization in persons with +traumatic spinal cord injury: The importance of multi- +morbidity and the impact on patient outcomes. 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Further reproduction +prohibited without permission. diff --git a/subfolder_0/Normative data for the digit letter substitution task in school children.txt b/subfolder_0/Normative data for the digit letter substitution task in school children.txt new file mode 100644 index 0000000000000000000000000000000000000000..a4c42fe02541d12a1175aeb5831a35d090e4d479 --- /dev/null +++ b/subfolder_0/Normative data for the digit letter substitution task in school children.txt @@ -0,0 +1,621 @@ +69 +International Journal of Yoga y Vol. 2 y Jul-Dec-2009 +Normative data for the digit–letter substitution task in school +children +Balaram Pradhan, HR Nagendra +Division of Yoga and Life Sciences, Swamy Vivekananda Yoga Anusandhana Samsthana, Bangalore, India +Address for correspondence: Dr. HR Nagendra, +Swamy Vivekananda Yoga Anusandhana Samsthana, +# 19, K.G. Nagar, Bangalore - 560 019, India. +E-mail: hrnagendra@rediffmail.com +DOI: 10.4103/0973-6131.60047 +Original Article +Background/Aims: To establish the norms for the substitution task, a measure of psychomotor performance. +Materials and Methods: Eight hundred and forty three school students were selected in the present study aged between +9-16 years (mean age = 12.14; SD = 1.77). Subjects were assessed one at a time for Digit-Letter Substitution Task (DLST). +Results: Both age and sex infl + uenced performance on the DLST; therefore, correction scores were obtained on the basis of +these factors. +Conclusions: The availability of the Indian normative data for the DLST will allow wider application of this test in clinical practice. +Key words: Information processing speed; psychomotor task; substitution; sustained attention. +ABSTRACT +INTRODUCTION +The cognitive demands of the Symbol Digit Modality Test +(SDMT) include attention, visual scanning, and motor and +psychomotor speed. The SDMT is purportedly sensitive +to a wide range of neurologic and neuropsychiatric +disorders but may lack disorder specificity.[1] For example, +SDMT was used as a screening instrument on 28 brain- +damaged males in the age range of 8-16 years compared +with 28 nondamaged matching controls. The performance +of brain-damaged group was poor than the other +group. +[2] Schizophrenia and depression have symptomatology +of slowing in both motor and mental activities, denoted in +depression as ‘psychomotor retardation’ and in schizophrenia +as ‘psychomotor poverty’. This was observed by writing +movements recorded during the performance of the Digit +Symbol Test (DST). It was observed that psychomotor +performance was found to be slowing in both disorders.[3] In +another study 30 schizophrenic inpatients and 30 matched +controls were digitally recorded during performance of the +SDST. The study revealed that both matching time and +writing time were longer in the schizophrenic patients.[4] +Anorexia nervosa patients were also found abnormal on +the DST.[5] A recent review of published SDMT normative +data was based on the community based control sample +across age, education, gender, and income groupings.[6] Most +studies have focused on adults aged over 60 years, which +may be of limited utility to clinicians and investigators +working with a wider range of adults.[7] Currently, normative +data are unavailable for the Indian population. +The DLST was developed from Digit Symbol Substitution T +est +(DSST), one of the subsets of the Wechsler intelligence scale. +[8] +Substitution tests are essentially speed--dependent tasks that +require the subject to match particular signs – symbols, digits, +or letters – to other signs within a specified time period. The +DLST has the advantage of using letters and digits, signs +that are already well known to those taking the test.[9] Thus, +there is no question of a need to learn new symbols while +being tested. Such learning ability is definitely not the only +aptitude studied for in the trial. For this reason, the DLST was +used instead of the DSST.[10] Substitution tasks involve visual +scanning, mental flexibility, sustained attention, psychomotor +speed, and speed of information processing.[11] +The purposes of this study were to develop the normative +data of a modified version DLST[12] performance and provide +normative data for clinical and research use from a large, +nationally representative sample of Indian children population. +MATERIALS AND METHODS +Subjects +Eight hundred and forty three school students aged +between 9-16 years (mean age = 12.14; SD = 1.77) were +[Downloaded free from http://www.ijoy.org.in on Friday, March 12, 2010] +International Journal of Yoga y Vol. 2 y Jul-Dec-2009 +70 +selected for the present study. All of them were healthy +and proficient in English. Participants were excluded +from the study if they indicated that they had a history +of neurological or psychiatric disturbance and were on +medication affecting the central nervous system; or had +had a history of learning disability. Following complete +description of the study, written informed consent was +obtained from the participants. +Instrument +The DLST test sheet is given in the Appendix. The +DLST consisted of a worksheet, which has 8 rows and +12 columns and randomly arranged digits in rows +and columns. The students are asked to substitute as +many target digits as possible in the specified time of +90 seconds. The letter substitution may be undertaken in +a horizontal, vertical, or randomized manner by selecting +a particular digit. The total number of substitutions +and wrong substitutions are scored. The net score was +obtained by deducting wrong substitutions from the +total substitutions attempted.[12] Five trained assistants at +the neuropsychological test laboratory administered +tests. +Data analysis +The normative procedure for DLST scores involved the +fitting of multiple linear regression models adjusted for +age (in years) and sex. The core assumptions of regression +analysis (homoscedasticity, normal distribution of the +residuals, absence of multicollinearity, and absence +of ‘influential cases’) were tested for each model. +Homoscedasticity was evaluated by visual inspection of +the scatter plots of the residuals on the predicted values. +The normal distribution of the residuals was investigated +by visual inspection of the histograms and the normal +probability plots. The occurrence of multicollinearity +was checked by calculating the Variance Inflation Factors +(VIFs), which should not exceed 10.[13] Cook’s distances +were computed to identify possible influential cases. +Normative data can then be obtained by calculating +the residuals for the DLST scores (ei = observed score – +predicted score). The residuals are then standardized (Zi = +ei/SD (residual)) so that the performance of the participant +can be evaluated via a Z distribution table with cumulative +probabilities. All analyses were performed using the SPSS +10.0 version software package. +RESULTS +Linear multiple regression models were fitted for the +DLST scores. The residuals were sufficiently normally +distributed, and no heteroscedasticity was observed. VIFs +of the predictors in the regression models had a maximum +value of 1.001, which is well below the cut-off value of 10. +The outliers had virtually no effect (maximum Cook’s +distance =.02). +Table 1 presents the regression models. Age and sex had a +significantly positive and negative (P < 0.001) influence +on the predicted DLST scores. The predicted DLST scores +of females were significantly higher (P < 0.001) than those +of males. +Combining these regression models with the standard +deviations of the residuals provides normative data. +First, the predicted values of the scores (predicted yi) for +the DLST are calculated by inserting the coded values +of the predictor variables in the regression models +[Table 2]. Next, the residuals of both scores are calculated +(ei = observed yi – predicted yi) and then standardized +(Zi = ei/SD (residual)). The SD (residual) equals 10.41 for +the DLST scores. +Multiple linear regressions provided a multiple R value +of 0.688 with a corresponding R2 determination index +of 0.474, indicating that 47% of the score variance was +explained by the combination of age and sex. The model +equation was: DLST score = –13.45 + 5.313 × Age – +5.647 × sex. This indicates that for each progressive year +of age, the DLST score increases, on average, by 5.31 +and decreases by –5.65 for each sex. These coefficients +allowed us to calculate the correction scores to apply to +individual subjects in order to consider the effects of age +and sex. Table 3 provides normative DLST data based on +the regression models in Table 2 stratified by age and sex. +If an individual is 9, 10, . . ., 16 years. +DISCUSSION +The results found that scores were positively correlated +for both age and sex, and females outperformed males +in DLST performance. The present study had similar +finding on earlier study, that the Letter–Digit Substitution +Test (LDST) was administered to cognitively screened +sample of adults. Age was the most important predictor +of LDST performance, and females outperformed males. +Pradhan and Nagendra +Table 1: Mean and standard deviation of digit-letter +substitution task scores stratified by age and sex +Age (years) +Females +Males +n +Mean ± SD +n +Mean ± SD +9 +10 +35.5 ± 6.69 +18 +29.44 ± 6.01 +10 +70 +39.57 ± 9.76 +93 +34.02 ± 6.68 +11 +41 +43.46 ± 10.14 +98 +39.08 ± 8.69 +12 +50 +48.74 ± 9.23 +121 +43.6 ± 9.69 +13 +67 +58.87 ± 12.51 +72 +52.85 ± 10.88 +14 +31 +57.1 ± 12.02 +69 +55.87 ± 11.69 +15 +36 +66.94 ± 9.95 +45 +60.73 ± 16 +16 +10 +72.9 ± 10.31 +12 +56.58 ± 11.45 +Total +315 +51.42 ± 14.68 +528 +45.21 ± 13.66 +[Downloaded free from http://www.ijoy.org.in on Friday, March 12, 2010] +71 +International Journal of Yoga y Vol. 2 y Jul-Dec-2009 +Table 2: Multiple linear regression models of the digit–letter substitution task scores with age and sex as predictors +Variables +B +Std. error +T +P values +Standardized B +VIF +R2 +SD (residuals) +Constant +–13.45 +2.545 +–5.285 +<0.001 +- +- +- +- +Age +5.313 +0.203 +26.199 +<0.001 +0.656 +1.001 +- +- +Sex +–5.647 +0.743 +–7.604 +<0.001 +–0.190 +1.001 +0.474 +10.41 +Norms for psychomotor task +Table 3: Net digit-letter substitution tasks stratified by age and sex of raw scores of percentile +Percentile +Females +Males +Age (years) +Age (years) +9 +10 +11 +12 +13 +14 +15 +16 +9 +10 +11 +12 +13 +14 +15 +16 +5 +26 +23.55 +24.3 +31.65 +40.6 +41.6 +52 +55 +21 +22.7 +24.95 +29 +35.65 +36 +27 +37 +10 +26 +26.1 +27.6 +34.2 +44.8 +43 +54.7 +55.9 +21 +25 +27 +30 +38.6 +41 +46.2 +37.3 +25 +30.5 +32.75 +36 +42.75 +48 +48 +60 +70 +24.75 +28 +33.75 +37 +47 +49 +50.5 +51.75 +50 +36 +40 +45 +50 +59 +55 +65.5 +72.5 +30 +34 +39 +44 +53 +56 +60 +55.5 +75 +38.5 +46 +50 +53.25 +67 +72 +71.5 +75.5 +32 +39 +45 +49 +60 +63 +68 +63 +90 +48.1 +53.9 +52.8 +61.9 +72.2 +74 +81.9 +94.1 +37 +42 +50.1 +56.8 +63 +72 +86 +74.1 +95 +- +56.35 +61.5 +64 +81.6 +77.2 +86.65 +- +- +45 +54 +61.9 +68.4 +73.5 +96 +- +The high level of education profoundly influenced LDST +performance and high level of education had better +performance than low level of education.[9] The modified +SDMT (M-SDMT) performance was influenced by race/ +ethnicity, age, education, and gender on the National +Survey of American Life. African–Americans and +nonLatino Whites (NLW) groups had similar M-SDMT +performances, which differed from Caribbean Blacks.[14] +In contrast, the variables across age, education, gender, +and socioeconomic status had no impact on SDMT +performance and a robust screening test for community +adult neuropsychological impairment.[6] +The DLST used in earlier studies on 50 psychiatic +inpatients were diagnosed having substance-related +disorder, schizophrenia, bipolar disorder, depressive +disorder, or anxiety disorder had low scores than normal +volunteers,[15] and also scores increased following +consumption of coffee, a stimulant.[12] To our knowledge, a +prior study on the DLST[12] reported a general description +of performance but did not provide means or standard +deviations of performance on this measure on children +population. Moreover, the effect of demographic +variables on DLST performance had not been previously +examined. However, examination of percentile ranks +revealed an unstable pattern of DLST performance +across age and gender groups. This study was limited +to the children population and uneven cell sizes across +derived age and sex. Further research with larger samples +is needed to clarify this relation with adult age range. +Nonetheless, these results permit quantitative evaluation +of performance on the DLST in healthy school children. +As the DLST is easy to administer in a less amount of +time and potentially useful in the assessment of attention, +neglect, and psychomotor ability,[12] it is hoped that these +normative data will increase its use in children clinical +populations. +REFERENCES +1. +Lezak M, Howieson DB, Loring DW. Neuropsychological assessment. +New York: Oxford University Press; 2004. +2. +Lewandowski LJ. The symbol digit modalities test: A screening instrument +for brain-damaged children. Percept Mot Skills 1984;59:615-8. +3. +van Hoof JJ, Jogems-Kosterman BJ, Sabbe BG, Zitman FG, Hulstijn W. +Appendix: Digit letter substitutions test +Instructions: +Substitute the digits with corresponding letter as per the given key. +Substitute as many possible within the given time. +Start and stop only when told. +Substitute Letters: +1 +2 +3 +4 +5 +6 +7 +8 +9 +L +H +Y +N +R +E +D +T +J +6 +2 +4 +1 +5 +7 +9 +3 +2 +6 +8 +5 +5 +4 +7 +8 +1 +2 +3 +4 +9 +6 +3 +7 +2 +4 +6 +7 +8 +9 +3 +1 +2 +3 +7 +4 +2 +9 +4 +6 +8 +1 +2 +5 +9 +3 +4 +7 +9 +7 +4 +2 +3 +8 +1 +5 +6 +2 +9 +1 +8 +6 +2 +3 +9 +4 +5 +7 +1 +4 +3 +9 +3 +5 +9 +1 +2 +5 +6 +2 +7 +8 +9 +1 +5 +4 +9 +2 +7 +1 +3 +2 +8 +9 +5 +6 +[ D o w n l o a d e d f r e e f r o m h t t p : / / w w w . i j o y . o r g . i n o n F r i d a y , M a r c h 1 2 , 2 0 +International Journal of Yoga y Vol. 2 y Jul-Dec-2009 +72 +Author Institution Mapping (AIM) +Please note that not all the institutions may get mapped due to non-availability of the requisite information in the Google Map. For AIM of other +issues, please check the Archives/Back Issues page on the journal’s website. +Pradhan and Nagendra +Differentiation of cognitive and motor slowing in the Digit Symbol Test +(DST): Differences between depression and schizophrenia. J Psychiatr Res +1998;32:99-103. +4. +Morrens M, Hulstijn W, van HJ, Peuskens J, Sabbe BG. Sensorimotor +and cognitive slowing in schizophrenia as measured by the Symbol Digit +Substitution Test. J Psychiatr Res 2006;40:200-6. +5. +Palazidou E, Robinson P, Lishman WA. Neuroradiological and neuropsychological +assessment in anorexia nervosa. Psychol Med 1990;20:521-7. +6. +Sheridan LK, Fitzgerald HE, Adams KM, Nigg JT, Martel MM, Puttler LI, +et al. Normative symbol digit modalities test performance in a community- +based sample. Arch Clin Neuropsychol 2006;21:23-8. +7. +Manly JJ, Byrd DA, Touradji P, Stern Y. Acculturation, reading level, and +neuropsychological test performance among African American elders. Applied +Neuropsychol 2004;11:37-46. +8. +WAIS-R manual. New York: The Psychological Corporation. 1981. +9. +Vander Elst W, van Boxtel MP, van Breukelen GJ, Jolles J. The Letter Digit +Substitution Test: normative data for 1,858 healthy participants aged 24-81 +from the Maastricht Aging Study (MAAS): Infl + uence of age, education, and +sex. J Clin Exp Neuropsychol 2006;28:998-1009. +10. Natu MV, Agarwal AK. Digit letter substitution test (DLST) as an alternative +to digit symbol substitution test (DSST). Hum Psycopharmacol Clin Exp +2002;10:339-43. +11. van Hoof JJ, Lezak MD. Neuropsychological assessment, 3rd ed. New York: +Oxford UP; 1995. +12. Natu MV, Agarawal AK. Testing of stimulant effects of coffee on the +psychomotor performance: An exercise in clinical pharmacology. Indian J +Pharmacol 1997;29:11-4. +13. Belsley DA, Kuh E, Welsch RE. Regression diagnostics: Identifying the +infl + uential data and source of collinearity. New York: Wiley; 1980. +14. Gonzalez HM, Whitfi + eld KE, West BT, Williams DR, Lichtenberg PA, +Jackson JS. Modifi + ed-symbol digit modalities test for African Americans, +Caribbean Black Americans, and non-Latino Whites: Nationally representative +normative data from the National Survey of American Life. Arch Clin +Neuropsychol 2007;22:605-13. +15. Agarwal AK, Kalra R, Natu MV, Dadhich AP, Deswal RS. Psychomotor +performance of psychiatric inpatients under therapy: Assessment by paper +and pencil tests. Hum Psychopharmacol 2002;17:91-3. +[Downloaded free from http://www.ijoy.org.in on Friday, March 12, 2010] diff --git "a/subfolder_0/Perceived stress and depression in prediabetes and diabetes in an Indian population\342\200\224A call for a.txt" "b/subfolder_0/Perceived stress and depression in prediabetes and diabetes in an Indian population\342\200\224A call for a.txt" new file mode 100644 index 0000000000000000000000000000000000000000..6c0854dca54f78a7c5e0e9f00df55cb0b2672d9a --- /dev/null +++ "b/subfolder_0/Perceived stress and depression in prediabetes and diabetes in an Indian population\342\200\224A call for a.txt" @@ -0,0 +1,371 @@ +Contents lists available at ScienceDirect +General Hospital Psychiatry +journal homepage: www.elsevier.com/locate/genhospsych +Letter to the Editor +Perceived stress and depression in prediabetes and diabetes in an Indian population—A call for a +mindfulness-based intervention +A R T I C L E I N F O +Keywords: +Perceived stress +Counter stress +Diabetes +Depression +Mindfulness +Diabetes mellitus (DM) is a chronic metabolic disorder with sig- +nificant morbidity, mortality, and healthcare expenditure. The overall +prevalence of DM in India is 7.3% [1], representing 70 million persons, +with an expected rise to 120.5 million by 2040 [2]. Several modifiable +environmental factors, including obesity, physical inactivity, diet +quality, smoking, hypertension and hyperlipidemia, have been attrib- +uted to increased risk of DM [3]. However, despite efforts to combat +these factors, DM incidence continues to rise. This indicates a need to +identify additional contributing factors and develop new public health +strategies to combat the disease. +Psychological stress is a risk factor for chronic conditions including +DM. Kelly et al. reported that stress-related factors (such as stressful +workplace or traumatic life events, depression; type A personality, and +mental health problems) are associated with the development of DM, +and these connections between DM and stress, physical inactivity, +dietary changes and unhealthy lifestyle conditions appears to hold true +in India as well [1]. This is supported by underlying biological path- +ways. Stressors have been hypothesized to activate the hypothalamo- +pituitary-adrenal (HPA) axis, resulting in release of various insulin +counter-regulatory hormones such as cortisol and adrenaline [4]. +The increased genetic susceptibility of Indian population to DM +provides a good opportunity for delineating the role of stress. +Prediabetes, a precursor to DM, is becoming more common and is es- +timated to affect 33.9% of the adult U.S. population. It is thus important +to understand the role of stress in prediabetes to understand its asso- +ciation with progression to DM. Previous studies have examined stress +levels in diabetic and prediabetic patients, but there is a no nationwide +data that describes stress levels in patients with prediabetes and DM. +Accordingly, we conducted an observational study on 16,368 par- +ticipants with a mean age of 47.8 ± 12.5 years [5]. The study was +undertaken in all Indian zones under the National Multicentric Diabetes +Control Program. It included both urban (54.7%) and rural (36.8%) +participants. Ethical permission was obtained from Institutional Ethics +committee (IEC) meeting held at Morarji Desai National Institute of +Yoga vide reference no. RES/IEC-IYA/001 dated 16th Dec 2016. +Stress was determined using the Perceived Stress Scale (PSS-10) {n, +prediabetic (PD) = 649, diabetic (D) = 485} and Visual Analog scale +(VAS) {n, PD = 2173, D = 2144}. The Patient Health Questionnaire +(PHQ-9) was administered to assess depression {n, PD = 597, +D = 440}. Table 1 outlines stress scores from each scale to compare +stress levels in persons with prediabetes and DM. Total VAS scores were +(non-significantly) higher in those with DM than those with prediabetes +(VAS: 21.20 vs. 20.6; test statistic −1.66; p = 0.09). In contrast, uni- +directional analysis of the PSS scale showed a significant difference +between those with prediabetes and DM (13.6 vs. 12.4; test statistic +2.16; p = 0.03) group. Furthermore, bidirectional analysis revealed a +significant difference in stress factors in prediabetic group (7.7 vs. 7.0; +test statistic 2.10; p = 0.03). Persons with prediabetes had significantly +higher depression scores (mean PHQ-9 scores: 6.9 vs. 6.1; test statistic +1.95; p = 0.04) than those with DM. +This is the first report from the India describing the perceived stress +among persons with prediabetes and DM. Our findings revealed that +persons with prediabetes had higher perceived stress and depression on +some, but not all, scales as compared to those with existing DM. Despite +higher reported stress in the prediabetes group, longitudinal studies are +imperative before any cause/effect relationships between stress and +conversion of prediabetes to DM can be established. +These findings have important potential implications. Stress has +been long believed to be closely related with DM [6]. For example, a +Swedish study has described that self-perceived chronic stress was as- +sociated with 45% increased risk of DM diagnosis, independent of +conventional diabetic risk factors [7]. As previously noted, prolonged +stress and depression may adversely impact the HPA axis and lead to +abdominal obesity [4]. Furthermore, immune dysregulation (increased +proinflammatory cytokines and cortisol release), in response to chronic +stressors, has also been postulated to be responsible for DM [8]. Karo +et al. have also previously shown the association of perceived mental +stress with the onset of DM [10]. However, none of these studies esti- +mated the ability of participants to counter stress, and stress coping +strategies, like yoga, may have positive effect on the onset of DM, +glycemic index, and quality of life [9]. +In this context, it is imperative that a multicentric study examines +the role of stress in the progression of prediabetes to DM to best assess +cause and effect relationships between stress and progression of pre- +diabetes to DM. +https://doi.org/10.1016/j.genhosppsych.2020.01.001 +Received 17 November 2019; Received in revised form 6 January 2020; Accepted 7 January 2020 +G +e +n +e +r +a +l + +H +o +s +p +i +t +a +l + +P +s +y +c +h +i +a +t +r +y + +6 +4 + +( +2 +0 +2 +0 +) + +1 +2 +7 +– +1 +2 +8 +0 +1 +6 +3 +- +8 +3 +4 +3 +/ + +© + +2 +0 +2 +0 + +E +l +s +e +v +i +e +r + +I +n +c +. + +A +l +l + +r +i +g +h +t +s + +r +e +s +e +r +v +e +d +. +T +Author contributions +AM collected data, VP, SM and RK compiled the manuscript, RN and +HRA edited and planned the study while AA conceptualized the re- +search letter. +Declaration of competing interest +Authors declare that they have no competing interest. +Acknowledgements +Authors would like to acknowledge the volunteers of Niyantrita +Madhumeh Bharat for their help in data collection, Dr. Rama Malhotra +and Dr. Suchitra for data analysis, Abdul Ghani for data digitization, +CCRYN for providing support as manpower and MOHFW for providing +financial help for the cost of investigations. We also thank IYA for the +overall project implementation and Dr. Deepti, Head of Department of +English, Panjab University for proof reading. +Source of funding +This +research +work +was +supported +by +Ministry +of +AYUSH, +Government of India (grant number 16-63/2016-17/CCRYN/RES/Y& +D/MCT/) +References +[1] Sendhilkumar M, Tripathy JP, Harries AD, Dongre AR, Deepa M, Vidyulatha A, et al. +Factors associated with high stress levels in adults with diabetes mellitus attending a +tertiary diabetes care center, Chennai, Tamil Nadu, India. Indian J Endocrinol Metab +2017;21(1):56–63. Jan-Feb. +[2] Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho +NH, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 +and 2040. Diabetes Res Clin Pract 2017;128:40–50. Jun 1. +[3] Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with +type 2 diabetes and diabetic vascular complications. Rev Diabet Stud +2012;9(1):6–22. Spring. +[4] Kelly SJ, Ismail M. Stress and type 2 diabetes: a review of how stress contributes to +the development of type 2 diabetes. Annu Rev Public Health 2015;36:441–62. +Mar 18. +[5] Nagendra HR, Nagarathna R, Rajesh SK, Amit S, Telles S, Hankey A. Niyantrita +Madhumeha Bharata 2017, methodology for a nationwide diabetes prevalence esti- +mate: part 1. Int J Yoga 2019;12(3):179–92. Sep-Dec. +[6] Rod NH, Grønbaek M, Schnohr P, Prescott E, Kristensen TS. Perceived stress as a risk +factor for changes in health behaviour and cardiac risk profile: a longitudinal study. J +Intern Med 2009;266(5):467–75. Nov. +[7] Novak M, Björck L, Giang KW, Heden-Ståhl C, Wilhelmsen L, Rosengren A. Perceived +stress and incidence of Type 2 diabetes: a 35-year follow-up study of middle-aged +Swedish men. Diabet Med 2013;30(1):e8–16. Jan. +[8] Leonard BE, Myint A. The psychoneuroimmunology of depression. Human +Psychopharmacology: Clinical and Experimental 2009;24(3):165–75. Apr. +[9] Lloyd C, Smith J, Weinger K. Stress and diabetes: a review of the links. Diabetes +Spectrum 2005;18(2):121–7. Apr 1. +[10] Kato M, Noda M, Inoue M, Kadowaki T, Tsugane S. Psychological factors, coffee and +risk of diabetes mellitus among middle-aged Japanese: a population-based pro- +spective study in the JPHC study cohort. Endocr J 2009;56(3):459–68. +Amit Mishrab, Vivek Podderc, Shweta Modgila, Radhika Khoslaa, +Akshay Ananda,⁎⁎, Raghuram Nagarathnab,⁎, Amit Kumar Singhb, +Hongasandra R. Nagendrab +a Neuroscience Research Lab, Department of Neurology, Postgraduate +Institute of Medical Education and Research (PGIMER), Chandigarh, India +b Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India +c Kamineni Institute of Medical Sciences, Narketpally, India +E-mail addresses: akshay1anand@rediffmail.com (A. Anand), +rnagaratna@gmail.com (R. Nagarathna). +Table 1 +The stress and depression levels in people with diabetes and prediabetes based +on analysis of multiple scales (VAS, PHQ, PSS). +Scales +Group +N +Mean +Std. deviation +t-Value +p-Value +VAS +Pre-diabetes +2173 +20.62 +11.38 +−1.66 +0.09 +Diabetes +2144 +21.20 +11.66 +PHQ +Pre-diabetes +597 +6.87 +6.66 +1.95 +0.04 +Diabetes +440 +6.09 +6.01 +PSS +Pre-diabetes +649 +13.58 +8.93 +2.16 +0.03 +Diabetes +485 +12.41 +8.98 +Stress (f1) +Pre-diabetes +656 +7.66 +5.65 +2.10 +0.03 +Diabetes +495 +6.95 +5.65 +Counter stress +(f2) +Pre-diabetes +704 +5.91 +4.05 +1.35 +0.17 +Diabetes +508 +5.58 +4.24 +⁎ Correspondence to: R. Nagarathna, Arogya Dham, SVYASA, Bangalore, India. +⁎⁎ Correspondence to: A. Anand, Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), +Chandigarh, India +Letter to the Editor +G +e +n +e +r +a +l + +H +o +s +p +i +t +a +l + +P +s +y +c +h +i +a +t +r +y + +6 +4 + +( +2 +0 +2 +0 +) + +1 +2 +7 +– +1 +2 +8 +1 +2 +8 diff --git a/subfolder_0/Predictors of family caregiver burden in schizophrenia Study from an in-patient tertiary care hospital in India..txt b/subfolder_0/Predictors of family caregiver burden in schizophrenia Study from an in-patient tertiary care hospital in India..txt new file mode 100644 index 0000000000000000000000000000000000000000..7bc21f07c2fa5274d412551ffc91baee8ca30d78 --- /dev/null +++ b/subfolder_0/Predictors of family caregiver burden in schizophrenia Study from an in-patient tertiary care hospital in India..txt @@ -0,0 +1,696 @@ +This article appeared in a journal published by Elsevier. The attached +copy is furnished to the author for internal non-commercial research +and education use, including for instruction at the authors institution +and sharing with colleagues. +Other uses, including reproduction and distribution, or selling or +licensing copies, or posting to personal, institutional or third party +websites are prohibited. +In most cases authors are permitted to post their version of the +article (e.g. in Word or Tex form) to their personal website or +institutional repository. Authors requiring further information +regarding Elsevier’s archiving and manuscript policies are +encouraged to visit: +http://www.elsevier.com/authorsrights +Author's personal copy +Predictors of family caregiver burden in schizophrenia: +Study from an in-patient tertiary care hospital in India +Aarti Jagannathan a,*, Jagadisha Thirthalli b, Ameer Hamza c, H.R. Nagendra d, +B.N. Gangadhar e +a Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bangalore, India +b Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India +c Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India +d Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore, India +e Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India +1. Introduction +Family caregivers provide considerable support to their ill +relative and in turn experience significant burden (Leff, 1994; Li +et al., 2007). Zarit et al. (1986) defined burden as the extent to +which caregivers perceived their emotional and physical health, +social life and financial status as suffering as a result of caring for +their relative. Burden has two components – objective and +subjective. Objective burden refers to the quantifiable challenges +faced by the family members in everyday life such as financial +costs, loss of free time and altered social relationships. Subjective +burden refers to the abstract or emotional costs faced by the family +as a result of the patient’s illness. +In the context of research conducted internationally on +predictors of caregiver burden in patients with schizophrenia, +high levels of caregiver burden were often significantly associated +with some demographic variables and with positive and negative +symptoms of schizophrenia (Ukpong, 2006; Caqueo-Urizar and +Gutie +´rrez-Maldonado, 2006; Gutie +´rrez-Maldonado et al., 2005). +Caregivers who were in ‘high contact’ with the patient in their daily +life (Winefield and Harvey, 1994), who were parents and were +aged (Hadrys et al., 2011; Lauber et al., 2003) often faced the +Asian Journal of Psychiatry 8 (2014) 94–98 +A R T I C L E +I N F O +Article history: +Received 12 September 2013 +Received in revised form 24 December 2013 +Accepted 26 December 2013 +Keywords: +Predictors +Family caregivers +Burden +Schizophrenia +A B S T R A C T +Background: Family caregivers experience significant burden in taking care of their patients with +schizophrenia. Research on predictors of caregiver burden in India, where families are the primary +caregivers of schizophrenia patients, is lacking. +Aim: To study the predictors of burden experienced by the family caregivers of first admission in-patient +schizophrenia patients in India. +Methods and materials: Family caregivers of 137 schizophrenia patients admitted to an in-patient facility +of a hospital in south India were interviewed using the Burden Assessment Schedule. The coping, +knowledge about schizophrenia, perceived social support of the caregivers and illness severity, +psychopathology and disability experienced by the patients were also assessed. +Statistical analysis: Bivariate correlation and multivariate regression analysis were used to study the +association of different factors on burden. +Results: Duration of illness and levels of psychopathology and disability had significant direct +correlation with total burden score; perceived social support had significant inverse correlation with +total burden score. There was a high correlation between psychopathology and disability (p < 0.001). +Two separate regression analyses, each including total PANSS score (psychopathology) or total IDEAS +score (disability) showed that duration of illness and perceived social support were significant predictors +of burden in addition to psychopathology and disability. +Conclusion: During the first hospitalization, in addition to symptom reduction and disability limitation, +focus should be on enhancing social support in order to reduce caregiver burden among family members +of schizophrenia patients. + 2014 Elsevier B.V. All rights reserved. +* Corresponding author at: # 19, ‘Eknath Bhavan’, Gavipuram Circle, Kempe +Gowda Nagar, Bangalore 560019, India. Tel.: +91 9448150690; +fax: +91 80 26608645. +E-mail addresses: jaganaarti@gmail.com (A. Jagannathan), jagatth@yahoo.com +(J. Thirthalli), drameerhamza@gmail.com (A. Hamza), hrn@vyasa.org +(H.R. Nagendra), kalyanybg@yahoo.com (B.N. Gangadhar). +Contents lists available at ScienceDirect +Asian Journal of Psychiatry +jo u rn al h om epag e: ww w.els evier.c o m/lo cat e/ajp +1876-2018/$ – see front matter  2014 Elsevier B.V. All rights reserved. +http://dx.doi.org/10.1016/j.ajp.2013.12.018 +Author's personal copy +highest burden. A five year follow-up study conducted in Ethiopia +showed that while poor social support predicted higher burden +score, longer period in remission and reduction in positive +symptoms predicted lower level of caregiver burden (Shibre +et al., 2012). Lower burden was also associated with the caregivers’ +subjective feelings of being able to cope with problems and to +pursue their own activities (Hadrys et al., 2011; Lauber et al., +2003). In a three year follow-study in Italy, patients’ severity of +illness, higher numbers of patient-rated needs, lower global +functioning and poor quality of life were found to be related to +the severity of family burden (Parabiaghi et al., 2007). +Studies conducted in Asia have shown that the greater +caregivers’ burden was best predicted by lower education (Li +et al., 2007), higher age, greater social support (Chien et al., 2007) +and monthly income; the number of family members living with +the patient was negatively correlated with burden. Further, the +physical and mental health of the caregiver was observed to be +another important factor in determining the caregiver burden +(Hou et al., 2008). +In India, the issue of family burden assumes significant +importance because a majority of the patients with schizophrenia +stay with their families (Thara et al., 1998; Murthy, 2006). Due to +this cultural variation (Awad and Voruganti, 2008) the predictors +of burden in India are often seen to be entirely different from those +of the west (Pai and Kapur, 1981). Studies conducted in India +(Thara et al., 1998; Chakrabarti et al., 1995; Talwar and Matheiken, +2010) have found that burden is experienced in the form of +disruption in family life, financial burden, disruption of family +interactions, well-being and health. +From the above review it can be observed that the correlates or +predictors of caregiver burden have hardly been studied. Further, +none of the studies have looked at predictors of caregiver burden in +first admission acute patients of schizophrenia. An understanding +of the predictors of caregiver burden at the start of admission, +could aid better understanding of issues that we need to address +with the caregivers to help them in the continuum of care. Also, we +have attempted to understand the correlation between caregiver +burden and the coping style used by the caregiver, which has been +explored only by a few previous research studies (Rammohan et al., +2002; Creado et al., 2006; Chadda et al., 2007). In lieu of the above, +in this study the predictors of family caregiver’s burden in a cohort +of first admission in-patient schizophrenia patients from a tertiary +care hospital in India has been analyzed and presented. +2. Methodology +2.1. Sample +The participants were 137 family caregivers of inpatients with +schizophrenia who were recruited to be part of a four arm, single +blind randomized controlled trial, to test the efficacy of yoga and +psychosocial programme on the burden and coping of caregivers of +patients with schizophrenia (Jagannathan et al., 2012). The sample +was recruited from the in-patient wards of the National Institute of +Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India +– a tertiary care centre, 900-bed teaching hospital with training +and research facilities in psychiatry and other neurosciences. +Family caregivers (aged 18–75 years) of first time admitted +patients with a diagnosis of schizophrenia (according to ICD 10; +World Health Organization, 2002) were included in the study if +their patients had been ill at least for a minimum of three months +prior to their enrollment into the study. Caregivers who also +continued to provide care to them following discharge and spoke +Kannada, Tamil, English or Hindi were included. Family caregivers +with psychiatric or neurological disorders who scored more than +the universal cut-off of eight on the Self Reporting Questionnaire +(SRQ; Beusenberg and Orley, 1994) and those caring for another +relative with psychiatric illness were excluded. +Initially, 438 family caregivers (of in-patients suffering from +schizophrenia) were screened for the study during the period of June +2009–June 2010. Out of this sample, 145 family caregivers were +excluded because they spoke a language other than those listed +above (N = 45), their patients’ were planned for discharge early +(N = 70), the primary caregiver was not available (N = 25) or +caregiver refused to participate in the study (N = 5). Logistical +issues did not permit the researcher to recruit some family +caregivers (N = 103; due to patient symptoms, legal issues, not +coming for follow-up) and 53 family caregivers did not meet the +inclusion criteria. Finally, a total of 137 family caregivers were +recruited and written informed consent was taken from them after +explaining the details of the study. +2.2. Assessments +Consenting family caregivers were assessed in one sitting over a +2 hour period. Apart from eliciting their socio-demographic details, +the main outcome variable they were assessed on was their burden +[Burden Assessment Schedule (BAS; Thara et al., 1998)]. Out of the +two burden scales developed, validated and widely used with the +Indian population, it was observed that Family Burden Interview +Schedule (FBIS; Pai and Kapur, 1981) focused more on the objective +measure of burden whereas the BAS gave both subjective and +objective measures of burden. Further, BAS was developed for the +chronically ill mental patients (especially schizophrenia) whereas +the FBIS could be generalized to caregivers of all psychiatric +disorders. Hence it was decided to use BAS to assess both the +objective and subjective measures of burden over the last one +month in this study, as the patient sample was from those suffering +from acute schizophrenia. +The BAS (Thara et al., 1998) was developed using the step-wise +ethnographic exploration method, to develop items that were +contextual and reflected the opinions of the caregivers rather than +those of the researchers. The schedule contains forty items which +were rated on a three point rating scale, marked 1–3 – anchor +points indicative of ‘not at all’, ‘to some extent’ and ‘very much’. +Some of the items are reverse coded. The score ranges from 40 to +120, with higher scores indicating higher burden. The schedule +assesses burden in seven areas namely; financial burden, patient +behaviour, social relations, caregiver health, caregiver occupation, +leisure and emotional burden. The BAS has been validated against +the (FBIS; Pai and Kapur, 1981) and the correlations ranged from +0.71 to 0.82 for most items. Inter rater reliability for the scale is +0.80 (kappa, p < 0.01). The test–retest reliability computed for a +period of three months was 0.92. +A few items of the BAS were not applicable to most caregivers +(i.e., items 17–20 are applicable only if the patient is spouse of +the interviewed caregiver). As this would influence their total +score, we used the average BAS score for statistical analysis. +Average BAS score was calculated by dividing the total BAS score +by 36 in non-spouse caregivers and by 40 in caregivers who were +also spouses. +The other outcome variables also assessed were Coping [Coping +Checklist (CCL); Rao et al., 1989], knowledge [Knowledge About +Schizophrenia (KASI); Barrowclough et al., 1987] and perceived +social support [Perceived Social Support (PSS); Pillay and Rao, +2002]. Information about the positive and negative symptoms of +the patient [Positive and Negative Symptoms of Schizophrenia +(PANSS); Kay et al., 1987], disability level [Indian Disability +Evaluation and Assessment Schedule (IDEAS); Rehabilitation +Committee of Indian Psychiatry Society, 2000] and illness severity +[Clinical Global Impression-Severity (CGI-S); Guy, 1976] were +procured from the family caregiver and the hospital medical +A. Jagannathan et al. / Asian Journal of Psychiatry 8 (2014) 94–98 +95 +Author's personal copy +records of the patient (as most of the information is elicited from +the patient as part of routine clinical assessment). +2.3. Procedure +This study was approved by the Institutional Ethics Committee +of NIMHANS. Family caregivers who passed all the steps of +screening were approached personally by the researcher in their +respective wards for recruitment into the study. A caregiver was +deemed recruited for the study only when he provided his written +informed consent (which included aspects of assessments as well +as interventions) to the researcher. Post the assessments the family +caregivers were offered psychosocial and/or yoga interventions to +help them deal with their burden. +2.4. Data analysis +The mean burden score at baseline was used for analysis. The +socio-demographic characteristics and outcome variables were +correlated with mean burden score using the Pearson’s correlation +analysis, t test and Univariate Analysis of Variance (ANOVA). +Multiple linear regression analysis was also conducted to examine +the association of burden with the predictor variables. The +variables that showed significant association with mean family +burden in univariate analysis were selected to be included in the +regression analysis. +3. Results +Details of the family caregivers and the patients are shown in +Table 1. The mean (SD) age of the caregivers 49 (14.1) years and +about half of them were females. Their mean (SD) education was 11 +(5.4) years and the majority of them were parents of the patients +(66.7%) and of Hindu religion (87.4%). About 72.6% of them were +married and 47.4% of them were employed. Most of them did not +have any physical (55.2%) or substance related problems (74.6%). +Further most of them were staying in nuclear families (87.3%). +The mean (SD) age of the patients was 30 (8.1) years and their +mean (SD) years of education was 12.2 (3.7) years. The mean (SD) +duration of their illness was 7.9 (5.9) years and 23.8% of the +patients had a family history of psychiatric illness. Around 47.8% +were females and the majority of them (53.7%) of the patients were +diagnosed with paranoid schizophrenia. Most patients were +treatment compliant and on an average, their symptoms were +mild and they had moderate level of disability. A majority of them +were unemployed (79.9%) due to their illness. +3.1. Burden +The mean (SD) total burden of the caregivers (excluding +spouses of the patient) was 80.02 (11.53), and the mean (SD) total +burden of caregivers who were spouses of the patients was 74.94 +(11.27). For further analysis we have taken the average BAS score; +the mean (SD) of the average BAS score was 1.94 (0.31). The results +of correlation analysis of the determinants of burden with average +BAS appear in Table 2. The education level of the caregiver had a +significant negative correlation with burden whereas the age of the +patient had a significant positive correlation with caregiver +burden. The longer the duration of illness (DOI) and higher the +psychopathology (individual domains as well as total score of +PANSS), severity of illness (CGI-S) and disability (individual +domains as well as total score of IDEAS), the greater was the +burden. Further, caregivers experienced higher burden when they +perceived lesser social support. +Table 1 +Socio-demographic data of family caregivers and patients. +Caregivers (n = 137) +Patients (n = 137) +Variable +N (%) +*Mean (SD) +Variable +N (%) +*Mean (SD) +Age (in years)* +49 (14.1) +Age (in years)* +30.0 (8.1) +Education (in years)* +11 (5.4) +Education (in years)* +12.2 (3.7) +Gender (female) +70 (51.1) +Duration of illness (DOI)* +7.9 (5.9) +Family type (nuclear family) +117 (87.3) +Gender (female) +64 (47.8) +Relationship with patient +Patient diagnosis +Parent +90 (66.7) +Paranoid +72 (53.7) +Sibling +19 (14.1) +Hebephrenic +4 (3.0) +Spouse +18 (13.3) +Undifferentiated +31 (23.1) +Child +4.0 (3.0) +Treatment resistant +4 (3.0) +Others +4 (2.9) +Simple schizophrenia +15 (11.2) +Schizoaffective +8 (6.0) +Religion +Family history of psychiatric illness (yes) +Hindu +118 (87.4) +32 (23.8) +Christian +5(3.7) +Muslim +12 (8.9) +Occupation +Occupation +Unemployed +6 (4.4) +Unemployed +107 (79.9) +Employed/Self employed +64 (47.4) +Employed/Self employed +7 (5.1) +Housewife +43 (31.9) +Housewife +13 (9.7) +Retired +22 (16.3) +Student +7 (5.2) +Marital status (currently married) +98 (72.6) +Treatment compliance (yes) +83 (61.9) +Comorbid physical illness +PANSS (total)* +58.5 (18.9) +Nil +74 (55.2) +HT +18 (13.4) +DM +14 (10.4) +Others +28 (20.8) +Substance use +IDEAS* +7 (4.0) +Nil +100 (74.6) +Nicotine +17 (12.7) +Alcohol +4 (3.0) +Multiple +13 (9.7) +A. Jagannathan et al. / Asian Journal of Psychiatry 8 (2014) 94–98 +96 +Author's personal copy +There was no significant association between caregiver’s burden +and caregiver’s employment [currently employed/unemployed/ +housewife; F = 0.97, p = 0.38], gender [t = 1.64, p = 0.10], relationship +with patient [parent/spouse/others; F = 0.71, p = 0.55], and marital +status [t = 0.33, p = 0.74]. Further, there was no significant +association between caregiver’s average burden and patients’ +gender [t = 0.36, p = 0.72] or treatment compliance [t = 0.92, +p = 0.36]. +It was observed that there was a high correlation between +psychopathology and disability (p < 0.001). Hence, in order to +assess the relative contribution of different variables towards +family burden, we ran two separate regression analyses, each +including total PANSS score (psychopathology) or total IDEAS score +(disability). In both regression analyses, we used average family +burden as the dependent variable and education of the caregiver, +age of patient, duration of illness, and total perceived social +support as additional independent variables. +The model including total PANSS score was significant at p < 0.01 +and explained 21% of variance (Adjusted R Square = 0.213). Total +PANSS score (Beta = 0.194; p = 0.015), education of the caregiver +(Beta = 0.173; p = 0.031), DOI (Beta = 0.212; p = 0.020) and PSS +(Beta = 0.253; p = 0.002) emerged as significant predictors. Simi- +larly, the model including total IDEAS score was significant at +p < 0.001 +and +explained +22% +of +variance +(Adjusted +R +Square = 0.221). Total IDEAS score (Beta = 0.233; p = 0.007), DOI +(Beta = 0.226; +p = 0.013) +and +PSS +(Beta = 0.192; +p = 0.026) +emerged as significant predictors. +4. Discussion +In this study we have attempted to understand the predictors of +caregiver’s burden in a cohort from a tertiary care hospital in India. +The most important finding was that burden experienced by +caregivers of schizophrenia in-patients depends on the psychopa- +thology, level of disability duration of illness, education of +caregiver and perceived social support. Other socio-demographic +variables examined in this study did not have influence on burden. +The socio-demographic profile of the caregivers who partici- +pated in both the programmes was consistent with that of earlier +studies on Indian caregivers of persons with schizophrenia +(Murthy, 2006; Srinivasan, 2006). Further, the mean total burden +of the caregivers in our study was similar to studies conducted in +out-patient hospital settings by Srivastava (2005) and Creado et al. +(2006). A highly significant correlation between psychopathology +and burden suggests that burden was substantially dependent on +patient psychopathology. This is consistent with the results of our +previous study on the ‘assessment of caregiver’s needs’ (Jagan- +nathan et al., 2011), where the most important need of the in- +patient family caregivers was to manage the illness behaviour of +the patient. +Some studies have found that caregiver burden is positively +correlated with avoidance type of coping or use of denial +(Rammohan et al., 2002; Chadda et al., 2007) Others have reported +that problem-focused coping and expressive-action decreased the +burden of caregivers, while emotion-focused coping, i.e., fatalism +and passivity, increased it (Creado et al., 2006). We did not find any +correlation +between +the +type +of +coping +used +and +burden +experienced in our study. This is likely to be because the previous +studies assessed the coping and burden of caregivers whose +patients were taking out-patient treatment. Possibly caregivers of +first admission in-patients with schizophrenia are preoccupied +with the recovery of their patient and understanding the problem. +Use of specific coping strategies could be relevant much later in the +continuum of care. +Our study also brought out that caregiver’s education level and +PSS, has a bearing on the burden level. These findings are similar to +other Asian and Indian literature which mention the above +predictors of caregiver burden as unique to the Asian and Indian +setting (Li et al., 2007; Chien et al., 2007; Thara et al., 1998; Pai and +Kapur, 1981). +This study has a number of methodological strengths. First, in +this study, trained raters and psychiatrists used standardized tools +for establishing diagnosis and assessing psychopathology, disabil- +ity and burden. Second, the tools used in this study (especially for +the main outcome variables) were developed, validated and +standardized in the South Indian population (Thara et al., 1998; +Rao et al., 1989). Hence the tools used in this study were culture +and region specific. Further, hardly any studies have looked at +predictors of caregiver burden in first admission acute patients of +schizophrenia. An understanding of the predictors of caregiver +burden at the start of admission, could aid better understanding of +issues that we need to address with the caregivers to help them in +the continuum of care. +However a very small percentage of patients suffering from +schizophrenia get admitted as in-patients in a treatment facility. +The majority of them receive out-patient treatment. Their needs, +caregiver burden and interventions are different (Cleary et al., +2006) and have been less explored. Hence the generalization of this +sample would be limited and the results of this study cannot be +extrapolated to the out-patient family caregivers. Future studies +should explore this aspect of research. Another limitation of this +study is that it employs a cross-sectional design and we have no +way of knowing the temporal sequence of the predictors and +outcome. Future studies should employ prospective design to +clarify this issue. +5. Conclusion +Burden experienced by family caregivers of schizophrenia in- +patients primarily depends on the psychopathology, level of +disability and duration of illness of the patient; education and +Table 2 +Correlation between mean burden score and other variables (n = 137). +Variable +Pearson’s R +p value +Age of the caregiver +0.12 +0.16 +Education of caregiver +0.24 +0.01 +Age of the patient +0.21 +0.02 +Education of patient +0.11 +0.20 +Duration of illness +0.25 +<0.01 +Total PANSSa +0.23 +0.01 +Positive symptoms +0.16 +0.07 +Negative symptoms +0.21 +0.02 +General symptoms +0.53 +<0.01 +CGI-Sb +0.34 +<0.001 +Total IDEASc +0.33 +<0.001 +Self care +0.23 +0.01 +Interpersonal activities +0.33 +<0.001 +Communication +0.35 +<0.001 +Work +0.27 +<0.01 +CCLd +Problem focused +0.04 +0.66 +Emotion focused +0.09 +0.32 +Social support +0.05 +0.53 +Total KASIe +0.14 +0.11 +Total PSSf +0.33 +<0.001 +a PANSS: Positive And Negative Syndrome Scale. +b CGI-S: Clinical Global Impression-Severity. +c IDEAS: Indian Disability Evaluation and Assessment Scale. +d CCL: Coping Check List. +e KASI: Knowledge About Schizophrenia Interview. +f PSS: Perceived Social Support scale. +A. Jagannathan et al. / Asian Journal of Psychiatry 8 (2014) 94–98 +97 +Author's personal copy +perceived social support of the caregiver. During the first hospitali- +zation, in addition to symptom reduction and disability limitation +with antipsychotic medications (pharmacotherapy), focus should be +on enhancing social support in order to reduce caregiver burden +among family members of schizophrenia patients. +Role of funding source +No funding source was involved in the current study, as the +study was conducted as part of PhD degree programme under the +Department of Psychiatric Social Work, NIMHANS, Bangalore +560029, India. The primary author was the PhD research scholar +who conducted the study and the other mentioned co-authors +were her guides/co-guides for the PhD dissertation. Hence it was a +self-funded project, no external or internal funding was availed of. +Conflicts of interest +None. +Acknowledgements +The team would like to thank Manoranjitha Gautam Kumar, +Mounesh Yadav and Shanivaram Reddy for helping out in rating/ +scoring the patient assessments (raters were blind to the treatment +status). +References +Awad, A.G., Voruganti, L.N., 2008. The burden of schizophrenia on caregivers: a +review. Pharmacoeconomics 26, 149–162. +Barrowclough, C., Tarrier, N., Watts, S., Vaughn, C., Bamrah, J.S., Freeman, H.L., 1987. +Assessing the functional value of relatives’ knowledge about schizophrenia: a +preliminary report. British Journal of Psychiatry 151, 1–8. +Beusenberg, M., Orley, J., 1994. A User’s Guide to Self Reporting Questionnaire +(SRQ). Division of Mental Health. World Health Organization, Geneva. +Caqueo-Urizar, A., Gutie +´rrez-Maldonado, J., 2006. Burden of care in families of +patients with schizophrenia. 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Jagannathan et al. / Asian Journal of Psychiatry 8 (2014) 94–98 +98 diff --git a/subfolder_0/Prevalence of type 2 diabetes among Yoga practitioners A pilot cross-sectional study in two districts in India.txt b/subfolder_0/Prevalence of type 2 diabetes among Yoga practitioners A pilot cross-sectional study in two districts in India.txt new file mode 100644 index 0000000000000000000000000000000000000000..ee6c5ea97574dc4a80d746dfdc87a770473bb4fb --- /dev/null +++ b/subfolder_0/Prevalence of type 2 diabetes among Yoga practitioners A pilot cross-sectional study in two districts in India.txt @@ -0,0 +1,812 @@ +International Journal of Yoga • Vol. 8 • Jul-Dec-2015 +148 +Prevalence of type 2 diabetes among Yoga practitioners: +A pilot cross‑sectional study in two districts in India +Aarti Jagannathan, Narayanan VV, Isha Kulkarni, Sonali P Jogdand, Subramanya Pailoor1, Nagarathna R +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, 1Swami Vivekananda Yoga +Anusandhana Samasthana, Bengaluru, Karnataka, India +Address for correspondence: Dr. Aarti Jagannathan, + +Swami Vivekananda Yoga Anusandhana Samasthana, 19, Gavipuuram, KG Nagar, Bengaluru ‑ 560 019, Karnataka, India. +E‑mail: jaganaarti@gmail.com +diabetes, Yoga is considered as a safe and cost‑effective +intervention.[2‑4] +The latest statistics presented by International Federation +of Diabetes (IDF) depict the prevalence of diabetes in +India as 9%.[5] Published studies on selected populations +in India have suggested that the prevalence of known +diabetes in urban areas is around 5.0%.[6‑9] As Yoga asanas +and Pranayama are observed to better glycemic control +and stable autonomic functions in type 2 diabetes,[10] it +would be interesting to study the prevalence of type 2 +diabetes among Yoga practitioners in India. In this context, +the current pilot project was undertaken to study the +cross‑sectional prevalence of self‑reported type 2 diabetes +in Yoga practitioners in two districts of India (one each in +West and South of India). +METHODOLOGY +The study was approved by the Institute Ethics +Committee (IEC) of Swami Vivekananda Yoga Anusandhana +INTRODUCTION +Yoga aims to incorporate the body, mind, and spirit to +bring about physical, mental, and spiritual health. Yoga +practitioners are observed to gain physical strength and +flexibility as well as calmness of the mind with Yoga +postures, breathing and meditation. Though a number +of healthy individuals take to Yoga to maintain their +health, Yoga is also often observed to be practiced as +a therapy postdiagnosis of a chronic condition such +as diabetes, hypertension, obesity, and anxiety‑related +conditions.[1] Especially in management of type  2 +Access this article online +Website: +www.ijoy.org.in +Quick Response Code +DOI: +10.4103/0973-6131.158485 +Introduction: Diabetes is one of the major health diseases in the world today. The efficacy of Yoga in the management of type 2 +diabetes is well‑established. The aim of this study was to assess the prevalence of type 2 diabetes among Yoga practitioners +in two districts of India (one each in West and South of India). +Methodology: In this cross‑sectional field study, 155 Yoga practitioners from Pune and 192 from Ernakulam districts were +assessed using the diabetes risk test and fasting blood sugar. The data collected were entered in a statistics software package +and analyzed using the Pearson’s correlation analysis, t‑test, univariate ANOVA, and linear regression to understand the +predictors of risk for diabetes. +Results: The overall prevalence of diabetes among Yoga practitioners in Central Pune was 3.6% (95% confidence +interval [CI]: [0.01–0.04]). 18.9% of participants (95% CI: [0.16–0.19]) were diagnosed to be “at risk” for diabetes. In Ernakulam, +the overall prevalence of diabetes among practitioners was 26% (95% CI: [0.05‑0.06]) with 12% of practitioners (95% +CI: [0.05‑0.06]) diagnosed to be “at risk” for diabetes (prediabetic). Higher age and lesser duration of Yoga practice were +significant predictors of diabetes. +Conclusion: It is essential for every person above the age of 40 to undergo regular health check‑ups and screening for +diabetes and involve oneself in lifestyle modification programs such as Yoga for significantly long duration of time on a daily +basis, to better manage diabetes. +Key words: Prevalence; type 2 diabetes; Yoga practitioners. +ABSTRACT +Short Communication +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Jagannathan, et al.: Type 2 diabetes among Yoga practitioners +149 +International Journal of Yoga • Vol. 8 • Jul-Dec-2015 +Samasthana. To study the prevalence of type 2 diabetes +among Yoga practitioners, a pilot cross‑sectional sample +from one zone each in two districts of India‑Pune (West +of India) and Ernakulam (South of India) was selected. +The selection of these districts was completely random: +Initially, one state each was randomly selected from the +West of India (Maharashtra) and South of India (Kerala); +next, the districts in each of the states were listed (with +urban/semi‑urban areas) and one district was randomly +selected for each state (Pune in Maharashtra and Ernakulam +in Kerala). The purpose of choosing districts with urban/ +semi‑urban locations in each state was the growth of Yoga +centers/classes and institutions in the last few years. It was +observed that the growth of these Yoga centers was more +prominent in the urban and semi‑urban areas than the +rural. As this was a pilot project, only one zone in each +district was randomly selected for this survey (Central +Pune [mainly Pune, Pimpri, Kharakwasala] and South +Ernakulam [mainly Paravur, Kunnathunad and Kochi]). +For selecting the sample for the survey, the total number +of Yoga practitioners in the selected zones was initially +enumerated. For this, the research team personally +called each Yoga institution in the zone and elicited the +number of Yoga practitioners enrolled with them. A Yoga +practitioner was operationally defined as someone who +has been practicing Yoga regularly for a minimum of +1‑year. Those practitioners above the age of 40 years, with +minimum 1‑year of regular Yoga practice were included in +the study. The researcher also contacted individual Yoga +practitioners and Yoga teachers through the method of +snow ball sampling. Once the number of Yoga practitioners +in the zone was elicited, consent was taken from the Yoga +centers and individual Yoga teachers to collect data. Those +who were not willing to participate in the study and who +had multiple co‑morbid disorders were excluded from the +study sample. As published studies on selected population +in India suggested that the prevalence of known diabetes +in urban/semi‑urban areas is around 5%,[6‑9] the researchers +randomly selected 5% of the practitioners who fulfilled the +inclusion and exclusion criteria, from the available sample +for the study. In this method, the final sample surveyed in +Pune was 155 and Ernakulam was 192. The study profile +and recruitment process have been depicted in Figure 1. +A cross‑sectional field survey was conducted in Yoga +institutions, individual Yoga classes and the different Yoga +schools operating in the two zones for the data collection. +Participants who consented to participate and fitted the +inclusion criteria of the study were asked to sign the written +informed consent and fill in their sociodemographic +data. The American Diabetes Association’s diabetes risk +test (DRT)[11] was then administered and if their score +was found to be >5, the participant was advised to take a +blood sugar test and report the results to the researcher. +The participants who were already diabetic were asked +to submit their latest doctor’s prescription and blood test +reports to note the fasting blood sugar (FBS) levels. In +the Central Pune sample, additional information about +the quality‑of‑life of Yoga practitioners diagnosed with +diabetes was collected using the quality‑of‑life Instrument +for Indian Diabetes Patients, which is a 33 item reliable, +valid, and sensitive tool in English language for the +assessment of diabetes specific quality‑of‑life in India.[12] +Almost all the participants underwent a blood test (on +the advice of the researcher) or submitted their blood +test reports. Based on the FBS values mentioned in their +reports, the decision on whether they were diabetic or “at +risk for diabetes” was taken and the percentage of people +with diabetes in the selected sample was calculated. Those +who did not submit their reports even after repeated +reminders were excluded from the analysis of the study. +The data were entered in a statistics software package and +analyzed. The prevalence of diabetics was calculated along +with confidence intervals (CIs). The sociodemographic +details were analyzed and correlated with mean DRT +score using the Pearson’s correlation analysis, t‑test and +univariate ANOVA to understand the predictors of risk +for diabetes. Further linear regression was used to assess +the relative contribution of different variables toward +diabetes risk. +RESULTS +A look at the profile of the two zones from where the sample +was collected will give us a better context to understand +the results. Pune district is located in Maharashtra state. +As per the 2011 Census of India, the population of Pune +district is 9,429,408. 52.3% of Pune’s population is in +the 15-59 years age category. The average literacy rate of +Pune was 87.19% in 2011 and sex ratio was 915 females +Figure 1: Study profile and recruitment process +CENTRAL PUNE +SOUTH ERNAKULAM +Yoga practitioners identified +5160 +Excluded +2060 +Declined +851 +Comorbid disorders +259 +Not regular +950 +Available +sample +3100 +Final sample +155 +Yoga practitioners identified +6000 +Excluded +2160 +Declined +1032 +Comorbid disorders +310 +Not regular +818 +Available +sample +3840 +Final sample +192 +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Jagannathan, et al.: Type 2 diabetes among Yoga practitioners +International Journal of Yoga • Vol. 8 • Jul-Dec-2015 +150 +per 1000 males.[13] There are approximately 5200 Yoga +practitioners in the district who practice out of group +Yoga classes and personal Yoga therapists. Ernakulam +district is located in Kerala state, India, and in 2011, it had +population of 3,282,388 of which male and female were +1,619,557 and 1,662,831, respectively, and the literacy +rates were 95.89%.[13] There are mainly five different Yoga +institutions, which have branches in most of the towns of +the district– overall there are 30-50 Yoga centers working +for a period of more than 10 years with approximately +6000 Yoga practitioners in the district. There is however +no count on the individual classes that are held in the +district. Both the districts differ with respect to their +population and sex ratio but are similar in their literacy +rates. The number of Yoga practitioners in this study from +Ernakulam was mainly from Yoga institutions, but the +number of Yoga practitioners sampled from Pune was from +Yoga institutions and individual therapists. +Participants from both areas who scored 5 and above on the +DRT,[11] but did not have abnormal FBS were considered +as “risk for diabetes.” Participants who scored above 110 +levels on FBS and/or were on medication for diabetes +were considered as having “diabetes.” The remaining +participants who did not fit into any of the above two +criteria were considered as “nondiabetic.” +Table  1 depicts the overall prevalence of diabetes in +Yoga practitioners in Central Pune and South Ernakulam +districts. In Central Pune, the overall prevalence of diabetes +was 3.6% (95% CI: [0.01–0.04]). 18.9% of participants (95% +CI:  [0.16‑0.19]) were diagnosed to be “at risk” for +diabetes and the remaining 77.5% (95% CI: [0.75–0.78]) +of participants were not found at risk for diabetes. In +South Ernakulam, the overall prevalence of diabetes was +26.0% (95% CI: [0.05–0.06]). 12.0% of practitioners (95% +CI: [0.05‑0.06]) were diagnosed to be “at risk” for diabetes +and the remaining 62.0%  (95% CI:  [0.04–0.07]) of +practitioners were found to be nondiabetic (not diabetic/ +not at risk for diabetes). +Table  2 depicts the sociodemographic profile of the +Yoga practitioners in the two districts. In Pune and in +Ernakulam, practitioners in the “diabetic” group and +“risk for diabetes” groups were significantly older than +the practitioners in the “nondiabetic” group. In Pune, +“diabetic” group  (mean  [standard deviation  (SD)]: +1.2719 [0.47]) practiced significantly more frequently in +a day as compared to the nondiabetic group (mean [SD]: +0.800 [0.31]) and to the “risk for diabetes” group (mean [SD]: +1.016 [0.36]; f = 7.36, P = 0.01) and the duration of practice +varied from 55–70 min daily in all three groups (f = 2.60, +P = 0.08). Majority of the practitioners in “nondiabetic” +group were married (Chi‑square: 16.62, P < 0.01) and did +not indulge in any addictive substances such as nicotine +and alcohol (Chi‑square: 12.37, P = 0.02), as compared to +the other two groups. +In Ernakulam, the “nondiabetic” group  (mean  [SD]: +71.16 [29.98] min) significantly practiced for longer duration +of time in minutes per day as compared to practitioners in +the “risk for diabetes” group (mean [SD]: 57.62 [21.25] min) +and to the “diabetic” group (mean [SD]: 50.52 [20.03] min; +f = 10.40, P < 0.01), with all the three groups practicing +some physical activity once a day (f = 2.47, P = 0.08). There +was a trend toward the “risk for diabetes” practitioners +being more educated than the “nondiabetic group” and +“diabetic” group (f = 2.90, P = 0.05). Significantly more +number of males as compared to females were in the +“risk for diabetes” group (chi sq: 6.47, P = 0.04). There +were significantly (Chi‑square = 17.65 P = 0.01) more +practitioners in the nondiabetic group (n[%]: 92 [77.3]) who +were employed as compared to the diabetic (n[%]: 24 [48.0]) +and the “risk for diabetes” group (n[%]: 14 [60.9]). Majority +of the practitioners in the diabetic group (n [%]: 9 [18.0]) +were either retired or housewives (n [%]: 16 [32.0]). Further, +majority of the practitioners in the diabetic group had a +family history of diabetes (n [%]: 31 [62.0]) as compared +to practitioners in the other two groups (n [%]: Risk for +diabetes’ group‑13 [56.5]; nondiabetic group‑ 41 [34.5]; +Chi‑square = 17.40, P = 0.03). +Table  3 depicts the determinants of diabetes risk. In +Pune, the mean (SD) total DRT score for the entire sample +was 6.02 (1.54). The age of the Yoga practitioners had a +significant positive correlation with diabetes risk (r = 0.62, +P < 0.01). Further, physical activity frequency (r = 0.40; +P  <  0.00) and duration  (r  =  0.26, P  <  0.00) were +significantly positively correlated with diabetes risk (DRT). +On Independent sample t‑test, it was observed that male +subjects had higher DRT score (mean [SD]: 6.41 [1.54]) +than female subjects (mean [SD]: 5.64 [1.45]; t = 3.33 +P < 0.01). Further, unmarried practitioners (mean [SD]: +6.57  [1.46]) had higher diabetes risk  (on DRT) than +married practitioners  (mean  [SD]: 4.91  [1.03]). On +Univariate ANOVA, the mean DRT score was observed to +be significantly higher for retired practitioners (mean [SD]: +7.55  [1.37]) as compared to employed  (mean  [SD]: +5.73  [1.30]), unemployed  (mean  [SD]: 6.60  [2.07]) or +housewives (mean [SD]: 5.82 [1.64]; f = 10.19 P < 0.01). On +analysis of the quality‑of‑life of Yoga practitioners (in Pune) +with “diabetes” and “risk for diabetes,” it was observed +Table  1: Prevalence of diabetes in Yoga practitioners in +Central Pune and South Ernakulam +Diagnosis +Central Pune +South Ernakulam +n (%) +CI +n (%) +CI +Diabetic +6 (3.6) +0.01-0.04 +50 (26.0) +0.05-0.06 +Risk for diabetes +32 (18.9) +0.16-0.19 +23 (12.0) +0.05-0.06 +Nondiabetic +131 (77.5) +0.75-0.78 +119 (62.0) +0.04-0.07 +Total +155 (100) +- +192 (100) +- +CI = Confidence interval +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Jagannathan, et al.: Type 2 diabetes among Yoga practitioners +151 +International Journal of Yoga • Vol. 8 • Jul-Dec-2015 +that there was a trend toward the quality‑of‑life being +better among diabetic group (mean [SD]: 133.2 [21.8]) +as compared to the risk for diabetes group (mean [SD]: +122.4 [12.1]; t = 1.24, P = 0.09). The regression model +was significant at P  <  0.001 and explained 43% of +variance (Adjusted R Square = 0.439). Age of the Yoga +practitioners  (Beta  =  0.095; P  <  0.001) emerged as a +significant predictor of risk for diabetes. +In Ernakulam, the mean (SD) total DRT score for the entire +sample was 3.74 (1.23). The age of the Yoga practitioners +had a significant negative correlation with diabetes +risk (r = 0.53, P < 0.01). The longer the duration (in +minutes) of physical activity indulged in a day, the +lesser was the risk for diabetes (r = −0.20, P = 0.01). +Further, practitioners who had higher number of years +of experience in practice of Yoga, had greater risk for +diabetes (r = 0.18, P < 0.01). The risk for diabetes was +observed to be significantly higher for males (mean [SD]: +3.96 [1.17]) as compared to females (mean [SD]: 3.42 [1.26]; +t = 3.01, P < 0.01). Practitioners who were unemployed +had a significantly higher risk for diabetes (mean [SD]: +4.48  [1.16]) than who were house wives  (mean  [SD]: +3.81  [1.31]) and employed  (mean  [SD]: 3.59  [1.18]; +f = 5.37, P < 0.01). Further practitioners who had a family +history of diabetes, had a significantly higher risk for +diabetes (mean [SD]: 4.15 [1.23]) than practitioners who +had family history of other disorders (f = 5.07, P < 0.01). +Practitioners who indulged in addictive substances such as +drugs, betel leaf, tobacco (others), (mean [SD]: 5.67 [1.53]), +and alcohol (mean [SD]: 4.15 [1.07]) had significantly +higher risk for diabetes than those practitioners who +indulged only in smoking (mean [SD]): 3.80 [0.84]) or who +did not have any addictive habits (mean [SD]: 3.67 [1.23]; +f = 2.40, P = 0.05). The regression model was significant +at P < 0.001 and explained 33% of variance (Adjusted R +Table  2: Sociodemographic profile of Yoga practitioners +Variable +Central Pune (n=155) +South Ernakulam (n=192) +Mean (SD) +F +P +Mean (SD) +F +P +Diabetic +Risk for +diabetes +Nondiabetic +Diabetic +Risk for +diabetes +Nondiabetic +Age (years) +56.91 (8.86) 55.17 (5.97) 52.50 (9.08) +3.22 +0.04# +57.88 (8.87) 56.70 (8.78) 49.55 (8.06) 20.67 <0.01* +Education (years) +14.34 (2.47) 12.50 (6.18) 14.47 (2.69) +1.40 +0.24 +12.98 (3.16) 14.52 (3.55) 13.97 (2.64) +2.90 +0.05 +Physical activity frequency/day 1.2719 (0.47) 0.800 (0.31) 1.016 (0.36) +7.36 +0.01# +1.04 (0.29) +1.00 (0.00) +1.14 (0.35) +2.47 +0.08 +Physical activity duration (min) 73.59 (27.83) 55.00 (12.25) 66.34 (19.31) 2.60 +0.08 +50.52 (20.03) 57.62 (21.25) 71.16 (29.98) 10.40 <0.01* +Years of Yoga practice +1.22 (0.42) +1.17 (0.41) +1.11 (0.32) +1.20 +0.30 +11.40 (11.76) 12.85 (11.79) 10.85 (9.24) +0.36 +0.69 +Gender +Male +3 (50.0) +18 (56.2) +61 (46.6) +0.99 +0.62 +26 (52.0) +19 (82.6) +68 (57.1) +6.47 +0.04# +Female +3 (50.0) +14 (43.8) +70 (53.4) +24 (48.0) +4 (17.4) +51 (42.9) +Occupation +10.26 +0.12 +17.65 0.01# +Unemployed +1 (3.1) +0 (0.0) +4 (3.1) +1 (2.0) +- +- +Employed +13 (40.6) +5 (83.3) +79 (60.3) +24 (48.0) +14 (60.9) +92 (77.3) +Retired +9 (28.1) +0 (0.0) +13 (9.9) +9 (18.0) +5 (21.7) +10 (8.4) +Housewife +9 (28.1) +1 (16.7) +35 (26.5) +16 (32.0) +4 (17.4) +17 (14.3) +Marital status +Single +5 (15.6) +6 (100.0) +45 (34.4) +16.62 <0.01* +- +1 (4.3) +4 (3.4) +1.88 +0.39 +Married +27 (84.4) +0 (0.0) +86 (65.6) +50 (100) +22 (95.7) +115 (96.6) +Family history +Nil +28 (87.5) +5 (83.5) +105 (80.2) +12.36 +0.14 +14 (28.0) +10 (43.5) +64 (53.8) +17.40 0.03# +Diabetes +4 (12.5) +1 (16.7) +4 (3.1) +31 (62.0) +13 (56.5) +41 (34.5) +Hypertension +0 (0.0) +0 (0.0) +18 (13.7) +3 (6.0) +- +6 (5.0) +Obesity/others +0 (0) +0 (0.0) +1 (0.8) +2 (4.0) +- +8 (6.7) +Diet +Vegetarian +23 (71.9) +4 (66.7) +100 (76.3) +0.514 +0.77 +21 (42.0) +12 (52.2) +55 (46.2) +0.68 +0.71 +Nonvegetarian +9 (28.1) +2 (33.3) +31 (23.7) +29 (58.0) +11 (47.8) +64 (53.8) +Addiction +Nil +31 (96.9) +3 (50.0) +117 (89.0) +12.37 0.02# +44 (88.0) +20 (87.0) +103 (86.6) +5.49 +0.71 +Smoking +0 (0.0) +2 (33.3) +9 (6.9) +1 (2.0) +- +4 (3.4) +Alcohol +1 (3.1) +1 (16.7) +5 (3.8) +3 (6.0) +2 (8.7) +8 (6.7) +Others +- +- +- +2 (4.0) +1 (4.3) +4 (3.3) +#P<0.05; *P<0.01. SD = Standard deviation +Table 3: Predictors of diabetes risk (Pearson’s correlation +coefficient test) +Variable +Central Pune +South Ernakulam +Pearson’s R +P +Pearson’s R +P +Age +0.62 +<0.01* +0.53 +<0.01* +Education +0.02 +0.85 +−0.04 +0.60 +Physical activity +frequency per day +0.40 +<0.01* +−0.07 +0.42 +Physical activity +duration (in min) +0.26 +<0.01* +−0.20 +0.01* +Years of experience +in Yoga +−0.04 +0.58 +0.18 +0.01* +FBS +−0.06 +0.71 +−0.14 +0.27 +*P<0.01. FBS = Fasting blood sugar +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Jagannathan, et al.: Type 2 diabetes among Yoga practitioners +International Journal of Yoga • Vol. 8 • Jul-Dec-2015 +152 +Square = 0.337). Age of the Yoga practitioners (Beta = 0.546; +P = 0.000) and duration of physical activity (in minutes) +indulged in by the practitioners (Beta =‑0.183; P = 0.005) +emerged as significant predictors of risk for diabetes. +DISCUSSION +Statistics show that 347 million people worldwide have +diabetes.[14] Data on diabetes prevalence by age and sex +from a limited number of countries were extrapolated to all +191 World Health Organization member states and applied +to United Nations’ population estimates for 2000 and 2030. +The prevalence of diabetes for all age‑groups worldwide +was estimated to be 2.8% in 2000 and 4.4% in 2030. The +total number of people with diabetes is projected to rise +from 171 million in 2000‑366 million in 2030.[15] According +to the Diabetes Atlas (2006), the number of people with +diabetes in India is currently around 40.9 million and is +expected to rise to 70 million by 2025.[16] Published studies +on selected population in India have suggested that the +prevalence of known diabetes in urban areas is around +5.0%.[6‑9] This was the available statistics when started +the study; however, when we completed the study a year +later, the prevalence of diabetes in India according to the +latest statistics presented by IDF was 9%.[5] As these data +were available only after we completed the study, we +have compared all our results to the earlier prevalence +rates of 5%. +The current study result shows the overall prevalence +of self‑reported diabetes among the Yoga practitioners +in Central Pune, Maharashtra state was 3.6%  (95% +CI: [0.01‑0.04]). 18.9% of participants (95% CI: [0.16‑0.19]) +were diagnosed to be “at risk” for diabetes and the +remaining 77.5% (95% CI:  [0.75‑0.78]) of participants +were not found at risk for diabetes. A comparison with +the already existing statistics shows that the prevalence +of type  2 diabetes in an urban slum of Pune city is +4.6%.[17] We can observe that the overall prevalence of +diabetes in Yoga practitioners in central Pune is lower +than the above‑mentioned Pune statistics, indicating that +possibly Yoga could be acting as a protective or effective +management intervention for type 2 diabetes. +Among the Yoga practitioners in Ernakulam district, +the overall prevalence of diabetes was 26% (95% CI: +[0.05–0.06]). 12% of practitioners (95% CI: [0.05‑0.06]) were +diagnosed to be “at risk” for diabetes and the remaining +62% (95% CI: [0.04–0.07]) of practitioners were found to be +nondiabetic (not diabetic/not at risk for diabetes). A study +in Kerala shows the prevalence of undetected diabetes +between ages 18 and 80 years (Reported prevalence of +known diabetes mellitus in the survey was 9.0%; (M‑8.7% +and F‑9.2%) The prevalence of newly diagnosed diabetes +was 10.5%. Increasing age, obesity, positive family history +of diabetes, abnormal sub scapular triceps skin fold ratio, +and presence of acanthosis nigricans were all found to be +associated with increased risk of DM.[17] We can observe +that the overall prevalence of diabetes in Yoga practitioners +in Ernakulam district is higher than the above mentioned +Kerala study.[18] This finding that Yoga practitioners have +a higher prevalence rate than the general population in +Kerala is surprising, as they are supposed to have the +beneficial effects of Yoga in management of diabetes. +Or possibly in Ernakulam, these practitioners had been +diagnosed with diabetes and hence joined Yoga to help +manage their diabetes. The other reasons possibly could +be that Ernakulam district statistics may be unique (based +on its diet, urbane locale, culture, and work patterns) and +cannot be generalized to the state of Kerala. Additional +data if collected on whether these Yoga practitioners in +both the districts started practicing Yoga before their +diagnosis of diabetes or after could have shed light on the +interpretation of these results. As a word of caution though, +routine screening of high‑risk groups for early detection +of the disease, and advocating for lifestyle modification +such as regular practice of Yoga for diabetes as a preventive +method needs be practiced. +Age of the Yoga practitioners (in Pune and Ernakulam) and +duration of physical activity (in minutes, in Ernakulam) +indulged in by the practitioners emerged as significant +predictors of risk for diabetes. Hence, it is important to +note from the results of this study that older people who +are prone to diabetes could opt to practice Yoga for longer +duration per day to manage their health and prevent +diabetes. +The results depict that there is a huge difference in the +diabetes prevalence rate among Yoga practitioners in +Pune and Ernakulam. Research has indicated earlier that +incidence of diabetes is very high among urban South +Indians.[6] Further, the unique diet, locale, culture, and +work patterns of each of the districts possibly added to +the rates. This prevalence complexity could have been +understood if additional parameters of work pattern, diet +details, and stress were assessed and correlated with the +prevalence of diabetes. In Ernakulam especially, the survey +was conducted with the help of Yoga school heads across +the district, due to the large magnitude of the sample. +Many Yoga schools falsely assuming this being a “diabetes +study” might have brought in known diabetics from +Yoga practitioners, instead of involving every student, to +participate in the study. Personalized data collection by +multiple researchers (instead of just one), as attempted in +Pune could have helped reduce this possible bias. +The current study results, only tells us the prevalence of +diabetes among Yoga practitioner in Pune and Ernakulam. It +did not elicit data on the number of years the practitioners +were suffering from type 2 diabetes. It could be possible +that these practitioners had been diagnosed with diabetes +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] +Jagannathan, et al.: Type 2 diabetes among Yoga practitioners +153 +International Journal of Yoga • Vol. 8 • Jul-Dec-2015 +and hence joined Yoga to help manage their diabetes. +A  comparison of prevalence among nonpractitioners, +and information on when they were diagnosed with +diabetes (before or after Yoga therapy) would give us an +idea whether Yoga has any effect on the prevalence rate +of diabetes among Yoga practitioners. This could form +the basis of future studies. However, as no studies have +been conducted to assess the prevalence of type 2 diabetes +among Yoga practitioners, the results of this study could +be considered as a significant pilot for future studies in +this area. +CONCLUSION +The overall prevalence of diabetes among Yoga practitioners +is 3.6% and 26% in Pune and Ernakulam districts, +respectively, and 18.9% (Pune) and 12% (Ernakulam) of +practitioners were “at risk” for diabetes. Higher age and +longer duration of Yoga practice are significant predictors +of diabetes. There is thus a need for every person above +the age of 40 to undergo regular health check‑ups and +screening for diabetes and involve himself in lifestyle +modification programs such as Yoga for significantly long +duration of time, on a daily basis. +REFERENCES +1. +Monk‑Turner E, Turner C. Does yoga shape body, mind and spiritual health +and happiness: Differences between yoga practitioners and college students. +Int J Yoga 2010;3:48‑54. +2. +Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, et al. Prevalence of diabetes +and impaired fasting glucose in Korea: Korean National Health and Nutrition +Survey 2001. Diabetes Care 2006;29:226‑31. +3. +Raub JA. Psychophysiologic effects of Hatha Yoga on musculoskeletal and +cardiopulmonary function: A literature review. J Altern Complement Med +2002;8:797‑812. +4. +Innes KE, Vincent HK. The influence of yoga‑based programs on risk profiles +in adults with type 2 diabetes mellitus: A systematic review. Evid Based +Complement Alternat Med 2007;4:469‑86. +5. +International Diabetes Federation. Summery table ‑ IDF Diabetes Atlas. 6th ed. +Brussels, Belgium: International Diabetes Federation; 2013. +6. +Mohan V, Deepa M, Anjana RM, Lanthorn H, Deepa R. Incidence of diabetes +and pre‑diabetes in a selected urban south Indian population (CUPS‑19). +J Assoc Physicians India 2008;56:152‑7. +7. +Sadikot SM, Nigam A, Das S, Bajaj S, Zargar AH, Prasannakumar KM, et al. +The burden of diabetes and impaired glucose tolerance in India using the WHO +1999 criteria: Prevalence of diabetes in India study (PODIS). Diabetes Res +Clin Pract 2004;66:301‑7. +8. +Mohan V. Age‑and sex‑specific prevalence of diabetes and impaired glucose +regulation in 11 Asian cohorts. Diabetes Care 2003;26:1770‑80. +9. +Ramachandran A, Snehalatha C, Vijay V, King H. Impact of poverty on the +prevalence of diabetes and its complications in urban southern India. Diabet +Med 2002;19:130‑5. +10. Nayak NN, Shankar K. Yoga: A therapeutic approach. Phys Med Rehabil +Clin N Am 2004;15:783‑98, vi. +11. +Bang  H, Edwards AM, Bomback AS, Ballantyne  CM, Brillon  D, +Callahan MA, et al. Development and validation of a patient self‑assessment +score for diabetes risk. Ann Intern Med 2009;151:775‑83. +12. Nagpal J, Kumar A, Kakar S, Bhartia A. The development of ‘Quality of +Life Instrument for Indian Diabetes patients (QOLID): A validation and +reliability study in middle and higher income groups. J Assoc Physicians +India 2010;58:295‑304. +13. Indian States Census 2011. Census Organization of India. Government of +India; 2011. Availible from: http://www.censusindia.gov.in/2011census/ +population_enumeration.html. [Last retrieved on 2014 Jan 01]. +14. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. +National, regional, and global trends in fasting plasma glucose and diabetes +prevalence since 1980: Systematic analysis of health examination surveys and +epidemiological studies with 370 country‑years and 27 million participants. +Lancet 2011;378:31‑40. +15. King H, Rewers M. Global estimates for prevalence of diabetes mellitus +and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting +Group. Diabetes Care 1993;16:157‑77. +16. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 +diabetes: Indian scenario. Epidemiology of type 2 diabetes: Indian scenario. +Indian J Med Res 2007;125:217‑30. +17. Patil RS, Gothankar JS. Prevalence of type‑2 diabetes mellitus and associated +risk factors in an urban slum of Pune City, India. Natl J Med Res 2013;3:346‑9. +18. Usha Menon V, Vinod Kumar K, Gilchrist A, Sugathan TN, Sundaram KR, +Nair V, et al. Prevalence of known and undetected diabetes and associated risk +factors in central Kerala – ADEPS. Diabetes Res Clin Pract 2006;74:289‑94. +How to cite this article: Jagannathan A, Narayanan VV, Kulkarni I, +Jogdand SP, Pailoor S, Nagarathna R. Prevalence of type 2 diabetes +among Yoga practitioners: A pilot cross-sectional study in two districts in +India. Int J Yoga 2015;8:148-53. +Source of Support: Study conducted as part of the M.Sc degree in +‘Yoga and Rehabilitation’, at SVYASA University, Bengaluru. Conflict of +Interest: None declared +[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82] diff --git a/subfolder_0/Response to _Yoga is not an intervention but may be yogopathy is_ _[PAUTHORS], International Journal of Yoga (IJoY).txt b/subfolder_0/Response to _Yoga is not an intervention but may be yogopathy is_ _[PAUTHORS], International Journal of Yoga (IJoY).txt new file mode 100644 index 0000000000000000000000000000000000000000..0772e4fb67fece986cd45bacacd5a757dc2fa451 --- /dev/null +++ b/subfolder_0/Response to _Yoga is not an intervention but may be yogopathy is_ _[PAUTHORS], International Journal of Yoga (IJoY).txt @@ -0,0 +1,64 @@ +8/11/2014 +Response to "Yoga is not an intervention but may be yogopathy is" :[PAUTHORS], International Journal of Yoga (IJoY) +http://www.ijoy.org.in/printarticle.asp?issn=0973-6131;year=2012;volume=5;issue=2;spage=158;epage=159;aulast=Nagarathna +1/1 +LETTER TO EDITOR +Year : 2012 | Volume : 5 | Issue : 2 | Page : 158--159 +Response to "Yoga is not an intervention but may be yogopathy is" +R Nagarathna + Dean, Division of Yoga and Life Sciences, SVYASA, Bangalore, India +Correspondence Address: +R Nagarathna +# 19, Eknath Bhavan, Gavipuram Circle, K. G. Nagar, Bangalore, Bangalore +India +How to cite this article: +Nagarathna R. Response to "Yoga is not an intervention but may be yogopathy is".Int J Yoga 2012;5:158-159 +How to cite this URL: +Nagarathna R. Response to "Yoga is not an intervention but may be yogopathy is". Int J Yoga [serial online] 2012 [cited 2014 Aug 11 ];5:158-159 +Available from: http://www.ijoy.org.in/text.asp?2012/5/2/158/98248 +Full Text +Sir, +Dr. Anand Bhavnani's letter is an expression of the concern of many researchers who are keen to promote holistic therapies that has become the need of the hour. [1] The +contributions of the so-called modern biomedicine (what do we mean by modern? Refer to the Editorial of the January 2012 issue of IJOY) has been enormous in handling +communicable diseases through several breakthrough inventions of the twentieth century while the health problems of twenty-first century are posing major challenges. We now +know that the cause of non-communicable diseases is internal and not necessarily an infective agent from outside. With all the billion dollar advances of the technology and drug +lobbies, we have not moved an inch in reducing the prevalence of these diseases; rather we are challenged with increasing incidence of many of these diseases. [2] We have +become technologists and robots who set right the megamachine of the body and mind through many interventions. The kind and caring humane doctor who examines and talks to +the patient to give him solace and confidence by touching his heart with genuine pure love has vanished. The editor has rightly pointed out the role of intravention instead of +intervention under these conditions. +It is clear that the best type of 'good modern practice' should be a holistic approach. What is missing in present day biomedicine is the lack of understanding and acceptance of the +existence of subtle energies. Imbalances at this level occur much earlier in many mind-body disorders. Yoga and other traditional systems of medical practice (such as Ayurveda, +Siddha and Traditional Chinese Medicine) have evolved methods of detecting and correcting the imbalances at the subtle level. Thus any genuine holistic therapy is not just a '- +pathy'; it is rather a complete system of body-mind-spirit catering to the gross and subtle layers of the human organism. +Hence we propose that the techniques of yoga and/or other holistic therapies where scientific data is now available through systematic clinical RCT using these traditional therapies +be incorporated in the treatment flow chart for lifestyle diseases. For example, presently there is enough data on the complimentary role of yoga ranging from life-style disorders [3] to +asthma, [4] cancer [5] and psychiatric disorders [6] to mention only a few. There are more than 4000 references in PubMed indexed journals on the efficacy of several natural +therapies such as massage therapy, herbals, Ayurveda, yoga, music therapy, qigong (acupuncture/pressure) and others. In USA, the department of NCCAM was set up more than +ten years ago to support researchers and has produced enough authentic data to recognize some of these therapies. If a drug (although there is no drug without side effects) that +shows even a marginal improvement can get into the market within a month, why is there such a long delay in recommending these therapies to be included in the main stream +management protocols? Why have the recommending bodies (such as American Diabetes Association, Cardiological Society and others) not taken it up seriously to add these +proven systems into the main stream practice? Why have they not been included in the syllabus in the medical schools at graduate and/or postgraduate levels? Is there no solution +to this? +I hope this dialogue opens up more and more insights and saves our species from the clutches of epidemics of lifestyle diseases and the negative side effects of the so-called +modern scientific peripheral molecular research lobby. +References +1 +Bhavanani AB. Yoga is not an intervention but maybe yogopathy is. 2012 [In Press]. +2 +United Nations, Department of Economic and Social Affairs, Population Division. Changing Levels and Trends in Mortality: the role of patterns of death by cause (United +Nations publication, ST/ESA/SER.A/318). 2012; pp 10. +3 +Innes KE, Bourguignon C and Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with Yoga: A +Systematic Review. J Am Board Fam Med 2005;18:491-519. +4 +Nagarathna R, Nagendra HR. Yoga for bronchial asthma: A controlled study. Br Med J 1985;291:1077-9. +5 +Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY. Effects of Yoga on psychological health, quality of life, and physical health of patients with cancer: A Meta-Analysis. Evid Based +Complement Alternat Med 2011;2011:659876. +6 +Khalsa-Shannahoff DS. An introduction to kundalini yoga meditation techniques that are specific for the treatment of psychiatric disorders. J Altern Complement Med +2004;10:91-101. + + +Monday, August 11, 2014 + Site Map | Home | Contact Us | Feedback | Copyright and Disclaimer diff --git a/subfolder_0/Role of Yoga in Chronic Kidney Disease A Hypothetical Review.txt b/subfolder_0/Role of Yoga in Chronic Kidney Disease A Hypothetical Review.txt new file mode 100644 index 0000000000000000000000000000000000000000..694a0cc9bb525465ddd44a3de98a5494b6e67d52 --- /dev/null +++ b/subfolder_0/Role of Yoga in Chronic Kidney Disease A Hypothetical Review.txt @@ -0,0 +1,520 @@ +Role of Yoga in Chronic Kidney Disease: A Hypothetical Review +Kashinath GM*, Hemant B, Praerna C, Nagarathna R and Nagendra HR +Division of Yoga and life sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA University), Banglore, India +*Corresponding author: Kashinath G Metri, Division of Yoga and life sciences, # 19 ekanath bhavan, Gavipuram Cirrcle, K G Nagar Bangalore, India, Tel: ++919035257626; E-mail: kgmhetre@gmail.com +Rec date: Mar 31, 2014, Acc date: May 10, 2014, Pub date: May 16, 2014 +Copyright: © 2014 Kashinath GM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits +unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. +Abstract +Chronic kidney disease (CKD) is a medical condition characterized by progressive renal dysfunction which leads +to permanent renal impairment and premature mortality, which affects patient’s quality of life significantly. Diabetes, +hypertension and glomerulo-nephritis are known to be the most common causes of CKD. Recent studies have +reported that there is a strong association of oxidative stress, chronic inflammation and psychological stress with +CKD. These factors significantly affect the treatment outcome in CKD. Treatment modalities which control these +factors can contribute significantly towards CKD management. +Yoga is an ancient traditional science which encompasses yogic physical postures (asanas), yogic breathing +practices (pranayama), meditations and relaxation techniques. Several scientific studies have shown that yoga +reduces blood pressure, heart rate, respiratory rate, oxidative stress, psychological stress and inflammatory +conditions. It also improves heart rate variability by bringing balance in autonomic nervous system by reducing +sympathetic tone and increasing parasympathetic activity. In several studies, it has been reported that yoga has +significant role in the management of non-communicable diseases like diabetes, hypertension, coronary heart +diseases etc. Regular yoga practice can help control sugar levels in diabetics, blood pressure in hypertensives and +reduce the risk of cardiac complications in patients with heart diseases. Thus, yoga has promising role in the primary +and secondary management of CKD as an adjuvant. Here, we compile all these researches and based on this +present a yoga module useful in CKD along with necessary precautions to be taken while doing yoga. +Keywords: Chronic Kidney Disease; Yoga module; Oxidative stress; +Sympathetic tone; inflammatory markers +Introduction +Chronic kidney disease (CKD) is a global health problem, with +adverse outcomes of kidney failure, cardiovascular disease (CVD), and +premature death. CKD is defined as kidney damage or glomerular +filtration rate (GFR) <60 mL/min/1.73 m2 for 3 months or more, +irrespective of cause [1]. It is a common and serious problem that +adversely affects patient’s health, quality of life, limits life span and +increases economical burden to health-care systems worldwide [2]. In +a survey by American Medical Society of Nephrology, it was estimated +that more than 10% of adults in the United States, which amounts to +more than 20 million people, may have CKD. Chances of occurrence +of CKD increase after 50 years of age and are most common among +adults older than 70 years [3]. Diabetes, hypertension and glomerulo- +nephritis are known to be the most common causes of CKD and +among these diabetes and hypertension are the leading causes of end +stage renal disease (ESRD) [4]. In 2011, diabetes or hypertension was +listed as the primary cause for 7 of 10 new cases of ESRD in the United +States [4]. Several studies have demonstrated that there is an +association of metabolic syndrome (high blood pressure, high serum +triglyceride level, elevated fasting glucose level and central obesity) +with CKD [5]. CKD further leads to co-morbidities such as +hypertension, congestive heart failure, dyslipidemia, and anemia of +chronic renal failure [6]. +In this review, some important risk factors for CKD such as +sympathetic tone [7], oxidative stress [8], chronic inflammation [8] +and psychological stress [9] have been highlighted and possible role of +yoga in management of CKD through modifications of these risk +factors have been postulated. +Oxidative Stress and CKD +Oxidative stress is potential risk for mortality and morbidity in +patient with CKD. Several studies have demonstrated the association +of oxidative stress with CKD Particularly in ESRD (End Stage renal +Disease) which is mainly because of reduce antioxidant system and +increased pro-oxidant activity [10]. Oxidative stress increases as CKD +progress [11], it worsens the CKD and in long run oxidative stress +leads to cardiovascular related complications in CKD [12]. Apart from +traditional +risk +factors, +chronic +inflammation, +oxidative +stress, malnutrition and endothelial dysfunction are important +in CVD development in renal patients [13]. +Inflammatory Markers in CKD +CKD is characterized by low grade inflammation [14]. Recent +scientific studies have demonstrated that CKD patients have elevated +level of inflammatory markers. These inflammatory markers are C- +reactive protein, IL-6, IL-10 etc., which worsen CKD and hamper the +treatment outcome [15]. Inflammation in CKD also increases chances +of atherosclerosis [16]. +Higher Sympathetic Tone and CKD +Researches show that higher sympathetic tone is potentially +involved in progression of CKD and higher rate of cardiovascular +Kashinath et al., J Nephrol Ther 2014, 4:3 +DOI: 10.4172/2161-0959.1000167 +J Nephrol Ther +ISSN:2161-0959 JNT, an open access journal +Volume 4 • Issue 3 • 1000167 +J +o +u +r +n +a +l + +o +f + +N +e +p +h +r +o +l +o +g +y +& +T +h +e +r +a +p +e +u +t +i +c +s +ISSN: 2161-0959 +Journal of Nephrology & Therapeutics +Review Article +Open Access +events in CKD patients [17]. It also promotes the development of +target organ damage [18]. There is growing evidence that an important +cause of the defect in renal excretory function in hypertension is an +increase in renal sympathetic nerve activity [19]. +Psychological Stress and CKD +Sedentary lifestyle and psychological stress are considered as +important contributors to non-communicable diseases. Frequent +hospitalization, economic conditions, worry about treatment outcome, +physical disability, poor family support are common sources of +psychological stress in CKD patients. Depression is considered as one +of the most common psychological condition in end-stage renal +disease (ESRD) which leads to anemia and malnutrition by reducing +the oral intake in chronic dialysis patients [15]. In a study, 24% +patients on dialysis were having depression and these patients had +significantly lower hemoglobin, hematocrit and serum albumin levels +and higher C-reactive protein and ferritin levels [20]. Another cross- +sectional study reported that patient with ESRD with depression had +2.95 fold more mortality than those without depression [21]. Number +of studies show that psychological stress increases oxidative stress [22] +and blood pressure, which further worsens CKD condition and +treatment outcome. Hence, stress management should be considered +in the management of CKD. +Quality of life in CKD +Health-related quality of life (QOL) is an important measure of how +disease affects patients' lives. New inventions in modern medical +science has increased the life expectancy of patients having chronic +disorders such as diabetes, cardiac disease, hypertension and cancer, +but at the same time, unfortunately, it failed to improve the quality of +life in these patients. This fact is especially true for patients with CKD +who are on dialysis [23]. Anemia, pain, depression, anxiety and other +comorbidies of CKD further hamper the quality of life of patients [24]. +Yoga +Yoga is an ancient traditional science which encompasses yogic +physical postures (asanas), yogic breathing practices (pranayama), +meditations and relaxation techniques. In present era Yoga is accepted +as science rather than religion or philosophy. Yoga advocates +individual existence in five dimensions and not merely physical. These +five dimensions are annamaya kosha (physical body), pranamaya +kosha (vital body), manomayakosha (Psychic body), vijanamayakosha +(intellectual body) and anandamayakosha (causal body). According to +Yoga philosophy, non-communicable diseases are the result of +imbalance that starts at manomayakosha level and percolates down to +the annamaya kosha level via pranamaya kosha, over a period of time. +Therefore, yoga therapy focuses on bringing balance at all these levels +of existence through various techniques. Its components such as +asanas work at physical level, pranayama works at vital energy level +and meditation works at psychological and intellectual levels. Recent +evidences show that yoga reduces heart rate, blood pressure and basal +metabolic rate by reducing sympathetic activity [25]. It has beneficial +effect in many non-communicable diseases such as hypertension, +diabetes and cancer. Yoga brings balance in autonomic nervous system +by reducing the sympathetic tone and increasing parasympathetic tone +[26]. Yoga has also been proven to produce various psychological +benefits by reducing stress, anxiety and depression and improving the +quality of life [27]. Hence yoga is a comprehensive approach to the +complex problem of non-communicable diseases like CKD. +Yoga and Sympathetic Tone +Growing evidences suggest that yoga reduces pulse rate, systolic and +diastolic blood pressure, basal metabolic rate by reducing sympathetic +tone and improving the parasympathetic tone in non-communicable +diseases. It reduces systolic, diastolic and mean blood pressure in the +patients with hypertension [28]. Yoga reduces fasting, post-prandial, +HbA1c sugar levels, cholesterol in diabetics [29]. Thus, yoga may help +in prevention of CKD in patients of diabetes and hypertension which +are known to be the main causes of CKD. +Yoga and psychological stress +Many scientific studies have shown that yoga significantly reduces +psychological stress in several physical and psychological ailments +[30]. In a study, practice of Hath yoga showed significant reduction in +perceived stress and negative effect [31]. In another RCT, there was +significant improvement in stress, anxiety and health status compared +to relaxation following yoga [32]. Yogic practices inhibit the areas +responsible for fear, aggressiveness and rage, and stimulate the +rewarding pleasure centers in the median forebrain and other areas +leading to a state of bliss and pleasure. This inhibition results in lower +anxiety, heart rate, respiratory rate, blood pressure, and cardiac output +in students practicing yoga and meditation. Thus it improves the +subjective wellbeing and quality of life [33]. Thus, yoga has significant +role to play in management of stress related to CKD. +Yoga and Oxidative stress +In a study, Hath yoga practice lead to significant improvement in +anti-oxidant status and reduced oxidative stress levels in the patients +with diabetes [34]. In another study, with 3 months follow up of yoga, +there was reduced oxidative stress, BMI and glucose levels in the +patients with diabetes type 2 [28]. A systematic review concluded that +yoga may reduce many risk factors for CVD including oxidative stress, +may improve clinical outcomes, and aid in the management of CVD +and other insulin resistance syndrome (IRS) related conditions [35]. +Yoga and CKD +In a study on patients with CKD (ESRD) who were on dialysis, it +was found that 30 minutes of hath yoga practice daily for 4 moths +showed significant reduction in oxidative stress (malondialdehyde, +protein oxidation, phospholipase A2 activity) and increase in anti- +oxidant activity (superoxide dismutase and catalase activities). This +study demonstrated therapeutic, preventative as well as protective +effects of Yoga in ESRD through reduction of oxidative stress [36]. +Another study in end stage renal disease patients reported that yoga +reduces cholesterol levels [37]. In another randomized controlled +study on hemodialysis patients, 12 week yoga intervention yoga has +proven to be safe and significantly effective in managing the pain, +fatigue, sleep disturbance along with significant improvement in hand +grip, significant reduction in creatinine, blood urea, alkaline +phosphatase and cholesterol along with significant improvement in +erythrocyte and hematocrit count [38]. Yoga therapy has been shown +to increase haemoglobin levels in anemic patients [39], it may also +help in improving the Hb% in CKD patients. In another recent study, +10 days Mindfulness-based stress reduction program reported +Citation: +Kashinath GM, Hemant B, Praerna C, Nagarathna R, Nagendra HR (2014) Role of Yoga in Chronic Kidney Disease: A Hypothetical +Review. J Nephrol Ther 4: 167. doi:10.4172/2161-0959.1000167 +Page 2 of 4 +J Nephrol Ther +ISSN:2161-0959 JNT, an open access journal +Volume 4 • Issue 3 • 1000167 +beneficial effect in improving quality and duration of sleep. It was +concluded that it has the potential of being an effective, accessible and +low-cost intervention that could significantly change transplant +recipients' overall health and well-being [40]. Mindfulness meditation +also reduced arterial blood pressure by reducing the sympathetic over +activity in the chronic kidney disease [41]. Meditation also improved +the quality of life and sympathetic over activity in Lupus Nephritis +Patients with Chronic Kidney Disease [42]. +Yogic Practices for CKD +Depending on the researches done so far, following yogic practices +(45 min/day twice a week for 3 months) are useful as an adjuvant to +conventional therapies in CKD [37-42]: +(1) +Physical postures done with awareness (āsanas; 1 minute each, +total ~ 10-minute session) to be performed as follows: +Standing āsanas—Mountain posture with arms stretched up +(TadasanaUrdhvaHastasana) +and +with +bound +hands +(TadasanaUrdhvaBaddhaHastasana) +Hand-to-foot +pose +(Pādahastāsana), +and +Half-waist-rotation +pose +(Ardha +Kati +Chakrāsana). +Sitting āsanas—Extension of the front body (Purvottānāsana), Hare +pose (Shashānkāsana), Seated twist (Bharadvājāsana/Vakrasana), +Butterfly (Tittaliasana) +Supine +āsanas-Reclining +bound +angle +posture +(Supta +Baddhakonasana), +Reclining cross legged posture (Supta Svastikāsana), Bridge pose +(Setubandhāsana), Shoulder stand on a chair (Salamba Sarvāngāsana), +Inverted +lake +pose +(ViparitaKarani), +Air +releasing +pose +(pavanmuktāsana), Corpse posture (Savāsana) with bolster support +under chest. +(2) +Breathing techniques7 Prānāyāma, total ~ 10-minute session)- +Hands in and out breathing (10 rounds in 2 minutes),hand stretch +breathing (10 rounds in 2 minutes),tiger breathing (10 rounds in 2 +minutes), alternate nostril breathing (Nādisuddhi; in 5 minutes),left +nostril breathing (Chandra AnulomaViloma; 27 rounds in 5 minutes, +4 times per day), humming bee breath (Bhramari; in 2 minutes), +Cooling pranayama (Sitali; 9 rounds) and abdominal breathing in +lying-down position in 2 minutes. +(3) Yogic relaxation techniques with imagery or mindfulness based +stress reduction for 20 minutes at the end of āsanas and prānāyamas. +(4) +Meditations—Mindfulness meditation, Om Meditation, cyclic +meditation and Yogic Counselling for 20 minutes. +Yogic Practices to be avoided in CKD +Few components of yoga such as complete inverted poses like head +stand pose (sirsāsana), fast breathing practices of kapalabhati and +bhastrika should be avoided as they are known to increase the +sympathetic activity and raise blood pressure. Apart from it, yogic +cleansing procedure of laghushankha praskhalana and vaman dhauti +should be avoided as it may precipitate electrolyte imbalances and +increase the load on kidneys. Practice of yoga in conditions like CKD +is advisable under medical supervision only. +Conclusion +Yoga being non-invasive, cost-effective therapeutic intervention +works at physical and psychological levels. It is effective intervention +to reduce the blood pressure, heart rate and inflammatory markers +both in healthy individuals and in patients with chronic diseases. +Hypertension and diabetes are well known risk factors for CKD. Yoga +helps in maintaining the blood sugars, blood pressure and lipid levels +in these conditions. Yoga has also been proven to reduce oxidative +stress, sympathetic tone, psychological stress and inflammatory +markers in chronic diseases. These risk factors hamper treatment +outcome of CKD. Yoga reduces general symptoms like fatigue, pain +associated with CKD it also improves the hematocrit levels. Hence +yoga has potential role as an adjunct in prevention and management +of CKD. Further RCTs are needed to explore the role of yoga in CKD. +Yoga should be administered with caution under the guidance of an +expert as there are some practices which may worsen the condition. +References +1. +Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, et al. (2005) +Definition and classification of chronic kidney disease: a position +statement from Kidney Disease: Improving Global Outcomes (KDIGO). +Kidney Int 67: 2089-2100. +2. +Small DM, Coombes JS, Bennett N, Johnson DW, Gobe GC (2012) +Oxidative stress, anti-oxidant therapies and chronic kidney disease. +Nephrology (Carlton) 17: 311-321. +3. +Smith DH, Gullion CM, Nichols G, Keith DS, Brown JB (2004) Cost of +medical care for chronic kidney disease and comorbidity among +enrollees in a large HMO population. J Am Soc Nephrol 15: 1300-1306. +4. +Center for Disease control and prevention, CDC 24/7, National Chronic +Kidney Disease Fact Sheet, 2014. Division of Diabetes Translation. +5. +Li Y, Chen Y, Liu X, Liang Y, Shao X, et al. (2014) Metabolic Syndrome +and Chronic Kidney Disease in a Southern chinese population. +Nephrology. +6. +Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH (2004) +Longitudinal follow-up and outcomes among a population with chronic +kidney disease in a large managed care organization. Arch Intern Med +164: 659-663. +7. +Schlaich MP, Socratous F, Hennebry S, Eikelis N, Lambert EA, et al. +(2009) Sympathetic activation in chronic renal failure. J Am Soc Nephrol +20: 933-939. +8. +Cachofeiro V, Goicochea M, de Vinuesa SG, Oubiña P, Lahera V, et al. +(2008) Oxidative stress and inflammation, a link between chronic kidney +disease and cardiovascular disease. Kidney Int Suppl : S4-9. +9. +Wright RG, Sand P, Livingston G (1966) Psychological stress during +hemodialysis for chronic renal failure. Ann Intern Med 64: 611-621. +10. +Locatelli F, Canaud B, Eckardt KU, Stenvinkel P, Wanner C, et al. (2003) +Oxidative stress in end-stage renal disease: an emerging threat to patient +outcome. Nephrol Dial Transplant 18: 1272-1280. +11. +Dounousi E, Papavasiliou E, Makedou A, Ioannou K, Katopodis KP, et al. +(2006) Oxidative stress is progressively enhanced with advancing stages +of CKD. Am J Kidney Dis 48: 752-760. +12. +Ghiadoni L, Cupisti A, Huang Y, Mattei P, Cardinal H, et al. (2004) +Endothelial dysfunction and oxidative stress in chronic renal failure. J +Nephrol 17: 512-519. +13. +Annuk M, Soveri I, Zilmer M, Lind L, Hulthe J, et al. (2005) Endothelial +function, CRP and oxidative stress in chronic kidney disease. J Nephrol +18: 721-726. +14. +Yilmaz MI, Carrero JJ, Axelsson J, Lindholm B, Stenvinkel P (2007) Low- +grade inflammation in chronic kidney disease patients before the start of +renal replacement therapy: sources and consequences. Clinical +Nephrology, 68: 1-9 +Citation: +Kashinath GM, Hemant B, Praerna C, Nagarathna R, Nagendra HR (2014) Role of Yoga in Chronic Kidney Disease: A Hypothetical +Review. J Nephrol Ther 4: 167. doi:10.4172/2161-0959.1000167 +Page 3 of 4 +J Nephrol Ther +ISSN:2161-0959 JNT, an open access journal +Volume 4 • Issue 3 • 1000167 +15. +Oberg BP McMenamin E, Lucas FL, McMonagle E, Morrow J, et al. +(2004) Increased prevalence of oxidant stress and inflammation in +patients with moderate to severe chronic kidney disease. Kidney Int 65: +1009-1016. +16. +Srinivasan Beddhu, Paul L. Kimmel, Nirupama Ramkumar, Alfred K. +Cheung. Associations of Metabolic Syndrome With Inflammation in +CKD: Results From the Third National Health and Nutrition +Examination Survey (NHANES III). American Journal of Kidney disease. +46: 577-586. +17. +Schlaich MP, Socratous F, Hennebry S, Eikelis N, Lambert EA, et al. +(2009) Sympathetic activation in chronic renal failure. J Am Soc Nephrol +20: 933-939. +18. +Grassi G, Bertoli S, Seravalle G (2012) Sympathetic nervous system: role +in hypertension and in chronic kidney disease. Curr Opin Nephrol +Hypertens 21: 46-51. +19. +DiBona GF (2002) Sympathetic nervous system and the kidney in +hypertension. Curr Opin Nephrol Hypertens 11: 197-200. +20. +Kalender B, Ozdemir AC, Koroglu G (2006) Association of depression +with markers of nutrition and inflammation in chronic kidney disease +and end-stage renal disease. Nephron Clin Pract 102: c115-121. +21. +Young BA, Von Korff M, Heckbert SR, Ludman EJ, Rutter C, et al. (2010) +Association of major depression and mortality in Stage 5 diabetic chronic +kidney disease. Gen Hosp Psychiatry 32: 119-124. +22. +Rahman MM, Ichiyanagi T, Komiyama T, Sato S, Konishi T (2008) +Effects of anthocyanins on psychological stress-induced oxidative stress +and neurotransmitter status. J Agric Food Chem 56: 7545-7550. +23. +Mujais SK, Story K, Brouillette J, Takano T, Soroka S, et al. (2009) +Health-related quality of life in CKD Patients: correlates and evolution +over time. Clin J Am Soc Nephrol 4: 1293-1301. +24. +Rachel LP, Fredric O. Finkelstein, Lei Liu, Erik Roys, Margaret Kiser, et +al. (2005) Quality of life in Chronic Kidney Disease (CKD): A cross- +sectional analysis in the Renal Research Institute-CKD study. American +Journal of Kidney Diseases, 45: 658-666. +25. +Schell FJ, Allolio B, Schonecke OW (1994) Physiological and +psychological effects of Hatha-Yoga exercise in healthy women. Int J +Psychosom 41: 46-52. +26. +Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP (2012) Effects +of yoga on the autonomic nervous system, gamma-aminobutyric-acid, +and allostasis in epilepsy, depression, and post-traumatic stress disorder. +Med Hypotheses 78: 571-579. +27. +Berger B, Owen D (1988) Yoga, and Stress Reduction and Mood +Enhancement in Four Exercise Modes: Swimming, Body Conditioning, +Hatha Yoga, and Fencing. Research Quarterly for Exercise and Sport, 59: +148-159. +28. +Innes KE, Bourguignon C, Taylor AG (2005) Risk Indices Associated +with the Insulin Resistance Syndrome, Cardiovascular Disease, and +Possible Protection with Yoga: A Systematic Review. The Journal of the +American Board of Family Medicine, 18: 491–519. +29. +Patel C (1975) 12-month follow-up of yoga and bio-feedback in the +management of hypertension. Lancet 1: 62-64. +30. +Schell FJ, Allolio B, Schonecke OW (1994) Physiological and +psychological effects of Hatha-Yoga exercise in healthy women. +International Journal of Psychosomatics, 41: 46–52. +31. +West J, Otte C, Geher K, Johnson J, Mohr DC (2004) Effects of Hatha +yoga and African dance on perceived stress, affect, and salivary cortisol. +Ann Behav Med 28: 114-118. +32. +Smith C, Hancock H, Blake-Mortimer J, Eckert K (2007) A randomised +comparative trial of yoga and relaxation to reduce stress and anxiety. +Complement Ther Med 15: 77-83. +33. +Woodyard C (2011) Exploring the therapeutic effects of yoga and its +ability to increase quality of life. Int J Yoga 4: 49-54. +34. +Gordon LA, Morrison EY, McGrowder DA, Young R, Fraser YT, et al. +(2008) Effect of exercise therapy on lipid profile and oxidative stress +indicators in patients with type 2 diabetes. BMC Complement Altern +Med 8: 21. +35. +Hegde SV, Adhikari P, Kotian S, Pinto VJ, D'Souza S, et al. (2011) Effect +of 3-month yoga on oxidative stress in type 2 diabetes with or without +complications: a controlled clinical trial. Diabetes Care 34: 2208-2210. +36. +Gordon L, McGrowder DA, Pena YT, Cabrera E, Lawrence-Wright MB +(2013) Effect of yoga exercise therapy on oxidative stress indicators with +end-stage renal disease on hemodialysis. Int J Yoga 6: 31-38. +37. +Gordon L, McGrowder DA, Pena YT, Cabrera E, Lawrence-Wright M +(2012) Effect of exercise therapy on lipid parameters in patients with end- +stage renal disease on hemodialysis. J Lab Physicians, 4: 17-23. +38. +Yurtkuran M1, Alp A, Yurtkuran M, Dilek K (2007) A modified yoga- +based exercise program in hemodialysis patients: a randomized +controlled study. Complement Ther Med 15: 164-171. +39. +Ramanath B, Tajuddin Shaik, Somasekhar M (2013) A randomized +control study of yoga on anemic patients. International Journal of +Research in Medical Sciences. Int J Res Med Sci. 1: 240-242. +40. +Kreitzer MJ, Gross CR, Ye X, Russas V, Treesak C (2005) Longitudinal +impact of mindfulness meditation on illness burden in solid-organ +transplant recipients. Prog Transplant 15: 166-172. +41. +Jeanie Park, Susan BW (2013) Mindfulness meditation lowers blood +pressure and sympathetic activity in hypertensive patients with chronic +kidney disease The FASEB Journal. 27: 1118-1141. +42. +Sirawit B, Wattana W, Poungpetch H, Somruedee C, Nuttasith L, et al. +(2014) Role of Meditation in Reducing Sympathetic Hyperactivity and +Improving Quality of Life in Lupus Nephritis Patients with Chronic +Kidney Disease. Journal of the Medical Association of Thailand. 97(3) + +Citation: +Kashinath GM, Hemant B, Praerna C, Nagarathna R, Nagendra HR (2014) Role of Yoga in Chronic Kidney Disease: A Hypothetical +Review. J Nephrol Ther 4: 167. doi:10.4172/2161-0959.1000167 +Page 4 of 4 +J Nephrol Ther +ISSN:2161-0959 JNT, an open access journal +Volume 4 • Issue 3 • 1000167 diff --git "a/subfolder_0/Role of mind\342\200\223Body intervention on lipid profile A cross-sectional study.txt" "b/subfolder_0/Role of mind\342\200\223Body intervention on lipid profile A cross-sectional study.txt" new file mode 100644 index 0000000000000000000000000000000000000000..0585f539426a4fe351bfc07ac90c0e95e20da387 --- /dev/null +++ "b/subfolder_0/Role of mind\342\200\223Body intervention on lipid profile A cross-sectional study.txt" @@ -0,0 +1,669 @@ +© 2021 International Journal of Yoga | Published by Wolters Kluwer ‑ Medknow +168 +Introduction +According +to +the +World +Health +Organization, +approximately +2 +million +people died per year due to physical +inactivity and sedentary lifestyle[1] which +causes various diseases such as diabetes, +obesity, depression, anxiety, cardiovascular +disorder, +and +neurological impairment. +Therefore, maintaining a healthy and +physically active lifestyle is an important +aspect to prevent illnesses in the present +scenario. Studies have shown the evidence +of improving the lifestyle of the individuals +by practicing yoga.[2,3] +Regular +and +long‑term +practice +of +Yoga improves flexibility, strength, and +strengthens the immune system.[4] Yoga +improves the quality of life and also +improves the lipid profile. Mahesh et  al. +2018 +found +a +significant +effect +of    +Sudarshan kriya on blood lipid level in +hypertensive participants.[1,5] Alterations in +the ratio of high‑density lipoprotein (HDL) +and low‑density lipoprotein (LDL), is +one of the major risk factors for many +non-communicable +diseases +such +as +cardiovascular +disease, +diabetes, +and +polycystic +ovarian +syndrome. +Earlier +randomized +controlled +studies +have +Address for correspondence: +Prof. Raghuram Nagarathna, +Medical Director, Arogyadhama +Swami Vivekananda Yoga +Research Foundation +(SVYASA), Bengaluru, India. +E‑mail: rnagaratna@gmail.com +Dr. Akshay Anand, +Department of Neurology, +Neuroscience Research +Lab, Postgraduate Institute +of Medical Education and +Research (PGIMER), Sector - +12, Chandigarh – 160012, India +E-mail: akshay1anand@ +rediffmail.com +Access this article online +Website: www.ijoy.org.in +DOI: 10.4103/ijoy.IJOY_51_20 +Quick Response Code: +Abstract +Background: Yoga is a combination of physical‑breathing and meditative techniques that assist in +the unification of the mind–body, which improves the quality of life. It was shown that long‑term +Yoga practitioners had superior control over respiratory rate, reduced stress and anxiety, and a +better‑controlled lipid profile. Purpose: We aimed to investigate the lipid profile of long‑term yoga +practitioners who were practicing yoga for more than 1 year in comparison with the nonyoga group. +Methods: A nationwide survey was conducted in which the long‑term yoga practitioners (n = 76) and +nonyoga practitioners (n = 80) were recruited for assessment for the lipid parameters. Results: The +mean (standard deviation) values of both groups were within normal range with serum cholesterol at +189.715 ± 20.4 and 180.88 ± 29.7 and triglycerides at 216.72 ± 92.5 and 207.665 ± 88.3, low‑density +lipoprotein at 126.65  ±  18.5 and 120.775  ±  26.5, and high‑density lipoprotein at 47.17  ±  6.6 and +44.99  ±  7.0, respectively, in yoga and no‑yoga groups. Conclusion: The lipid profile values were +similar in yoga and nonyoga practitioners in the 2017 survey. +Keywords: Meditation, mind–body intervention, physical activity, practitioners, yoga +Role of Mind–Body Intervention on Lipid Profile: A Cross‑sectional Study +Priya Mehra1,2, +Akshay Anand2,3,4, +R Nagarathna5, +Navneet Kaur6, +Neeru Malik7, +Amit Singh5, +Viraaj Pannu8, +Pramod Avti9, +Suchitra Patil5, +H R Nagendra5 +Departments of 1Biotechnology +and 6Physical Education, +Panjab University, 2Department +of Neurology, Neurosciences +Research Lab, Post Graduate +Institute of Medical Education +and Research, 3Centre for Mind +Body Medicine, PGIMER, +4Centre for Cognitive Sciences, +Phenomenology and Philosophy, +Panjab University, 7Dev Samaj +College of Education, Panjab +University, 8Government Medical +College Hospital, 9Department +of Biophysics, Post Graduate +Institute of Medical Education +and Research, Chandigarh, +5S-VYASA University, Bengaluru, +Karnataka, India +How to cite this article: Mehra P, Anand A, +Nagarathna R, Kaur N, Malik N, Singh A, et  al. +Role of mind–body intervention on lipid profile: +A cross‑sectional study. Int J Yoga 2021;14:168-72. +Submitted: 15-May-2020 +Revised: +12-Dec-2020 +Accepted: 23-Mar-2021 Published: 10-May-2021 +shown +that +practicing +yoga‑based +mind–body +techniques +can +normalize +elevated concentrations of lipid values as +compared to control groups.[5,6] Studies have +also reported the lipid profile normalizing +effect of yoga in long‑term practitioners.[7] +Yoga is known to bring about a calm +state of mind which is the basis for stress +reduction and biochemical homeostasis that +reflects on the lifestyle and also the lipid +profile.[8‑10] The observation of significantly +lower resting metabolic rate by Chaya +et  al. in regular long‑term practitioners of +integrated yoga (yogic postures, pranayama, +and meditation) based lifestyle in inmates of +a residential university seems to point to the +mechanism of yoga’s effect of calming down +the mind that may reflect on lipid profile. +Hemispheric synchrony of high‑amplitude +gamma waves in the electroencephalographic +of long‑term meditators,[11] positive spiritual +experiences reported by long‑term meditation +practitioners diagnosed with breast cancer,[12] +and the health benefits reported by long‑term +practitioners of workplace yoga across rural +and urban India[13] point to the holistic +approach of yoga. +We planned to compare the lipid profile +values of self‑reported long‑term yoga +This +is +an +open +access +journal, +and +articles +are +distributed under the terms of the Creative Commons +Attribution‑NonCommercial‑ShareAlike 4.0 License, which +allows others to remix, tweak, and build upon the work +non‑commercially, as long as appropriate credit is given and +the new creations are licensed under the identical terms. +For reprints contact: WKHLRPMedknow_reprints@wolterskluwer +.com +Short Communication +Mehra, et al.: Role of yoga in lipid profile parameters +169 +International Journal of Yoga | Volume 14 | Issue 2 | May-August 2021 +practitioners with nonyoga practitioners in the cohort +of respondents to the query relayed to yoga practice, in +a nation‑wide survey planned as a diabetes prevention +program. +Methods +This study is part of a pan‑India diabetes control +study (Niyantrita Madhumeha Bharata Abhiyaan). A subset +of 156 respondents in which 76 were yoga practitioners +and 80 were nonyoga practitioners  [Figure  1]. The study +group included all respondents who had reported practicing +yoga for more than 1 year in their answers to a query “Do +you practice Yoga? If “Yes” mark how long you have been +practicing yoga (duration in ….Years)” in the survey form. +We have not segregated data on the basis of hemoglobin +A1C, but we have segregated data on the basis of duration +of self‑reported yoga practice in whom blood lipid profile +values were available. +Study design +This +was +a +cross‑sectional +prospective +two‑armed +controlled study that compared long‑term yoga practitioners +with age‑  and gender‑matched control group. The detailed +study design is already published.[14] +Selection criteria +Individuals of both genders in the age range of 30–60 years +after detailed assessments were recruited. The data of only +those participants who self‑declared the duration of yoga +practice, but may not have mentioned the details of specific +asanas or meditation they were practicing, were used for +analysis. +Prior written informed consent in local language (Hindi) +was obtained from all participants +Ethical approval was obtained from the Institutional Ethical +Committee of the Indian Yoga Association  (IYA). Central +Trial Registry of India  (CTRI) Registration was done +registration number – trial REF/2018/02/017724.[15] +Statistical analysis +IBM Corp. Released 2015. IBM SPSS Statistics for +Windows, Version 23.0. (Armonk, NY:, Based in Chicago, +SPSS Inc) was used for statistical analysis. ANCOVA test +was used to compare the two groups, namely the intervention +group (Yoga practice for more than 1‑year duration) and the +age‑matched control group  (no Yoga practice). Subgroup +comparisons were done by segregating those with abnormal +values (above the cutoff value of the range provided by the +laboratory for total cholesterol  [TC], triglycerides  [TG], +LDL, and below for HDL). Subgroup analysis was also +done using ANCOVA. Participants were recruited for +the study between age groups of 30 and 60  years; the +mean  ±  standard deviation  (SD) for the two groups was +51.25743  ±  7.350329 and 47.575  ±  7.847881 in the Yoga +practitioners group and control group, respectively. +Results +Figure  1 shows the study profile. Of the 498 who had +responded to the query related to yoga during the first +round of house‑to‑house screening in the randomly selected +urban and rural clusters, 342 individuals did not respond to +the blood tests. +The data available on 156 participants aged between 30 +and 60 years were part of this study. Of these, 76 were in +the Yoga practitioners group  (46  females and 30  males), +and 80 participants were in the control group  (50  females +and 30 males). +Table  1 shows the demographics of the control and yoga +practitioners group. +Table 2 shows the mean and SD values and the comparison +of biochemical parameters of Yoga practitioners and +the control group. There were no significant differences +found in cholesterol  (P  =  0.23), triglyceride  (P  =  0.63), +HDL (P = 0.53), and LDL (P = 0.83). +Table 3 shows the mean and SD values and the comparison +of biochemical parameters of Yoga practitioners and +the control group. There were no significant differences +Figure  1: Details of screening participants along with inclusion and +exclusion criteria +Mehra, et al.: Role of yoga in lipid profile parameters +170 +International Journal of Yoga | Volume 14 | Issue 2 | May-August 2021 +found in cholesterol  (P  =  0.29), triglyceride  (P  =  0.97), +HDL  (P  =  0.36), and LDL  (P  =  0.41). On subgroup +analysis also, there was a nonsignificant difference between +groups in those with abnormal or normal values. +Discussion +The current study focuses on a group of Indian long‑term +Yoga practitioners in order to understand differences in +lipid profiles in comparison to nonyoga practitioners. +We compared the data in individuals in a healthy or at‑risk +range of lipid profile values and found no significant +difference between the two groups. +TG and LDL–nonsignificant difference between groups +could be because there were very few with dyslipidemia +in both yoga and control groups. It is known that exercise +is beneficial in reducing dyslipidemia. The control group +also may have practiced exercise as they were responsible +persons who were careful to respond to this query as +nonyoga practitioners as compared to the large cohort who +had not responded to this query at all. +TC  –  the mean values were only marginally higher even +those who had abnormal values above 200mg/dl.      +HDL – mean values of HDL in those >45 mg/dl seem to be +better in the yoga group although nonsignificant between +groups. +Our earlier published study in a well‑planned funded RCT +in diabetes individuals had shown that although both groups +had a significant reduction in bad cholesterol, there was a +significantly better increase in HDL. This present study +which was a community‑based screening (unlike an RCT) +also seems to support our earlier observation.[14,16] +HDL which is considered as good cholesterol helps in +the clearance of “bad cholesterol” from the blood stream. +Upregulation of HDL also stabilizes weight and hence is +preventive for obesity and related disorders. It has been +shown through studies that HDL and its protein component +apolipoprotein A I (apoA‑I) increase glucose uptake and +synthesis of glycogen in skeletal muscle cells through +insulin‑independent pathways. It also enhances glycolysis +and mitochondrial oxidative phosphorylation in skeletal +muscles.[17] HDL is also found to be downregulated in +Type 2 diabetes mellitus and high HDL is found to +be a strong, consistent and independent predictor of +cardiovascular events.[18] +Yoga and breathing practices have been known to stabilize +the HDL secretion and hence can be a preventive +for diabetes and related metabolic disorders.[19] Also, +through enhancement in HDL, yoga may also prevent +cardiovascular diseases.[20] +The sedentary lifestyle is known as a major causative factor +of disease progression in obesity, dyslipidemia, diabetes, +hypertension, stress, depression, and many more. The main +cause of all these has been established to be the unhealthy +lifestyle including wrong eating pattern, lack of physical +activity, sleep disorders, stress, and depression.[21] Regular +exercise, yoga asanas, pranayama, and meditation have +been shown to prevent and correct these abnormalities[22,23] +Studies point to the beneficial effect of yoga in maintaining +physiological balance of lipid profile parameters[6,24,25] a nd +prevention of the related cardiac complications.[26] Other +Table 1: Demographics of the control and yoga +practitioner groups +Characteristics +Control group +Yoga practitioners +Female +Male +Female +Male +Gender +50 +30 +46 +30 +Age +47±1 +47±1 +48±1 +51±1 +Table 2: Analysis of whole group yoga and control group +Variables +Yoga +group (n=76) +Control +group (n=80) +P +Cholesterol +189.715 ± 20.4 +180.88 ± 29.7 +0.23 +Triglyceride +216.72 ± 92.5 +207.665 ± 88.3 +0.63 +HDL +47.17 ± 6.6 +44.99 ± 7.0 +0.53 +LDL +126.65 ± 18.5 +120.775 ± 26.5 +0.83 +HDL = High‑density lipoprotein, LDL = Low‑density lipoprotein +Table 3: Subgroup analysis based on cutoff for abnormal values +Variables +Yoga group +No‑yoga group +P +Yoga group +No‑yoga group +P +Cholesterol +n=31 +≤200 mg/dl +n=44 +≤200 mg/dl +0.29 +n=45 +>200 mg/dl +n=36 +>200 mg/dl +0.18 +159.87±17.49 +148.38±21.57 +218.39±34.02 +207.97±28.53 +Triglyceride +n=60 +≤200 mg/dl +n=57 +≤200 mg/dl +0.56 +n=16 +>200 mg/dl +n=17 +>200 mg/dl +0.97 +117.73±34.42 +120.48±42.43 +257.44±41.09 +256.88±56.81 +HDL +n=42 +≤45 mg/dl +n=54 +≤45 mg/dl +0.78 +n=34 +>45 mg/dl +n=26 +>45 mg/dl +0.36 +37.10±5.16 +36.74±6.46 +57.24±8.13 +53.27±7.69 +LDL +n=53 +≤130 mg/dl +n=65 +<130 mg/dl +0.41 +n=23 +>130 mg/dl +n=15 +>130 mg/dl +0.41 +98.23±20.22 +88.95±27.42 +156.25±24.35 +146.71±14.77 +HDL=High‑density lipoprotein, LDL=Low‑density lipoprotein +Mehra, et al.: Role of yoga in lipid profile parameters +171 +International Journal of Yoga | Volume 14 | Issue 2 | May-August 2021 +studies[27] also point to the beneficial effects of physical +exercises in ameliorating dyslipidemia by upregulating HDL +levels and downregulating LDL and TGL;[28] it has been +reported that HDL seems to play a key role in maintaining +triglyceride levels.[29] Further, Kumari et  al., 2013,[30] +looking at the mechanism points out that Yoga practices +may improve the lipid profile in by elevating hepatic lipase +activity which may facilitate better triglyceride metabolism +in the adipose tissue.[30] +Reasons for no difference +Our study has found significantly higher HDL levels; +however, no other lipid parameters have shown any +differences between the two groups. HDL increased has +been found to be the protective factor to reduce the risk of +disease such as cardiovascular disorder, obesity, coronary +heart +disease, +hyperlipidemia, +or +hypolipidemia.[31] +However, HDL level is inversely proportional with obesity +and weight loss.[32] So, practicing yoga can be beneficial +to cure/delay the onset of disease and maintain the body +parameters in the defined manner in older ages. Yoga‑based +lifestyle intervention can be used as a complementary +therapy to decrease the risk of cardiovascular disorders. +Azami et  al., 2019, explored that Yoga enhances fatty +acids in blood plasma which further facilitates elevated +level of blood flow which results in the production +of energy. In addition, physical activity like Yoga +augmented fatty acid‑binding protein which played the +major role in regulating the activity of fatty acids by +elevating the cell substrates. Subsequently, Yoga also +plays the mitigating role in increasing and decreasing +levels of lipolysis and fatty acids, respectively.[33] It was +concluded that long‑term practice might be responsible for +improving health parameters. A  regular practice of Yoga +has neuroprotective effects. There were some limitations +in this study as we were unable to decipher a particular +neurological/physiological pathway which could have +helped in maintaining optimum functioning of the body +as this study was self‑declared and specific details about +the type of yoga, daily duration of yoga, timing of doing +the yogic practice were not obtained. Also, the number of +participants was small. +Our findings are preliminary because this was a retrospective +self‑declared data during a community‑based screening +for diabetes. The information such as the components of +yoga, frequency of practice, and duration of the individual +sessions etc were not available. However, further prospective +randomized controlled trials are needed to objectively assess +the outcome of long‑term Yoga practice. +Conclusion +This comparison of lipid profile values in a small cohort +of self‑declared Yoga practitioners (more than 1 year) and +nonyoga practitioners showed no significant difference +between groups. However, might be the specifically +designed Yoga protocols; targeting lipid parameters could +help in improving the lipid profile of the individual. +Ethical statement +The ethical approval was taken from the Institutional +Ethical Committee of IYA. The study was registered on +CTRI (Registration Number– Study REF/2018/02/017724). +Acknowledgments +We acknowledged AYUSH for the support of CCRYN +for manpower, MOHFW for the cost of investigation, +and IYA for the overall project implementation. We also +acknowledged Dr. Shreyas A Chawathey for the help. +Financial support and sponsorship +This study was financially supported by the Ministry of +AYUSH, Government of India. +Conflicts of interest +There are no conflicts of interest. +References +1. +Physical inactivity a leading cause of disease and disability, +warns WHO. J Adv Nurs 2002;39:518. +2. +Moonaz  SH, Bingham CO 3rd, Wissow  L, Bartlett  SJ. Yoga in +sedentary adults with arthritis: Effects of a randomized controlled +pragmatic trial. J Rheumatol 2015;42:1194‑202. +3. +Peter  R, Sood  S, Dhawan  A. Spectral parameters of HRV In +yoga practitioners, athletes and sedentary males. Indian J Physiol +Pharmacol 2015;59:380‑7. +4. +Atkinson NL, Permuth‑Levine R. Benefits, barriers, and cues to +action of yoga practice: A  focus group approach. Am J Health +Behav 2009;33:3‑14. +5. +Mahesh NK, Kumar A, Bhat KG, Verma N. 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Azami  M, Hafezi Ahmadi  MR, YektaKooshali  MH, Qavam  S. +Effect of yoga on lipid profile and C‑reactive protein in women. +Int J Prev Med 2019;10:81. diff --git a/subfolder_0/Role of yoga intervention and its effect on jataragni in ayurveda and CCINV-A RCT.txt b/subfolder_0/Role of yoga intervention and its effect on jataragni in ayurveda and CCINV-A RCT.txt new file mode 100644 index 0000000000000000000000000000000000000000..ef153cc591f7d2569272fb95169642643e0d5ad7 --- /dev/null +++ b/subfolder_0/Role of yoga intervention and its effect on jataragni in ayurveda and CCINV-A RCT.txt @@ -0,0 +1,772 @@ +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +ROLE OF YOGA INTERVENTION AND ITS EFFECT ON +JATARAGNI IN AYURVEDA AND CCINV-A RCT + +PKLNandini1,RaghavendraRao M2, Malur R +Usharani2,RadheshyamNaik2,NagarathnaR1,Shubha.V.Hegde3,Shekhar G +Patil2, Diwakar B Ravi2andBasavalinga S Ajaikumar2 +Author Affiliation: +1. Swami Vivekananda Yoga AnusandhanaSamsthana, Bengaluru +2. Health Care Global Enterprises Ltd., Bengaluru +3. Sri KalabhireshwaraAyurvedic Medical College, Bengaluru + +Abstract +Adverse events caused by CCINV especially the GI disturbances need to +be addressed in a holistic approach as there is substantial gap in +treating and practicing guidelines for complete control or for maximum +benefit. In this study Yoga intervention is used as a complimentary +therapy to address the gap in treating the GI disturbances which is well +documented in ancient literatures. +Methods +Freshly diagnosed Solid malignancies and lymphomasubjects receiving +highly or moderately emetogenic, chemotherapy were recruited after +confirming to the selection criteria in a three group randomized control +yoga based study .to evaluate the effect of yoga on jataragni using JIC- +a new comprehensive reliable and valid checklist for assessing GI +disturbances –jataragni impairment during CCINV +Results +Significant effect for time alone with in subjects but no significant +group by time intervention effect was observed. +Trend for decrease in Agni impairment in Yoga group was seen but +increase in Jataragni in Jacobsons and Waitlist control were not +significant. +www.ijmer.in +242 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +There was significant improvement in Quantity of meal taken in Yoga +group +compared +toJacobsons +and +Waitlist +control +by +fourth +cycle(p=0.01) +Conclusion + Yoga therapy acts as a complimentary treatment in reducing +impairment in jataragni that manifests as chemotherapy induced +nausea and vomiting and other related GI symptomatology in cancer +patients undergoing chemotherapy. +Key Words +Nausea, vomiting, Jataragni, GI disturbances, Yoga.Ayurveda. +Introduction +Research studies have shown that, Chemotherapy has increased +patients’ survival rate, compromising on quality of life because of +adverse effects (Hawkins&Grunberg, 2009). 80% of patients’ experience +adverse effects with chemotherapy, among which nausea and vomiting +being one of the commonest and most feared side effects (Khalifa, +A.M.E,2002)66-91% +of +these +patients +receiving +chemotherapy +experience Nausea and emesis (. Rhodes et. al 2001). Also, +approximately 10% –15% of patients may even refuse or delay their +chemotherapy treatments (Pendergrass, 1998). In two studies, nausea +ranks number 1 with vomiting ranking as the 3rd and the 5th most +distressing symptoms ( adverse event) of chemotherapy (Ballatori and +Roila 2003). )..Nausea is a protective reflex against the ingestion of +toxins and is defined as a subjective phenomenon of an unpleasant +sensation in the epigastrium and in the back of the throat that may or +may not culminate in vomiting (. Rhodes et. al1997).. In the case of +cancer patients Nausea is found to be more psychological than +pharmacological(Burish and Tope 1992)Nearly 70% of patients who +experience anticipatory nausea and emesis attribute these side effects +www.ijmer.in +243 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +to a psychological etiology (Morrow 1982). There is a significant +relationship between autonomic dysfunction and gastric dysrhythmias +during nausea following chemotherapy giving credence to a psycho +physiologic pathophysiology. (Schwartzet al1996).Among different side +effects, though Nausea and Vomiting (N & V) are ranked +higher.(Khalifa, +A.M.E, +2002),(Martin +et +al +2003).Other +GI +disturbances are not emphasised A study shows that aversion for food +is due to Nausea. (Schwartzet al1996). +Yoga intervention has shown to be beneficial in reducing chemotherapy +induced nausea and emesis(Raghavendra, Nagarathna et al. 2006). A +review study on cancer patients and survivors has shown physical and +psychosocial benefits due to Yoga tharepy(Buffart et al 2012).Studies +reviewed show that complementary and alternative medicine and +mind/body approaches are useful in reducing nausea and emesis either +alone or in combination with antiemetic and anxiolytic medications +(Mundy et al 2003).Reddet al 2001)..Even ancient texts have +documented that, Yoga therapy increases appetite,(Hata yoga pradipika +; Asana: Chapter 2 verse19),(HaridasaSamskrithaGranthamala 106 +Chap 2 Verse 10 ), and .The classical text books of Ayurveda has +described that, Nausea is a prodromal symptom of Vomiting and that, +Uthklesha (irritation to the stomach), Bhaya (fear),Kroda (anger) etc. +causes impairment in Jataragni (Bio energy of the entire GI +tract)leading to Vata Pitta charadilakshsnas which is described in the +present study as CCINV(Trikamji, 1935 Chap 20 Verse 6,7 and 20)In +Ayurveda Psychosomatic aspect of the disease is considered while +giving treatment . Health in Ayurveda is defined in an individual as +equilibrium of doshaAgni (Bio energy),dhatu (Tissue),mala (Waste +products),kriya +(Physiology) + +with +sound +soul, +sense +and +mind(Trikamji, 1935 Chap 1 Verse 53) , (Trikamji, 1981 Chap 15 Verse +44) . +www.ijmer.in +244 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +Ayurveda attributes origin of all the disease to ama (Haridasa +Samskritha Granthamala106 Chap 13 Verse 25 and 27) that is +toxins produced on account of Agni impairment. Alsoas per ancient +texts Quantity of meal is an extrapolation of Agni quality and +regulation of Agni is done throughVayuNiyantrana (directing the +energy channels), but directing the energy channels is the outcome of +yoga therapy. As Chemotherapy is one of the foremost therapies for +treating cancer patients, newer approaches have to be introduced which +will address treating Nausea at its root level(Hawkins et al. 2009).Thus +there is a need to study about reestablishment of Jataragni. +Aim and objective +To assess the Role and effect of yoga therapy on Jataragni (collective +component involved in the entire digestion process at the gastro +intestinal tract –GIT),using Jataragni impairment checklist (JIC) in +CCINV. + Hypotheses: +Yoga intervention will lead to greater decrease in Agni impairment and +in turn nausea and vomiting outcomes following chemotherapy than +progressive muscle relaxation or only conventional treatment with +antiemetic support. + Methodology: + Study Subjects: Chemo naïveSubjects with solid malignancies and +lymphomas receiving highly or moderately emetogenic, chemotherapy +were recruited after screening and suited the the selection criteria + + + +www.ijmer.in +245 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +Screening and recruitment of volunteers: +Subjects solicited with referrals from oncologists of Health Care Global +(HCG) Bangalore, who gave their consent to participate in the study, +were recruited +These subjects were randomized into three groups’ viz. yoga plus +antiemetics, relaxation plus antiemetics and antiemetic sonly +Power and Sample Size After screening, 40 subjects were allocated +into each arm based on (standardized effect size with yoga +intervention vs. supportive therapy as 0.69 for nausea +frequency and 0.95 for nausea intensity (Raghu et al, 2006). +average estimate of the two d= 0.82. Considering p at 0.05 and +80% power, the C p, power valuewas 7.9. Going by the formula we +had n= 3 / 0.82 2 x 7.9 = 36 subjects in each arm. Taking into +consideration a dropout of 10% (3 subjects) we recruited +approximately 40 subjects in each arm). + Selection Criteria: +a) Inclusion Criteria: +1. Patients with solid malignancies and lymphomas. +2. Age between 18-70 years. +3. Chemotherapy naïve. +4. Ability to read and write English or Kannada. +5. Eastern cooperative oncology group(ECOG) performance status +<2 +b) Exclusion criteria: +1. Those with brain, metastases +2. Concurrent medical condition likely to influence survival and in +the +opinion +of +the +investigator +could +affect +the +assessment/intervention mentioned in the study or might +www.ijmer.in +246 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +interfere with the nausea/vomiting response including severe +renal or hepatic impairment. +3. Uncontrolled diabetes and hypertension +4. GI malignancies , ascitis, uraemia +5. Neurological disorders such as Parkinson’s disease, myotonic +dystrophy etc. +6. GI obstruction, +7. H/o abdominal surgeries in the last 3 months +8. No cognitive impairments. +9. Regular participation in a behavioral intervention/yoga in the +last six months. +10. Surgeries less than 3 weeks prior to randomization with acute +unresolved toxicities +Justification:The selection criteria were designed to include as many +subjects as possible into the study. The exclusion criteria was designed +to exclude all the factors which would interfere with treatment and +confound results + Design of the study: Randomized Controlled Trial: +Randomization: Subjects were randomized into any of the three +groups using envelopes with group assignments. Random numbers +were generated using software program randomized .com for 3 group +assignment. Opaque envelopes were placed in the order of assignment +and numbered +Study outcomes: +1. JIC: Involves measure for capturing GI disturbances (Jataragni +impairment) using JIC. JIC is a thirteen symptom self-report check list +used for measuring patients” Jataragni impairment level during cancer +treatment Subjects were evaluated with the self-report JIC as a reliable +and valid checklist with Cronbachs alpha=0.74 (Nandini et al 2014) --- +www.ijmer.in +247 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +Patients were asked to rate on a four point scale – None, mild, +moderate and severe. JIC is used both during acute and delayed phase +of CCINV with a 24 hour recall period and four day recall period +respectively. +2. VAS (Visual Analogue Scale): is used for assessing Quantity of meal +taken by the patients. Subjects were asked to mark the level of +reduction in food quantity on a Ten point meter scale.(zero- (100 +percent reduction) to Ten being severe) + These measures were administered before and after chemotherapy, on +day 1 & day 6 for next 3 cycles respectively +Intervention: +The subjects were randomized to receive any of the 3 interventions +before chemotherapy. The yoga intervention consisted of a series of +asanas (postures), breathing exercises, regulated nostril breathing +(pranayama) and relaxation techniques (QRT) for 25 minutes. For the +relaxationgroup, the progressive muscle relaxation (PMR) developed by +Jacobson was used. This involves tightening each and every muscle of +the body and then relaxing the same one by one for 25 minutes. Control +group received only counseling about the role of stress and mind in +CCINV. Patients in all three groups received antiemetic therapy as per +the current -ASCO guidelines during their course of chemotherapy +Chemotherapy regimen: All subjects in this study received highly or +moderately emetogenic chemotherapy schedule during the course of +their chemotherapy (ASCO Guidelines). The chemotherapy schedule +and the cycle duration were decided by the Oncologists at the study +start. +Data analysis: ---Primary Analysis: +Data were analysed using SPSS 16 for windows. Data were analysed +using repeated measures ANOVA with post hoc Bonferroni correction. +www.ijmer.in +248 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +Both within groups and group by time effects were observed. For +ordinal variables in quantity of each meal Pearsons correlation +coefficient R was used. +Results: +Impairment in Agni using Jataragni checklist -JIC: +In all the 3 groups between subjects effect was not significant for +changes in total Agni score following 3 consecutive chemotherapy cycles +F(2,97)=1.19, p=0.31. However within subjects effects was significant +for time F(3,97)=23.2, P<0.001 only. There was no significant group by +time interaction effects (See Fig1) +Within yoga group there was a significant increase in Agni impairment +score between baseline and day 5-6 of first cycle (p<0.001) and decrease +between D5-6 and second chemotherapy cycle (p=0.001). In Jacobson’s +group there was a significant increase between baseline and day 5-6 of +first cycle (p=0.001) and 4th chemotherapy cycle (p=0.004). There was a +significant increase in Agni scores between baseline and D5-6 of first +cycle (p<0.001) in waitlist control group. Though there was a trend for +decreases in Agni impairment scores in yoga group it was not +significant between groups. +Table 1. Comparison of Agni scores between groups using +Repeated measures ANOVA +CHEMOTHERAPY YOGA + +JACOBSON’S +RELAXATION +WAITLIST +CONTROL + +N= +N= +N= + +Mean ± SD +Mean ± SD +Mean ± SD +CYCLE 1 +2.40 ±2.83 +2.44 ±3.23** +2.05±2.92 +www.ijmer.in +249 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +CYCLE 1, DAY 5 +6.31 +±4.73*** +6.93± 5.78** +5.65±5.82 + +CYCLE 2 +2.82±2.37** 3.77±4.84 +4.16±3.73 +CYCLE 3 +4.14 ±3.62 +5.74±4.33** +4.53±3.82** + + + + +**p<0.01 , ***p<0.001 for changes in Agni between baseline and +subsequent chemotherapy cycles. + +Fig1. Group by time interaction effects on impairment in Agni +during various chemotherapy cycles. +Quantity of meal: +Quantity of meal was assessed as an ordinal response variable. There +was no significant change in quantity of meal between Yoga, Jacobsons +and Waitlist control group at baseline, day5-6 of 1st cycle and 2nd cycle of +chemotherapy. There was a significant improvement in quantity of +meal taken by 4th cycle of chemotherapy in yoga group compared to +Jacobsons group and controls indicating decrease in Agni impairment +in yoga group (r=0.23, p=0.02). +www.ijmer.in +250 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +Table 2. Comparisonof quantity of meal taken at each +chemotherapy cycle. + +0(NONE) +1(MILD) +2(MODERATE) +3(SEVERE) + + +N (%) +N (%) +N (%) +N (%) +PEARSONS +R, P VALUE +CYCLE 1 + + + + + +YOGA +30(75.0) +8(20.0) +2(5.0) +0(0.0) +(0.02), (0.86) +JRT +26(66.7) +7(17.9) +4(10.3) +2(5.1) +WLC +30(81.1) +3(8.1) +3(8.1) +1(2.7) +CYCLE 1- +D5/D7 + + + + +(0.10), (0.27) +YOGA +12(30.8) +14(35.9) +10(25.6) +3(7.7) +JRT +13(31.7) +15(36.6) +9(22.0) +4(9.8) +WLC +10(32.3) +8(25.8) +4(12.9) +9(29.0) +CYCLE 2 + + + + + +YOGA +19(50.0) +12(31.6) +5(13.2) +2(5.3) +(0.06), (0.57) + +JRT +19(48.7) +15(38.5) +4(10.3) +1(2.6) +WLC +13(43.3) +9(30.0) +7(23.3) +1(3.3) +CYCLE 3 + + + + + + YOGA +19(51.4) +14(37.8) +3(8.1) +1(2.7) +(0.23), (0.01) +JRT +11(31.4) +15(42.9) +5(14.3) +4(11.4) +WLC +9(32.1) +9(32.1) +7(25.0) +3(10.7) +JRT-Jacobson’s relaxation technique WLC-Wait list control +Findings: +Effect was significant for time alone within subjects. There was no +significant, group by time, interaction effects.There was a trend for +decreases in Agni impairment scores in yoga group and increase in Agni +impairment in Jacobson’s and waitlist group with no significance +between groups. There was a significant improvement in quantity of +meal taken by 4th cycle of chemotherapy in yoga group compared to +Jacobson’s group and controls indicating decrease in Agni impairment +in yoga group +www.ijmer.in +251 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +Jataragni concept in Ayurveda covers a cluster of gastrointestinal +symptoms due to hypo or hyper functioning of Jataragni either due to +some pathology or treatment ((Trikamji, 1935 Chap 12 Verse 11). +Clustering of such symptoms would also imply that these are correlated +and modification due to vitiation of doshas.. For example reduction in +nausea will reduce anorexia and increase uptake of meals ((Nandini et +al, 2014)in the process of correction of vitiated doshas..Though anorexia +and nausea seem to be related, there are similar symptoms with +underlying gastro paresis playing a dominant role in their +causation((Taneja, Deepak et al. 2004).). According to Ayurveda texts +this jataragni is the physiological principle that governs all GI functions +including digestion, assimilation and excretion through a regulated +release of digestive juices and enzymes and timed gastric motility and +any impairment will lead to exacerbation of these GI symptoms +((Shabdakalpadrum) (HaridasaSamskrithaGranthamala 106 Chap 11 +Verse 34, Chap3Verse 50-54), (Trikamji, 1935 Chap 15 Verse 3). The +reduction in symptoms and improvement in quantity of meal is in +concurrence with the classical texts that have elucidated ways to +modulate jataragni by diet (Ahara), medication (Aoshada) and exercise +(Vihara). Ayurveda texts advocate healthy physical activity and yoga to +restore balance of jataragni (HaridasaSamskrithaGranthamala 106 +Chap 2 Verse 10)) as a part of treatment. Studies have also shown +physical activity such as exercise and yoga to improve GI symptoms in +both cancer (Kerry S.etal,2007) and non-cancer populations((Taneja, +Deepak et al. 2004).). It is found that, when there is vitiation +(hypofunctioning)of Jataragni, the quantity of meals consumed is also +reduced. As Nausea is due to aversion of food (Schwartz et al1996).and +decrease in Jataragni ((Trikamji, 1935 Chap 8 Verse 120),there is +decrease in quantity of meals taken. Hence increase in quantity of +meals is due to decrease in aversion of food and nausea In Ayurveda +Agni is one of the ten factors which are required to be examined before +www.ijmer.in +252 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +initiating the treatment of a patient(DashavidharogiparikshaTrikamji, +1935 Chap 8Verse 94).). Jataragni is very important source for +digestion of food consumed. As jataragni is subtle in nature it is +nourished +and +kindled +by +Pranavayu,samanavayu +and +ApanavayuSamanavayu being located in the pitta sthana is mainly +concerned with metabolic process pertaining to digestion (DoshaDhatu +Mala Vignanam).. In short approach to Agni correction is done through +vayu. Hence yoga intervention being a comprehensive technique for +regulation of vayu is advocated. The Concept of Jataragini which is +always in existence in the living body is being extrapolated in the study +by using yoga intervention and the results are interpreted by using this +conceptualisation. +Yoga as a both mind body intervention and stress management +intervention can help modulate Agni by reducing anxiety or reducing +gastro paresis(Geldof, Van der Schee et al. 1986)),(Taneja, Deepak et al. +2004) It is difficult to ascertain what has contributed to reduction in +jataragni impairment in our study as significant between groups effects +were not found for jataragni impairment.In short we can conclude that +Yoga therapy acts as a complimentary treatment in reducing jataragni +impairment dealt in this study as chemotherapy induced nausea and +vomiting and other related GI symptomatology in cancer patients +undergoing chemotherapy. +Suggestions: + Further studies should be conducted witha larger sample size to +demonstrate a significant change in jataragni impairment as this is a +abstract and subtle concept that underlies gross symptomatology that is +amenable to minute changes over time with or without treatment. +Ethical issues: This study was approved by HCG institutional ethics +committee. Written informed consent was taken from all subjects prior +to their participation. No invasive procedures were used in the study. +www.ijmer.in +253 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +Acknowledgement: +This study is a part of the author's Doctoral research work. The author +gratefully acknowledges and thanks CCRYN for funding this project; +Health Care Global Consultants , Dr.MariyammaPhilip- Department of +Biostatistics, National Institute of Mental Health and Neurosciences, +Bangalore and Swami Vivekananda Yoga AnusandhanaSamsthana, +Bengaluru faculties for their support. +References: +1. Ballatori E, RoilaF(2003). Impact of nausea and vomiting on quality of +life in cancer patients during chemotherapy. Health and quality of life +outcomes.; 1(1):46. +2. 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(2006) Effects of an integrated yoga programme on +chemotherapy - induced nausea and emesis in breast cancer patients. +European Journal of cancer care; 16(6):462-74. +22. Ramachandra +Krishna +Kulkarni(1982)DoshaDhatu +Mala +VignanamDoshaVignanaChapter2,Belagave. +23. Redd WH, Montgomery GH, DuHamel KN (200)1. Behavioral +intervention for cancer treatment side effects. J Natl Cancer Inst Jun +6; 93: 810-23. +www.ijmer.in +255 +INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY EDUCATIONAL RESEARCH +ISSN : 2277-7881; IMPACT FACTOR - 2.972; IC VALUE:5.16 +VOLUME 3, ISSUE 11(1), NOVEMBER 2014 + + + + +24. Rhodes VA, Mc Daniel RW(2001). Nausea, vomiting, and retching: +complex problems in palliative care.CA Cancer J Clin. Jul-Aug; 51: +232-48 +25. Rhodes VA, McDaniel RW (1997). Measuring nausea, vomiting, and +retching. Instruments for Assessing Clinical Problems Sudbury, Mass: +Jones and Bartlett.:509-17. +26. Schwartz MD, Jacobsen PB, Bovbjerg DH. 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(1981). Sushrutha Samhita of +Sushrutacharya, Sootra Sthana; 1 ed, Chapter 15 Verse 44. Nirnaya +Sagar Press. (Jadavji Trikamji, 1981) +www.ijmer.in +256 diff --git a/subfolder_0/SENSORY PERCEPTION DURING SLEEP AND MEDITATION.txt b/subfolder_0/SENSORY PERCEPTION DURING SLEEP AND MEDITATION.txt new file mode 100644 index 0000000000000000000000000000000000000000..98bf907428b089ca0b77d6bdd5f79bd22cafd7c4 --- /dev/null +++ b/subfolder_0/SENSORY PERCEPTION DURING SLEEP AND MEDITATION.txt @@ -0,0 +1,19 @@ + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/Self rated ability to follow instructions for four mental states described in yoga texts.txt b/subfolder_0/Self rated ability to follow instructions for four mental states described in yoga texts.txt new file mode 100644 index 0000000000000000000000000000000000000000..1de758288861fb44585a46afa17258729f66262a --- /dev/null +++ b/subfolder_0/Self rated ability to follow instructions for four mental states described in yoga texts.txt @@ -0,0 +1,399 @@ + +TANG / www.e-tang.org 2012 / Volume 2 / Issue 3 / e28 +1 +Original Article + +Self-rated ability to follow instructions for four mental states described in yoga +texts + +Raghavendra Bhat Ramachandra1, Shirley Telles2,*, Nagendra Rama Rao Hongasandra1 + +1Division of Yoga and Life sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India; 2Patanjali Research +Foundation, Patanjali Yogpeeth, Haridwar, Uttarakhand 249408, India + + +ABSTRACT +There were no studies available measuring the ability to follow instructions for meditation. Hence, the +present study was planned to assess the ability to follow instructions for the four mental states viz., +cancalata (random thinking), ekagrata (non-meditative concentration), dharana (focused meditation) and +dhyana (defocused meditation or effortless meditation) described in yoga texts. Sixty male volunteers +with ages ranging from 18 to 31 years (group mean age ± S.D., 22.78 ± 2.73) participated in the study. +They were assessed using a visual analog scale immediately after each of the four states on four different +days. The results showed that following dharana, scores on the visual analog scale were significantly +lower compared to those related to cancalata, ekagrata and dhyana. Hence, dharana is the most difficult +of the four states. + +Keywords four mental states, cancalata, ekagrata, dharana, dhyana, visual analog scale + + + +INTRODUCTION + +The practice of meditation has become increasingly popular all +over the world in the last few decades. Positive physiological +and psychological changes following meditation are supported +by a number of research studies (Cahn and Polich, 2006; Keng +et al., 2011). However, the results are distinct and different. +This may be due to differences in the methods and principles of +the practice of meditation. +Recently, there was a report which described three broad +categories of meditation techniques and their EEG patterns +(Travis and Shear, 2010). The three categories were (i) focused +attention, which involves voluntary and sustained attention on a +chosen object, (ii) open monitoring meditation in which there is +non-reactive monitoring of the moment-to-moment content of +the experience, and (iii) automatic self-transcending, which +includes techniques intended to transcend the practitioner’s +own activity. All these modern derived meditation techniques +are supposed to fit in the above-mentioned categories. Specific +meditation techniques may be more effective for certain +persons based on their psychological characteristics. +In Patanjali’s Yoga Sutras (PYS), ancient Indian yoga text +(Circa 900 B.C.), there are two meditative states described +(Taimini, 1986). Sage Patanjali lays out eight stages of yoga in +Yoga Sutras (aphorisms). These are (i) and (ii) yamas and +niyamas (rules for good conduct), (iii) asanas (physical +postures), (iv) pranayamas (voluntarily regulated breathing), (v) +pratyahara (withdrawal, particularly from external sensations), +(vi) dharana (focused meditation), (vii) dhyana (defocused +meditation or effortless meditation), and (viii) samadhi (an +experience of transcendence or ultimate realization). The sixth +and seventh stages are pertaining to meditation. Dharana +(focused meditation), is defined as confining the mind within a +limited mental area (PYS 3.1). The next stage is dhyana +(effortless meditation or defocused meditation) (PYS 3.2) +which is characterized by the uninterrupted flow of the mind +towards the object chosen for meditation. Dharana and dhyana +may be considered as the last two of four stages, which form a +continuum in the process and practice of meditation. The first +two stages are described in another ancient Indian text the +Bhagavad Gita (Sarasvati and Swami, 1998). The first stage is +cancalata, which is a stage of random thinking. The second +stage is ekagrata, during which the attention is directed to a +series of associated thoughts. The concept of the four mental +states described in yoga texts is schematically presented in Fig. +1. +A study was conducted on 30 volunteers to assess the +changes +in +these +mental +processes +in +brainstem +auditory-evoked potentials (Kumar et al., 2010). The peak +latency of wave V increased significantly during the dharana, +ekagrata and cancalata sessions, but there was no change +during the practice of dhyana. The findings suggest that dhyana +practice alone does not delay auditory transmission at the level +of the brainstem, showing the effectiveness dhyana has over +other processes. In another study, mid-latency auditory-evoked +potentials were assessed in 60 participants during the four +mental states (Telles et al., 2012). The results showed +prolongation in the latencies of Na and Pa waves during +meditation (dhyana), suggesting that auditory information +transmissions at the levels of the medial geniculate and primary +auditory cortex were delayed. Similarly, performances in a +cancellation task studied in 70 normal, healthy male volunteers +showed a significant increase after dharana and a decrease +after cancalata, suggesting better attention after dharana +(Kumar and Telles, 2009). There were no changes in dhyana +and ekagrata. +The concept of an analog scale to assess subjective feelings +was described early in 1921 (Hayes and Patterson, 1921). +Lately, a visual analog scale has been widely used in rating the +subjective feelings (Aitken, 1969). The advantages include it is +*Correspondence: Shirley Telles +E-mail: shirleytelles@gmail.com +Received June 5, 2012; Accepted August 23, 2012; Published August +31, 2012 +doi: http://dx.doi.org/10.5667/tang.2012.0023 +©2012 by Association of genuine traditional medicine +Ability to follow instructions for cancalata, ekagrata, dharana and dhyana +TANG / www.e-tang.org 2012 / Volume 2 / Issue 3 / e28 +2 +easy for the subject to grasp, quick to fill out and score, and as +the subject is not restricted to direct quantitate terms, one can +make a fine discrimination. In an early study on the effect of +meditation on shooting performance, a visual analog scale was +used to assess the experience of tension during shooting +(Solberg et al., 1996). In another study, a visual analog scale +was used to assess global well-being, pain, sleep, fatigue, and +tiredness upon awakening in fibromyalgia patients before and +after participation in a stress-reduction cognitive-behavioral +treatment program (Don et al., 1994). Recently, in a study on +the effects of yoga on the quality of life in cancer patients, their +satisfaction levels related to the yoga program were evaluated +using a visual analog scale (Ulger, 2010). +However, there have been no studies available measuring +the ability to follow instructions for meditation. Hence, the +present study was planned to assess the ability to follow +instructions for the four mental states (cancalata, ekagrata, +dharana, and dhyana) described in yoga texts. + + +MATERIALS AND METHODS + +Participants +Sixty male volunteers with ages ranging from 18 to 31 years +(group mean age ± S.D., 22.78 ± 2.73) were recruited to the +study. All of them were of normal health based on a routine +case history and clinical examination. They were all students at +a yoga University in South India. They had a minimum of six +months experience in meditation (group average experience ± +S.D., 20.95 ± 14.21 months). Apart from their prior experience +of meditation on Om, they were given a three-month +orientation program under the guidance of an experienced +meditation teacher. Male volunteers alone were selected as their +mental state is known to vary with the phases of the menstrual +cycle in females (Little and Zahn, 1974). All participants +expressed their willingness to participate in the experiment, and +the project was approved by the institution’s ethics committee. +The study protocol was explained to the subjects and their +signed consent was obtained. + +Design +Assessments were made on four different days, which were not +necessarily on consecutive days, but at the same time of the day. +The allocation of participants to the four sessions was random +using a standard random number table. Two of them were +meditation sessions viz., dharana and dhyana; whereas the +other two were non-meditation sessions viz., ekagrata and +cancalata. Instructions for all four sessions were played from a +compiled audio CD. The duration of all the four sessions was +20 min. A visual analog scale was given immediately after the +session. The study design has been schematically presented in +Fig. 2. + + +Fig. 1. Schematic representation of four mental states described in yoga texts. + +Fig. 2. Schematic representation of the design. +Ability to follow instructions for cancalata, ekagrata, dharana and dhyana +TANG / www.e-tang.org 2012 / Volume 2 / Issue 3 / e28 +3 +Interventions +Throughout all the sessions participants sat cross legged and +kept their eyes closed following the pre-recorded instructions +for a period of 20 min. +Cancalata (Random thinking) +Participants were asked to allow their thoughts to wander freely +as they listened to a compiled audio CD consisting of brief +periods of conversation, announcements, advertisements and +talks on diverse topics recorded from a local radio station +transmission. All these conversations were not connected and +could induce the state of random thinking. +Ekagrata (Non-meditative concentration) +Participants listened to a pre-recorded lecture on meditation. +This was not about meditation on the Sanskrit syllable Om, but +about meditation, in general. This was supposed to induce a +state of non-meditative concentration. +Dharana (Focused meditation) +Participants were asked to open their eyes and gaze at the +syllable ‘Om’ as it is written in Sanskrit. During this time, +guided instructions required them to direct their thoughts to the +physical attributes of the syllable (i.e., the shape and color), and +then to close their eyes and continue to visualize the syllable +mentally. +Dhyana (Effortless meditation or defocused meditation) +During this session participants were instructed to keep their +eyes closed and dwell on the Om picture without any effort, +particularly on the subtle (rather than physical) attributes and +connotations of the syllable. This involved the effortless +chanting of Om, bringing about the effect of defocusing. + +Assessments +A Visual Analogue Scale (VAS) is an instrument that tries to +measure a characteristic or attitude that is believed to range +across a continuum of values and cannot easily be directly +measured (Wewers and Lowe, 1990). A visual analogue scale is +a horizontal line, 10 cm in length, anchored by word +descriptors at each end, as illustrated in Fig. 3. Immediately +after the session, participants were asked to put a mark on the +line which represents how much they were able to follow the +instructions for the four mental states. + + +Data analysis +Statistical analysis was done using SPSS (Version 16.0). +Repeated measured analysis of variance (ANOVA) was +performed with one 'within subjects' factor, i.e., sessions: +cancalata, ekagrata, dharana, and dhyana. This was followed +by a post-hoc analysis with a Bonferroni adjustment for +multiple comparisons between the mean values of different +sessions. + + +RESULTS + +The group mean values ± SD for cancalata, ekagrata, dharana +and dhyana are given in Table I. Repeated measures of the +analysis of variance (ANOVA) showed significant differences +between sessions [F = 31.04, df = (2.46, 145.13), Huynh-Feldt +epsilon = 0.820, p < 0.001]. Post-hoc analyses with a +Bonferroni adjustment were performed to see the changes +between the sessions. Following dharana, scores on the visual +analog scale were significantly lower compared to those for +cancalata (p < 0.001), ekagrata (p < 0.001), and dhyana (p < +0.001). + + +DISCUSSION + +The present study was conducted to assess the self-rated ability +to follow the instructions to achieve the four mental state’s viz., +cancalata, ekagrata, dharana and dhyana using a visual analog +scale. The results showed that following dharana, scores on the +visual analog scale were significantly lower compared to those +for cancalata, ekagrata and dhyana. +A study has shown the brain areas involved in FA (Focused +Attention) and OM (Open Monitoring) meditations are distinct +and different (Lutz et al., 2008). FA meditation improves the +practitioner’s ability to sustain attention on a particular object +for prolonged periods. During FA meditation, functional +magnetic resonance imaging (fMRI) has shown activation in +the brain regions involved in monitoring, engaging attention +and attentional orienting. In contrast, OM meditation has +shown activation in the brain regions implicated in monitoring, +vigilance and disengaging attention from stimuli which could +distract attention from the experience at that moment. Hence, it +is very much evident that the brain areas involved in these four +mental states are different. +Dharana involves mental visualization and intense +focusing on the Sanskrit syllable Om. Some people may have +difficulties in mentally visualizing the symbol for a long time. +Also, participants might have had difficulties in keeping the +intense focus on the syllable Om for 20 min. The average +attention span in healthy adults is between 15 - 20 min. +Dharana requires focused attention; whereas dhyana, ekagrata +and cancalata do not need focused attention. +The usefulness of practicing dharana is well known. +Focused attention on a single object removes cancalata and +takes us to a higher state than ekagrata by moving the mind +from multiple thoughts to a single thought of a visual picture as +‘Om’ used here. However, according to yoga, it is well known +that dharana involves intense effort to keep the focus on the +given object for longer durations. It causes fatigue as it drains + +Fig. 3. Visual analog scale. +Table 1. Scores on visual analog scale following four mental states +Sessions +Cancalata +Ekagrata +Dharana +Dhyana +Mean ± S.D. +8.08 ± 0.50 +8.07 ± 0.56 +7.45 ± 0.65*** +8.22 ± 0.70 +***Comparing dharana with cancalata, ekagrata, and dhyana sessions shows significant differences with all three (p < 0.001 for each). +Ability to follow instructions for cancalata, ekagrata, dharana and dhyana +TANG / www.e-tang.org 2012 / Volume 2 / Issue 3 / e28 +4 +away the energy. However, it is useful for removing drowsiness +(Tamas) and inducing alertness. +Hence, traditionally (PYS 3.2) dharana is used for a short +duration, about a minute and then one proceeds to perform +dhyana by making the mind to stay on a single thought +effortlessly. The five main features of the dhyana state are +single thought, effortlessness, slowness, wakefulness and +expansiveness. A long duration of meditation helps one to gain +mastery +over +the +mind +and +leads +to +a +state +of +superconsciousness called samadhi (PYS 3.4). +In summary, the study has shown that, (i) cancalata and +ekagrata and dhyana can be done with equal ease, and (ii) +dharana is the most difficult state compared to the cancalata, +ekagrata and dhyana states. + + +ACKNOWLEDGEMENTS + +The authors gratefully acknowledge the funding from the +Indian Council of Medical Research (ICMR), Government of +India, as part of a grant (Project No. 2001-05010) towards the +Center for Advanced Research in Yoga and Neurophysiology +(CAR-Y&N). + + +CONFLICT OF INTEREST + +The authors have no conflicting financial interests. + + +REFERENCES + +Aitken RC. Measurement of feelings using visual analogue +scales. Proc R Soc Med. 1969;62:989-993. + +Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and +neuroimaging studies. Psychol Bull. 2006;132:180-211. + +Don L. Goldenberg, Kenneth H, Kaplan, Maureen G, Nadeau, +Brodeur C, Smith S, Christopher H, Schmid A. Controlled +Study of a Stress-Reduction, Cognitive-Behavioral Treatment +Program +in +Fibromyalgia. +J +Musculoskeletal +Pain. 1994;2:53-66. + +Hayes MHS, Patterson DG. Experimental development of the +graphic rating method. Psychol Bull. 1921;18:98-99. + +Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on +psychological health: a review of empirical studies. Clin +Psychol Rev. 2011;31:1041-1056. + +Kumar S, Nagendra HR, Naveen KV, Manjunath NK, Telles S. +Brainstem auditory-evoked potentials in two meditative mental +states. Int J Yoga. 2010;3:37-41. + +Kumar S, Telles S. Meditative states based on yoga texts and +their effects on performance of a cancellation task. Percept Mot +Skills. 2009;109:679-689. + +Little BC, Zahn TP. Changes in Mood and Autonomic +Functioning During the Menstrual Cycle. Psychophysiology. +1974;11:579-590. + +Lutz A, Slagter HA, Dunne JD, Davidson RJ. Attention +regulation and monitoring in meditation. Trends Cogn Sci. +2008;12:163-169. + +Sarasvati M, Swami G. Bhagavad Gita. (Calcutta, India: +Advaita Ashrama), 1998. + +Solberg EE, Berglund KA, Engen O, Ekeberg O, Loeb M. The +effect of meditation on shooting performance. Br J Sports Med. +1996;30:342-346. + +Taimini IK. The science of yoga. (Madras, India: The +Theosophical Publishing House), 1986. + +Telles S, Raghavendra BR, Naveen KV, Manjunath NK, +Subramanya P. Mid-Latency Auditory Evoked Potentials in 2 +Meditative States. Clin EEG Neurosci. 2012;43:154-160. + +Travis F, Shear J. Focused attention, open monitoring and +automatic self-transcending: categories to organize meditations +from Vedic, Buddhist and Chinese traditions. Conscious Cogn. +2010;19:1110-1118. + +Ulger O, Yağli NV. Effects of yoga on the quality of life in +cancer patients. Complement Ther Clin Pract. 2010;16:60-63. + +Wewers ME, Lowe NK. A critical review of visual analogue +scales in the measurement of clinical phenomena. Res Nurs +Health. 1990;13:227-236. + diff --git "a/subfolder_0/Single Bout of Yoga Practices (Asana) Effect on Low Frequency (LF) of Heart Rate Variability\342\200\223A Pilot Study..txt" "b/subfolder_0/Single Bout of Yoga Practices (Asana) Effect on Low Frequency (LF) of Heart Rate Variability\342\200\223A Pilot Study..txt" new file mode 100644 index 0000000000000000000000000000000000000000..7be3c69fca0c3c54e476c86a84d9ea344101bb12 --- /dev/null +++ "b/subfolder_0/Single Bout of Yoga Practices (Asana) Effect on Low Frequency (LF) of Heart Rate Variability\342\200\223A Pilot Study..txt" @@ -0,0 +1,464 @@ +Int J Med. Public Health. 2019; 9(4):160-163. +A Multifaceted Peer Reviewed Journal in the field of Medicine and Public Health +www.ijmedph.org | www.journalonweb.com/ijmedph +Short Communication +International Journal of Medicine and Public Health, Vol 9, Issue 4, Oct-Dec, 2019 +160 +Anup De1, Samiran +Mondal2, Singh +Deepeshwar3,4,* +1Department of Physical Education and +Sport Science, Visva-Bharati University, +Santiniketan, West Bengal, INDIA. +2Department of Yogic Art and Science, +Visva-Bharati, Santiniketan, West +Bengal, INDIA. +3Department of Yoga and Life Science, +Swami Vivekananda Yoga University +(S-VYASA), Bangalore, Karnataka, +INDIA. +Correspondence +Dr. Deepeshwar Singh, +Visiting Professor, Department of Yogic +Arts and Sciences, Visva-Bharti, Santinik­ +etan-731235, West Bengal, INDIA. +Mobile no: +91 080 22639906 +Email: deepeshwar.singh@gmail.com +History +• Submission Date: 13-08-2019; +• Revised Date: 11-11-2019; +• Accepted Date: 19-11-2019; +DOI : 10.5530/ijmedph.2019.4.34 +Article Available online +http://www.ijmedph.org/v9/i4 +Copyright +© 2019 Phcog.Net. This is an open- +access article distributed under the terms +of the Creative Commons Attribution 4.0 +International license. +Cite this article : De A, Mondal S, Deepeshwar S. Single Bout of Yoga Practices (Asana) Effect on Low Frequency +(LF) of Heart Rate Variability – A Pilot Study. Int J Med Public Health. 2019;9(4):160-3. +ABSTRACT +The Heart Rate Variability (HRV) is an important parameter to assess psychophysiological chang­ +es associated with Autonomic Nervous System (ANS). The present study aimed to assess the +effect of single bout yoga postures practice on parasympathetic nervous system activity of ANS. +Three male subjects having more than 5 years of experience in yoga postures were selected +in the current study. These participants were assessed for HRV immediately before and after +practice of specific yoga postures practiced for 15 min, 21 min and 27 min on three different +days. The yoga practices were selected from hatha yogic texts that may influence brain blood +flow resulting autonomic activities. +Key words: Yoga Postures (asana), Autonomic nervous system, Heart rate variability, Low +frequency, Single bout. +Key message: The regular practice of yogic postures improves autonomic modulation and +enhances deep relaxation. +Single Bout of Yoga Practices (Asana) Effect on Low Frequency +(LF) of Heart Rate Variability – A Pilot Study +Anup De1, Samiran Mondal1,2, Singh Deepeshwar2,3,* +INTRODUCTION +Mind-body practices have been shown modulation +in Heart Rate Variability (HRV) of practitioners. +HRV is the promising and non-invasive measure­ +ment of instantaneous variation in heart rhythm due +to physical and mental stress. The mind-body prac­ +tices such as yoga, tai-chi, meditation, etc., facilitate +autonomic balance in immediate or long-term prac­ +titioners. Higher HRV indicates greater parasympa­ +thetic control, whereas lower HRV indicates lesser +parasympathetic control in the autonomic nervous +system.1 Autonomic imbalance positively associated +with aerobic exercise, physical activity, psychological +and physiological flexibility and negatively associated +with physical exhaustion, mental stress, psychologi­ +cal distress and physical strain.2 +Previous studies on yoga reflected positive changes +in various other markers of physiological health such +as Heart Rate (HR), Galvanic Skin Resistance (GSR), +baroreflex sensitivity and evoked potentials.1,3,4 Fur­ +ther, the association between yoga and HRV has been +reported in clinical studies as well. But most of the +studies on yoga and HRV is based on either medita­ +tion or breathing practices or integrated practice of +yoga. Recently, there is a study on regular yoga prac­ +titioners affect HRV components and found during +standing yoga postures there were increased in the LF +power and decreased in the HF power and during in­ +verted and forward bending postures showed oppo­ +site results i.e., decrease in the LF power and increase +in the HF power.5,6 Other few earlier studies also re­ +ported that after yoga postures, there is a withdrawal +of sympathetic arousal in regular yoga practitioners +and reduced Heart Rate (HR).7,8 However, there is no +investigation recorded the autonomic modulation in +three different time periods (i.e., 15 min, 21 min and +27 min) on different days in the same yoga practi­ +tioners in single bout of yoga posture practices. The +selected postures are also supposed to enhance cogni­ +tive functions. +Therefore, the present study is designed to investigate +the yoga postures intervention effect on the Parasym­ +pathetic Nervous System (PNS) using HRV indices. +MATERIALS AND METHODS +Three normal healthy male yoga practitioners (mean +age of 25 years) willing to participate in this study +after advertising in University notice board. These +recruited participants were from the Post Graduate +(PG) level and their socioeconomic status was lower +middle class. The average height, weight and BMI +were 163.16 cm, 61 kg and 22.9 kg/m2 respectively. +All participants had five years’ experience in yoga +practice. The HRV data were acquired using the NeX­ +us-10 device (Medical Device Directive 93/42/EEC; +TMS International BV, the Netherlands). The study +was approved by ethical committee of the Univer­ +sity and signed informed consent form was obtained +from each participants. +Study design +The design of the study was pre-post repetitive as­ +sessments where all three participants underwent for +three intervention conditions, i.e., 15 min, 21 min +De, et al.: Yoga Practices and Sympathetic Activity +International Journal of Medicine and Public Health, Vol 9, Issue 4, Oct-Dec, 2019 +161 +and 27 min practice of yoga. The data were collected immediately be­ +fore and after yoga postures practice on three consecutive days but at +the same time of the day. The schematic representation of the design is +shown in Figure 1. +Assessments +Heart Rate Variability (HRV): The HRV outcomes included LF in per­ +centage (%), HF% and amplitude recorded in Hz unit. The HRV spec­ +trum contains two major components: The High Frequency (HF) (0.18- +0.4 Hz) component, which is synchronous with respiration. The second +is a Low Frequency (LF) (0.04 to 0.15 Hz) component that appears to +be mediated by both the vagus and cardiac sympathetic nerves. High- +frequency (HF) activity has been found to decrease under conditions of +acute time pressure and emotional strain and elevated state anxiety, pre­ +sumably related to focused attention and motor inhibition.8,9 +Intervention +The five yoga postures (asanas) were selected for the present study which +is associated with brain functions.10 Each yoga posture (asana) was per­ +formed for an allotted time and repetition cycles accordingly. The details +of the yoga practices protocol are shown in Table 1. +Statistical Analysis +The obtained data were analyzed with descriptive statistics viz. mean, +standard deviation and standard error of the mean and percentage +changes. However, paired ‘t’ test was not applied to determine the statis­ +tical significance of differences due to the very small sample size. +RESULTS +The outcome of the HRV components showed there was an increase in +LF % band and decrease in HF % band immediately after 15 min and 21 +min practice of yoga postures. But there was a decrease in LF% band af­ +ter 27 min yoga postures practice. Another component of HRV was HRV +Table 1: The details of yoga protocol intervention for 15 min, 21 min and 27 min. +Yoga Postures +Starting +to Final +Posture +Maintenance +Final +to +Initial +Repetition/ +Frequency +Repetition/ +Frequency +Repetition/ +Frequency +Rest +between +Asana +Rest +between +repetition +Total +Time for +15 min +Total +Time for +21 min +Total +Time +for 27 +min +15 Min +Yoga +Postures +21 min Yoga +Postures +27 min Yoga +Postures +Surya +namaskar (Sun +Salutation) +(12 Posture) +1 time +1 time +1 time +15 sec +- +165 sec +150 sec +135 sec +Sarvangasana +(Shoulder Stand +Pose) +15 sec +30 sec +15 sec +2 times +3 Times +4 Times +15 sec +15 sec +150 sec +225 sec +300 sec +Karnapidasana +(Ear Pressure +Pose) +15 sec +30 sec +15 sec +2 times +3 Times +4 Times +15 sec +15 sec +150 sec +225 sec +300 sec +Chakrasana +(Wheel Pose) +15 sec +30 sec +15 sec +2 times +3 Times +4 Times +15 sec +15 sec +150sec +225 sec +300 sec +Vrischikasana +(Scorpion Pose) +15 sec +30 sec +15 sec +2 times +3 Times +4 Times +15 sec +15 sec +150 sec +225 sec +300 sec +Sirshasana +(Head Stand) +15 sec +30 sec +15 sec +2 times +3 Times +4 Times +- +15 sec +135 sec +210 sec +285 sec +Total time duration for yogasana posture practices +15 Min +(900 +sec) +21 Min +(1260 +sec) +27 Min +(1620 +sec) +Figure 1: Pre-Test – Post Test Experimental Design. +amplitude, which showed a trend towards a decrease in 21 min and 27 +min of yoga postures. The mean, Standard Deviations (SD) and Standard +Error Mean (SEM) of HRV components are given in Table 2. The heart +rate variability before and after yogasana practice is depicted in Figure 2 +(LF%), Figure 3 (HF%) and Figure 4 HRV amplitude. +DISCUSSION +The results of the present study showed that the 15 min and 21 min of +yoga postures (asana) practice increases in the low frequency (LF%) +band and decreases high frequency (HF%). Whereas, after 27 min of +yoga postures there were decreased in the LF% band and HRV ampli­ +tude. Typically, LF band (0.04-0.15 Hz) mainly reflects baroreceptor +activity and sympathetic activity during rest and exercise8,11 and other +studies have reported no change in LF and LF-HF ratio during exer­ +cise.12 The increased HF band suggests an increase in the vagal activity +(parasympathetic) whereas the increased sympathetic activity is asso­ +ciated with LF band of HRV.8 Generally, the sympathetic activation is +required during vigilance and considered necessary to perform an at­ +tentional task, while efferent vagal (parasympathetic) activity especially +seen in clinical and experimental observations of autonomic maneuvers +such as electrical vagal stimulation, muscarinic receptor blockade and +vagotomy.13 But the embedded mechanism of yoga practice effect on the +autonomic nervous system is not fully explored. Few studies speculated +that after yoga postures there is stimulation of the vagus nerve and en­ +De, et al.: Yoga Practices and Sympathetic Activity +162 +International Journal of Medicine and Public Health, Vol 9, Issue 4, Oct-Dec, 2019 +hance parasympathetic outflow and control sensory input to the brain +and enhanced mood and reflecting in cardiac functions.14 Few stud­ +ies have been reported that a well-balanced vagal activity in long-term +yoga practitioners where yoga practices consisted of physical postures +(asana), breathing practices (pranayama), meditation (dhyana) and re­ +laxation.7,15 In contrast to previous studies, the current study showed the +sympathetic arousal and baroreflex activity after 15 and 21 min practice +and decreased after 27 min practice of only yoga postures, which sug­ +gest that the long-term practice may modulate the autonomic activity +and increase vagal tone. As mentioned by the Sage Patanjali in Yoga Su­ +tra (PYS), that when an individual practice yoga postures (asana) for a +Table 2: The result table included mean, standard deviation (SD) and standard error mean (SEM) of Heart Rate +Variability components (LF%, HF% and HRV Amplitude) are given below. +Duration +LF % +HF % +HRV Amplitude +Mean (SD) +SEM +Mean (SD) +SEM +Mean (SD) +SEM +15 Min +Pre-Test +45.33 (17.51) +10.11 +54.67 (17.51) +10.11 +9.15 (1.56) +0.90 +Post Test +46.14 (17.26) +9.96 +53.86 (17.26) +9.96 +9.29 (2.19) +1.26 +21 Min +Pre-Test +39.97 (24.15) +13.94 +60.03 (24.15) +13.94 +8.88 (2.56) +1.48 +Post Test +45.49 (29.69) +17.14 +54.51 (29.69) +17.14 +8.50 (2.77) +1.60 +27 Min +Pre-Test +49.44 (21.14) +12.20 +50.56 (21.14) +12.20 +9.84 (2.60) +1.50 +Post Test +43.45 (16.28) +9.40 +56.55 (16.28) +9.40 +8.10 (1.77) +1.02 +Figure 2: Heart rate variability (LF %) after 15 min, 21 min and 27 min of +yogasana practice. +Figure 3: Heart rate variability (HF %) after 15 min, 21 min and 27 min of +yogasana practice. +Figure 4: Heart rate variability amplitude after 15 min, 21 min and 27 min of +yogasana practice. +longer duration, the practice becomes steady, stable and firm that leads +to ease and comfortable which enhances pleasure and relaxation (PSY +Chapter 2- Verses 46-47).16 The outcome of the present study followed +the ancient literature also reflects that the regular and repeated practice +of yoga may enhance relaxation and increases parasympathetic outflow. +This outcome may be helpful for cognitive behavior and emotional re­ +sponses. The limitations of the study are straightforward including, the +small sample size; absence of the control group and self as control de­ +sign. Therefore, further study can be done using an adequate sample size, +with complete autonomic and neurophysiological assessments such as +Electroencephalogram (EEG), Functional Near-Infrared Spectroscopy +(fNIRS) and Evoked Potentials (EPs). +ACKNOWLEDGEMENT +The researchers are thankful to University Grant Commission, Ministry +of Human Resource Development, Govt. of India for their financial sup­ +port in this project. We are also thankful to Department of Yogic Art and +Science, Visva-Bharati, Central University, for providing participants. +CONFLICT OF INTEREST +The authors declare no Conflict of interest +ABBREVIATIONS +HRV: Heart Rate Variability; LF: Low Frequency; HF: High Frequency; +De, et al.: Yoga Practices and Sympathetic Activity +International Journal of Medicine and Public Health, Vol 9, Issue 4, Oct-Dec, 2019 +163 +ANS: Autonomic Nervous System; PNS: Parasympathetic Nervous Sys­ +tem; GSR: Galvanic Skin Resistance; HR: Heart Rate; SD: Standard De­ +viation. +REFERENCES +1.  Cheema BS, Marshall PW, Chang D, Colagiuri B, Machliss B. Effect of an office +worksite-based yoga program on heart rate variability: A randomized controlled +trial. BMC Public Health. 2011;11(1):578. doi:10.1186/1471-2458-11-578 +2.  Friis AM, Sollers JJ. Yoga Improves Autonomic Control in Males: A Preliminary +Study Into the Heart of an Ancient Practice. J Evidence-Based Complement +Altern Med. 2013;18(3):176-82. doi:10.1177/2156587212470454 +3.  Bowman AJ, Clayton RH, Murray A, Reed JW, Subhan MM, Ford GA. Effects of +aerobic exercise training and yoga on the baroreflex in healthy elderly persons. +Eur J Clin Invest. 1997;27(5):443-9. +4.  Bhavanani A, Pal G, Udupa K, Krishnamurthy N, Trakroo M. A comparative +study of the effects of asan, pranayama and asan-pranayama training on neuro­ +logical and neuromuscular functions of Pondicherry police trainees. Int J Yoga. +2013;6(2):96. doi:10.4103/0973-6131.113398 +5.  Manjunath NK, Telles S. Effects of Sirsasana (headstand) practice on autonomic +and respiratory variables. Indian J Physiol Pharmacol. 2003;47(1):34-42. +6.  Kulkarni R, Nagarathna R, Nagendra H, An H. Measures of heart rate vari­ +ability in women following a meditation technique. Int J Yoga. 2010;3(1):6. +doi:10.4103/0973-6131.66772 +7 +.  Khattab K, Khattab AA, Ortak J, Richardt G, Bonnemeier H. Iyengar Yoga in­ +creases cardiac parasympathetic nervous modulation among healthy yoga +practitioners. Evidence-based Complement Altern Med. 2007;4(4):511-7 +. +doi:10.1093/ecam/nem087 +8.  Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho- +vagal balance. Front Physiol. 2013;4(2):26. doi:10.3389/fphys.2013.00026 +9.  Jönsson P +. Respiratory sinus arrhythmia as a function of state anxiety in +healthy individuals. Int J Psychophysiol. 2007;63(1):48-54. doi:10.1016/j.ijpsy­ +cho.2006.08.002 +10.  Saraswati S. Asana Pranayama Mudra Bandha. Yoga Publications Trust. 2013. +11.  Electrophysiology TF o.t. ES o.t. NAS. Heart Rate Variability: Standards of +Measurement, Physiological Interpretation and Clinical Use. Circulation. +1996;93(5):1043-65. doi:10.1161/01.CIR.93.5.1043 +12.  Yamamoto Y +, Hughson RL, Peterson JC. Autonomic control of heart rate dur­ +ing exercise studied by heart rate variability spectral analysis. J Appl Physiol. +1991;71(3):1136-42. doi:10.1152/jappl.1991.71.3.1136 +13.  Subramanya P +, Telles S. Performance in the Stroop Task and Simultane­ +ously Recorded Heart Rate Variability before and after Meditation, Supine +Rest and No-Intervention. Int J Brain Cogn Sci. 2015;4(1):8-14. doi:10.5923/j. +ijbcs.20150401.03 +14.  Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin re­ +sistance syndrome, cardiovascular disease and possible protection with yoga: +A systematic review. J Am Board Fam Pr. 2005;18(6):491-519. doi:18/6/491 [pii] +15.  Muralikrishnan K, Balakrishnan B, Balasubramanian K, Visnegarawla F +. Mea­ +surement of the effect of Isha Yoga on cardiac autonomic nervous system +using short-term heart rate variability. J Ayurveda Integr Med. 2012;3(2):91. +doi:10.4103/0975-9476.96528 +16.  Taimni IK. The Science of Yoga: The Yoga-Sūtras of Patañjali in Sanskrit with +Transliteration in Roman, +Translation and Commentary in English. Madras: +Theo­ +sophical Publishing House. 1999. +Cite this article : De A, Mondal S, Deepeshwar S. Single Bout of Yoga Practices (Asana) Effect on Low Frequency (LF) of Heart Rate Variability – A Pilot Study. +Int J Med Public Health. 2019;9(4):160-3. diff --git a/subfolder_0/Stress and Sleep in Addictive Behavior and Application of Yoga-based Interventions A Short Narrative Review.txt b/subfolder_0/Stress and Sleep in Addictive Behavior and Application of Yoga-based Interventions A Short Narrative Review.txt new file mode 100644 index 0000000000000000000000000000000000000000..d1baf2e8cf841482eeafddacfe5c69d49ae88f77 --- /dev/null +++ b/subfolder_0/Stress and Sleep in Addictive Behavior and Application of Yoga-based Interventions A Short Narrative Review.txt @@ -0,0 +1,612 @@ + + + +Gaihre A, et al. OHJN 2021 Jan-Jun;01(01):1-5 + + + + 1 + + +OHJN | VOL 01 | NO. 01 | ISSUE 01 | Jan-Jun, 2021 + + One Health Journal of Nepal + + + +Stress and Sleep in Addictive Behavior and Application of +Yoga-based Interventions: A Short Narrative Review + +Ananda Gaihre,1 Rajesh Kumar Sasidharan,2 Suman Bista,3* Rakshya Khadka,4 Lisasha +Poudel,5 Sujana Bista,2 Vijaya Sapkota6 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +Review Article + + + + + + + + Open Access + +ABSTRACT +Individuals who attempt to change their addictive behaviour frequently undergo relapse. There is +substantial evidence that stress and sleep plays a crucial role in the relapse. The stressful situation and +poor sleep quality represent a risk factor that may play a critical role in predicting individuals' success in +abstaining. Diagnosing and treating stress and sleep disorders will have a significant impact on the +management of addictive behaviour. The extents of impairments are at biopsychosocial-spiritual levels. +Therefore, it needs to be recognized and addressed in an individual at the physical, psychological, social +and spiritual levels. Recent studies have shown yoga as a promising complementary therapy for treating +and preventing addictive behaviours at biopsychosocial-spiritual levels. Yoga may work on addictive +behaviour through down-regulation of the hypothalamic-pituitary-adrenal (HPA) axis and bringing a +state of parasympathetic nervous system (PNS) dominance. + +Keywords: Drugs; Stress; Yoga. + +*Correspondence: suman.bista002@gmail.com +National Institute of Mental Health and Neuro +Sciences (NIMHANS), Bengaluru, India +1Himalayan Yoga and Prakritik Hospital, Kathmandu, Nepal, 2Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India, +3National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India, 4Centre for Mental Health and Counseling Services- +Nepal, Kathmandu, Nepal, 5Dhulikel Hospital - Kathmandu University Hospital, Nepal, 6Sambodhi, Yoga Studio, Kathmandu, Nepal. + + + + +Gaihre A, et al. OHJN 2021 Jan-Jun;01(01):1-5 + + + + 2 + + +OHJN | VOL 01 | NO. 01 | ISSUE 01 | Jan-Jun, 2021 + +INTRODUCTION + +According to the clinicians and researchers, addictive +behaviour is considered as abnormal behaviour, +where the individual is actively involved in something +harmful substance or undesirable behaviour even +though it creates a burden at psychosocial and bio- +spiritual levels. A recent report from the United +Nations Office on Drugs and Crime (UNODC) on +addictive behaviours estimated that about 5 per cent +of the adult population aged 15-64 years, used drugs +at least once in 2015.1 + +The current study tries to investigate the role of sleep +and stress on addictive behaviour. Further, it reviews +the +scientific +studies +related +to +yoga-based +intervention on addictive behaviour. + + +STRESS + +Stress is defined as a reaction towards a demand +(usually noxious), reflected on the physiology2 which +alters psychological and physiological homeostatic3 +mainly through the activation of the hypothalamic- +pituitary-adrenal (HPA) axis. Stress is a crucial risk +factor for the progress of addiction and addiction +relapse. The brain pathways may play a vibrant part +in the transition to and upkeep of substance +dependence once initiated.4 Further, the empirical +findings and neurobiological evidence indicate an +important role of brain stress pathways in addiction +relapse. The pathways are vulnerable to the adverse +emotive condition produced by the addiction that +motivates +drug-seeking +through +negative +reinforcement mechanisms. There are significant +pieces of evidence that initial stressful life events are +risk factors for the advance of addiction and serve as +cues that trigger relapses.5 Stress-induced increase in +glucocorticoid secretion, which in turn enhances the +drug-induced release of dopamine in the nucleus +accumbent, seems to be an essential substrate of such +an effect of stress.6 The changes are accompanied by +high +physiologic +arousal, +dysregulated +HPA +responses, and a persistent distress and craving state +that is slow to return to baseline.7 + + +SLEEP + +Many youngsters suffer from various sleep disorders, +including insomnia and sleep deprivation, resulting in +poor sleep quality.8 Almost all forms of addiction +including alcohol have disruptive effects on sleep, +sleep stages and consequent next-day alertness. + +These sleep and alertness disturbances may have a +contributory role in the initiation, maintenance, and +relapse of substance use disorders.9 Systematically +evaluated various sleep disorders in addictive +behaviour seem 5 to 10 times more likely to have +sleep disorders.10 Addictive behaviour related sleep +disturbances are often associated with both the acute +and prolonged withdrawal from the substance. +Further, the sleep disturbance may persist even after +weeks or years of withdrawal.11 Preliminary evidence +indicates that participants who completed four or +more sessions in the treatment program showed +improved sleep and that improving sleep may lead to +a reduction in substance abuse problems at the 12- +month follow-up.12 + + +STRESS, SLEEP AND SUBSTANCE USE + +Stress and sleep have well documented bidirectional +effects.13 The arousal due to stress persists into the +usual sleep period, which leads to insomnia. Several +studies reported an inhibitory effect of sleep on +cortisol secretion and slightly higher plasma cortisol +levels during total sleep deprivation.14,15 Further, +stress is associated with increased sleep debt16 sleep +quantity and morning cortisol.13 There are long- +standing pieces of evidence of reciprocal interactions +between stress, sleep and substance abuse. The +findings also suggest that sleep difficulties are an +important factor that contributes to substance use in +victims +with +post-traumatic +stress +disorder.17 +Furthermore, results showed the interaction of poor +mental health on drinking motives and poor sleep. +Most of the drinking motivations (social, coping, +conformity, and enhancement) and poor sleep were +found to explain substance use and negative +substance abuse consequences.18 + + +YOGA AND STRESS MARKERS + +Extensive studies have explored the effect of yoga on +stress at psychological, physiological and biomarker +levels. A systematic review exploring the effects of +yoga on stress suggests that yoga practice helps in the +regulation of the sympathetic nervous system and +hypothalamic-pituitary-adrenal system in various +populations.19 Further, a systematic review and meta- +analysis of randomized controlled trials reported that +yoga appeared to be associated with reduced +ambulatory systolic blood pressure, resting heart rate +and high-frequency heart rate variability which are + + + +Gaihre A, et al. OHJN 2021 Jan-Jun;01(01):1-5 + + + + 3 + + +OHJN | VOL 01 | NO. 01 | ISSUE 01 | Jan-Jun, 2021 + +the markers of stress.20 Furthermore, a meta- +analysis evaluating yoga on post-traumatic stress +disorder (PTSD) outcomes in adult patients suggest +that +yoga +and +meditation +are +promising +complementary approaches for PTSD.21 The data +from salivary cortisol analysis indicated that yoga +practice was effective in reducing the values of +psychophysiological markers for stress levels.22 + + +YOGA AND SLEEP OUCTOMES + +Studies have demonstrated the effectiveness of yoga +intervention on the improvement of sleep quality in +several types of populations.23 A regular yoga +intervention +was +associated +with +better +improvement in sleep quality in staff nurses +compared to the nurses in the non-yoga group.24 +Similarly, a recent study investigating the effect of +yoga and aerobics exercise on sleep quality in women +with Type 2 diabetes mellitus (T2DM) concluded that +yoga is more effective in improving sleep quality in +comparison with the same course of aerobic +exercise.25 Further, another recent study seeing the +effect of yoga on sleep quality in metastatic breast +cancer patients showed a significant decrease in +distress, sleep disturbance and overall insomnia +score.26 Studies also found statistically significant +improvements in insomnia and sleep disturbance in +older adults with osteoarthritis.27 A systematic +review with meta-analysis on meditative movement +intervention on sleep quality in the elderly concluded +that yogic practices are effective in improving sleep +quality and reducing insomnia.28 + + +YOGA-BASED +INTERVENTION +IN +MANAGEMENT +OF +ADDICTIVE +BEHAVIOUR + +Yoga is an ancient system of philosophy and lifestyle +management, which help people to achieve bio- +psychosocial and spiritual homeostasis.29 A scientific +review presented yoga and mindfulness as promising +complementary therapies for treating and preventing +addictive behaviours.30 An earlier study has also +stated that meditation practices help as a protective +factor in the area of alcohol abuse.31 A meta-analysis +found that transcendental meditation produced +highly significant reductions in smoking, alcohol +consumption and illicit drug use.32 Vipassana +Meditation participants showed a decrease in +alcohol-related problems and psychiatric symptoms +as well as an increase in positive psychosocial +outcomes.33 The role of spirituality in addiction +treatment continues to be supported by a growing +number of empirical studies. Mindfulness training +weakened the relation between negative cognitive- +emotional states and subjective experiences of +craving.34 Mindfulness reduced stress and thought +suppression, increased physiological recovery from +alcohol cues, and modulated alcohol attentional +bias.35 Mindfulness training also demonstrated +attenuated psychological and physiological responses +to stress provocation.36 In a study, alcohol-dependent +adults in early recovery who used meditation as an +adjunctive therapy reported 1) continued reduction +of some aspects of their drinking, 2) improved mental +health and stress-related outcomes during the study, +3) high level of satisfaction with meditation +intervention, and 4) meditation intervention was a +helpful therapeutic tool during their recovery.37 + +Mindfulness-based +multicomponent +behavioural +sleep treatment was associated with improvements +in sleep, emotional distress severity and substance +use recidivism rate. Increased sleep interval was +associated with improvements in distress, relapse +resistance, and substance-related problems.38 A study +on the antidepressant effects of Sudarshana Kriya +Yoga (SKY) in alcohol-dependent subjects showed a +reduction +in +stress +hormones +along +with +depression.39 Relapse is associated with the cognitive +deficit, depression, anxiety and disturbed sleep. +Initial efficacy was supported by significantly lower +rates of substance use in those who received yoga- +based intervention as compared to those in treatment +as usual (TAU) over the 4-month post-intervention +period. Further, participants in the yoga group +demonstrated more significant decreases in craving, +and increases in acceptance and acting with +awareness as compared to TAU.40 + + +WAYS FORWARD + +Yoga has been found to be positively associated with +the improvement in psychological health, quality of +sleep, autonomic balance and healthy lifestyle. Yoga- +based add-on therapy appears to be effective in the +management of addictive behaviour. Yoga is an +ancient science having powerful components of +regulated +breathing, +present +awareness, +deep +relaxation and physical postures. Each of the +components of yoga may work on addictive +behaviour +through +down-regulation +of +the +hypothalamic-pituitary-adrenal axis and bringing a +state of parasympathetic nervous system dominance. + + + +Gaihre A, et al. OHJN 2021 Jan-Jun;01(01):1-5 + + + + 4 + + +OHJN | VOL 01 | NO. 01 | ISSUE 01 | Jan-Jun, 2021 + +Yoga may provide a low-cost and risk-free alternative +or supplement to existing treatments for addictive +behaviour. + +CONFLICT OF INTEREST + +None + + +REFERENCES + +1. +United Nations Office on Drugs and Crime. Global overview +of drug demand and supply. United Nations publication. +2017. Available at: +https://www.unodc.org/wdr2017/field/Booklet_2_HEAL +TH.pdf +2. +Selye H. 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Mindfulness is Inversely Associated with Alcohol +Attentional Bias Among Recovering Alcohol-Dependent +Adults. Cognit Ther Res. 2012 Oct 1;36(5):441-450. +36. +Brewer JA, Sinha R, Chen JA, Michalsen RN, Babuscio TA, +Nich C, Grier A, Bergquist KL, Reis DL, Potenza MN, Carroll +KM, Rounsaville BJ. Mindfulness training and stress + + + +Gaihre A, et al. OHJN 2021 Jan-Jun;01(01):1-5 + + + + 5 + + +OHJN | VOL 01 | NO. 01 | ISSUE 01 | Jan-Jun, 2021 + +reactivity in substance abuse: results from a randomized, +controlled stage I pilot study. Subst Abus. 2009 Oct- +Dec;30(4):306-17. +37. +Zgierska A, Rabago D, Zuelsdorff M, Coe C, Miller M, +Fleming M. Mindfulness meditation for alcohol relapse +prevention: a feasibility pilot study. J Addict Med. 2008 +Sep;2(3):165-73. +38. +Britton WB, Bootzin RR, Cousins JC, Hasler BP, Peck T, +Shapiro SL. The contribution of mindfulness practice to a +multicomponent behavioral sleep intervention following +substance abuse treatment in adolescents: a treatment- +development study. Subst Abus. 2010 Apr;31(2):86-97. +39. +Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, +Subbakrishna DK, Sureshbabu SV, Gangadhar BN. +Antidepressant +efficacy +and +hormonal +effects +of +Sudarshana Kriya Yoga (SKY) in alcohol dependent +individuals. J Affect Disord. 2006 Aug;94(1-3):249-53. +40. +Bowen S, Chawla N, Collins SE, Witkiewitz K, Hsu S, Grow J, +Clifasefi S, Garner M, Douglass A, Larimer ME, Marlatt A. +Mindfulness-based relapse prevention for substance use +disorders: a pilot efficacy trial. Subst Abus. 2009 Oct- +Dec;30(4):295-305. + + + + + + diff --git "a/subfolder_0/Stress and its Expression Perseverative Cognition and the Pa\303\257ca ko\303\247as.txt" "b/subfolder_0/Stress and its Expression Perseverative Cognition and the Pa\303\257ca ko\303\247as.txt" new file mode 100644 index 0000000000000000000000000000000000000000..2565d58fc25354067abea231110911ef55b468ef --- /dev/null +++ "b/subfolder_0/Stress and its Expression Perseverative Cognition and the Pa\303\257ca ko\303\247as.txt" @@ -0,0 +1,456 @@ +139 +*Ph.D. Senior Research Fellow, Department of Psychology, **Ph.D. Junior Research Fellow, +Department of Psychology, ***Ph.D. Dean, Division of Yoga and Physical Sciences, ****Ph.D. Chancellor, +Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore, Karnataka, India +Address correspondence to: Dr. Sasidharan K. Rajesh, Senior Research Fellow, Department of +Psychology, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA). 19, Eknath Bhavan, +Gavipuram Circle, K.G. Nagar, Bangalore - 560 019, India. E-mail: rajesheskay@svyasa.org +Received 6 Aug 2013. Revised 2 Oct 2013. Accepted 19 Feb 2014. +Indian and Western Perspectives +Stress and its Expression According to +Contemporary Science and Ancient Indian +Wisdom: Perseverative Cognition and the +Païca koças +Sasidharan K. Rajesh*, Judu V. Ilavarasu**, + +T. M. Srinivasan***, H. R. Nagendra**** +ABSTRACT +Stress is recognised as the most challenging issue of modern times. Contemporary +science has understood this phenomenon from one aspect and Indian philosophy gives +its traditional reasons based on classical texts. Modern science has recently proposed a +concept of perseverative cognition (PC) as an important reason for chronic stress. This +has shown how constant rumination on an unpalatable event, object or person leads to +various lifestyle disorders. Similarly classical yoga texts like the Taittiriya Upanishad, +the Bhagavad Gita, and the Yoga Vashistha describe stress in their unique ways. We +have here attempted a detailed classification, description, manifestation, and development +of a disease and its management through these models. This paper in a nutshell projects +these two models of stress and shows how they could be used in future for harmonious +management of lifestyle disorders. +CITATION: Rajesh SK, Ilavarasu JV, Srinivasan TM, Nagendra HR. Stress and its Expression +According to Contemporary Science and Ancient Indian Wisdom: Perseverative Cognition +and the Païca koças. Mens Sana Monogr 2014;12:139-52. +Access this article online +Quick Response Code: +Website: +www.msmonographs.org +DOI: +10.4103/0973-1229.130323 +MSM : www.msmonographs.org +140  +Mens Sana Monographs, Vol. 12(1), Jan - Dec 2014 +Key Words: Païca koças; PC; Perseverative Cognition; Stress; Yoga +Peer reviewer for this paper: Anon +Introduction +Stress in varying degrees has become a part of everyone’s life due to a +shift from traditional to modern lifestyle. Stress may be best defined as a +psychophysiological process, usually experienced as a negative emotional state, +resulting from physical or psychosocial demands (Agarwal and Marshall, 2001[1]). +Stress can be categorized in several ways (Larzelere and Jones, 2008[13]): Duration +(acute/chronic), domain (physical/psychological), and severity (traumatic/ +daily hassles). Stress produces both adaptive and maladaptive effects on the +physiological system. The burden of chronic stress can cause inhibition of +neurogenesis, disruption of neuronal plasticity, even neurotoxicity (McEwen, +2007[15]). Further, accompanying changes in personal behaviour due to chronic +stress cause wear and tear in the body (“allostatic load”), which in turn alters +physical and mental health (Juster et al., 2010[8]). +Contemporary science has been greatly influenced by matter-based +paradigms, while classical Indian thought has emphasised the role of +consciousness-based approaches. Matter-based paradigms are rooted in +technological advancement, while consciousness-based approaches have their +roots in ancient Vedic literature. The two are not mutually exclusive, as both are +interdependent and play an equal role in understanding aspects of the world +(Nagendra, 2010[11]). An amalgamation of eastern and western concepts would +give deeper insights to help face the present day demanding situations. +Perseverative Cognition (PC), an emerging idea from modern science, +and essential concepts from classical yoga texts like the Taittiriya Upanishad, +the Bhagavad Gita, and the Yoga Vasistha, are reviewed here, and a conceptual +framework of stress is presented. Further, this article intends to explain the +cause of stress and propose a framework to explain development of illness +from stress. +What is perseverative cognition (PC)? +In recent times, perception of an event is given prominence to study +individual’s response to a given environmentally demanding situation. A gradual +shift in the consensus from external control to internal control has paved the +way for new researches. This is especially supported by emerging concepts in +stress research like the concept of Perseverative Cognition. Mind wandering is +considered as a default mode of functioning of the brain. However, the state of +MSM : www.msmonographs.org +141 +S. K. Rajesh, et al., (2014), Stress: Contemporary science and ancient Indian Wisdom +mind wandering sometimes shifts to the state of repetitive thinking and leads +to a prolonged and aroused state of physiology (Brosschot et al., 2005[2]). This +phenomenon is named Perseverative Cognition (PC). +Model of stress response according to perseverative cognition theory +PC hypothesis has provided valuable insight into the link between stressful +events, psychopathology, and somatic health (Brosschot et al., 2005[2]). This +can be explained as shown in the following schematic diagram [Figure 1] +(Brosschot et al., 2010[3]). +According to the above model, when the individual copes well with +stressors, it leads to short stress response and the recovery is quite fast. +However, when appraisal results in ruminating and worrying responses (PC), +it may lead to prolonged stress response, which includes enhanced arousal +of physiological and psychological systems. Perseverative Cognition causes +delayed recovery period (Larsen and Christenfeld, 2010[14]), which condition +may lead to psychosomatic ailments/organic diseases. The amount of control +executed in this situation is different in different individuals. As seen in this +model, PC can be unconscious or conscious. Unconscious PC includes constant +rumination without much awareness. Loops of thoughts happen without the +awareness of the individual. Handling unconscious PC is more challenging +than conscious PC. +Prolonged and improper physiological activity is considered a direct +outcome of stress and it further leads to psychosomatic ailments. For every +stressor that we face in our life we form a mental representation in the form +Figure 1: The extended Perseverative Cognition Hypothesis model, adapted, with permission, from +Brosschot et al., 2010[2] +MSM : www.msmonographs.org +142  +Mens Sana Monographs, Vol. 12(1), Jan - Dec 2014 +of imprints, and this is stored in our cognitive repository. It has been found +that activation of these mental representations causes severe damage which +could be more than the actual stressor itself. This process may become long +lasting and even continue during sleep. Many times these stressors can be +anticipatory worry or rumination i.e., a sort of worry towards a situation +which has not happened but has formed only in our mind. The term prolonged +perseverative cognition includes all physiological responses that do not +occur when the stressor is introduced. According to Brosschot, there are +two bases for PC: +1. There is slow recovery after the stressor has been removed or continued +autonomic activity before the stressor was introduced, just in anticipation +of future events. +2. We form mental images of stressors and activate them irrespective of the +presence of the actual stressor. This is called perseverative cognition. +Unconscious perseverative cognition is a major source of concern. Brosschot, +Verkuil, and Thayer (2010[3]) have found out that conscious worry or conscious +perseverative cognition is only explaining a part of the variance in stress +response, and more than 50 percent is yet to be explained. There are stronger +reasons to consider that this major portion of unexplained variance could come +from the unconscious domain, as most of our daily activities are controlled by +automatic processes without our conscious awareness. Hence in unconsciousness +perseverative cognition, mental representations of stressors are activated without +conscious awareness and they could cause prolonged physiological activities +creating autonomic imbalances, and further, the development of various +psychosomatic ailments. +Management according to Contemporary Science (McEwen, 2007[15]) +• Brain-Centered Interventions such as lifestyle modification +• Pharmaceutical agents which counteract some of the problems associated +with being stressed. +• Moderate physical activity. +• Social support at an individual level +Ancient Indian Concept: The five layers of our existence (Païca koças) +The Upaniñads are a culmination of Vedic knowledge. The Taittiriya Upaniñad +discusses five levels of existence in the human condition (Chinmayananda,1992[4];. +Nagendra, 2010[19]). The grossest and the outermost, the physical frame, is called +the annamayä koça, followed by the präëamayä koça, manomayä koça, vijïananmaya +koça, and the subtlest, the änandamayä koça [Figure 2]. +The annamayä koça refers to the gross physical body which is a sheath +sustained by food. The second subtler sheath is the präëamayä koça, the sheath +of energy body, featured by the predominance of präëa, the life principle, which +MSM : www.msmonographs.org +143 +S. K. Rajesh, et al., (2014), Stress: Contemporary science and ancient Indian Wisdom +flows through invisible channels called nadis. The next sheath in order of subtlety +is manomayä koça — the sheath of sensory capacities (emotions dominate and start +governing our actions). Next is the vijïananmaya koça — the sheath of cognitive +function (power of discernment and discrimination predominates). Finally, +there is the änandamayä koça — the shealth of blissfulness. Further, the five koças +can be classified into three groups — the physical (annamayä koça), the subtle +(präëamayä koça, manomayä koça, vijïananmaya koça), and the causal (änandamayä +koça) (Chinmayananda, 1992[4]; Nagarathna and Nagendra, 2001[17]). +Model of stress response according to classical Yoga texts +The Classical Yoga texts model of stress is explained as imbalance in different +koças. In waking state, occurrence of an event or demanding situation results in +repeated thinking and further leads to attachment (sangah). Intense attachment +(käma) in its turn, leads to an avalanche of thoughts (strong likes and dislikes). +When this avalanche of thoughts is unfulfilled, it transforms into intense anger +(krodhah): +Dhyäyato viñayän puàsaù saìgasteñüpajäyate| +Saìgät saïjäyate kämaù kämätkrodho’bhijäyate | +Bhagavad Giéa|2|62|| +Figure 2: Five sheaths (païca koças) +MSM : www.msmonographs.org +144  +Mens Sana Monographs, Vol. 12(1), Jan - Dec 2014 +[When a man thinks of the objects, attachment for them arises; from attachment +desire is born; from desire anger arises (Sivananda, 2013[25])] +Intense Käma and Krodha set out an involuntary impulse in the vijïananmayakoça: +Çaknotéhaiva yaù soòhuà präkçaréravimokñaņät| +Kämakrodhodbhavaà vegaà sa yuktaù sa sukhé naraù || +Bhagavad Géta|5|23|| +[He who is able, while still here (in this world) to withstand, before the liberation +from the body, the impulse born out of desire and anger — he is a Yogi, he is a happy +man (Sivananda, 2013[25])]. +For a person who is able to withstand the impulses born out of desire +and anger, all the actions will be governed by total knowledge based at the +vijïananmaya koça. Hence there will not be any adhi (stress) and the person +achieves a state of perfect mental health. Those who do not have mastery over +involuntary impulses due to desire and anger, continue towards infatuation, +lack of awareness, and power of discrimination at vijïananmaya koça: +Krodhätbhavati sammohaù sammohät småtivibbhramaù| +Småtibhramçät buddhinäço buddhinäçät praņaçyati || +Bhagavad Giéa |2|63|| +[From anger comes delusion; from delusion loss of memory; from loss of memory +the destruction of discrimination; from the destruction of discrimination he perishes +(Sivananda, 2013[25])] +Further, vijïananmaya koça endows manomaya koça with unending thought +processes and wrong cognition which leads to and manifests as adhi (stress) +(Nagendra and Nagarathna, 2003[18]). When the manomaya koça is afflicted, the +body follows the disturbance completely. Due to these disturbances, flow of präëa +in nadis gets vitiated. These imbalances in the flow of präëa at the präëamayä koça +finally culminate in disease at the annamayä koça or physical body level [Figure 3]: +Citte vidhurite dehaù saìkñobham upayäti hi | +Saìkñobhät sämyam utsåjya vahanti präëaväyavaù|| +Yogaväsiñöha |25|3.35|| +MSM : www.msmonographs.org +145 +S. K. Rajesh, et al., (2014), Stress: Contemporary science and ancient Indian Wisdom +[When the mind is agitated, the body indeed goes to the state of agitation. On +account of agitation, the vital airs (or currents of bioenergy) flow, giving up evenness. +(Jïänänanda, 1982[26])] +Management according to ancient scriptures +The question arises: How are the methods and theories of ancient Indian +scriptures and the model of PC connected, if at all? +Figure 3: Development of psychosomatic ailments according to ancient scriptures +MSM : www.msmonographs.org +146  +Mens Sana Monographs, Vol. 12(1), Jan - Dec 2014 +The model of perseverative cognition (PC) proposes the adverse effects of +repetitive thinking, either through rumination of the past or anticipatory worry +of the future. The model also suggests the predominantly unconscious nature +of PC. The ancient model from Bhagavad Gita explains how initial contact with +sense objects, later repeated contact with them invokes desire and how that desire +is further processed. From the scriptures we can develop a more comprehensive +model as follows: a) cause of desire and repeated thinking, b) adverse effects of +uncontrolled repeated thinking. +Further scriptures suggest management of uncontrolled repeated thinking. +This is by Pratiprasavah (involution), i.e., going back to our original source of +existence. It would be worthwhile understanding what this is and how does +one do it. +Pratiprasavah (involution), Gunas and Kaivalya +Pratiprasavah (involution) is the most significant technique for restraining +mind-modifications. It is the process of involution, where objects merge into +their cause progressively, so that ultimately the gunas remain in an undisturbed +condition (Satyananda, 2002[21]). +Every individual has a combination of three temperamental characteristics +called the gunas: Unactivity (sattva), Activity (rajas) and Inactivity (tamas) +(Chinmayananda, 1992[5]; Tapasyananda, 2003[27]). At any one time, one of +these natures predominates in the person. When the person reaches the state +of kaivalya (liberation), the temperaments revert to their casual state having +fulfilled their purpose. Thus the process of pratiprasava or involution of the +gunas ends in kaivalya (liberation). +The method of achieving the state of kaivalya (liberation) is proposed +in Pataïjali yoga sutra through an eight step process called Astanga Yoga +(Satyananda, 2002[21]): +puruñärthaçünyänäà guëänäà pratiprasavaù kaivalyaà +svarüpapratiñöhä vä citiçaktiriti |PYS|4|34|| +[Kaivalya is the involution of gunas because of the fulfillment of their purpose; or it is +the restoration of purusha to its natural form which is pure consciousness (Satyananda, +2002[21])] +As the sheaths become subtler, there is a progressive influence of +consciousness in one’s being, the freedom of operation due to discrimination +increases, bondage with the body decreases, and bliss and a feeling of happiness +increases. +MSM : www.msmonographs.org +147 +S. K. Rajesh, et al., (2014), Stress: Contemporary science and ancient Indian Wisdom +There are four ways to transcend the koças, namely, Karma Yoga, Bhakti Yoga, +Raja Yoga and Jnana Yoga. Karma yoga is suitable for people of active temperament, +Bhakti Yoga for the people of devotional temperament, Raja Yoga for men of mystic +temperament, and Jnana yoga for people of intellectual temperament with bold +understanding and strong will-power (Sivananda, 1958[24]). +Integrated approach of yoga suitable for modern times +In modern times, an Integrated Approach of Yoga (Nagarathna and +Nagendra, 2001[17]) techniques may be a solution to reduce the heightened +activity of stress. Healthy yogic diet, Kriyäs, loosening exercises and yogäsanas +can be used to operate on the Annamaya Koça (Kiecolt-Glaser et al., 2010[9]). +Practicing proper breathing, Kriyäs and präëayama help at the präëamaya Koça +(Sengupta, 2012[23]; Zope and Zope, 2013[28]). Culturing of manomaya Koça can +be accomplished by relaxed dwelling of the mind in single thought (Dhyäna) +(Hoge et al., 2013[6]) and emotion culture by devotional session containing +prayers (Lambert et al., 201011]; Lambert et al., 2009[12]), Chants, Bhajans, Dhuns +and Stotras. At the vijïänamaya Koça cognitive transformation can take place +through lectures and individual counselling (Moritz et al., 2011[16]; Hsiao, +2012[7]). The Änandamaya Koça techniques can come under the heading of +karma yoga (Kumar and Kumar, 2013[10]), the secret of action. The secret lies in +maintaining a present moment awareness, inner silence, and equipoise while +we perform all our actions. By regular practice of yoga, one moves from gross +state of awareness to the subtle. +Pataïjali and the five mental afflictions (kleshas) +Sage Pataïjali enumerates five mental afflictions (kleshas): Avidyä (self- +ignorance), asmitä (I-feeling), räga (likes), dveça (repulsion), and abhiniveçä (attachment +to life) as causes for the modification of mind. +Avidyäsmitä-räga-dveñäbhiniveçäù kleçäù +|PYS|2|3|| +[Ignorance, I-feeling, liking, disliking and fear of death are the pains (Satyananda, 2002[21])] +Sage Pataïjali makes two major recommendations: Añöäìga yoga or the +eight-limbed yoga and pratipakñabhävana (Sangeetha, 2010[20]). The eight-fold +yoga includes: Five self-restraints — yama (non-violence, truthfulness, honesty, +sensual abstinence, non-acquisitiveness), five observances — niyama (cleanliness, +contentment, austerity, self-study, resignation to god), äsana (seat or meditative +posture), präëäyäma (regulation of breath), pratyähära (withdrawing mind from +the objects of sense experiences), dhäraëa (confinement of the mind to one point or +one object or one area), dhyäna (relaxed dwelling of the mind in a single thought +MSM : www.msmonographs.org +148  +Mens Sana Monographs, Vol. 12(1), Jan - Dec 2014 +with awareness that you are practicing unbroken concentration), and samädhi +(becoming one with the artha, that is, the object of concentration). +yamaniyamäsanapräëäyämapratyähäradhäraëädhyänasamädhayo’ñöävaìgäni +|PYS|2|29|| +[Self restraints, fixed rules, postures, breath control, sense withdrawal , concentration, +meditation and samadhi consititute the eight parts of yoga discipline (Satyananda, +2002[21])] +Pratipakña bhävana is the process of sublimating negative thought by invoking +opposite positive thought. Suppression will not work, and it may cause rebound +effect of thought. The best thing is to sublimate from negativities to the opposite +(positive) thoughts (Sangeetha, 2010[20]). +vitarkabädhane pratipakñabhävanam |PYS|2| 33|| +[When the mind is disturbed by passions one should practice pondering over the +opposites (Satyananda, 2002[21])] +vitarkä hiàsädayaù kåtakäritänumoditä lobhakrodhamohapürvakä +mådumadhyädhimäträ duùkhäjïänänantaphalä iti pratipakñabhävanam +|PYS|2| 34|| +[Thinking of evil thought such as violence, whether done through oneself, through +others, or approved, is caused by greed, anger and confusion. They can be either mild, +medium or intense. Pratipakña bhävana is thinking that evil thoughts cause infinite pain +and ignorance (Satyananda, 2002[21])] +Concluding Remarks [See also Figure 4: Flowchart of paper] +It is now clear that for management of stress and related response, focusing at +physical and mental levels are not enough. An integrated approach with awareness +of the five sheaths (Païca koças) that constitute a person is required. With such an +approach, it is possible to correct the manifest imbalances in the mind-body complex. +Research in this direction has given a positive response in individuals and thus, has +provided a base for scientific viability of this five-layer model of a human being +(Satyapriya, 2009[22]). A synthesis of modern and ancient perspective will give the +benefit of technology and knowledge base of scripture to the stressed. It will also +lead a person to higher levels of human emotional and spiritual activity. By adopting +this not only can we address stress-related crisis but also ensure good preventive +strategies. Thereby we can approach the goal of holistic mental health and well-being. +MSM : www.msmonographs.org +149 +S. K. Rajesh, et al., (2014), Stress: Contemporary science and ancient Indian Wisdom +Take home messages +1. Uncontrolled rumination/stress (Perseverative Cognition or PC) is the major +cause for various psychosomatic ailments. +2. Mind management is more essential than fighting external causes. +3. Modern science can gain insights for development of their theories from +Indian concepts like the Païca koças, Pratiprasava, Añöäìga yoga (or the eight- +limbed yoga) and pratipakñabhävana. +4. Holistic mental health is a potential combatant of modern ailments. +Conflict of interest +None declared. +Declaration +This is our original unpublished work, not submitted for publication +elsewhere. +Figure 4: Flowchart of the paper +MSM : www.msmonographs.org +150  +Mens Sana Monographs, Vol. 12(1), Jan - Dec 2014 +Acknowledgement +We thank SVYASA for providing necessary support. +References +1. +Agarwal SK, Marshall GD. Stress effects on immunity and its application to clinical +immunology. Clin Exp Allergy 2001;31:25-31. +2. +Brosschot JF, Pieper S, Thayer JF. 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Delhi: Motilal Banarsidas Publishers; 2010. p. 212-26. +MSM : www.msmonographs.org +151 +S. K. Rajesh, et al., (2014), Stress: Contemporary science and ancient Indian Wisdom +21. Satyananda S. Four Chapters on Freedom. Munger: Bihar School of Yoga; 1st ed. 2002. +22. Satyapriya M, Nagendra HR, Nagarathna R, Padmalatha V. Effect of integrated +yoga on stress and heart rate variability in pregnant women. Int J Gynaecol Obstet +2009;104:218-22. +23. Sengupta P. Health impacts of Yoga and Pranayama: A state-of-the-art review. Int J Prev +Med 2012;3:444-58. +24. Sivananda S. Sadhana. Delhi: Motilal Banarsidas Publishers; 1st ed. 1958/1974. p. 3-23. +25. Sivananda S. The Bhagavad Gita. Rishikesh: Divine Life Trust Society; 14th ed. 2013. p. 50-118. +26. Jñānānanda B. The essence of Yogavāsiñöha. Pondicherry: Samata Books; 1st ed. 1982. p. 263. +27. Tapasyananda Swami. Śrīmad Bhagavad Gītā. Madras: Sri Ramkrishna Math; 2003. p. 358. +28. Zope SA, Zope RA. Sudarshan kriya yoga: Breathing for health. Int J Yoga 2013;6:4-10. +Questions that the Paper Raises +1. Can the developments of western science and the Indian knowledge base be +incorporated into modern health practice? +2. Will mind-based interventions/therapies like yoga gain more importance in +addressing modern lifestyle diseases? +3. Will modern mental health care system understand and accept the key role +of mind? +4. Will we be able to quantify all levels of koças? +About the Author +Rajesh S. K. is currently the Senior Research Fellow and lecturer at +the S-VYASA, Yoga University, Bengaluru, India. His area of interest +is psychology, especially impulsivity, mindfulness, response inhibition, +and implicit cognition. He is working on impulsivity and its application +to yoga. +About the Author +V. Judu Ilavarasu, is currently a Junior Research Fellow in S-VYASA +University, Bengaluru, India. His area of interest is psychology, especially +implicit cognition. He is working on developing implicit tool to measure +gunas. +MSM : www.msmonographs.org +152  +Mens Sana Monographs, Vol. 12(1), Jan - Dec 2014 +About the Author +Prof. T. M. Srinivasan is Dean, Division of Yoga and Physical Sciences +S-VYASA, Yoga University, Bengaluru, India. He is the founder member +and past president and editor of the International Society for the Study +of Subtle Energies and Energy Medicine. He has edited two books: Sense +Perception in Sciences and Sastras and Energy Medicine around the +World. His area of expertise is Biomedical Engineering, yoga, acupuncture, +Tai Chi, Energy Medicine, developing medical devices for holistic health. +About the Author +Prof H. R. Nagendra is Chancellor of S-VYASA, Yoga University, +Bengaluru. He has developed many scientifically proven special techniques +to manage modern day lifestyle ailments. He is a former Scientist of +NASA, and Harvard University Consultant. Presently, he is a Member +of the Planning Commission on Health, Govt. of India and Member of +NIMHANS Society. He is the present President of VYASA and Chairman +of VYASA International. He has published more than 90 research papers +on Yoga and its applications and is author of over 30 books in the field of yoga. diff --git a/subfolder_0/The Role of Yoga Intervention in the Treatment of Allergic Rhinitis_ A Narrative Review and Proposed Model.txt b/subfolder_0/The Role of Yoga Intervention in the Treatment of Allergic Rhinitis_ A Narrative Review and Proposed Model.txt new file mode 100644 index 0000000000000000000000000000000000000000..23967d8b6312c2df2f565da9718068deb97ff6f2 --- /dev/null +++ b/subfolder_0/The Role of Yoga Intervention in the Treatment of Allergic Rhinitis_ A Narrative Review and Proposed Model.txt @@ -0,0 +1,1042 @@ + + +1 +CellMed + +2020 / Volume 10 / Issue 3 / e25 +Review Article + +The Role of Yoga Intervention in the Treatment of Allergic Rhinitis: A +Narrative Review and Proposed Model + +Ripudaman Singh Chauhan1*, Rajesh S.K2 + +1*Ph.D. Scholar, Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana,19, EknathBhavan, +Gavipuram Circle, K.G.Nagar, Bangalore, India, 2Associate Professor, Division of Yoga and Physical Sciences, Swami +Vivekananda Yoga Anusandhana Samsthana,19, EknathBhavan, Gavipuram Circle, K.G.Nagar, Bangalore, India, + + +ABSTRACT +Allergic Rhinitis (AR) is an IgE (immunoglobin-E) mediated inflammatory condition of upper respiratory +tract; main clinical features involve runny nose, sneezing, nasal obstruction, itching and watery eyes. AR +is a global problem and has large variations in incidences, currently affects up to 20% - 40% of the +population worldwide. It may not be a life-threatening disease per se but indisposition from the condition +can be severe and has the potential to adversely affect the daily functioning of life. Classical yoga +literature indicates that, components of yoga have been used to treat numerous inflammatory conditions +including upper respiratory tract. A few yoga intervention studies reported improvement in lung capacity, +Nasal air flow and symptoms of allergic rhinitis. This review examined various anti-inflammatory +pathways mediated through Yoga that include downregulation of pro-inflammatory cytokines and +upregulation of anti-inflammatory cytokines. The hypothalaminic-pitutary-adrenal (HPA) axis and vagal +efferent stimulation has been reported to mediate anti-inflammatory effect. A significant reduction is also +reported in other inflammatory biomarkers like- TNF-alpha, nuclear factor kappa B (NF-κB), plasma +CRP and Cortisol level. Neti, a yogic nasal cleansing technique, reported beneficial effect on AR by direct +physical cleansing of thick mucus, allergens, and inflammatory mediator from nasal mucosa resulting in +improved ciliary beat frequency. We do not find any study showing effect of yoga on neurogenic +inflammation. In summary, Integrated Yoga Therapy may have beneficial effect in reducing symptoms +and improving quality of life for patients with allergic rhinitis. Yoga may reduce inflammation through +mediating neuro-endocrino-immunological network. Future studies are needed to explore the mechanism +how yoga might modulate immune inflammation cascade and neurogenic inflammation at the cellular +level in relevance to allergic rhinitis; the effects of kriyas (yogic cleansing techniques) also need to be +evaluated in early and late phase of AR. So the proposed model could guide future research. + +Keywords Inflammatory mediators, Shuddhi Kriya, Neti, Yoga, Allergic Rhinitis + + + +INTRODUCTION + +Allergic Rhinitis (AR) is an IgE (immunoglobin-E) mediated +inflammatory condition of upper airways (Hellings&Fokkens, +2006). The main clinical features involve a runny nose, +sneezing, nasal congestion, nasal itching and epiphora (watery +eyes) (Varshney&Varshney, 2015; Di, Lou, Ye, Miao, & Zhao, +2016). Further, additional symptoms may be sniffing, post nasal +drip, impaired sense of smell and mouth breathing (Ng et al., +2000). AR is a global problem and has large variations in +incidences, currently affects up to 20%-40% of the population +worldwide (Soléetal., 2015; Settipane& Charnock, 2007), +Europe has estimated 23% (Bauchau & Durham, 2004), and +11.03% of the Delhi population (excluding those having asthma) +in India suffer from allergic rhinitis (Gaur et al., 2006). +Though not life threatening, AR symptoms are often +distressing, adversely affecting the job, quality of life, and +placing a burden on individuals and society (Schatz, 2007; +Canonica et al., 2007). The total direct medical cost of allergic +rhinitis is approximately $3.4 billion in US (Meltzer & +Bukstein, 2011). Association of allergic rhinitis with asthma +adds to its financial burden (Nathan, 2007). AR is highly +prevalent and significantly affects the quality of life through its +symptoms and comorbidities. AR has a close association with +Asthma (Dara, 2017), rhinosinusitis and atopic dermatitis (Tan +&Corren, 2011). Our search yielded few studies on the effect of +yoga on allergic rhinitis (Chanta, A. et al., 2019; Chellaaetal, +2019). A study concluded that AR contributes 3.6 days of +absenteeism per annum and unproductive 2.3 hour per workday +when experiencing symptoms (Lambetal, 2006). AR symptoms +may lead to both physical and mental complications. In +children, it adversely affects the quality of life, sleep, and +school performance and may progress to asthma causing a +significant +burden +on +his +life +(Meltzeretal, +2009). +Immunological inflammation in AR is critically involved neural +pathways thus it can impact psychological health or vice versa +(Mandhane et al., 2011). Psychoneuroimmunology and medical +genetics research suggest that CNS (central nervous system) +*Correspondence: Ripudaman Singh Chauhan +E-mail: drripudaman84@gmail.com +Received May 19, 2020; Accepted Aug 7, 2020; Published Aug 31, +2020 +doi: http://dx.doi.org/10.5667/CellMed.2020.0025 +©2020 by CellMedOrthocellular Medicine Pharmaceutical Association +This is an open access article under the CC BY-NC license. +(http://creativecommons.org/licenses/by-nc/3.0/) +The Role of Yoga Intervention in the Treatment of Allergic Rhinitis: A Narrative Review and Proposed Model + +2 +CellMed + +2020 / Volume 10 / Issue 3 / e25 +may get affected by biochemical changes taking place due to +allergic reactions (Marshall et al., 2002). Pharmacological +treatments for AR include the use of oral intranasal H1- +antihistamines, intranasal corticosteroids, and leukotriene +receptor antagonists either alone or in combination (Brożeketal, +2017). Immunotherapy also shows a significant reduction in +symptom scores and medication use (Mueller, 2013). +Yoga intervention-based studies had document edits +efficacy on upper and lower respiratory tract conditions like +Allergic rhinitis (Chanta A. et al., 2019), Rhinosinusitis, +Asthma and bronchitis (Shankarappa et al., 2012; Raoetal, +2014). However, there are shreds of evidence of the +effectiveness of yoga intervention on conditions that coexist +with Allergic Rhinitis like Asthma (Cramer et al., 2014) and +rhino-sinusitis (Rastogi, 2007), Sleep difficulty (Mustianetal, +2013; Fang&Li, 2015), etc. +Yoga is a holistic way of life, which leads to bio- +psychosocial and spiritual homeostasis. The root of the word +yoga, is yuj which had Sanskrit origin, which means to bind or +join (Distasio, 2008). Even though the primary goal of yoga is +self-realization, recent studies highlight the therapeutic +application of yoga for non-communicable diseases (Taneja, +2014). Traditionally, two schools of yoga are widely practiced: +Raja Yoga and Hatha Yoga. The practical steps of Raja Yoga +were highlighted in the form of 196 aphorisms in Patanjali +Yoga sutras. Raja Yoga emphasizes more on mental +purification. The Hatha yoga branch focuses on physical +postures and breathing. Further Hatha Yoga School gives +importance to cleansing practices called Kriyas. In the Yogic +tradition of India, Hatha yoga is a considerable apparatus to +prevent +and +overcome +various +disease +conditions +(Muktibodhanand, 1998). Sage Swatmaram in a classical text +Hatha Yoga Pradipika (H.Y.P.) and sage Gherand in Gherand +Samhita explains about Shatkarmas (six cleansing techniques) +they are as follows Dhauti (cleansing of digestive tract), Basti +(colon cleansing), Neti (Nasal cleansing), Trataka (eye +cleansing), Nauli (abdominal muscle movement) and +Kapalbhati (skull cleansing) (Muktibodhanand, 1998). Yogic +scriptures highlight that diseases caused by an excess of mucus +can be managed by Dhauti karma (Muktibodhanand, 1998). +And most of the disease, which manifests above the throat can +be managed by Neti-kriya. There are many yogic practices that +are traditionally exercised to reduce symptoms of AR. +The emerging evidence has shown yoga as a potential +alternative or complementary treatment for AR (Chanta, A. et +al., 2019; Chellaa et al., 2019). Based on the recent trend in +yoga, it is essential to scrutinize the application of yoga as a +potential add-on therapy for AR. Hence the narrative review +intended to comprehend the possible mechanisms of action of +yoga in AR, the limitations of prevalent literature and direction +for the future study. This review is aimed at finding the +mechanism with that yoga may interfere in the pathophysiology +of AR. + + +METHODS + +Search Strategy +The research team performed an electronic literature search +using the search terms yoga and “allergic rhinitis,” +“inflammation,” “anti-inflammatory,” “cytokine”, “vagal tone”, +“parasympathetic nervous system”, “Nasal irrigation”, “Neti” +in the following databases: Pubmed, Google Scholar. +Experimental papers, case studies, review studies revealing the +effect of yoga on inflammation, sympathovagal balance, +inflammatory or pro-inflammatory mediators and effect of +nasal irrigation were included. In addition, classical yoga text +Hatha Yoga Pradipikaand PatanjaliYoga Sutra were hand- +searched. + +Clinical Efficacy and Effectiveness of Yoga for the +management of Allergic Rhinitis +A recent study has shown the effectiveness of three months of +Hatha yoga-based intervention among Allergic rhinitis patients. +The study evaluated the resistance level of both the upper and +lower respiratory tract using a rhinomanometer and spirometer. +The results highlighted a significant decrease in Nasal Airway +Resistance, an increase in forced expiratory volume (FEV1) & % +residual +standard +deviation +(%RSD). +Further +standard +questionnaires for Allergic rhinitis were assessed. The scores of +“Sino-Nasal outcome test (SNOT)” and “Short form-12(SF-12)” +were found significantly improved (Chellaa et al., 2019). That +signifies that yoga not only increases lung capacity but also +reduces nasal congestion to AR patients. Further, eight-week +Yoga-based intervention program, consisting of yoga warm-up, +Asanas, Pranayama, Relaxation and Meditation sessions for 60 +minutes three days a week has shown significant improvement +in Peak Nasal Inspiratory Flow Rate and increased secretion of +interleukin (IL)-2 in the nasal discharge (ChantaA. et al., 2019). +This signifies that Yoga practice may improve the cytokine +level along with symptom score and nasal airflow. + + +MECHANISMS +BY +WHICH +YOGA +MAY +MODERATE THE CLINICAL SYMPTOMS OF +ALLERGIC RHINITIS + +1. +Overview +of +Possible +Anti-Inflammatory +Mechanisms of Yoga +Recent research has elucidated some of the mechanisms +underpinning the anti-inflammatory effects of yoga practices +that may have an impact on reducing symptoms of allergic +rhinitis (Sarubin et al., 2014) Several physiological pathways +seem to mediate the anti-inflammatory effects of Yoga include +– regulation of inflammatory cytokine, Hypothalamus- +Pituitary-Adrenal (HPA) axis, plasma CRP level, plasma +GABA level, Vagus stimulation and clearing of the nasal +pathway from annoying substances through yogic cleansing +techniques. + +1.1. Yoga and Inflammatory cytokine +Allergic rhinitis occurs in two phases i.e. early and late; the +early phase starts with the degradation of mast cells and +releases histamine and tryptase resulting in localized +inflammation, sneezing, itching, and rhinorrhoea, on the +exposure of potential allergen to the nasal mucosa (Mandhane +et al., 2011; Y. Min, 2010). Late phase caused by migration of +eosinophil, mast cells, T-cells and other inflammatory cells to +the nasal mucosa. These cells produce cytokines, and +eosinophil produces oxygen-free radicals and hydrogen +peroxide result in epithelial damage and nasal congestion (Y. +Min, 2010). +Yoga-based 6-month long clinical trials on moderate +asthma cases found a significant reduction in blood eosinophil +count, which plays a key role in AR (Kant, 2014). Interleukin- +10 (IL-10), a potent immunosuppressant, reduces inflammation +in two ways; indirectly by preventing antigen-specific T-cell +activation and directly by inhibiting IL-2 production from a +monocyte, macrophages, Langerhans cells and dendritic cells +thereby controls the expansion of T-cells (De Vries, 1995). +Yoga-Based intervention for three months on 38 individuals +observes an increase in anti-inflammatory cytokine IL-10, in +The Role of Yoga Intervention in the Treatment of Allergic Rhinitis: A Narrative Review and Proposed Model + +3 +CellMed + +2020 / Volume 10 / Issue 3 / e25 +addition study found a reduction in Pro-inflammatory Cytokine +IL-12 (Cahn et al., 2017). Further, yoga intervention found to +have reduced activity of the pro-inflammatory transcription +factor Nuclear Factor Kappa B (NF-κB) and increased activity +of the anti-inflammatory glucocorticoid receptor among breast +cancer survivors (Bower et al., 2014). Furthermore, yoga-based +study with 86 subjects found a reduction in Serum Interleukin-6 +and Tumor Necrosis Factor [TNF]-a level in 10 days (Yadav et +al., 2012). Thereby yoga has shown as a potential intervention +that modulates the anti-inflammatory effect. + +1.2. Yoga and HPA axis +Research has shown that the HPA axis is associated with an +acute allergic inflammatory condition, and increased cytokine +level activates in AR (Buske-Kirschbaum et al., 2010). Yoga +has shown to be modulating the HPA axis in a number of +human studies. A recent study on eight weeks of Yoga training +on female patients with multiple sclerosis results shows a +significant difference in serum ACTH and cortisol levels in +comparison to controls (Moghadasi & Najafi, 2017). Further, a +15-day yoga-based breathing technique has shown a reduction +in serum ACTH and cortisol reduction among substance +abusers (Vedamurthachar et al., 2006). Furthermore, yoga +intervention study on enhancement of sleep physiological, +indicates higher efficiency of the HPA axis (Vera et al., 2009). +The involvement of the HPA axis in the anti-inflammatory +effects of Yoga was further supported by changes in levels of +Salivary cortisol and Serum cortisol in yoga-based clinical +trials (Michalsen et al., 2005; Raghavendra et al., 2009; +Vedamurthachar et al., 2006; Yadav et al., 2012). The +reduction in inflammation, mediated through the HPA axis +(Ross & Thomas, 2010) may reduce nasal congestion. + +1.3. Yoga and C-reactive protein (CRP) levels +CRP is a potent biomarker for inflammation, rising rapidly in +inflammatory conditions (Marnell et al., 2005). Previous ten +days of a yoga intervention study showed a significant +reduction in plasma CRP level along with other inflammatory +markers like IL-6 and TNF- α (Yadav et al., 2012). Further, 12- +week Yoga intervention study on COPD patients found a +marked reduction in CRP level (Arora et al., 2013). +Furthermore, a study has reported that yoga reduces plasma +CRP levels in patients with heart disease (Pullen et al., 2008). + +1.4. Yoga and Gamma-aminobutyric acid (GABA) +level +An animal study reported that GABA down regulates both T- +cell autoimmunity and antigen-presenting cell (APC) activity +by reducing the proliferation of reactive T cells. Thus, GABA +can reduce T-cell to mediate the inflammation (Tian et al., +2011). A pilot study with 19 subjects suggests 60-minute yoga +intervention enhances GABA level up to 27%, while no change +observed in control (Streeter et al., 2007). A randomized +control trial on 34 subjects demonstrated an increased level of +thalamic GABA following 12 weeks of Yoga intervention in +comparison to walking among healthy individuals (Streeter et +al., 2010). Further, 12 week-long controlled intervention on +MDD (Major depressive disorder) subjects reported improved +GABA levels following the practice of yogasanas and +pranayama (Streeter et al., 2018). + +1.5. Role of Yoga on Psychological Stress and Immune +mechanism +Psychological stress is another important factor that aggravates +inflammation it can be objectively documented by CRP and +cortisol level (Almadi et al., 2013). Biochemical changes +during the allergen challenge in AR is also characterized by +tiredness, malaise, irritability, and possibly neurocognitive +deficits (Skoner, 2001). Evidence suggests that both stress and +anxiety promote priming and hyper responsiveness to produce +allergens in AR patients (Kiecolt-Glaser et al., 2009). A review +on neuro inflammation suggests that neuropeptides like +substance P may be released along with other inflammatory +mediators and mast cells; in response to sensory nerve +stimulation due to psychological stress (Black, 2002). +Psychological stress kindles neuro-endocrine, sympathetic and +immune response resulting in activation of the HPA axis and +regulation of inflammatory mediators (Powell et al., 2013). +Psychological stress has proven the role to stir up inflammation +(Powell et al., 2013). Yoga has proven its role in reducing +psychological stress in many clinical trials through various +mechanisms. A Yoga study found increased brain alpha waves +activities and serum cortisol levels +following +asana, +pranayama and soham meditation (Kamei et al., 2000). A +clinical trial on students concluded, regular practice of yoga +practices +may +maintain +physiological +parameters +and +biomarkers of stress (Serum IFN-γ and cortisol level) following +stress condition (Gopal et al., 2011). A 12-week yoga +intervention study on chronic back pain sufferers revealed a +significant rise in BDNF level in comparison to control (Lee et +al., 2014). Yoga and meditation are capable of shifting brain +execution, neurotropic and inflammatory pathways. Three-fold +increase in BDNF (brain-derived neurotrophic factor) level and +significant improvement in CAR (cortisol awakening response) +following yoga and meditation program, suggesting an +improvement in psychological parameters and rhythmicity of +adrenocortical activity (Cahn et al., 2017). Pranayama (yogic +breathing) +decreases +hyperventilation; +this +results +in +normalization of CO2 level, and reduction of bronchospasm +and +breathlessness. +Additionally, +Pranayama +improves +immunological parameters and reduces anxiety (Sankar & Das, +2018). + +1.6. Yoga and Neurogenic Inflammation +When nerve endings come in contact with cytotoxins released +by inflammatory cells (Eosinophil & Mast cells) it leads to +excitation of the both afferent and efferent nerve pathways this +makes to secrete neuropeptides, including Substance P and +Neurokine +A, +(Togias, +2000). +In +response +to +these +neuropeptides, adjacent mast cells release histamine. Histamine, +in turn, evokes neuropeptide release, this exhibits a +bidirectional link (Rosa & Fantozzi, 2013), and this is called +neurogenic inflammation. It results in plasma extravasation and +glandular secretion (Tai & Baraniuk, 2002). The sensation of +pain and stiffness also developed due to the involvement of +nasal sensory nerves (Tai & Baraniuk, 2002). A recent study in +pediatric settings with mind-body therapy to evaluate its effect +on neuropeptides (calcitonin gene-related peptide (CGRP) and +vasoactive intestinal polypeptide (VIP)), could not find any +significant difference, possibly due to inadequate sample size +(Gershan et al., 2015). We do not find any yoga intervention +study to evaluate its role in modulating neuropeptides. Yoga +reduces cells of inflammation (Kant, 2014) those are +responsible for cytokine secretion thereby initiates a cascade of +Neurogenic Inflammation, so it has been proposed that the +practice of yoga reduces neurogenic inflammation; however, no +direct experimental confirmation is currently available. + +1.7. The cholinergic anti-inflammatory pathway +Inhibition of pro-inflammatory cytokines and systemic +inflammation through efferent vagal is termed as “The +cholinergic anti-inflammatory pathway” (Czura & Tracey, +The Role of Yoga Intervention in the Treatment of Allergic Rhinitis: A Narrative Review and Proposed Model + +4 +CellMed + +2020 / Volume 10 / Issue 3 / e25 +2013). Electrical stimulation of vagus nerve may suppress both +local and systemic inflammation (Martelli et al., 2014). A +clinical trial with an objective to assess the role of yoga on +autonomic nervous system found the well-balanced beneficial +activity +of +vagal +efferent +among +the +yoga +groups +(Muralikrishnan et al., 2012). Researchers reported that +relaxation by Iyengar Yoga practice increases cardiac vagal +modulation in healthy yoga practitioners (Khattab et al., 2007). +This provides an insight on physiological mechanism for +immunomodulation through the motor branches of the vagus +nerve, and CNS control of peripheral inflammatory responses. + +2. +Yoga and Hyper-responsiveness in AR +Hyper-responsiveness of airways is closely related to an IgE +mediated allergic inflammatory condition (Sears et al., 1991). +Chronic exposure to allergens in AR can lead to hyper- +responsiveness of the nasal mucosa (Baraniuk & Kim, 2007). +Airway hyper-responsiveness also may be due to airway +inflammation, airway remodeling and abnormalities of smooth +muscles and neural control (Berend et al., 2008). Neurotrophins, +such as the NGF (Nerve Growth Factor) are the mediators of +neural hyper-responsiveness (Togias, 2000). Yoga has a +calming effect on the mind, the devotional sessions that help to +harness the emotional upsurges are particularly useful in +eliminating emotional stresses (Nagendra & Nagarathna, 1986). +Yogic SuddhiKriya like Neti clear nasal pathway from allergens +and other annoying substances (Rabone & Saraswati, 1999) +that can reduce the number of inflammatory cells and cytokine +levels in the nasal mucosa which may result in lessening of +hyper-responsiveness. This signifies that yoga induces a greater +degree of physiological relaxation and reduces hyper- +responsiveness. + +3. +Effect of Yogic Shuddhi Kriyas in reducing +allergen and inflammatory mediators +Roots of nasal irrigation are in ancient yogic purification +technique involves Neti Kriya (nasal cleansing), there are two +types of Neti; JalaNeti, i.e nasal irrigation with lukewarm +saline water and Sutra Neti, i.e cleaning of the nasal path with a +thread or catheter. Neti removes foreign bodies like allergens +and dust from the nasal passage (Muktibodhanand, 1998). +There are sufficient studies available that show the positive +effect of nasal irrigation on nasal symptom scores (Tomooka et +al., 2000; Rabone & Saraswati, 1999). A recent review study +suggests that JalaNeti (yogic nasal cleansing techniques) and +Pranayama (Yogic breathing) have a therapeutic effect for +people suffering from AR including asthma (Agnihotri, et al., +2016). A 10-week long clinical trial with the daily practice of +saline nasal spray significantly reduced symptoms of nasal +symptoms and episodes of rhinitis (Tano&Tano, 2004). +JalaNeti helps in preventing upper respiratory tract diseases +equally in adults and children (Meera et al., 2019). Nasal +lavage with isotonic seawater shown significant improvement +in mucociliary clearance, Nasal Peak Expiratory Flow (NPEF) +and nasal symptoms such as obstruction, posterior secretions, +itching, irritation and sneezing (Holmström, et al., 1997). A +single case study reported the beneficial results of Sutra Neti in +his snoring and sleep apnoea condition (Ramalingam & Smith, +1990). A review study found saline nasal irrigation a safe +procedure for both adults and children. It is helpful in flushing +and moisturizing the nasal cavity also promotes mucociliary +clearance (Papsin, & McTavish, 2003). A clinical trial with +thirty allergic rhinitis patients underwent saline nasal irrigation +and heated water vapor at 43 and 41°C, at different points of +time, results revealed that saline nasal irrigation significantly +reduces histamine concentration from nasal secretion (Georgitis, +1994). Another clinical trial on pediatric subjects for 12 weeks +reported a significant reduction in AR symptoms and +Eosinophil count (Chen et al., 2014). + +3.1. Mechanism of action for Neti +The mechanism of action of JalaNeti or nasal irrigation can be +understood in four ways. +1. +Direct physical cleansing by flushing out thick +mucus, crusts, debris, allergens, air pollutants (Blake +& McTavish, 2003; Rabone & Saraswati, 1999). +2. +The removal of inflammatory mediators (Georgitis, +1994; Chen et al., 2014). +3. +Better mucociliary clearance by improving ciliary +beat frequency (Holmström et al., 1997). +4. +Desensitization of Nasal Mucosa - Yogic cleansing +techniques Kriyas may desensitize the vagal end +receptors by systematic exposure to nonspecific +graded irritants followed by deep relaxation +(Nagendra & Nagarathna, 1986). + +4. +A Proposed Model for the Mechanism of Yoga +therapy in Allergic Rhinitis +Given the multifaceted discussion on pathways in allergic +inflammation, it is hypothesized that yoga might exert anti- +inflammatory actions in allergic rhinitis in the following ways: +The local effect by improving mucociliary clearance, reducing +inflammatory cytokines and inflammatory cells in the nasal +mucosa. Further, the general effect mediated through the HPA +axis, Efferent vagal stimulation, CRP level, and GABA. Yoga +has shown improvement on Lung capacity and nasal airflow in +AR patients. If yoga can be shown to have these actions on +modulating cytokines and other pathways potentially mediating +inflammation, then these modulations would be expected to be +correlated with improvements in clinical signs and symptoms, +including a reduction in rhinorrhea, sneezing and nasal +obstruction. This review integrates current approaches and +scientific evidence to illustrate how practicing traditional +factors of yoga helps in the management of Allergic Rhinitis. + + +CONCLUSION + +Yoga has recently emerged as having health benefits in allergic +and other chronic conditions, yet yoga has not been +systematically evaluated as therapy for AR. Evidence support +that yoga reduces inflammation by modulating inflammatory +mediators in some studies for conditions other than allergic +rhinitis. Further, pieces of evidence support that yoga reduces +nasal congestion, improves lung capacity, improve nasal +airflow and symptom score in allergic rhinitis cases. Few +studies reported Netikriya (yogic nasal cleansing) and a similar +technique, saline nasal irrigation was effective in reducing +symptoms of allergic rhinitis. Role of yoga in modulating +neuropeptides like SP, CGRP, and VIP, and Neurotrophins NGF +and BDNF had to be studied as they are shown to contribute in +the early and late phases of AR respectively. Therefore, it is +suggested in our proposed model that, yoga may downregulate +certain +inflammatory +and +pro-inflammatory +cytokines. +Furthermore, yoga up-regulates anti-inflammatory interleukins. +Yoga, a mind-body therapy, embraces a holistic model of health +and well-being. Yoga not only focuses on cardinal symptoms of +AR but may also reduce psychological stress and sleep +difficulty. Yoga may also reduce the hyper-responsiveness of +nasal airway by improving sympathovagal balance. The +delimitations of the present review include restricting the +search to open online databases, which might narrow the access +The Role of Yoga Intervention in the Treatment of Allergic Rhinitis: A Narrative Review and Proposed Model + +5 +CellMed + +2020 / Volume 10 / Issue 3 / e25 +to substantial research work done in the domain. Furthermore, +the prevailing review is constrained to the narrative in nature, +and statistical accountability was not presented. Current review +highlights +the +importance +of +integrating +yoga-based +interventions as add-on therapy for AR. Further, there is a need +for large scale, long-term effect, systematic study with +augmented methodological designs to comprehend the potential +neurobiological mechanisms of yoga-based intervention in +patients with Allergic Rhinitis is needed. + + +CONFLICT OF INTEREST + +Authors declared that there was no conflict of interest. + + +ACKNOWLEDGEMENT + +None + + +REFERENCES + +Agnihotri S, Kant S, Kumar S, Mishra RK, Mishra SK. Impact +of yoga on biochemical profile of asthmatics: A randomized +controlled study. International journal of yoga. 2014;7(1):17. + +Almadi T, Cathers I, Chow CM. Associations among +work‐related stress, cortisol, inflammation, and metabolic +syndrome. Psychophysiology. 2013;50(9):821-30. + +Arora S, Guleria R, Kumar G, Yadav SL, Mohan A. Efficacy of +yoga on inflammatory markers, dyspnea, and quality of life in +COPD. Chest. 2013;144(4):787A. + +Baraniuk JN, Kim D. Nasonasal reflexes, the nasal cycle, and +sneeze. 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Effects of a yoga program on +The Role of Yoga Intervention in the Treatment of Allergic Rhinitis: A Narrative Review and Proposed Model + +7 +CellMed + +2020 / Volume 10 / Issue 3 / e25 +cortisol rhythm and mood states in early breast cancer patients +undergoing adjuvant radiotherapy: a randomized controlled +trial. Integrative cancer therapies. 2009;8(1):37-46. + +Ramalingam KK, Smith MC. Simple treatment for snoring also +a means of prediction of uvulopalatopharyngoplastysuccess?. +The Journal of Laryngology & Otology. 1990;104(5):428-9. + +Rao YC, Kadam A, Jagannathan A, Babina N, Rao R, +Nagendra HR. Efficacy of naturopathy and yoga in bronchial +asthma. Indian J PhysiolPharmacol. 2014;58(3):233-9. + +Rastogi S.JalaNetiApplication in acute rhino sinusitis. Indian +Journal of Traditional Knowledge.2007; 6:324-327. + +Rosa AC, Fantozzi R. The role of histamine in neurogenic +inflammation. +British +journal +of +pharmacology. +2013;170(1):38-45. + +Ross A, Thomas S. 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Allergic rhinitis: An overview. +IndianJournal of Otolaryngology and Head & Neck Surgery. +2015;67(2):143-9. + +Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, +Subbakrishna +DK, +Sureshbabu +SV, +Gangadhar +BN. +Antidepressant efficacy and hormonal effects of Sudarshana +Kriya Yoga (SKY) in alcohol dependent individuals. Journal of +affective disorders. 2006;94(1-3):249-53. + +Vera FM, Manzaneque JM, Maldonado EF, Carranque GA, +Rodriguez FM, Blanca MJ, Morell M. Subjective sleep quality +and hormonal modulation in long-term yoga practitioners. +Biological psychology. 2009;81(3):164-8. + +Yadav RK, Magan D, Mehta N, Sharma R, Mahapatra SC. +Efficacy of a short-term yoga-based lifestyle intervention in +reducing stress and inflammation: preliminary results. The +journal +of +alternative +and +complementary +medicine. +2012;18(7):662-7. diff --git a/subfolder_0/The integrated approch of yoga a therapeutic tool for mentally retarded children.txt b/subfolder_0/The integrated approch of yoga a therapeutic tool for mentally retarded children.txt new file mode 100644 index 0000000000000000000000000000000000000000..30b472ee69f49462cdeacbd4e58583c3ff14cc29 --- /dev/null +++ b/subfolder_0/The integrated approch of yoga a therapeutic tool for mentally retarded children.txt @@ -0,0 +1,13 @@ + + + + + + + + + + + + + diff --git a/subfolder_0/The relationship between dispositional mindfulness and wellbeing.txt b/subfolder_0/The relationship between dispositional mindfulness and wellbeing.txt new file mode 100644 index 0000000000000000000000000000000000000000..e4037953103847610f3e6a0987f5a2a09dc5c086 --- /dev/null +++ b/subfolder_0/The relationship between dispositional mindfulness and wellbeing.txt @@ -0,0 +1,244 @@ +In recent years, construct mindfulness has emerged as one of the main focus of study within the positive psychology +movement. The purpose of this study was to investigate the relationship between dispositional mindfulness and +wellbeing in a sample of college students. The sample comprised 275 under graduate students (204 =Female; +76=Male; 5= unreported; in the age range18 to 29 years) from three colleges in Southern India. The Mindful +Attention Awareness Scale( MAAS) was used to measure dispositional mindfulness. Further wellbeing was +measure using Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) and Short Depression +Happiness Scale (SDHS). Spearman correlation coefficients were used to examine the association between +mindfulness and well-being domains. Dispositional mindfulness was positively and significantly correlated with +well-being related constructs SWEMWBS (rs = .46) and happiness (rs = .42) (all p's < .01). The results showed that +participants higher on mindfulness had greater concordance with well-being. +Keywords: mindfulness, positive psychology, happiness +terms of the degree to which a person is fully functioning”( Ryan & +In recent years, growing literature in positive psychology focus on +Deci, 2001). +human well-being, strengths and virtues that allow people to flourish +(Seligman & Csikzentmihalyi, 2000) rather than over emphasizing +A cross-sectional study was conducted to determine prevalence of +on the area of psychological distress or psychopathology. Over 1,000 +current depressive, anxiety, and stress-related symptoms in a sample +articles are published in peer-reviewed journals between 2000 and +of young adults, showed 18.5% mild to extremely severe depressive +2011. Related areas of study include mindfulness, spirituality, well- +symptoms, anxiety in 24.4%, and stress in 20%. Clinical depression +being, forgiveness, happiness, and mental strength and how they are +was present in 12.1% and generalized anxiety disorder in 19.0% +associated to physical and psychological well being. Recently, these +(Sahoo & Khess, 2010). +areas of research are expanding to college students in addition to +Hence detecting the well-being spectrum and further enhancing +adult population. +those domains may be a preventive strategy, which can help in +The concept of mindfulness and the practice employed to develop +preventing psychological distress among young adult. Recent +mindfulness have in recent years emerged as one of the main focus of +research indicates that mindfulness is a natural quality that promotes +study within the positive psychology movement. Mindfulness is +adaptive human functioning and antidotes against common forms of +conceptualized as a state of attentiveness to present events and +psychological distress (Hayes & Feldman, 2004; Keng, Smoski & +experiences that is unmediated by discriminating cognition (Brown, +Robins, 2011). +Ryan, & Creswell, 2007). Study demonstrated that mindfulness is +However, the majority of this research has been conducted in US +measurable quality possessed even by those who do not practice +samples. Hence aim of the present study was to investigate the +mindfulness meditation (Hollis-Walker & Colosimo, 2011). +relationship between mindfulness and wellbeing in a sample of +Therefore, mindfulness can be regarded as a positive dispositional +college student in India. Our hypothesis was that high dispositional +trait inherent to all of us. +mindfulness would be associated with higher levels of wellbeing; +There is increasing recognition of concept of mindfulness and the +that is, mindfulness scores on the Mindfulness Awareness Attention +practice employed to develop mindfulness. Empirical literature +Scale (Brown & Ryan, 2003) would positively correlate with +reviews on cross-sectional, intervention and laboratory-based, +wellbeing scores on the short Warwick-Edinburgh Mental Well- +experimental research on the effects of dispositional and +Being Scale (SWEMWBS; Stewart-Brown, et al., 2009) and Short +mindfulness oriented intervention on psychological health conclude +Depression happiness Scale (SDHS; Joseph, Linley, Harwood, +that mindfulness brings about various positive psychological effects, +Lewis, & McCollam, 2004). +including increased subjective well-being, reduced psychological +Method +symptoms and emotional reactivity, and improved behavioral +regulation(Keng, Smoski & Robins, 2011). +Participants +Well-being is a multifaceted construct that concerns optimal +Participants were 275 under graduate students (204 female, 76 male, +experience and functioning. Recent research on well-being has been +five unreported) from three colleges affiliated to Mahatma Gandhi +focusing on two general perspectives: “the hedonic approach, which +University, Kerala, Southern India. Participants age ranged from 18 +focuses on happiness and defines well-being in terms of pleasure +to 29 years with a mean age of 19.73 years (SD=1.54). +attainment and pain avoidance; and the eudaimonic approach, which +focuses on meaning and self-realization and defines well-being in +The religious affiliations were as follows: 55.5% Hinduism, +20.7% Christianity, 20% Islam, and 3.6% had not reported religion. +Participants received no monetary compensation for their +participation. +The relationship between dispositional mindfulness and +well-being in a sample of college students +Correspondence should be sent to Rajesh S.K., Swami +Vivekananda Yoga Anusandhana Samsthana, Bangalore, India +Indian Journal of Positive Psychology +2012, 3(3), 299-301 +© 2012 Indian Association of Health, +Research and Welfare +S.K. Rajesh, V.J. Ilavarasu, and T.M. Srinivasan +Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnatka +Table 1: Descriptive Statistics on well-being and Correlations with +Procedure +dispositional Mindfulness +Each participant read and signed an informed consent document. All +Variable +M +SD +Range +MAAS +procedures were reviewed and accepted by the appropriate +rs +institutional review board. Participants were given questionnaire +MAAS +58.19 +9.58 +33-83 +packets including a number of self-report measures, only some of +SWEMWBS +24.71 +4.59 +14-35 +which were relevant to the present study (listed below; see +SDHS +11.88 +3.04 +4-18 +Measures). Each packet was assigned an arbitrary code number so +that confidentiality could be maintained. The average completion +Note: N=275; rs =Spearman's rho; MAAS = Mindful Attention +time for the study was 35 minutes. +Awareness Scale; SWEMWBS= Short Warwick-Edinburgh Mental +Well-being Scale; SDHS= Short Depression Happiness Scale; * +Instruments +Correlation is significant at the 0.01 level. +The Mindful Attention Awareness Scale (MAAS; Brown & Ryan, +2003) was used to measure dispositional mindfulness. MAAS is a +Discussion +15-item, 6-point Likert scale (1 = almost always to 6 = almost never) +This study set out to examine the relationship between well-being +measure that assesses the quality of attention and awareness that +and dispositional mindfulness among college students. Participants +individuals apply to their daily lives. All items of the MAAS are +in this study had no formal training in mindfulness techniques. In +worded in a negative direction (e.g., I find myself doing things +line with the hypothesis, the results showed that participants higher +without paying attention, I could be experiencing some emotion and +on mindfulness had greater concordance with well-being. This +not be conscious of it until sometime later, it seems I am “running on +study supports the emerging literature on the benefits of mindfulness +automatic” without much awareness of what I am doing). +construct. +Participant's responses on each item are summed to create a total +When combined with previous studies, dispositional mindfulness +score. A high score indicates a high degree of mindfulness. +may enhance wellbeing in several ways. Elements of mindfulness, +Short Warwick-Edinburgh Mental Well-being Scale +such as awareness of internal experiences and nonjudgmental +(SWEMWBS) was used to measure Well-being. SWEMWBS +acceptance of one's moment-to-moment experience may facilitate +consists of seven items phrased positively to cover positive aspects +against common forms of psychological distress which are +of wellbeing. Items cover a range of aspects of well-being including +characterized by a lack of reflection and over-engagement with one's +many which will be familiar from other well known scales (e.g. I've +distressing thoughts and emotions (Hayes & Feldman, 2004). +been feeling relaxed, I have been thinking clearly). Responses in the +There are some weaknesses of this study that need to be +form of a Likert scale comprise 'None of the time'; 'Rarely'; 'Some of +addressed. The sample included only college students and +the time'; 'Often' and 'All of the time'. Scores range from 7 to 35, with +predominantly female sample, may limit the generalizability of our +a higher score reflecting a higher level of mental well-being +findings to more diverse populations, including those that are less +(Stewart-Brown, et al., 2009). +educated. Apart from the limitations of cross-sectional design used +Happiness was measured using the Short Depression Happiness +in the present study, questionnaire based assessment may be +Scale (Joseph, et al., 2004). The SDHS was designed to extend +compromised by response biases. Furthermore, participants were +existing measures of depression beyond the zero point to measure not +generally healthy young adults, so it would be important to replicate +only the absence of depression but also the presence of happiness. +findings with more general as well as clinical populations with more +The SDHS consists of six items, three items measuring happiness +objective measurements. +(e.g., I felt happy) and three reverse coded items measure depressive +Despite these limitations, the present study extends the existing +states (e.g., I felt my life was meaningless). Participants rate how +literature on mindfulness and well-being. To our knowledge, this +frequently they feel the way described in the item on a four point +may be the first study in Indian sample to understand the relationship +scale (0 = never, 1 = rarely, 2 = sometimes, 3 = often). When the items +between dispositional mindfulness and well-being. Thompson and +are summed, people can score from 0 (depressive state) through 9 +Waltz (2007) suggest that mindfulness can be a dispositional trait +(neither unhappy nor happy) to 18 (very happy). +which is enhanced by training. Our study suggests that development +of mindfulness in younger populations may be a fruitful avenue for +Results +future research. +All statistical analyses were performed using SPSS version 16.0 +(SPSS Inc., Chicago, IL, USA). Data were inspected for normal +References +distribution. Responses on the well-being variables were not +Brown, K. W., & Ryan, R. M. (2003). The Benefits of Being Present : Mindfulness and +normally distributed and could not be transformed to normality using +Its Role in Psychological Well-Being. Journal of Personality and Social +Psychology, 84(4), 822- 848. +log or square root transformations. Therefore, nonparametric tests +Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness : Theoretical +were used to analyze these variables. Spearman correlation +Foundations and Evidence for its Salutary Effects. Psychological Inquiry, 18(4), +coefficients were used to examine the association between +211-237. +mindfulness and well-being domains. Descriptive statistics for all +Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on +three questionnaires and Correlations with dispositional +psychological health: A review of empirical studies. Clinical Psychology Review, +31(6), 1041-1056. +Mindfulness are reported in Table 1. As hypothesized, mindfulness +Hayes, A., & Feldman, G.(2004). Clarifying the Construct of Mindfulness in the +was positively and significantly correlated with well-being related +Context of Emotion Regulation and the Process of Change in Therapy. Clinical +constructs, namely SWEMWBS (rs = .46) and happiness (rs = .42) +Psychology: Science and Practice, 11(3), 255-262. +(all p's < .01). +RAJESH ET AL./ THE RELATIONSHIP BETWEEN DISPOSITIONAL +300 +Hollis-Walker, L., & Colosimo, K. (2011). Mindfulness, self-compassion, and happiness +male adults in India: a dimensional and categorical diagnoses-based study. Journal +in non-meditators: A theoretical and empirical examination. Personality and +of Nervous and Mental Disease, 198(12), 901-904. +Individual Differences, 50(2), 222-227. +Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology. An introduction. +Joseph, S., Linley, P. A., Harwood, J., Lewis, C. A., & McCollam, P. (2004). Rapid +American Psychologist, 55(1), 5-14. +assessment of well-being: The Short Depression-Happiness Scale (SDHS). +Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J., & Weich, S. (2009). +Psychology and psychotherapy, 77, 463-78. +Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale + Roberts, K. C., & Danoff-burg, S. (2010). Mindfulness and Health Behaviors : Is Paying +(WEMWBS): a Rasch analysis using data from the Scottish Health Education +Attention Good for You ? Journal of American College Health, 59(3), 165-173. +Population Survey. Health and quality of life outcomes, 7, 15. +Ryan, R. M., & Deci, E. L. (2001). On happiness and human potentials: a review of research +Thompson, B., & Waltz, J. (2007). Everyday mindfulness and mindfulness meditation: +on hedonic and eudaimonic well-being. Annual review of psychology, 52, 141-66. +Overlapping constructs or not? Personality and Individual Differences, 43(7), 1875- +1885. +Sahoo, S., & Khess, C. R. Prevalence of depression, anxiety, and stress among young +Indian Journal of Positive Psychology 2012, 3(3), 299-301 +301 diff --git a/subfolder_0/Transcranial Doppler studies of middle cerebral artery blood flow following different test conditions.txt b/subfolder_0/Transcranial Doppler studies of middle cerebral artery blood flow following different test conditions.txt new file mode 100644 index 0000000000000000000000000000000000000000..375618244cb9b239adb72ae2fd21492daea681b3 --- /dev/null +++ b/subfolder_0/Transcranial Doppler studies of middle cerebral artery blood flow following different test conditions.txt @@ -0,0 +1,70 @@ +3/9/2017 +Transcranial Doppler studies of middle cerebral artery blood flow following different test conditions. :KV Naveen, HR Nagendra, S Telles, C Garn… +http://www.neurologyindia.com/printarticle.asp?issn=0028­3886;year=1999;volume=47;issue=3;spage=249;epage=249;aulast=Naveen +1/2 +Home  +  +Year : 1999  |  Volume : 47  |  Issue : 3  |  Page : 249­ +Transcranial Doppler studies of middle cerebral artery blood flow following different test +conditions. +KV Naveen, HR Nagendra, S Telles, C Garner  +  +Correspondence Address: +K V Naveen +How to cite this article: +Naveen K V, Nagendra H R, Telles S, Garner C. Transcranial Doppler studies of middle cerebral artery blood flow following +different test conditions. Neurol India 1999;47:249­249 +How to cite this URL: +Naveen K V, Nagendra H R, Telles S, Garner C. Transcranial Doppler studies of middle cerebral artery blood flow following +different test conditions. Neurol India [serial online] 1999 [cited 2017 Mar 9 ];47:249­249  +Available from: http://www.neurologyindia.com/text.asp?1999/47/3/249/1599 +Full Text +Transcranial Doppler ultrasound (TCD) is a noninvasive method of studying cerebral haemodynamics, allowing the +measurement of blood velocity in the major intracranial vessels using ultrasound signals transmitted through bone. +[1] Cerebral circulation is controlled mainly by auto regulation and fluctuations in blood CO2 and O2, with scarcely +any changes when arterial pressure is constant between 50 and 140mmHg.[2] We recorded the blood velocity in +both right and left middle cerebral arteries (MCA) in a 26 year old male volunteer with TCD (DWL Ultrasonic Doppler +System, Sipplingen, Germany). There were six repetitions on each side, and recordings were made before and +immediately after breath holding, Valsalva maneuver +, mental arithmetic, mental route finding, a yoga rapid shallow +breathing at 120 times per minute and hyperventilation. A 2 MHz doppler probe, connected to a TCD device was +mounted at a 30 degree angle over the squamous temporal bone using an elastic head band. The high pass filter +was 250 Hz with emitted ultrasonic power of 56.0 mW. +There was a significant increase in systolic and diastolic blood flow velocity(sbfv, dbfv) following valsalva maneuver +for both right and left MCA (P<.005, t test for paired data in all comparisons against the preceding baseline). In +contrast following hyperventilation and rapid yoga breathing there was a significant decrease in dbfv for the right +MCA (P<.002, both cases). Following hyperventilation the sbfv of the left MCA reduced (P<.001). There were no +changes following breath holding, isometric contraction, mental arithmetic and mental route finding. An increase in +blood flow velocity may be correlated with increased cerebral blood flow or reduced vessel diameter +.[3] Immediately +after the valsalva maneuver the systemic blood pressure has been reported to be approximately 170 mmHg.[4] As +the BP rises above 140 mmHg, cerebral blood flow is known to increase, as was demonstrated here by increased +bfv. Breath holding may not have increased systemic BP to the same extent as valsalva, hence not influencing +cerebral blood flow. Hyperventilation is known to reduce CO2 in the blood and hence cerebral blood flow would +reduce,1 this was reflected in reduced bfv. The same result followed rapid yoga breathing, suggesting that this +practice, like hyperventilation reduces cerebral blood flow, possibly also by carbondioxide washout. +3/9/2017 +Transcranial Doppler studies of middle cerebral artery blood flow following different test conditions. :KV Naveen, HR Nagendra, S Telles, C Garn… +http://www.neurologyindia.com/printarticle.asp?issn=0028­3886;year=1999;volume=47;issue=3;spage=249;epage=249;aulast=Naveen +2/2 +Hence TCD appears to allow simple, rapid and repeatable measures of changes in cerebral blood flow related to +changes in systemic pressure and blood CO2. In the present study changes in cerebral blood flow related to +cognitive activities (such as mental route finding) were not recorded. +References +1 +Peters P +, Datta K : Middle cerebral artery blood flow velocity studied during quiet breathing, reflects +hypercapnic breathing in man. In : Modelling and control of ventilation, Semple SJG, Adams L and Whipp BJ +(eds). Plenum Press New York 1995; 293­295. +2 +McHenry C : Cerebral blood flow and metabolism. In : Cerebral Vascular Diseases, Harrison MJ and Dyken ML +(eds). Butterworths & Co. London 1983; 67­85. +3 +Chan KH, Dearden WM, Miller JD : The significance of post traumatic increase in cerebral blood flow velocity : A +Transcranial doppler ultrasound study. Neurosurgery 1992; 30 : 697­700. +4 +Ganong WF : Review of medical physiology, California : Lange Medical Publication, 1981. +  +  +Thursday, March 09, 2017 + Site Map | Home | Contact Us | Feedback | Copyright and Disclaimer diff --git a/subfolder_0/Trends of Hypertension and Neurological Diseases in India A Nationwide Survey Reporting the Distribution Across Geographical Areas.txt b/subfolder_0/Trends of Hypertension and Neurological Diseases in India A Nationwide Survey Reporting the Distribution Across Geographical Areas.txt new file mode 100644 index 0000000000000000000000000000000000000000..0ec338cfcc1d3ed8cad59ebae9fba6d105495b9e --- /dev/null +++ b/subfolder_0/Trends of Hypertension and Neurological Diseases in India A Nationwide Survey Reporting the Distribution Across Geographical Areas.txt @@ -0,0 +1,849 @@ +https://doi.org/10.1177/0972753120987457 +Annals of Neurosciences +27(3-4) 162­ +–168, 2020 +© The Author(s) 2021 +Reprints and permissions: +in.sagepub.com/journals-permissions-india +DOI: 10.1177/0972753120987457 +journals.sagepub.com/home/aon +Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution- +NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-Commercial use, reproduction and +distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https:// +us.sagepub.com/en-us/nam/open-access-at-sage). +Original Article +Trends of Hypertension and Neurological Diseases +in India: A Nationwide Survey Reporting the +Distribution Across Geographical Areas +Sriloy Mohanty1 +, Raghuram Nagarathna2, Kashinath Metri3, Suchitra Patil4, +Sanjay Kumar5, Amit Singh4 and Hongasandra R Nagendra4 +Abstract +Background: Hypertension has remained an imperative risk factor for cardiovascular and cerebrovascular diseases, +increasing the national burden of premature deaths over the decades. +Purpose: There is limited data on the prevalence of hypertension and its distribution across all geographic regions in India. +This nationwide survey was conducted in 2017 to assess the prevalence of hypertension and prehypertension among the +Indian adults. +Methods: A multilevel stratified cluster sampling technique, with a random selection among the urban and rural populations, +was adopted to achieve a sample of 70,031 adults from 24 states and 4 union territories. Blood pressure was measured +twice using automated oscillometric machines with a minimum of 3-min gap, and the average was recorded. This was +later categorized into prehypertension (elevated blood pressure) and hypertension subgroups as defined by the new 2017 +American Heart Association guidelines. +Results: The prevalence of prehypertension and hypertension in our study population across all ages was found to be 18.2% +and 24%, respectively. Prehypertension was common at a younger age, whereas the prevalence of hypertension was higher in +the older age groups. The urban population (24.4%) and males (24.7%) were positively associated with prehypertension and +hypertension. The western zone had the highest prevalence of hypertension, whereas the eastern population had the lowest. +Conclusion: Our study revealed an alarmingly high prevalence of hypertension, accounting up to one hypertensive in every +four adults in India. There is a need for more robust national strategies for identifying and treating hypertension to reduce +the national and the global burden of hypertension by 25% before 2025. +Keywords +Nationwide survey, Prevalence, Hypertension, Prehypertension +Received 01 October 2020; revised 07 October 2020; accepted 07 October 2020 +1 Centre of Integrative Medicine and Research, All India Institute of Medical +Sciences, New Delhi, India +2 Arogyadhama, Vivekananda Yoga Anusandhana Samsthana, Bangalore, +Karnataka, India +3 Department of Yoga, Central University of Rajasthan, Kishangarh, +Rajasthan, India +4 Department of Life Science, Swami Vivekananda Yoga Anusandhana +Samsthana, Bangalore, Karnataka, India +5 Department of Health, Vivekananda Yoga Anusandhana Samsthana, +Bangalore, Karanataka, India +Corresponding author: +Sriloy Mohanty, Centre for Integrative Medicine and Research, All India +Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. +E-mail: sriloy21@gmail.com +Introduction +The global action plan endorsed by the World Health +Assembly for the prevention and control of noncommunicable +diseases (NCDs) in 2013 aimed at a 25% relative reduction in +the prevalence of raised blood pressure (BP) to reduce the +global burden of premature deaths by 25% before 2025.1 +Hypertension has emerged as the most imperative risk factor +for the global disease burden and estimated to contribute to +more than 12% of the global deaths.2 Hypertension is directly +responsible for 57% and 24% of mortality because of stroke +and coronary heart disease, respectively, in India.3 India alone +accounts for one-fifth of the global premature deaths related +Mohanty et al. +163 +to cardiovascular diseases (CVDs).4 Furthermore, the Indian +population tends to develop CVDs a decade earlier in life +than the European population.5 Therefore, the global reduction +of cardiovascular and cerebrovascular morbidity and +mortality depends significantly on India.6 Sensing the global +pressure and overviewing the larger portion of CVDs +contributing to the national NCD burden, the national health +policy has earmarked for a 25% reduction of the premature +mortality related to CVDs and 80% screening and treatment +of hypertension by 2025.7 +Despite rigorous nationwide health awareness and health +approaches, the recent upward trend in hypertension and +other CVDs in India has raised a concern regarding the +achievement of the sustainable development goals as +formulated by the United Nations.8 Although multiple studies +report the prevalence of hypertension about a particular age, +gender, or region of the country,9–12 India still lacks in studies +reporting a nationwide systemic evaluation for the prevalence +of hypertension. The “global burden of hypertension” study +also highlighted the need for national studies representing the +hypertension’s prevalence in India.13 The national family +health survey was aimed to evaluate the prevalence of +hypertension among young and middle-aged men and women +using a representative sampling from all over the country. +The study reported an overall prevalence of hypertension as +13.6% and 8.8% in men and women, respectively, between +the ages of 15 and 59 years. The study also reported a +significantly greater prevalence in the urban populations in +comparison to the rural.12 Another study by Geldsetzer et al.. +pooled and reported the data from District Level Household +Survey-4 and Annual Health Survey.14 This study also +reported an unadjusted prevalence of hypertension as 25.3% +(CI [25.0, 25.6]), with a higher prevalence in men as compared +to women (23.6%, CI [23.3, 23.8] vs. 27.4%, CI [27.0, 27.7]; +P < .001). The “great Indian hypertension” survey by +Ramakrishnan et al.. reported an overall unadjusted +prevalence of hypertension to be 30.7% (CI [30.5, 30.9]) and +the one adjusted for the World Health Organization (WHO) +reference population to be 32.8%.15 This alarming rise in the +prevalence trend may be attributed to cardiometabolic risk +factors of hypertension that are the resultant of the unequal +distribution of rapid economic growth and urbanization in +India over the past two decades. Understanding this rapid +economic growth and rate of urbanization and its impact on +the prevalence of hypertension particularly, we premeditated +the current survey using the Niyantrita Madhumeha Bharata +Abhiyaan—India’s largest politico-scientific enterprise.16,17 +Methodology +Study Design and Setting +The current study was a nationwide cross-sectional survey +conducted in 2017 using a multilevel stratified cluster +sampling technique, with a random selection among the urban +and rural populations covering all states and union territories +(UTs). The Indian Yoga Association provided the ethical +approval to the study, and written consent was obtained +before enrolling the subjects for the survey. The detailed +methodology has previously been published.18 +Participants +The study included all men and women above 20 years of +age, covering a population of 4,000 per district (50% rural +and 50% urban) in the sampling area. Sampling was done at +four levels: zones, states, districts, and villages (rural) or +towns (urban). To factor the cultural heterogeneity, the +country was stratified into seven zones, and within each zone, +individual states were considered. A total of 24 most populous +states and 4 UTs were included in the survey after excluding +the remote or smaller states/UTs for operational reasons. To +ensure that district samples within a state were not clustered, +we grouped the state into geographical regions and chose a +district from each region. Later, from the selected districts, +villages with an adult population of about 500 (100 to 175 +households) were listed and grouped geographically into +north, south, east, and west. +Similarly, the list of urban clusters (towns/cities) in the +selected district as per Census 2011 was grouped into four +geographic locations. Randomly, urban and rural clusters +were included, and all households within the cluster were +surveyed. Using the census location map, each sampling unit +(villages or census enumeration blocks), and a mapping, a +household listing operation was carried out, and consecutive +unique numbers were assigned to every household. +The execution of the study was done in two steps. In the +first step, information regarding demographic and health +status by door-to-door surveys was acquired using a mobile +app (Niyantrita Madhumeha Bharata Abhiyaan: https://goo. +gl/7zBCw1), and in the second step, individuals having +hypertension or with a high risk were invited to camps for +health checkups. +Blood Pressure Measurement +After collecting demographic details and self-reported health +status from the subjects and obtaining their consent, each +subject was asked to be seated for at least 10 min. After this, +their BP was measured twice by the research staff, using +automated oscillometric machines. The average of the two +BP measurements was recorded. The new 2017 hypertension +classification guideline, as postulated by the American Heart +Association, was used to define prehypertension (elevated +BP) and hypertension subgroups. +Statistical Analysis +The statistical analysis was carried out using the SPSS +statistics 23.0 software to analyze the mean, standard +164 +Annals of Neurosciences 27(3-4) +deviations, and proportions. The distribution of BP across the +five classifications [normal, prehypertension (elevated BP; +120 to 129/<80 mmHg), stage 1 hypertension (130 to 139/80 +to 89 mmHg), stage 2 hypertension (>140/>90 mmHg), and +hypertension crisis (>180/>120 mmHg)], as per the 2017 +American Heart Association guidelines,19 was calculated +across different zones, genders, age groups (18 to 34, 35 to 44, +45 to 64, and ≥65 years), body mass index (BMI) categories +(18 to 24.9, 25 to 29.9, >30 kg/m2), and three socioeconomic +status groups (low, middle, and high as per the Kuppuswamy +scale20 for the year 2014). A chi-square test was applied to +calculate the association of these factors with the hypertension +burden. A P-value < .05 was considered as significant. A +weighted prevalence in overall and subgroups was checked +by using the nonresponse rate. An odds ratio (OR) was +calculated by using the multinomial logistic regression. +Results +A total of 70,031 subjects (51.9% females, 51.6% urban +population) with a mean age of 41.39 ± 13.76 years were +surveyed. The mean systolic and diastolic BP were found to +be 128.9 ± 19.07 and 84.2 ± 13.33, respectively. Demographic +details including age, sex, BMI, mean systolic, and diastolic +BP have been tabulated in Table 1. There were statistical +differences between the urban and rural populations in all +characters. Among males and females, there were similar +trends. +Prevalence of Hypertension and +Prehypertension +The prevalence of prehypertension and hypertension in our +population across all ages was 18.2% and 24%, respectively. +There were significant differences in the prevalence of +hypertension and prehypertension between males and females +(hypertension, 24.77% vs. 23.5%, P < .001; prehypertension, +18.7% vs. 17.7%, P < .001; Table 2). The prevalence between +the rural and urban populations was also statistically different +(hypertension, 23.6% vs. 24.4%, P < .001; prehypertension, +18.2% vs. 18.2%, P < .001). +Table 2. Weighted Prevalence of Prehypertension and Hypertension +Categories +Normal +Prehypertension +Hypertension Stage 1 +Hypertension +Stage 2 +Hypertension +Crisis +Hypertension +Prevalence +P-Value +Overall +57.8% +18.2% +9.4% +14.6% +0.2% +24.0% +Rural +58.2% +18.2% +9.1% +14.6% +0.2% +23.6% +< .001 +Urban +57.3% +18.2% +9.8% +14.6% +0.2% +24.4% +Male +56.6% +18.7% +9.8% +14.9% +0.2% +24.7% +< .001 +Female +58.8% +17.7% +9.2% +14.3% +0.2% +23.5% +Age (18–34) +62.8% +21.1% +8.3% +7.8% +0.1% +16.1% +< .001 +Age (35–44) +58.4% +17.9% +9.6% +14.1% +0.2% +23.7% +Age (45–64) +53.2% +15.9% +10.7% +20.2% +0.4% +30.9% +Age >65 +54.1% +12.8% +9.4% +23.7% +0.3% +33.1% +(Table 2 continued) +Table 1. Characteristics of the Study Participants +Characteristics +Rural +Urban +Male +Female +T +otal +P-Value for +Area +P-Value for +Gender +N (%) +33,873 +(48.4) +36,158 (51.6) +33,668 (48.0) +36,363 (51.9) +70,031 +Mean age +41.1 ± 13.7 +41.6 ± 13.8 +42.3 ± 14.1 +40.5 ± 13.4 +41.3 ± 13.7 +< .001 +< .001 +Mean BMI +24.1 ± 4.66 +25.8 ± 4.81 +24.4 ± 4.43 +24.7 ± 5.04 +24.6 ± 4.76 +< .001 +< .001 +BMI (18.5–24.9) +60.8% +51.4% +58.0% +54.1% +55.9% +< .001 +< .001 +BMI (25–29.9) +27.9% +33.5% +30.9% +30.7% +30.8% +BMI >30 +11.3% +15.1% +11.1% +15.2% +13.2% +Mean SBP +128.4 ± +19.96 +129.3 ± 18.17 +130.4 ± 18.46 +127.5 ± 19.50 +128.9 ± 19.07 +<.001 +< .001 +Mean DBP +83.6 ± 19.34 +84.7 ± 13.50 +85.1 ± 13.35) +83.38 ± 11.36 +84.2 ± 13.33 +< .001 +.56 +Notes: Data as a mean ± standard deviation. +Abbreviations: BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure. +Mohanty et al. +165 +Categories +Normal +Prehypertension +Hypertension Stage 1 +Hypertension +Stage 2 +Hypertension +Crisis +Hypertension +Prevalence +P-Value +BMI (18.5–24.9) +57.6% +19.5% +9.6% +13.3% +0.1% +22.9% +< .001 +BMI (25–29.9) +56.0% +18.3% +10.2% +15.5% +0.2% +25.7% +BMI >30 +56.0% +18.8% +9.4% +15.7% +0.3% +25.1% +Lower SES +58.1% +18.8% +9.0% +14.0% +0.2% +23.1% +< .001 +Middle SES +59.5% +17.3% +9.3% +13.9% +0.2% +23.2% +Upper SES +64.1% +5.4% +4.2% +26.3% +0.3% +30.2% +Central +46.8% +30.4% +9.8% +12.9% +0.1% +22.7% +< .001 +East +57.2% +22.9% +10.7% +9.1% +0.1% +19.8% +J&K +53.2% +21.7% +11.1% +14.1% +0.0% +25.2% +North +65.6% +9.8% +8.3% +16.3% +0.3% +24.6% +Northeast +57.2% +18.8% +7.8% +16.2% +0.3% +24.0% +South +62.2% +13.3% +8.3% +16.2% +0.4% +24.5% +West +57.0% +15.1% +10.4% +17.5% +0.3% +27.9% +Notes: Data are represented as percentages unless otherwise indicated. +Abbreviations: BMI: body mass index; SES: socioeconomic status. +(Table 2 continued) +Table 3. Associations Between Categories of Hypertension With Characteristics of the Study Population +BP Categories +Sig. +Odds Ratio +95% Confidence Interval +Lower Bound +Upper Bound +Pre hypertension +Urban +0.13 +1.042 +0.988 +1.098 +Male +0.27 +1.030 +0.977 +1.085 +Age (35–44) +<0.001 +3.295 +2.936 +3.699 +Age (45–64) +<0.001 +2.076 +1.846 +2.334 +Age >65 +<0.001 +1.429 +1.275 +1.601 +BMI (25–29.9) +<0.001 +0.884 +0.814 +0.961 +BMI >30 +<0.001 +0.882 +0.808 +0.963 +Hypertension +Urban +0.64 +1.010 +0.968 +1.053 +Male +<0.001 +0.942 +0.903 +0.983 +Age (35–44) +<0.001 +2.309 +2.125 +2.509 +Age (45–64) +<0.001 +1.542 +1.419 +1.677 +Age >65 +<0.001 +1.117 +1.032 +1.209 +BMI (25–29.9) +0.55 +0.980 +0.917 +1.048 +BMI >30 +0.07 +0.939 +0.875 +1.007 +The prevalence of prehypertension was higher in the early +adulthood, i.e., between the ages of 18 and 34 years, which +gradually lowered with increasing age; however, the +prevalence of hypertension was contrasting to that of +prehypertension. Surprisingly, the prehypertension prevalence +was higher in individuals with a BMI of less than 25 kg/m2; +however, the prevalence of hypertension was lowest in these +adults. The central zone population had the highest +prehypertension prevalence, which was more than three times +higher than that in the north zone population of India, which +has the lowest prevalence (30.4% vs. 9.8%). The eastern +population represented the lowest prevalence of hypertension, +and the western showed the highest (19.8% vs. 27.9%). +In the regression analysis, men were significantly +associated with hypertension (OR = 0.942, CI [0.903, 0.983], +P < .005). Subjects with age ≥ 35 years were highly associated +with prehypertension (OR = 3.295, CI [2.936, 3.699], P < +.001) and hypertension (OR = 2.309, CI [2.125, 2.509], P < +.001). Participants with a BMI of more than 25 kg/m2 had a +higher association with prehypertension (between 25.0 to +29.9 kg/m2, OR = 0.884, CI [0.814, 0.961], P < .004 and >30 +kg/m2, OR = 0.882, CI [0.808, 0.963], P < .005) (Table 3). +166 +Annals of Neurosciences 27(3-4) +Discussion +The results of this nationwide cross-sectional survey +highlighted the higher prevalence of prehypertension and +hypertension in India. Prior to the initiation of the survey, we +assumed a higher prevalence of hypertension to be around +42% among non-Hispanic blacks as the impact of the new +2017 American Heart Association guidelines19 for the +diagnosis and treatment of hypertension in India.21 The +prevalence of prehypertension was 18.2% and the prevalence +of hypertension was 24.0%. Compared to the other studies,15,22 +our study had a lower prevalence of hypertension in India, +and the reason for the same can be attributed to multiple +factors. First, there was an equal distribution of males and +females and urban and rural representatives in the study +population. Second, about 57.6% of the subjects had a BMI +below 25 kg/m2. Our data were in concurrence with the +District Level Household Survey-4 and the second update of +the Annual Health Survey.14 A study conducted at All India +Institute of Medical Sciences, New Delhi reported a 65% +prevalence of hypertension among consecutive stroke patients +who were admitted between the years 2012 and 2014.23 In a +country with a population of 1.3 billion, one-sixth of the +world population, these numbers in India represent a +considerable burden of prehypertensives and hypertensives.24 +This study is the first study to use the new 2017 hypertension +classification guidelines among the Indian adults as postulated +by the American Heart Association,19 which may attribute to +the lower prehypertension (elevated BP) prevalence in our +study. As premeditated, the urban population had a higher +disease burden, but the rural areas were not far behind. +Male participants had a higher prevalence of both hypertension and +prehypertension than female participants, which is similar to +that reported by Ramakrishnan et al..,15 but the prevalence in +male subjects in our study was lower than their report. We also +observed a higher prevalence with the higher age categories, +which is in line with the previous literature.15 The elderly had +more than double the prevalence of hypertension when com- +pared to the early adulthood population. Simultaneously, the +prevalence of prehypertension was lower in the elderly and +highest in the young adults. The regression analysis revealed +that the urban population had a higher association with prehy- +pertension, the reason being the sedentary lifestyle, high-fat +diet, and lack of physical activity. Particularly males showed +a higher association with hypertension than females; however, +there was no association between males and prehypertension in +the regression analysis. +The mean BMI was 24.6 ± 4.76 kg/m2 in the overall study +population, as 60.8% of the Indian population had the ideal +body weight as per the WHO guidelines. This population had +a lower disease burden than the overweight and obese +population; however, the prehypertension was highest in this +population. Obesity was strongly associated with the +prevalence of prehypertension. The higher socioeconomic +population had a lower prevalence of prehypertension, with +the highest prevalence of hypertension. +In the current survey, to factor the cultural heterogeneity, +the country was stratified into seven zones. All states except +the eastern zone had a similar trend in the prevalence of +hypertension. The eastern zone had the lowest (19.8%) and +the western zone (28%) had the highest prevalence of +hypertension when compared to other parts of the country. +The higher prevalence of hypertension in the northern region +may be attributed to the rapid urbanization of the rural +population with consequent lifestyle changes, including the +high-fat diet and sedentariness. Similarly, the prevalence of +prehypertension was lower in the north and south zone +populations, which is in contrast to the previous study +reporting the highest prevalence in India.14,25 Jammu and +Kashmir showed a higher prevalence of hypertension as well +as prehypertension. +Homogeneous data collection, equal representation from +genders and urban and rural populations, prevalence based on +different zones, age groups, and BMI are some of the strengths +of this survey. Our study was the first study to report the +prevalence of prehypertension and hypertension in the Jammu +and Kashmir region. +This study had several limitations too. First, dietary salt +consumption, psychological stress, physical activity, +smoking status, and family history of hypertension were not +incorporated in the current analysis. Animal models and +alternate models should be tested and confirmed for new +hypertensives and its effectiveness.26–46 Second, most of the +study participants, who consented to participate in the +survey, were with ideal body weight, which may have limited +the population’s actual prevalence. Third, in the current +study, we have not taken into account the population below +the age of 19 years, which can add to the disease burden. +Fourth, we have used a standard cut off while measuring the +BP for all groups of subjects, which may be a limitation of +the current survey. +Conclusion +This study revealed that the prevalence of both prehypertension +and hypertension is alarmingly high across various zones in +India. Prehypertension was common at a younger age, +whereas the prevalence of hypertension was higher in the +older age groups. The urban population and males were +positively associated with both prehypertension and +hypertension. However, there is a need for more robust +national strategies for identifying and treating hypertension to +reduce the national and global burden of hypertension by +25% before 2025. India may follow the WHO global action +plan for the prevention of NCDs, which has advocated for +harnessing the potential of traditional and complementary +therapies because of their potentially lower costs and greater +cultural acceptability.37 +Mohanty et al. +167 +Acknowledgments +We acknowledge the Ministry of AYUSH, Government of India, +New Delhi, for funding this project. We also acknowledge the +support of CCRYN for human resources, MoHFW for supporting +the cost of investigations, and Indian Yoga Association (IYA) for +the overall project implementation. We thank the advisory research +committee, senior research fellows, Ms. Payal Sharma, Ms. Ranjana +Rana, yoga volunteers, and the President of IYA for contributing to +this project. +Declaration of Conflicting Interests +The authors declared no potential conflicts of interest with respect to +the research, authorship, and/or publication of this article. +Funding +This research was funded by Central Council for Research in Yoga +and Naturopathy (CCRYN), New Delhi (Ref F.No. 16-63/2016-17/ +CCRYN/RES/Y&D/MCT/Dated: 15.12.2016). +ORCID iD +Sriloy Mohanty + https://orcid.org/0000-0001-6981-9178 +References +1. World Health Organization. Global action plan for the preven- +tion and control of noncommunicable diseases 2013-2020. +DOI: 9789241506236. +2. Gakidou E, Afshin A, Abajobir AA, et al. Global, regional, +and cural, environmental and occupational, and metabolic risks +or clusters of risks, 1990–2016: A systematic analysis for the +Global Burden of Disease Study 2016. 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Stem Cells Dev +2012; 21(3): 448–454. diff --git a/subfolder_0/Vaidyamadham Cheriya Narayanan Namboodiri. 2010.txt b/subfolder_0/Vaidyamadham Cheriya Narayanan Namboodiri. 2010.txt new file mode 100644 index 0000000000000000000000000000000000000000..fae037ebe3c31737c73839f00df39529afdaf7fe --- /dev/null +++ b/subfolder_0/Vaidyamadham Cheriya Narayanan Namboodiri. 2010.txt @@ -0,0 +1,252 @@ +136 +Journal of Ayurveda & Integrative Medicine | April 2010 | Vol 1 | Issue 2 +Vaidyamadham Cheriya Narayanan Namboodiri +G. Rohith Kumar, S. K. Rajesh +Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India +L I F E P R O F I L E S +Vaidyamadham is one of the famous Ashthavaidya +families in Kerala, the only extant family belonging to +the Bharadwajiya group. The family is believed to have +been invited to Kerala as Shalavaidyas about 1700 years +ago to conduct Yajnas, by none other than the famous +Mezhathole Agnihotri, who conducted 99 Somayagas to +re-establish the Vedic Karma and Yagnya culture of India. +Shalavaidya is a status conferred on a family of physicians +responsible for the health of Yagnya participants. Many +past family members were Rajvaidyas (Royal Physicians) +to Kerala’s reigning families. Vaidyamadham Cheriya +Narayanan Namboodiri’s father and grandfather were both +legendary, and consulted by royalty. Even today, members +of state and central governments, political leaders, and +famous personalities from every walk of life are in touch +with the family either for consultation or for treatment. +Vaidyamadham Cheriya Narayanan Namboodiri is the +present chief Vaidya, or physician, in the family. +His grandfather, Ashtavaidyan Vaidyamadham Valiya +Narayanan Namboodiri - 1 (1882–1959), remembered by +many for his astonishing diagnostic skills and simple and +effective treatments, was expert in detecting signs of death +(Maranalakshana). His treatments had the reputation of +being 100% reliable and never failing. As a confident and +daring physician, he re-established the practice of many +complicated treatments. One was Siravedha, cutting a vein +to release impure blood, a very rare treatment. Another +was Kutipraveshikam, complete restoration of youth, which +people seem little concerned with today because of its +lengthy duration – many months. +His father, Ashtavaidyan Vaidyamadham Valiya Narayanan +Namboodiri - 2 (1912–1988), was also a legend in his own +lifetime. Sometimes referred to as the “most efficient +Ayurvedic physician ever,” he traveled the length and +breadth of India to treat patients with complicated +chronic diseases. A versatile genius who commanded the +highest respect from the leaders of every walk of life, he +also delivered lectures on Ayurveda and took part in the +discussions and seminars on the propagation of treatments +cited in Ayurvedic texts wherever he went. Due to his +extensive knowledge of Sanskrit, Vedas, Mythology, ancient +Indian culture, and classical arts, he was known as a “living +encyclopedia.” +Family history anecdotally recalls famous occasions and +incidents illustrating legendary skills of their forbears told +through the generations. One such, illustrating Ayurveda’s +extraordinary powers in the hands of its greatest exponents, +concerns the birth of Pareekshith Thampuran, a noted +scholar, and one of Kerala’s most celebrated rulers. Delivery +problems had brought both mother and child’s lives into +mortal danger. The then Vaidyamadham fortunately arrived +at the scene. After obtaining consent from the king, he +selected herbs from the palace courtyard and ground them +into paste, making two medicines. These he applied to +opposite sides of a wooden board, instructing the midwife +to expose one side of the board to the queen’s delivery +channel till birth was complete, and then immediately +to reverse the board, as otherwise all her internal parts +would prolapse resulting in her death; no medicine was +applied externally or taken internally. The child was named +Pareekshith (Pareeksha means “daring experiment”) because +of these circumstances surrounding his birth. +Address for correspondence: +Dr. S. K. Rajesh, SVYASA, Prashantikutiram, Jigani, +Bangalore - 562 106, India. E-mail: rajesheskay@yahoo.co.in +Received: 12-Apr-2010 +Revised: 19-Apr-2010 +Accepted: 26-Apr-2010 +DOI: 10.4103/0975-9476.65093 +Shri Vaidyamadham Cheriya Narayanan Namboodiri +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ -XO\   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Journal of Ayurveda & Integrative Medicine | April 2010 | Vol 1 | Issue 2 +137 +Vaidyamadham Cheriya Narayanan Namboodiri was born +on 10th April 1930 and recently had his 80th birthday (28th +March 2010, as per the Indian Lunar Calendar, Pooram +Nakshatram) for which we offer him the greatest felicitations, +and congratulations on reaching his 9th decade. He studied +Sanskrit under two famous pundits – Vidvan Kalakkathu +Raman Nambiar and Vaishravanath Rama Namboodiri – as +the basis for his studies of Ayurveda, which he began at +the age of 20, under his grandfather, Vaidyamadham Valiya +Narayanan Namboodiri - 1. For clinical study, he attended +Vaidhyamadham Vaidhyashala and Nursing Home, or V.N. +Vaidyashala as it used to be called before 1981. By the time +his grandfather passed on in 1959, he was a fully qualified +practitioner of Ayurveda. In 1982, as a tribute to his +grandfather’s memory, he established the Vaidyamadham +Valiya Narayanan Namboodiri Dakshinamoorthy Trust, +established with the aims of providing the needy with +medical care; rehabilitation of physically and mentally ill +persons; creating Ayurveda research facilities; imparting +intensive training in different branches of Ayurveda; +gathering and maintaining old Ayurveda manuscripts; and +setting up a library of Ayurvedic books. +Working with his father and grandfather brought +remarkable experiences. For example, in the 1950s, he +witnessed Kuti Praveshika Chikithsa, the famous treatment +using rasayanas to reverse ageing and counteract disease, +particularly the former, carried out under their supervision. +Today, scientific medicine has realized the tremendous +potential market for reversing ageing processes and is trying +to develop anti-ageing medicines. Here in Ayurveda there is +an ancient tradition of the process, and it is still practiced +as originally laid out in ancient texts like Charaka Samhita +and Ashthanga Hridaya. +His father and grandfather were the major influences in his +clinical training. On one occasion, Chembai Vaidyanatha +Bhagavatar, the famous vocalist musician, lost his voice +completely and was unable to sing a note. Vaidyamadham's +father, Vaidyamadham Valiya Narayan Namboodiri - 2, +treated him and cured the problem. +As a physician, Cheriya Narayanan Namboodiri possesses +remarkable abilities, so deeply embedded as to be traits +of his practice, e.g., he is one of those Vaidyas who are +able to diagnose most conditions on sight, just by looking +at the patient. Of all health conditions, which he regularly +treats, his greatest and most consistent successes have +come in treating Arthritis, a field in which he stands apart, +and has consequently gained the greatest reputation. His +treatments are said to unfailingly bring patients solace +and relief. +On one occasion, a case from a medical college diagnosed +as esophageal cancer was sent to him. Severe vomiting +prevented the patient from eating or drinking. It was a +challenging case because in Ayurveda, most medicines are +administered orally. The patient was advised to take 5 to 6 +drops medicine hourly – slowly the vomiting stopped to a +certain extent. At the next consultation, he prescribed sputa +kashaya. To take that kashaya (decoction) several do’s and +don’ts must be followed: no salt, only to drink hot water, +milk, sugar, green gram are only permitted. After sometime +on this medicine, prepared specially and specifically for this +patient, the disease was cured. +On another occasion, he was called to treat the late +Thirunavai Moos, a famous Ayurvedic physician, for a +stomach disease. When he arrived, his patient was not +even responding to questions, but he was able to make a +diagnosis anyway: early symptoms of paralysis and blockage +of Apana Vayu. With great effort, he was able to give the +patient a medicine enabling him to take food, which he +had been unable to do for the previous 48 hours. When +Sri Thirunavai Moos was almost cured, he enquired what +his disease had been, but VMC Narayanan Namboodiri +kept silent, so the patient started to share his treatment +experiences. He advised VMC Namboodiri to practice +Aswini Gayatri Mantra, the prayer to the Ashwins, the +divine physicians to the Devas, practice of which frees a +physician from all mistakes when treating. +As a physician and humanitarian, VMC Namboodiri is +one of today’s great luminaries in Ayurveda, a Vaidya +whose thoughts and guiding principles continue to sustain +its popularity, and acceptance as a unique way of life +aimed at achieving Swasthya, perfect health, not just as an +alternative mode of treatment. He has uplifted the Ayurveda +system by strictly following traditional practice without any +compromise. The Panchakarma unit in Vaidyamadam closes +in the summer season for about one and half months during +April–May reopening when the rains start in June. He refuses +to prescribe Panchakarma treatment during the hot season +because it is difficult for patients to withstand purificatory +treatments at that time. Therefore, he would have to +compromise their treatment, which he is not willing to do. +Many patients coming to Vaidyamadham want to stay in +the nursing home immediately, and take Panchakarma and +related treatments. But VMC Narayanan Namboothiri +suggests that patients should take medicine for 1 or 2 +months’ preliminary treatment, during which the vaidya +can gain a more subtle understanding of each case. Based +on that, further treatments are decided. +With respect to modernizing Ayurveda, Cheriya Narayanan +Namboodiri is fully aware of the challenges that Ayurveda +faces in making its practice and theory accepted today. In +Kumar and Rajesh: Vaidyamadham Cheriya Narayanan Namboodiri +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ -XO\   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +138 +Journal of Ayurveda & Integrative Medicine | April 2010 | Vol 1 | Issue 2 +his own domain, he has been instrumental in modernizing +the Vaidyasala (pharmacy) and Nursing Home founded by +his Grandfather, and expanding them to their present form +and style. The pharmacy now has a unit for the production +of medicines. These are prepared in strict adherence to +the principles and procedures prescribed in Ayurveda +texts. More than 700 kinds of medicine are prepared at +the Vaidyamadham pharmacy. +Another project of great value to the practice of Ayurveda +came when he set up a botanical garden of rare herbs +and plants. Today, the herbarium has over 100 species of +medicinal plants. Current plans are to build traditionally +styled cottages inside the herbarium for visitors to see this +side of Ayurveda, especially tourists and others interested +in its nuances. In such projects, Cheriya Narayanan +Namboodiri consistently upholds family values and +principles to meet desired objectives. He consciously stands +for both tradition and modernity. +Vaidyamadham Cheriya Narayanan Namboodiri has written +and translated many books, for example, two collections +of articles appearing in local newspapers and magazines, +The Tradition of Ayurveda in Kerala and Longevity in Ayurveda, +the latter being combined with accounts of presentations +in Ayurveda seminars; in Chikitsa Anubhavam, a set of +case histories, “Experiences of Treating Patients through +Ayurveda” is the story of a challenging case of multiple +sclerosis. Family members of a patient came with great +faith in him, despite having been told by the doctors that +Ayurvedic medicine or oil would have negative effects. +His Ayurvedic diagnosis was “Sarvangavata with Avarana +Swabhava,” obstruction causing “Ama Avasta,” a toxic +condition. After giving appropriate medicine, he was slowly +able to withdraw steroids. Although still bedridden, the +patient improved so that at the end of 3 months, she was +able to get up and carry on her daily activities. She then +received in-patient treatment which led to another 80% +relief; she further continued taking medicine for a longer +period and is now restored to health. +Other books include translations into Malayalam of the first +14 chapters of the Ashtangahridaya, entitled Ayurvedathinte +Prathama Padhangal meaning “The Fundamentals of +Ayurveda”; the famous “Palakapyam” treatise on Ayurvedic +treatments for Elephants, entitled Hastiayurvedam; the Garga +Bhagavatam; and the Adhyatma Ramayana – the spiritual +version of that great work. On his 70th birthday, Ayurvedavum +Deerghayussum, a collection of essays on “Ayurveda for +Longevity” was published. His latest book, Albathille +Ormakal, “An Album of Memories,” appeared in 2009, a +witness to the marvelous preservation of health and faculties +attending those who practice Ayurveda as a way of life. +Vaidyamadham Cheriya Narayan Namboodiri has many +recognitions and awards to his credit. His two most +recent major awards have been the Vazhakunnum Award +in 2009, and this year in 2010, The Kerala government’s +“Ayurveda Acharya” award for contributions to the field +of Ayurveda. In conclusion, we offer sincere felicitations +to Vaidyamadham Cheriya Narayan Namboodiri on +the occasion of his 80th birthday, and wish him many +more years of life in health, happiness, and continued +productivity. +Kumar and Rajesh: Vaidyamadham Cheriya Narayanan Namboodiri +Dispatch and return notification by E-mail + +The journal now sends email notification to its members on dispatch of a print issue. The notification is sent to those members who have provided +their email address to the association/journal office. The email alerts you about an outdated address and return of issue due to incomplete/incorrect +address. +If you wish to receive such email notification, please send your email along with the membership number and full mailing address to the editorial +office by email. +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ -XO\   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO diff --git a/subfolder_0/Variations in microbial growth rates explained by traditional knowledge.txt b/subfolder_0/Variations in microbial growth rates explained by traditional knowledge.txt new file mode 100644 index 0000000000000000000000000000000000000000..0728dea5f5d40934d27d4ddb16899fe6bbe35a44 --- /dev/null +++ b/subfolder_0/Variations in microbial growth rates explained by traditional knowledge.txt @@ -0,0 +1,457 @@ +33 +© 2020 International Journal of Yoga - Philosophy, Psychology and Parapsychology | Published by Wolters Kluwer - Medknow +Background: Modern scientific methods have been used to test and verify +statements in the ancient Vedic literature. Jyotisha astrology Navagrahas have +been observed to influence results of microbiological processes. Aims and +Objectives: To extend previous work by investigating exponential phase growth +in easily repeatable growth experiments. Materials and Methods: 150 growth +curves of a non-pathogenic E. coli strain were generated for 72 start times over +an 18-month period, using OD-600 spectrophotometer measurements. Results: +Variations in maximum exponential phase growth correlated negatively with Kuja +(Mars) Shadbala, R2 was 0.20, P < 0.0005. Discussion: Previous research found +that Jupiter and Rahu consistently exerted opposing influences. Consistent with +Jyotisha tradition, Jupiter supported life, while Rahu opposed it. Kuja is malefic +like Rahu. The study suggests that he plays a similar role thwarting life processes. +Conclusion: Kuja’s role opposing microorganism growth seems similar to Rahu’s, +consistent with their common malefic nature posited by Jyotisha. +Keywords: Jyotisha, Kuja, maximum exponential phase, microbial growth, +Shadbala +Submission: 27-04-2019, +Revision: 11-07-2019, +Acceptance: 03-12-2019, +Publication: 28-01-2020 +Variations in Microbial Growth Rates Explained by Traditional Knowledge +Prabhakar Vegaraju, Alex Hankey, Ramesh Mavathur1 +Access this article online +Quick Response Code: +Website: www.ijoyppp.org +DOI: 10.4103/ijny.ijoyppp_3_19 +Address for correspondence: Prof. Alex Hankey, +Department of Yoga and Physical Science, Swami Vivekananda +Yoga Anusandhana Samsthana University, Prashanti Kutiram +Campus, Kallubalu Post, Jigani, Bengaluru ‑ 560 105, +Karnataka, India. + +E‑mail: alexhankey@gmail.com +Guru  (Jupiter), Sukra  (Venus), Sani  (Saturn), and Rahu +and Ketu (North and South Nodes of the Moon). The first +seven luminous bodies, usually visible in the night sky, +are known as the Sapta (seven) Grahas, whereas the last +two are known as shadowy Grahas, also as “sensitive +points.” Being invisible, their precise locations must be +computed by mathematical calculations. +Previous experiments designed by Dr.  Rameshrao N. +for his PhD thesis at S‑VYASA obtained revolutionary +results showing that certain Grahas strongly influence +vaccine production and vaccination processes in small +ruminants.[12,13] Graha Guru, Jupiter, was observed to +enhance cell growth and vaccination effectiveness. Rahu +Original Article +Introduction +O +ne of the aims of the author’s institution is to +identify statements in sections of the ancient +Vedic literature such as Yoga and Vedanta, for use as +conjectures that can be tested by scientific experiments. +Many aspects of Yoga[1] have been so tested. Its medical +applications,[2‑6] such as asthma,[2] depression,[3] other +mental illness,[4] lower back pain,[5] and childbirth,[6] +have proved, especially fruitful. So have similar tests +of Ayurveda[7] programs. Ayurveda, literally “biology,” +is the Vedic science of medicine, forming a system of +preventive medicine,[8] ideal for integrative practice.[9] +Such systems, when properly understood, can expand our +understanding of biology.[10] One such ancient science +is Jyotisha,[11] a sidereal system of astrology taking +the fixed stars as its points of reference, thus differing +fundamentally from the western system of astrology. +Jyotisha takes into consideration nine planetary bodies, +known as the Nava  (nine) Grahas: Surya  (Sun), +Chandra  (Moon), Kuja  (Mars), Budha  (Mercury), +Departments of Yoga and +Physical Sciences and +1Yoga and Life Sciences, +Swami Vivekananda Yoga +Anusandhana Samsthana +University, Prashanti +Kutiram Campus, Bengaluru, +Karnataka, India +This is an open access journal, and articles are distributed under the terms of the +Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows +others to remix, tweak, and build upon the work non‑commercially, as long as +appropriate credit is given and the new creations are licensed under the identical +terms. +For reprints contact: reprints@medknow.com +How to cite this article: Vegaraju P, Hankey A, Mavathur R. Variations +in microbial growth rates explained by traditional knowledge. Int J +Yoga - Philosop Psychol Parapsychol 2020;8:33-7. +Abstract +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Prabhakar, et al.: Microbial growth & jyotisha astrology +34 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 8  ¦  Issue 1  ¦  January‑June 2020 +weakened both, whereas the influence of Chandra, the +Moon, was to increase growth and neutralize the adverse +effects of Rahu. Those experiments were conducted +under the supervision of the Bangalore Veterinary +College, with vaccine production runs mostly performed +at its Institute for Animal Health and Veterinary +Biology  (IAH and VB). The latter experiments only +observed end points of growth processes, however, +raising the question of how, if at all, planetary bodies +may influence details of the growth curves. +In 2015, new experiments were, therefore, proposed, +with the aim of determining which, if any, of the nine +Navagrahas may directly influence growth curves. Since +the traditional texts give no indication which graha +might do so, the research hypothesis was very general, +namely that one or more of the Navagrahas would +influence exponential growth rate of the bacterium +selected for these experiments. +The main aim of the experiments was, therefore, +to investigate the commonly observed variations in +bacterial growth rates, which, though currently accepted +as normal, are anomalous and never discussed in +microbiology. The objective was to determine how +much can be attributed to quantifiable parameters in +Jyotisha astrology. More precisely, since the previous +experiments had shown that time of innoculation (TOI) +of the main growth flask represents an acceptable +Jyotisha muhurta  (the time at which to make detailed +Jyotisha predictions), the new experiments also used +the TOIs of the main growth flasks as the Lagna +muhurtas, i.e., the starting time of the process for which +Jyotisha predictions are tested. The predictions utilized +the Shadbala of the Saptagrahas, the strength of each +luminous planet, made up of six, Shat, components. +A  Graha’s overall strength is called its Shadbala  (the +nodes of the moon are not attributed Shadbalas). +Utilizing a nonpathogenic strain of Escherichia coli, the +experiments correlated variations in exponential growth +rates with variations in Shadbalas of Saptagrahas for +the growth curves. This article presents its results. +Methods +A nonpathogenic E. coli was selected, and 72 growth +curves generated over the period, February, 2017, +to August, 2018. As previously, time of main flask +inoculation was taken as the Jyotisha Muhurta. The +microorganism utilized was E.  coli strain, K‑12 MG +1655, obtained from the National Centre for Biological +Sciences, Bengaluru, and kept in glycerol stock +at  −80°C. It was grown in preautoclaved Luria broth +medium (catalog no. M575‑500G, HiMedia Laboratories +Pvt. Ltd., Mumbai, Maharashtra, India) held at 37°C +in a 180  rpm incubator‑cum‑shaker  (Model: 116736, +GeNei™, Mumbai, Maharashtra, India). In preparation, +first, the E.  coli K12‑MG 1655 in glycerol stock was +streaked onto preautoclaved YT agar plates (catalog no. +G032‑500G, HiMedia Laboratories Pvt. Ltd., Mumbai, +Maharashtra, India) and incubated overnight at 37°C and +stored for immediate future use within 3 days. +Furthermore, in preparation, containers to be used +were preautoclaved containing the correct amount of +Luria broth. First, 50  ml portions of distilled water +were taken and mixed with 1  g Luria broth powder. +These were put directly into 250ml conical flasks +(Catalogue no. 4980021, Borosil Glass Works Ltd, +Mumbai, Maharashtra, India) for use as main culture, +or main culture blank control. In addition, 3 ml +portions were placed in 15ml falcon tubes (Catalogue +no. 546021, Tarsons Products Pvt Ltd, Kolkata, West +Bengal, India).  All such prepared containers were then +autoclaved at 120°C and 15 bar pressure for 30 min. Ten +or more falcon tubes would be prepared at one time in +this way and stored for later use. +The next day, a preculture was made by inoculating +one of the preautoclaved falcon tubes with a single +colony from the streaked YT agar plate and incubating +it overnight at 37°C, starting some 12–14  h before the +intended Muhurta. This preculture was then used to +inoculate a preautoclaved 250‑ml conical flask with its +50 ml Luria medium, as the main culture for that growth +experiment. Each step of this process also incorporated +a preautoclaved blank control, verifying that without +adding E.  coli, growth was not observed: for step one, +a blank YT agar plate; for step two, a blank 15‑ml +falcon tube with its 3 ml Luria broth; and for step three, +a blank 50  ml Luria broth in its 250‑ml flat‑bottomed +conical flask. +The starting optical density  (OD) of the main cultures +was set at 0.002 at 600  nm, by measuring the OD +600  (using Thermo Scientific™ NanoDrop 2000c, +Wilmington, USA) of the preculture and calculating and +applying required dilution factors. The main culture was +incubated in the same shaker‑cum‑incubator maintained +at 37°C and 180  rpm. Each day that experiments were +Table 1: Gives general indications of the kind of +consideration used in precise calculations of each of the +six balas +1. Sthana Bala (positional): For positional strengths +2. Dig Bala (directional): According to direction in sky +3. Kala Bala (temporal): According to time of day +4. Cheshta Bala (motional): Prograde, stationary, retrograde +5. Naisargika Bala (natural): Fixed; does not change +6. Drik Bala (aspectual): Aspects by other grahas +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Prabhakar, et al.: Microbial growth & jyotisha astrology +35 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 8  ¦  Issue 1  ¦  January‑June 2020 +run, two or three growth curves were generated for +different main culture inoculation time Muhurtas, TOIs. +In this way, growth curves were generated for 72 TOIs. +Data extraction: OD 600 measurements were taken at +specified time points  (0, 60, 120, 150, 180, 210, 240, +300, and 360  min, after Muhurta) using 1  ml aliquots +from the culture. +Jyotisha Shadbalas for each growth curve: the six +constituent balas making up Shadbalas of each +Saptagraha for each muhurta are set out in Table  1 +(Chapter 27, “Evaluation of Strengths”, p. 263), together +with the name of the Santhanam textbook, which +presents formulae given in Brihat Parashara Hora +Shastra (BPHS), our main Jyotisha reference text.[11] +In +addition, +details +of +Lagna  +(rising +sign), +Nakshatra (star constellation), Trihi (day of the 15 days +lunar fortnight), Vara  (week day), and Yoga  (special +planetary conjunctions) are required. This enables +Shadbalas of the Saptagrahas to be calculated. This +experiment’s full report will provide computed data for +the Saptagraha Shadbalas for each muhurta. +Data analysis used  SPSS 21.0 (Statistical Package for +Social Sciences, IBM). OD 600 data were entered in +LibreOffice Calc Spreadsheets under Ubuntu (Linux) to +generate each growth curve, measurement times forming +abscissae, and OD values, ordinates [Figure 1]. +Steepest slopes (occurring between 180 min and 360 min) +were computed using the spreadsheet function to calculate +the gradient of the best‑fit line for the five time points at +180, 210, 240, 300, and 360 min. The mean and standard +deviation were calculated for both trend‑line gradients and +shadbalas; four outliers with distances from means  >2.5 +standard deviations were removed: the two with the +smallest slopes and the two with the largest Shadbalas. +The number of growth curves was thus reduced to 68. +Armed with the best‑fit trend lines, correlations between +them, and the Saptgraha Shadbalas were calculated for +the final set of growth curves. +Results +In this brief account of the experiment, we only give the +strongest correlation value. +The strongest correlation, R2 = 0.201, with P < 0.0005, +was for Kuja  (Mars)  [Figure  2]. This Kuja Shadbala +correlation was by far the most significant – sufficiently +so to report as a standalone result; particularly, as a +simple interpretation of it can be presented. Other planets +showed far weaker trends contributing to an overall +statistical model. Analysis of the combined effects will +be reported in a full account of the experiment. +Discussion +The value of the correlation between the mean slopes +of exponential phase growth and the Kuja Shadbala +suggests that Kuja accounts for 20% of the observed +variance. That naturally raises the question, “To what +can be attributed the other 80%?” Further analysis +of the data shows that  (1) a large fraction is intrinsic +and is present among growth curves started at the +same time;  (2) the other six Saptagrahas have lesser +correlations, but nevertheless take up a further fraction +of the variance; and  (3) so does another condition: the +presence of Rahu (the north node) in Lagna, as a number +of TOI muhurtas selected. Unlike the Upagrahas, for +example, Mandi or Gulika, the outer planets, Uranus, +Neptune, and Pluto, are not considered by traditional +Jyotisha as laid out in BPHS, as they are not visible to +the naked eye. However, they are widely accepted to +exert significant influences on people’s lives. Thus, they +should also exert some influence in our experiments; +so also should eclipses, the other condition extensively +investigated by Dr. Rameshrao N. +Results reported here are qualitatively different from +those on vaccine productions runs at IAH and VB.[12,13] +Those experiments reported microbial growth in terms +Figure  1: Model bacterial growth curve illustrating main phases, +Exponential phase, Deceleration phase, and Saturation phase +Figure 2: Scatter plot of trendline versus Kuja Shadbala for sixty‑eight +growth curves. The line of regression in the scatter plot indicates the way +that Kuja Graha influences cell growth +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Prabhakar, et al.: Microbial growth & jyotisha astrology +36 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 8  ¦  Issue 1  ¦  January‑June 2020 +of final vaccine output measured by nephelometric +turbidity or cell mass index. Most involved multiple +production runs on the same day; many on several days, +spaced out over 10 days or so.[12] They demonstrated that +Jupiter increases bacterial growth and decreases virus +propagation,[12] whereas Rahu, the north node of the +Moon, does the opposite, increasing virus propagation +rates and inhibiting bacterial growth.[12] For both bacteria +and viruses, the presence of a strong moon tended +to negate the effect of the north node. Significance +levels were extreme: P was less than one‑in‑a‑million, +P  ≤  10−6, for all experiments; for some, far better.[12] +Cumulative significance over the eight experiments was +P  ≤  10  −65.[12] Four concerned solar eclipses, which +were observed to strongly increase virus production.[13] +Cumulative significance over the eight experiments was +P ≤ 10 −65.[12] +Some opine that Dr.  Rameshrao’s results were +conclusive. Microbiologists should not doubt the +observed +effects, +no +matter +the +understandable +skepticism that they may bring to the experimental +hypothesis. Interestingly, influences of Jupiter and the +north node were consistently opposed to each other: +Jupiter was prolife, whereas the north node was inimical +to it, agreeing with the ancient texts.[11] The experiments’ +success led to the framing of a rigorous scientific theory +of how planets can influence cellular processes based on +quantum astrophysics and complexity biology.[14] +That earlier research was based on study hypotheses +aimed at obtaining support for statements in the +traditional Jyotisha literature, which were treated as +conjectures to be tested by experiment. They, thus, offer +empirical evidence for influences on microbial growth +by Jyotisha Grahas in the rising sign at TOI. All that +research suggested that planetary bodies influence +single‑cell processes. The proposed physics[12,14] is +quite simple and is based on the complexity biology +result that all biological processes are regulated from +criticality, i.e., critical instability, a condition sensitive +to systems with which they are correlated. Jyotisha +Grahas all embody high levels of quantum correlations +dating from their formation, including the nodes of +the moon. Constructing a physical theory of how +Grahas can influence regulation of organisms is quite +straightforward.[12,14] +High variability is always seen in vaccine production +runs, even those carried out under stringent conditions +specified in vaccine production manuals published by +authorities such as Merck Corp.  (www.merckmanuals. +com/vet/generalized_conditions/clostridial‑diseases/ +black +leg +Accessed +2019.04.10) +or +Terrestrial +Manual +OIE  +(http://www.oie.int/standard‑setting/ +terrestrial‑manual/access‑online/Accessed +2019.04.10) +The current theory of such variations[15] is that they +depend on “Small Numbers of Large Molecules.” +However, for growth processes, such a theory is a +nonstarter. Each organism varies independently; so, the +large numbers of organisms involved, usually more than +108, would reduce the original variance by the square +root of the number of organisms, i.e., by at least 10−4. +Reducing variations by a factor of 104 would clearly +leave little residual variance in growth rates to be +observed. +The previous experiments’ results may be summarized +by stating that they supported the roles traditionally +attributed to Guru and Rahu. Here, a completely new +correlation has emerged that between exponential phase +growth rate and the Shadbala of Kuja (Mars), a scientific +discovery in its own right. +The innovative vision of these recent experiments is +the relevance of the time, space, and consciousness +dimension embodied in Jyotisha astrology, which is +a higher dimension than those so far incorporated +in modern bioscience. The result gives rise to the +question: How does it fit in with the roles traditionally +attributed to Kuja, a naturally malefic Graha? Although +the general role of Kuja is a natural leader, his malefic +nature can cause problems to life and inflict great +harm.[11] Evidently, the latter property manifests here. +during maximum exponential phase growth, Kuja +Shadbala reduces growth curve gradients. +Conclusion +This novel result, though a Post hoc discovery, fits +information about the nature of Kuja from India’s +ancient Jyotisha tradition. He is genuinely malefic and +that quality applies to competitive growth processes in +challenging environments. This insight, together with its +intuitive explanation, seems an important result of the +present experiment. It is consistent with the day‑to‑day +practice of many traditionally minded Indians today, +who avoid undertaking important activities on Tuesdays, +Mangalwara, because Kuja is Lord of the Day, and his +influence is significantly increased and felt. +Acknowledgments +We should like to acknowledge the advice and help of +Dr.  Rameshrao N., Dr.  Ragavendra Samy, and Dr  Judu +Ilavarasu, and the support of Dr.  H. R. Nagendra, +Chancellor, S‑VYASA. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] +Prabhakar, et al.: Microbial growth & jyotisha astrology +37 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 8  ¦  Issue 1  ¦  January‑June 2020 +References +1. +Patanjali M. Yoga Sutras (Shearer A. Trans. The Yoga Sutras of +Patanjali.). London: Crown Publishing; 2010. +2. +Nagarathna  R, Nagendra  HR. 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Science 2002;297:1129‑31. +[Downloaded free from http://www.ijoyppp.org on Saturday, January 23, 2021, IP: 136.232.192.146] diff --git "a/subfolder_0/Voluntarily induced vomiting\342\200\223A yoga technique to enhance pulmonary functions in healthy humans.txt" "b/subfolder_0/Voluntarily induced vomiting\342\200\223A yoga technique to enhance pulmonary functions in healthy humans.txt" new file mode 100644 index 0000000000000000000000000000000000000000..639da39f252a5573ac77002c6692122228f7717a --- /dev/null +++ "b/subfolder_0/Voluntarily induced vomiting\342\200\223A yoga technique to enhance pulmonary functions in healthy humans.txt" @@ -0,0 +1,491 @@ +Short Communication +Voluntarily induced vomiting e A yoga technique to enhance +pulmonary functions in healthy humans +Ragavendrasamy Balakrishnan*, Ramesh Mavathur Nanjundaiah, +Nandi Krishnamurthy Manjunath +Anvesana Research Laboratories, S-VYASA University, India +a r t i c l e i n f o +Article history: +Received 6 January 2017 +Received in revised form +22 July 2017 +Accepted 22 July 2017 +Available online xxx +Keywords: +Kunjala Kriya +Voluntarily induced vomiting +Pulmonary functions +Yoga +Kriya +a b s t r a c t +Vomiting is a complex autonomic reflex orchestrated by several neurological centres in the brain. Vagus, +the cranial nerve plays a key role in regulation of vomiting. Kunjal Kriya (Voluntarily Induced Vomiting), +is a yogic cleansing technique which involves voluntarily inducing vomiting after drinking saline water +(5%) on empty stomach. This study was designed with an objective to understand the effect of voluntary +induced vomiting (ViV) on pulmonary functions in experienced practitioners and novices and derive its +possible therapeutic applications. Eighteen healthy individuals volunteered for the study of which nine +had prior experience of ViV while nine did not. Pulmonary function tests were performed before and +after 10 min of rest following ViV. Analysis of Covariance was performed adjusted for gender and baseline +values. No significant changes were observed across genders. The results of the present study suggest a +significant increase in Slow Vital Capacity [F(1,13) ¼ 5.699; p ¼ 0.03] and Forced Inspiratory Volume in 1st +Second [p ¼ 0.02] and reduction in Expiratory Reserve Volume [F(1,13) ¼ 5.029; p ¼ 0.04] and Respiratory +Rate [F(1,13) ¼ 3.244, p ¼ 0.09]. These changes suggest the possible role of ViV in enhancing the endurance +of the respiratory muscles, decreased airway resistance, better emptying of lungs and vagal predomi- +nance respectively. We conclude that ViV when practiced regularly enhances the endurance of the +respiratory muscles and decreases airway resistance. These findings also indicate need for scientific +understanding of ViV in the management of motion sickness and restrictive pulmonary disorders like +bronchitis and bronchial asthma. +© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services by +Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ +licenses/by-nc-nd/4.0/). +1. Introduction +Yoga is a comprehensive lifestyle practice which involves +practices for the body, mind and the intellect through physical +postures +(asanas), +voluntary +breath +regulation +(pranayama), +cleansing practices (kriya) and meditation (dhyana). Yoga is being +practiced in India since thousands of years. Studies have estab- +lished the therapeutic benefit of Yoga practices irrespective of an +individual being obese [1], hypertensive [2,3], diabetic [4] or even +suffering from cancer [5,6]. Yoga practices are efficacious in not +only regulating the autonomic nervous system but also beneficially +regulating the gene expressions [7]. With all the available evidence +to possibly suggest Yoga as a non-pharmacological intervention for +several lifestyle diseases and non-communicable diseases, the basic +underlying mechanism of several practices remains unexplored. +This study aims to understand the physiological adaptation of +pulmonary functions following Kunjal Kriya (voluntarily induced +vomiting e ViV), a yogic cleansing technique in experienced and +novice practitioners. There is no published scientific literature +available documenting safety and psycho-physiological effects of +ViV until date, making the present study as a novel effort. Despite +the practice being observed as ‘involving considerable risk’ by the +modern medical professionals, the safety of its practice is time +tested and no complications have been reported. +Hatha Yoga Pradipika, an ancient Yoga scripture describes Kunjal +Kriya (Voluntarily Induced Vomiting e ViV) as one of the six +cleansing techniques to clean the body and regulate the mind [8]. +Following practice of ViV, subjectively, an individual feels empti- +ness of stomach. Traditional practitioners suggest acute fever, +visceral +infection, +hernia +and +cardiovascular +disorders +as +contraindications for the practice. Gherenda Samhita, an ancient +* Corresponding author. +E-mail address: ragavendrasamy.b@svyasa.org (R. Balakrishnan). +Peer review under responsibility of Transdisciplinary University, Bangalore. +Contents lists available at ScienceDirect +Journal of Ayurveda and Integrative Medicine +journal homepage: http://elsevier.com/locate/jaim +http://dx.doi.org/10.1016/j.jaim.2017.07.001 +0975-9476/© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services by Elsevier B.V. This is an open access article under the CC +BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). +Journal of Ayurveda and Integrative Medicine xxx (2017) 1e4 +Please cite this article in press as: Balakrishnan R, et al., Voluntarily induced vomiting e A yoga technique to enhance pulmonary functions in +healthy humans, J Ayurveda Integr Med (2017), http://dx.doi.org/10.1016/j.jaim.2017.07.001 +treatise on Yoga claims that this practice when performed everyday +can cure ailments of liver and spleen [9]. +Vomiting, a survival mechanism conserved during evolution in +humans and several organisms is understood to be one of the most +complex autonomic reflex orchestrated by several neurological +centres in the brain. The stimulus is manifested as an orderly +response through excessive salivation, inhibition of normal gastric +motility, retro-peristaltic movement, relaxation of lower esopha- +geal +sphincter, +tachycardia, +sweating, +breath +retention +and +contraction of abdominal and thoracic muscles. Despite vomiting +being one of the most common clinical sign, understanding its +neurobiology and relevance in maintaining is incomplete. Current +understanding states, vagus as the key moderator of vomiting, +manifested in strict co-ordination of nucleus tractus solitarius with +area postrema, brainstem vestibular centres, sensory and emotional +areas and several other areas of the brain [10]. +ViV is a common practice observed in patients suffering from +bulimia apart from their laxative abuse, and diuretic abuse driven +by distorted body-image perception. Complications of repeated ViV +include dental erosion and discolouration of teeth. Due to the acidic +contents coming in contact with the oesophagus, pharynx and +oropharynx, symptoms of hoarseness, sore throat, dry cough, and +difficulty in swallowing are reported [11]. +ViV immediately after food has been viewed as a psychiatric +illness. Ancient Yogic literature recommends practice of ViV +following consumption of saline water in empty stomach to be +therapeutically beneficial. Hence, this study was designed with an +objective to document the safety of its practice and possibly explore +a mechanism of action of ViV from the perspective of Yoga +practices. +2. Materials and methods +A flyer was displayed in the classrooms of undergraduate +naturopathy and yoga medical students regarding the study. +Participants were recruited after obtaining a written informed +consent. Eighteen volunteers were recruited into two groups: +Novices and Experienced group. All participants were informed +about the study and a written informed consent was obtained. All +volunteers recruited for the study were reported to be healthy. +Emergency medical treatment facility was available to address any +unanticipated complications. The experimental and novices group +consisted of nine individuals in each group with age of 19.2 ± 0.9 +years and 19.6 ± 0.7 years respectively. Volunteers having expe- +rience of performing ViV for more than four times were recruited +in the experienced group. There were 5 men and 4 women and 7 +men and 2 women in the experienced and novices groups +respectively. +The practice of ViV involves drinking warm saline water (5%) in +the morning on an empty stomach, sitting in squatting position +until the individual feels a sense of fullness or nausea. The indi- +vidual is then recommended to stand and bend forward from the +low back and voluntarily trigger vomiting by gently touching the +root of the tongue and uvula. It is observed that with practice, +triggering the vomit may be required once or not at all whereas, in +novices, it is required to trigger three to four times until most of the +consumed water is vomited out. The participants rested in supine +position and voluntarily relaxed the entire body for 10 min +following vomiting. Pulmonary function tests were performed as +per standard guidelines [12] immediately before and after the +practice of ViV using Schiller Spirovit SP-1 system. +Analysis of co-variance (ANCOVA) was performed to understand +the between group changes, adjusted for the baseline values and +gender. Body Mass Index (BMI) was not considered as a covariate in +our study as all the volunteers in both groups were having a BMI of +20.1 ± 0.4 kg/m2. There was no significant difference observed +amongst the genders. +3. Results +The slow vital capacity [F(1,13) ¼ 5.699; p ¼ 0.03] increased in +experienced group as compared to the novices. Within group +comparison showed a contrasting change with a significant in- +crease in slow vital capacity (SVC) in experienced group (p ¼ 0.01) +as compared to the significant reduction observed in the novices +(p ¼ 0.02). Expiratory reserve volume (ERV) [F(1,13) ¼ 5.029; +p ¼ 0.04] decreased significantly in novices as compared to a non- +significant increase in experienced practitioners. Within group +comparison indicated a significant reduction in ERV in novices +(p ¼ 0.04) while no change was observed in the experienced group. +A reduction in respiratory rate (RR) was observed in both experi- +enced (p ¼ 0.01) and novices (p ¼ 0.03), with the extent of +reduction being greater in the experienced group [F(1,13) ¼ 3.244, +p ¼ 0.09]. A significant increase in Forced Inspiratory Volume in +first second (FIV1) was observed in experienced group (p ¼ 0.02) +(Table 1). +Table 1 +Table represents the Mean ± SD of the lung volumes measured in experienced and novices before and 10 min after ViV. +Variables +Experienced Group +Novices Group +F +Sig. (ANCOVA) p value +Partial Eta Squared +Pre +Post +p value +Pre +Post +p value +SVC +2.61 ± 0.6 +3.04 ± 0.4 +0.017a +3.02 ± 0.3 +2.56 ± 0.3 +0.027a +5.699 +0.033x +0.305 +ERV +0.87 ± 0.2 +0.97 ± 0.5 +0.588 +0.86 ± 0.1 +0.57 ± 0.4 +0.044a +5.029 +0.043x +0.279 +IRV +0.91 ± 0.4 +0.87 ± 0.4 +0.679 +0.93 ± 0.3 +0.93 ± 0.5 +0.996 +2.029 +0.178 +0.135 +FVC +2.61 ± 0.5 +2.71 ± 0.5 +0.533 +2.71 ± 0.5 +2.47 ± 0.7 +0.208 +1.042 +0.326 +0.074 +PEF +6.63 ± 1.9 +6.64 ± 1.6 +0.990 +7.62 ± 1.4 +6.98 ± 1.8 +0.170 +0.172 +0.685 +0.013 +FIVC +2.52 ± 0.5 +2.58 ± 0.5 +0.579 +2.81 ± 0.3 +2.65 ± 0.3 +0.116 +0.390 +0.543 +0.029 +FIV1 +2.36 ± 0.4 +2.49 ± 0.5 +0.021a +2.75 ± 0.4 +2.55 ± 0.3 +0.131 +1.268 +0.280 +0.089 +PIF +4.10 ± 1.4 +4.34 ± 1.2 +0.561 +4.83 ± 1.2 +4.44 ± 1.4 +0.075 +1.163 +0.300 +0.082 +RR +15.28 ± 4.3 +10.69 ± 2.7 +0.01b +16.36 ± 5.0 +13.44 ± 2.3 +0.032a +3.244 +0.095 +0.200 +TV +0.82 ± 0.1 +0.99 ± 0.4 +0.179 +0.72 ± 0.1 +0.87 ± 0.4 +0.264 +0.041 +0.843 +0.003 +Levels of significance as understood from within group comparison using paired t test: a p  0.05; b p  0.01; c p  0.001. +Levels of significance as understood from between group comparison using Analysis of Covariance adjusted for Gender and baseline differences: x p  0.05; y p  0.01; +z p  0.001. +SVC e Slow Vital Capacity; ERV e Expiratory Reserve Volume; IRV e Inspiratory Reserve Volume; FVC e Forced Vital Capacity; PEF e Peak Expiratory Flow; FIVC e Forced +Inspiratory Vital Capacity; FIV1 e Forced Inspiratory Volume in 1st Second; PIF e Peak Inspiratory Flow; RR e Respiratory Rate; TV e Tidal Volume. +R. Balakrishnan et al. / Journal of Ayurveda and Integrative Medicine xxx (2017) 1e4 +2 +Please cite this article in press as: Balakrishnan R, et al., Voluntarily induced vomiting e A yoga technique to enhance pulmonary functions in +healthy humans, J Ayurveda Integr Med (2017), http://dx.doi.org/10.1016/j.jaim.2017.07.001 +4. Discussion +The present study was designed with an objective to understand +the role of ViV on pulmonary function. All the volunteers were +healthy and did not report any clinical symptom following the +intervention the entire day suggesting the safety of the interven- +tion. This work is the first study conducted to understand the +physiology of (ViV) as a standalone intervention in healthy human +participants. +The results of the present study suggest a significant increase in +SVC and FIV1 in the experienced group as compared to the signif- +icant reduction in the SVC and ERV in the novice group. The in- +crease in SVC shall be attributed to better functioning of the +diaphragm [13]. These changes suggest the possible role of ViV in +enhancing the endurance of the respiratory muscles, decreased +airway resistance, better emptying of lungs and vagal predomi- +nance respectively with practice suggesting adaptation of the pul- +monary system. Reduced lung volume in the novices group shall be +attributed to the psychological stress involved in practicing ViV for +the first time. Both groups reported significant reduction in the +respiratory rate. Post hoc analysis of our study showed a statistical +power of 0.75, with an effect size of 1.32 and critical t ¼ 2.119 +indicating a strong evidence. +Vagus, the tenth cranial nerve orchestrates the vomiting reflex. +Two distinct vagal afferent mechanoreceptors from the stomach: +intra-ganglionic laminar ending (IGLE) and intramuscular array +(IMA) respond to distension and smooth muscle contractions and +also function as tension receptors [14]. These vagal afferents carry the +mechanical information to the nucleus tractus solitarius (NTS) from +stomach through jugular and nodose ganglion [15]. The NTS, located +inside the blood brain barrier apart from its connections with +mechanoreceptor vagal afferents from the stomach, also has intense +neurological connections with areas for control of respiration [16], +sensory and emotional areas of brain, and the brainstem vestibular +centres [17]. NTS is also connected with area postrema that serves as +the chemosensor, detecting any chemical change in the blood. +After distention of the stomach, NTS signals dorsal motor nu- +cleus of vagus to initiate vomiting. The neuronal firing of vagal af- +ferents decrease, resulting in relaxation of gastric wall tone and +reduction of acid production [18,19]. NTS signals to increase the +diaphragmatic functions through its mono-synaptic connections +with the rostral and caudal ventral respiratory group [20]. Simul- +taneously, NTS signals the respiratory smooth muscles, sub- +mucosal glands and pulmonary vasculature [21] through nucleus +ambiguous to alleviate airway resistance, facilitate better expira- +tion, mucosal clearance and better oxygen diffusion into the +vasculature [22]. Interestingly, integration of the cardiac function +also occurs at the nucleus ambiguous [10] e indicating a probable +influence of ViV on the cardiac autonomic functions. As there are no +chemicals sensed by the retro-trapezoid nucleus and the area +postrema, the evolutionary survival mechanism of chemicals trig- +gering vomiting will be conserved. +Studies on motion sickness suggest diaphragmatic breathing as +an effective non-pharmacological intervention [23]. We speculate +that the regular practice of ViV may enable the individual to control +motion sickness associated symptoms through better diaphrag- +matic breathing. The results from the novices of the present study +also indicate that vomiting might be an evolution conserved +response +to +relieve +the +organism +from +an +adverse +stimuli +(emotional, psychological shock or loss of equilibrium while at +Fig. 1. Probable mechanism of action of voluntarily induced vomiting (Kunjala Kriya). +R. Balakrishnan et al. / Journal of Ayurveda and Integrative Medicine xxx (2017) 1e4 +3 +Please cite this article in press as: Balakrishnan R, et al., Voluntarily induced vomiting e A yoga technique to enhance pulmonary functions in +healthy humans, J Ayurveda Integr Med (2017), http://dx.doi.org/10.1016/j.jaim.2017.07.001 +constant motion) and facilitate relaxation by promoting vagal +predominance. +Earlier studies show that administering mild irritants like 2e5% +sodium chloride increased the secretion of prostaglandins and +other factors like nitric oxide, leptin, ghrelin, cholecystokinin and +gastrin releasing peptide and facilitate ‘adaptive cytoprotection’ to +protect gastric mucosa [24,25]. Treatment with 5% sodium chloride +enhanced mucosal blood flow, mucous secretion, mucosal prolif- +eration and decreased acid secretion [26]. Also, the DNA content in +the gastric juice reduced indicating decreased mucosal damage and +cell shredding [27]. Interestingly, following exposure to sodium +chloride, histologically visible mucosal necrosis and plasma protein +leakage into the gastric lumen were observed [28]. These distinct +findings also point towards Kunjal Kriya as a potent ulcer protecting +agent. However, studies on representative human participants are +required to authenticate these preliminary findings. +Understanding the impact of ViV practice on biochemical +changes, teeth, pharynx and oro-pharynx is beyond the scope of the +present study and requires to be documented in the future studies. +Further detailed studies are required to ascertain the psycho- +physiological and biochemical changes following practice and the +frequency for safe practice requires to be established. +5. Conclusion +From the above findings, we have conceptualized the probable +mechanism of action of ViV and possible future directions for +research (Fig.1). Based on the findings from this study, we conclude +that ViV when practiced regularly is expected to be a technique to +enhance the endurance of the respiratory muscles and decrease the +airway resistance. These findings also indicate the possibility of +using the practice of ViV in the management of motion sickness and +restrictive pulmonary disorders like bronchitis and bronchial +asthma. +Sources of funding +S-VYASA University. +Conflict of interest +None. +References +[1] Jain SC, Uppal A, Bhatnagar SOD, Talukdar B. A study of response pattern of +non-insulin dependent diabetics to yoga therapy. Diabetes Res Clin Pract +1993;19(1):69e74. +[2] Gokal R, Shillito L, Maharaj SR. Positive impact of yoga and pranayam on +obesity, hypertension, blood sugar, and cholesterol: a pilot assessment. +J Altern Complement Med 2007;13(10):1056e8. +[3] Patel C, North WRS. Randomised controlled trial of yoga and bio-feedback in +management of hypertension. Lancet 1975;306(7925):93e5. +[4] Bijlani RL, Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma R, et al. A brief but +comprehensive lifestyle education program based on yoga reduces risk factors +for cardiovascular disease and diabetes mellitus. J Altern Complement Med +2005;11(2):267e74. +[5] Nicole Culos-Reed S, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of +yoga for breast cancer survivors: physical and psychological benefits. Psycho- +Oncology 2006;15(10):891e7. +[6] Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, Gopinath KS, et al. Effects of +an integrated yoga program in modulating psychological stress and radiation- +induced genotoxic stress in breast cancer patients undergoing radiotherapy. +Integr Cancer Ther 2007;6(3):242e50. +[7] Himani S, Palika D, Archna S, Sudip S, Narendra KB, Vinod K, et al. Gene +expression profiling in practitioners of Sudarshan Kriya. J Psychosomatic Res +2008;64:213e8. +[8] Muktibhodananda S. Hatha yoga Pradipika e a light on hatha yoga. Munger, +Bihar, India: Yoga Publications Trust; 1998. +[9] Niranjananda S. Gherenda Samhitha. Munger, Bihar, India: Yoga Publications +Trust; 2013. +[10] Babic T, Browning KN. The role of vagal neurocircuits in the regulation of +nausea and vomiting. Eur J Pharmacol 2014;722:38e47. +[11] Brown CA, Mehler PS. Medical complications of self-induced vomiting. Eat +Disord 2013;21(4):287e94. +[12] Miller MR, Hankinson JATS, Brusasco V, Burgos F, Casaburi R, Coates A, et al. +Standardisation of spirometry. Eur Respir J 2005;26(2):319e38. +[13] Wade OL, Gilson JC. The effect of posture on diaphragmatic movement and +vital capacity in normal subjects. Thorax 1951;6(2):103e26. +[14] Phillips RJ, Powley TL. Tension and stretch receptors in gastrointestinal +smooth muscle: re-evaluating vagal mechanoreceptor electrophysiology. +Brain Res Rev 2000;34(1):1e26. +[15] Sengupta JN, Gebhart GF. Gastrointestinal afferent fibers and sensation. In: +Johnson LR, editor. Physiology of the gastrointestinal tract. 3rd ed. New York: +Raven; 1994. p. 483e519. +[16] Ezure K, Otake K, Lipski J, She RBW. Efferent projections of pulmonary +rapidly adapting receptor relay neurons in the cat. Brain Res 1991;564(2): +268e78. +[17] Smith JC, Abdala AP, Borgmann A, Rybak IA, Paton JF. Brainstem respiratory +networks: building blocks and microcircuits. Trends Neurosci 2013;36(3): +152e62. +[18] Iggo A. Tension receptors in the stomach and the urinary bladder. J Physiol +1955;128(3):593e607. +[19] Iggo A. Gastro-intestinal tension receptors with unmyelinated afferent fibres +in the vagus of the cat. Q J Exp Physiol Cogn Med Sci 1957;42(1):130e43. +[20] Alheid GF, Jiao W, McCrimmon DR. Caudal nuclei of the rat nucleus of the +solitary tract differentially innervate respiratory compartments within the +ventrolateral medulla. Neuroscience 2011;190:207e27. +[21] Kc P, Martin RJ. Role of central neurotransmission and chemoreception on +airway control. Respir Physiol Neurobiol 2010;173(3):213e22. +[22] Feldman JL, Del Negro CA. Looking for inspiration: new perspectives on res- +piratory rhythm. Nat Rev Neurosci 2006;7(3):232e41. +[23] Stromberg SE, Russell ME, Carlson CR. Diaphragmatic breathing and its +effectiveness for the management of motion sickness. Aerosp Med Hum +Perform 2015;86(5):452e7. +[24] Robert A, Nezamis JE, Lancaster C, Davis JP, Field SO, Hanchar AJ. Mild irri- +tants prevent gastric necrosis through “adaptive cytoprotection” mediated +by prostaglandins. Am J Physiol Gastrointest Liver Physiol 1983;245(1): +G113e21. +[25] Brzozowski T, Konturek PC, Konturek SJ, Brzozowska I, Pawlik T. Role of +prostaglandins in gastroprotection and gastric adaptation. J Physiol Pharmacol +2005;56:33. +[26] Maiti R, Goel R. Effect of mild irritant on gastric mucosal offensive and +defensive factors. Indian J Physiol Pharmacol 1999;44(1999):185e91. +[27] Goel RK, Bhattacharya SK. Gastroduodenal mucosal defence and mucosal +protective agents. Indian J Exp Biol 1991;29(8):701e14. +[28] Wallace JL. Increased resistance of the rat gastric mucosa to hemorrhagic +damage after exposure to an irritant: role of the “mucoid cap” and prosta- +glandin synthesis. Gastroenterology 1988;94(1):22e32. +R. Balakrishnan et al. / Journal of Ayurveda and Integrative Medicine xxx (2017) 1e4 +4 +Please cite this article in press as: Balakrishnan R, et al., Voluntarily induced vomiting e A yoga technique to enhance pulmonary functions in +healthy humans, J Ayurveda Integr Med (2017), http://dx.doi.org/10.1016/j.jaim.2017.07.001 diff --git a/subfolder_0/YOGA BASED GUIDED RELAXATION REDUCES SYMPATHETIC ACTIVITY IN SUBJECTS.txt b/subfolder_0/YOGA BASED GUIDED RELAXATION REDUCES SYMPATHETIC ACTIVITY IN SUBJECTS.txt new file mode 100644 index 0000000000000000000000000000000000000000..de50d46d547164b08bdaacc80303b7f8cac1ae14 --- /dev/null +++ b/subfolder_0/YOGA BASED GUIDED RELAXATION REDUCES SYMPATHETIC ACTIVITY IN SUBJECTS.txt @@ -0,0 +1,36 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/Yoga and Ayurveda Complementary Systems of Healing for Use -2013.txt b/subfolder_0/Yoga and Ayurveda Complementary Systems of Healing for Use -2013.txt new file mode 100644 index 0000000000000000000000000000000000000000..a152c7f831033a9a8e78c74f7f471d34728004bd --- /dev/null +++ b/subfolder_0/Yoga and Ayurveda Complementary Systems of Healing for Use -2013.txt @@ -0,0 +1,659 @@ +37 +LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 | +Abstract +Modern medicine increasingly looks to traditional +systems of medicine to combat the chronic disease +crisis caused by non-communicable diseases. Yoga +and Ayurveda present two ways to eliminate +pathology and restore health. In ancient India, +health was promoted by the most powerful means +available. Traditional Indian systems of medicine +like Ayurveda and yoga often restore health when +all else has failed. They are increasingly accepted +as possible routes to regaining health, even in the +face of otherwise incurable chronic diseases. Their +seeds in the UpaniÈads are the paðcavÀyus (five +subtle energies), prÀõas (vital breaths), controlling +the physiology. Acting on ‘subtle levels’ that +control gross physical levels gives yoga and +Ayurveda their power to cure chronic diseases and +restore health. As integratively practiced today, +yoga–medicine combine traditional wisdom with +modern medicine. Mentally, yoga aims to balance +the mind (‘balance of mind’ is called yoga) by +balancing the three guõas. Physiologically, it acts +on the paðcakoÈas (five sheaths) surrounding the +abstract level of spirit or Self, so preventing +interference with processes maintaining balance +and health. Its lifestyle strategies prevent +imbalances from arising, thus promoting health. +Ayurveda similarly aims to restore balance to +regulatory systems in the physiology, describing +them in terms of three doÈas and their 15 sub-doÈas. +Both yoga and Ayurveda are similarly structured +and complement each other. Adopting their +lifestyle recommendations offers effective means +to avoid disease and maintain health. +Introduction +Yoga1 and Ayurveda2 are both traditional systems of +health promotion from ancient India. In yoga, the goal +is spiritual growth for which health is a logical side- +Yoga and Ayurveda +Complementary Systems of Healing for +Use in Integrative Medicine +H.R. Nagendra, Alex Hankey, and Kashinath Metri +benefit. The primary means is to balance the mind by +removing its tendency to enter states causing +imbalance3 through their qualities (triguõa). In +Ayurveda, the primary emphasis is on promoting +health and preventing pathology, and restoring health +when a person’s bad habits and bad karma have +compromised their state of health. The primary +emphasis is to create balance in the physiology,4 i.e. +in the regulatory systems described by tridoÈa. Cure +of disease very often results from application of the +same methods that produce health. It is only because +almost the sole application of modern biomedicine is +to cure disease, and because of its ignorance of how +to describe states of health, that ‘medicine’ is now +considered only to apply to disease. In earlier times +this was not true. The original meaning of the word +‘doctor’ is ‘teacher,’ from the Latin root ‘doceo,’ +meaning ‘I teach.’ With regard to health care, ‘doctors’ +were meant to teach health-promoting practices, as +indeed Ayurvedic doctors and yoga teachers do +today. +Of the two systems, yoga, with its origin in the +UpaniÈads,5 is possibly the more ancient science. +Descriptions of how a child should be sent for +advanced yoga practice are given in the ChÀndogya +UpaniÈad.6 Yoga was the system used by the ancient +¦Èis to bring their children to enlightenment,1 and +transform them into ¦Èis to guide coming generations. +MokÈa (enlightenment) is a state of perfect health, since +| LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 +38 +the basis for disease, prajðÀ aparÀdha7 (mistake of the +intellect) has been destroyed. When the individual +identifies with the infinite and the eternal, the cause +for negative emotions at the basis of the disease +process has been removed. The whole of Vedic +civilization was oriented around attainment of +spiritual liberation; all sixty-four arts aim for that goal, +and the whole structure of dharma (natural law) was +conceived as aiming for it, e.g. the phrase dharma– +artha–kÀma–mokÈa. Health of both body and mind was +seen as a consequence of attaining œÀnti (deep peace), +experienced in mokÈa. +The power of the Vedic sciences lies in their +mastery of ‘subtle’ levels of existence, which are +unsuspected until brought to awareness by refinement +of perception as the heart expands on the path to +enlightenment. Subtle levels control gross ones, so +acting on the subtle is more powerful than acting on +the gross. For this reason, technologies derived from +the Vedic sciences have greater power than those +derived from modern bioscience. There is no doubt +that the latter’s treatment of acute problems with +intensive care, surgeries, and wonder drugs has +achieved a tremendous amount, but modern medicine +has proved almost powerless against non- +communicable diseases. This has led to a pandemic +of modern ‘diseases of civilization’ and the continuing +‘chronic disease crisis.’ Their ability to restore health +in many cases of non-communicable disease makes +yoga and Ayurveda superior to modern science-based +medicine in the field of chronic illness. +Both yoga and Ayurveda recognize the existence +of prÀõa (life breath or vital energy) denied by modern +biology, and recommend strengthening it in various +ways to restore health. PrÀõa is one of the five +paðcavÀyus detailed in the UpaniÈads,8 the functions +of which are given in detail9 in the texts of Ayurveda. +They form the five sub-doÈas of vÀta doÈa, the most +important of the three fundamental systems functions, +or ‘doÈas,’ named in Ayurveda. VÀta doÈa can drive +other doÈas, and various tissues, out of balance10 when +it gets disturbed. Its balance is an important goal when +promoting health through Ayurveda. +Yoga and Yoga Medicine +Yoga’s power to restore health depends on its ability +to stimulate the flow of prÀõa in the body. PrÀõa may +be understood to be involved in the regulation of the +organism. Increasing the level of prÀõa improves +regulation of the organism and its organ sub-systems. +PrÀõa, however, can be directed by the mind; negative +emotions block its flow. Certain yoga practices can +stabilize the emotions, by balancing the factors which +drive them, the three guõas, thus preventing the mind +from interfering with the flow of prÀõa. They +encourage prÀõa to flow freely, reaching all the cells +and keeping them active and responsive. +A basic understanding from the UpaniÈads used +in yoga medicine is that the inner spirit of man is +surrounded by paðcakoÈas (five sheaths).11 Yoga +practices improve their functioning. Each koÈa is more +subtle than the preceding one and can assist or block +its function. The grossest of these is the annamaya +koÈa, usually identified with the physical body +perceived through the five senses. Next is the +prÀõamaya koÈa (body of subtle energy), which +regulates the physical body; the manomaya koÈa (body +of mind and emotions), controls the body of prÀõa, +while the vijðÀnamaya koÈa controls the mind, since +the range of a person’s emotional states is shaped by +their core understanding of the nature of life, the +universe and everything it involves. The final koÈa, +the Ànandamaya koÈa, controls the higher mind. +Swami Vivekananda, the famous reviver of +modern Hinduism, discussed four approaches to +yoga:12 the first, rÀja-yoga (yoga of meditation), +establishes the mind in inner silence and peace in +samÀdhi. The second, karma-yoga (yoga of action), +trains the mind to maintain inner peace when engaged +in outer activity. The third approach, bhakti-yoga, +uses devotion to expand the heart and raise awareness +to the Divine, while the fourth, jðÀna-yoga (yoga of +knowledge), brings understanding of the connection +between one’s Self and all things, removing prajða +aparÀdha and making permanent the changes brought +by the first three. +MaharÈi Pataðjali’s Yoga-SÂtras,1 considered the +main text on rÀja-yoga, has four padas (chapters), each +of which relates to one of these four approaches to +yoga. Understanding states of deep meditation (rÀja- +yoga) is the main topic of the first pada, the second +describes practices which will help stabilize +meditation’s effects – the role of karma-yoga; the third +concerns development of powers such as celestial +Author, please provide English terms +39 +LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 | +awareness which bring experience of the divine, the +goal of bhakti-yoga; while the fourth, final pada +explains how to understand and gain spiritual +liberation, the aim of jðÀna-yoga. Each approach to +yoga is of prime importance at a particular stage on +the path to mokÈa – spiritual liberation in +enlightenment. +At S-VYASA, the Integrative Approach to Yoga +Therapy13 (IAYT) promotes a system of yoga lifestyle +that includes all four approaches to yoga. It enhances +the ability to function at increasingly subtle levels of +awareness and to make changes permanent. The +practice of Àsanas (yoga postures) stops muscle +stiffness from blocking the flow of prÀõa, while +practice of prÀõÀyÀma directly increases its strength.14 +Cyclic meditation15 helps free the mind from +interfering emotions, also assisted by study of yama +and niyama (yoga ethics and injunctions). Chanting +helps attune the mind to higher levels, while study of +yoga philosophy16 helps establish awareness in the +highest level. +Research on these yoga practices has shown that +they produce significant results. On the physical level, +Àsanas reduce the sense of fatigue, increase muscular +strength, flexibility and endurance;17 they also reduce +basal metabolic rate, oxygen consumption, heart rate +and blood pressure.17 Their practice improves hand +grip strength,18 reduces stress hormones19 and +musculo skeletal pain.20 On the level of prÀõa they +reduce respiratory rate17 and rebalance prÀõa +imbalances.21 On the psychological level they reduce +psychological stress,22 and improve cognitive +functions like memory,23 attention24 and planning +ability.25, 26 Reducing psychological stress makes yoga +a good adjuvant therapy for mainstream medicine: +randomized controlled trials find it to improve +treatment outcomes for many diseases such as +diabetes,27 hypertension,28 asthma,29 Parkinson’s +disease,30 gastro-intestinal disease,31 and lower back +pain.32 It has also proven effective in management +of psychological disorders like anxiety,23, 33 +depression,26, 33 bipolar disease,34 and schizophrenia.35 +Ayurveda +Ayurveda’s basis lies in its deep understanding of +health as ‘balance of the three doÈas’:4 vÀta doÈa, of +which prÀõa is the leading sub-doÈa; pitta doÈa, +responsible for digestion and metabolism; and kapha +doÈa, responsible for energy storage, lubrication, and +structure. When the Ayurvedic texts are carefully +examined in order to understand the nature of the +doÈas in a deeper way, the process of ‘decoding +Ayurveda’ shows that the three doÈas concern the +three main functions of open systems (fig. 1a) – input/ +output (vÀta); turnover/transformation (pitta); and +storage (kapha).36 The reasoning is as follows: all five +vÀta sub-doÈas are based on membrane transport +processes, cellular input/output; all five pitta sub- +doÈas concern processes of energy regulation and +transformation through metabolism or enzyme +activity; and all five kapha sub-doÈas concern +functions using energy rich-molecules, originally used +to store energy. The three doÈas therefore concern the +three open systems functions in single cells (fig. 1b), +while their functions in the human body concern these +same functions for the whole organism (fig. 1c). It then +becomes possible to trace their roles continuously +from single cells through all stages of development +in animal life, up to mammals and primates. +fig. 1a: Three Basic Functions of Open Systems +fig. 1b: Tridosha in Single Cells +| LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 +40 +Every organism from a single cell upwards is an +open system, so figs. 1a-c show that tridoÈa applies +not simply to humans, but to all organisms. They are +completely general. In Ayurveda, compromising their +function corresponds to progressive stages of the +onset of disease. They therefore constitute a compact, +integrated description of both human physiology and +aetiology, probably the most compact devised by any +medical system. Further analysis shows that tridoÈa +is responsible for the regulation of these systems +functions, and that it lies in the realm of the ‘subtle’, +controlling the physical body. +PrÀõa, the first sub-doÈa of vÀta, promotes healthy +function in every aspect of the physical system. +Comparison with Qi in Chinese Medicine suggests +that it does so via electrical changes in the nÀçÁs, the +subtle energy channels in the body supporting the +subtle energy system, which are related to the +acupuncture meridians. Ayurveda’s system of +gaining knowledge of the patient through the nÀçÁs, +is known as nÀçivijðÀna. +Often, Ayurveda is wrongly described as a +‘system of herbal medicine’, or worse still, a system +of ‘humoral medicine.’ This happens only when its +deeper and wider properties outlined in the preceding +paragraphs are not understood. When the removal +of doÈa and related ‘imbalances’ is seen as the main +goal of medical practice, individualized diet and +lifestyle recommendations are seen to be the primary +aspects of health care and health restoration; similarly +for the yoga lifestyle approach to yoga medicine. Most +medical problems are caused by patients’ poor health +habits; when these are transformed, the basis for +disease is removed, and the disease often goes away, +without the need for actual medication. +Balancing doÈas is an art in itself, especially when +regulatory systems have been driven far out of +balance.10 Balance can usually be restored by +paðcakarma treatment which involves one or more of +five kinds of therapy, such as purgation. Simple +aspects of paðcakarma therapy are very enjoyable and +have proved extremely popular throughout the West, +since the time when they were first widely +popularized by Dr. Deepak Chopra when he was +working for Maharishi Mahesh Yogi.37 +Integrative Practice of Yoga and Ayurveda +Ayurveda and yoga are now practiced integratively +at many Ayurveda institutions, which make use of +yoga teachers to train patients in first practices of yoga +Àsanas, and prÀõÀyÀma breathing exercises. Simple +approaches to meditation are also taught, particularly +Cyclic Meditation,15 an approach to deep relaxation +and stress release, which was developed at S-VYASA +and has been widely employed in industry,38 and to +specific problems such as diabetes27, 39 where it has +proved most successful in helping remove stress. +In typical integrative practice, each patient is +assessed by an interdisciplinary team of doctors, and +a balance of systems most appropriate to the needs of +the patient is administered, possibly including +elements from physiotherapy, counselling and +Naturopathic medicine, as well as Ayurveda and +yoga. The yoga lifestyle program starts before dawn, +around 5 a.m. and continues into the evening until +bedtime at 10 p.m. Those who participate achieve +results according to their degree of compliance. +Data is taken from patients at the beginning and +end of their stay, usually 7 or 14 days, and sometimes +more frequently. In this way a program of ongoing +clinical research is maintained. The basic scientific +laboratories used to establish effects of various +different yoga techniques and practices are now being +extended to study associated biochemical and +epigenetic changes so that deeper mechanisms +underlying yoga and Ayurveda therapy can be +investigated. +Several recently developed instruments claim to +fig. 1c: Tridosha in Whole Organisms +41 +LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 | +be able to measure levels of subtle energy in the body, +particularly, (1) AcuGraph, a machine which uses +electrical conductance measurements at acupuncture +points around the hands and feet to estimate the +energy in each of the 24 principal meridians;40 (2) gas +discharge visualization (GDV),41 which takes Kirlian +photographs of the 10 finger tips on a glass electrode +to evaluate the health of different organs and organ +systems; and (3) nÀçÁtaraôgiõÁ,42 a system of radial +artery pulse measurement together with very +sophisticated software analysis that may estimate the +degree of aggravation of different Ayurveda doÈas. +Their basic reliability has been investigated,43 +establishing that they can show how different yoga +programs energize and balance prÀõa in various +ways.21, 44 Gender differences in prÀõa levels are well +recognized.45 Long-term practice of IAYT programs +even them out, increase prÀõa’s overall level, and +restore it to balance,21 as one would hope, but it is +good to see such basic concepts confirmed by +measurement. +In Ayurveda, many new questionnaires are +available to assess the prak¦ti (nature) of the +individual; the better known include AyuSoft from +Pune,46 the Mysore tridoÈa questionnaire,47 and the +Prakriti Analysis Inventory (PAI),48 one of the most +comprehensive inventories of tridoÈa prak¦ti +available. +These +psycho-physiological +test +instruments can simplify identification of patients’ +prak¦tis, and diseases to which they are prone. +Another approach is to use nÀçÁ-parÁkÈÀ (diagnosis on +the basis of pulse), one of eight kinds of diagnostic +examination – aÈta vidhÀ parÁkÈÀs. NÀçÁtaraôgiõÁ is a +system of pulse metabolic analysis using a pressure- +sense analyser,42 which can corroborate or replace the +questionnaires. It has been shown to correctly +diagnose the dominant doÈa in the body at different +times of day. +New methods such as these help monitor disease +progress and patient improvements. They may help +generate much needed understanding of underlying +mechanisms. For example, yoga practice has achieved +considerable success against diabetes. Occasionally +success is extreme: on one occasion a skeptical patient +dependent on a high dosage of insulin for 22 years, +returned to normality in 22 days, becoming a sworn +adherent of yoga therapy in the process. How such +results can be achieved so quickly is not widely +understood. Modern medicine regards diabetes mellitus +as a purely chemical disease, and considers any case +of yoga influencing the biochemistry so quickly and +profoundly as a mystery. But consideration of stress +makes it easy to understand: it is presently recognized +that every disease has a psychosomatic component +resulting from stress in the life of the patient, and, in +particular, that diabetes patients all have deep-rooted +stress and trauma in their past history. When the stress +has been removed, so that the disease’s psychosomatic +component is resolved, insulin resistance goes away +and the diabetes either progressively improves, or is +cured, similarly for other non-communicable diseases. +When mechanisms underlying yoga and +Ayurveda efficacy are understood in scientific terms +like these, corroborating those in the ancient texts, it +becomes possible to explain how the two systems +achieve their results, in ways that modern medical +administrators and doctors can accept. +Investigation of detailed mechanisms21, 38, 39, 44 +should therefore help yoga-based initiatives to reduce +diabetes incidence receive scientific and medical +support. As indicated above, integrative Ayurvedic +and yoga approaches are particularly effective in +treating it. Non-toxic Ayurvedic dravyas (herbal +formulations), such as kumÀrÁ, guçuci and arjuna, can +be used in place of standard Western drugs like +metformin, the side-effects of which may be +neutralized by other dravyas, e.g. its effect on the liver +with kalmegha. Yoga practices increase levels of +prÀõa,21, 38, 44 and remove deep-rooted stresses +underlying the disease;19, 22 balance in doÈas and +prÀõas is restored and health returns. +Conclusions +Yoga and Ayurveda have similar aims and their +lifestyle practices complement each other, particularly +in application to non-communicable disease. Both aim +to enhance prÀõa levels, and both act on subtle levels +of psycho-physiology, aiming to improve system +regulation. Yoga acts principally on the musculo +skeletal system, the breathing, and the mind, while +Ayurveda emphasizes health habits suited to +individual patient’s physiology so that balance is +restored to doÈa functioning. In Ayurveda, yoga is +specifically used for unmÀda (mental illness) as well +Author, please provide English term +| LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 +42 +as to improve prÀõa and remove stress. In yoga +medicine, restoring balance to tridoÈa is a useful way +to bring balance to the physiology, and remove doÈa +imbalances underlying specific cases of disease. +Yoga and Ayurveda are ideal partners in +integrative practice. Most Ayurveda treatments can +be improved by adding appropriate yoga practices. +Similarly, benefits of most yoga treatments can be +enhanced by including Ayurveda considerations. In +ancient times, it seems the two systems went hand- +in-hand. Today, they are thought of and taught +separately, something that must be remedied. Yoga +therapy uses physical postures (Àsanas), breathing +practices (prÀõÀyÀma), meditation and relaxation +techniques, all non-pharmacologic interventions, to +rebalance the physical, prÀõa, emotional and +intellectual levels. They bring to body and mind deep +rest, and help in healing disease. Ayurveda goes +beyond pharmacological and surgical interventions +to treat the root causes of susceptibility to disease, +identifying them in doÈa imbalances. Ayurveda’s +paðcakarma treatments restore doÈas to balance, +improve vigour and vitality, and are often key to +successful treatment; they also purify Àma (toxins) +from the body, sharpening the tone of all systems, so +preventing disease. +References +1. S. Satyananda, Four Chapters on Freedom, 1st edn., +Munger: Yoga Publication Trust, 2008: 58 (ch1 v12). +2. M.S. Valiathan, The Legacy of Caraka, Bangalore: Orient +Blackswan, 2003. +3. Swami Ramsukhadas (tr.), Shrimad Bhagavatam, 4th edn., +vol. 2, XIV.11, Gorakhapur: Gita Press, 2003. +4. P.V. Sharma (tr.), Caraka SaÚhitÀ, SÂtrasthÀna, 1st edn., +Varanasi: Chaukhambha Orientalia, 1986. +5. S. Radhakrishnan (tr.), The Principal Upanishads, New +Delhi: Harper Collins, 1994. +6. Swami Krishnanda, ChÀndogya UpaniÈad, Sections 5 and +6, Divine Life Society, Rishikesh: Sivananda Ashrama, +1984. +7. R.K. Sharma (tr.), Caraka SaÚhitÀ, SÂtrasthÀna XI.37, +p. 221, Chaukhamba Sankrit Series, 3rd edn., Varanasi: +Chaukhambha Orientalia, 1999. +8. S. Radhakrishnan (tr.), The Principal Upanishads, Praœna +UpaniÈad, V.12, New Delhi: Harper Collins, 1994. +9. R.K. Sharma (tr.), Caraka SaÚhitÀ, VimÀnasthÀna, 10.5. +Chaukambha Sanskrit Series 3rd edn., Varanasi: +Chaukhambha Orientalia, 1992. +10. R.K. Sharma (tr.), Caraka SaÚhitÀ, VimÀnasthÀna, 11.4, +Chaukambha Sanskrit Series 3rd edn., Varanasi: +Chaukhambha Orientalia, 1992. +11. S. Radhakrishnan (tr.), The Principal Upanishads, TaittirÁya +UpaniÈad, XI, New Delhi: Harper Collins, 1994. +12. Swami Tapasyananda, Four Paths of Yoga by Swami +Vivekananda, Kolkata: Advaita Ashrama, 2007. +13. R. Nagarathna, “Yoga in Medicine”, in: Y.P. Munjal, +(eds.) API Text Book of Medicine, 9th edn., New Delhi: JP +Medical Pub, 2012. +14. H.R. Nagendra, and R. Nagarathna, Art and Science of +Pranayama, Bangalore: Swami Vivekananda Yoga +Prakashana, 1990. +15. H.R. Nagendra, and R. Nagarathna, New Perspectives in +Stress Management, Chapter 15, Bangalore: Swami +Vivekananda Yoga Prakashana, 2000. +16. S.N. Dasgupta, Yoga Philosophy, 15th chapter, Banaras: +Motilal Banarsidas, 1930. +17. J.A. Raub, “Psycho-physiologic Effects of Hatha Yoga +on Musculoskeletal and Cardiopulmonary Function: A +Literature Review”, J Alt Complement Med, 2002; 8(6): +797-812. +18. M. Dash, and S. Telles “Improvement in Hand Grip +Strength in Normal Volunteers and Rheumatoid +Arthritis Patients Following Yoga Training”, Ind J Physiol +Pharmacol, 2001. +19. W. Jeremy, O. Christian, G. Kathleen, J. Joe, C. David, +and Mohr, “Effects of Hatha Yoga and African Dance +on Perceived Stress, Affect, and Salivary Cortisol”, +Annals of Behavioral Medicine, 2004; 28(2): 114-18. +20. J.L. Pimentel do Rosano, L.S. Orcesi, F.N. Kobayashi, +A.N. Aun, L.T.D. Assumpcao, B.J. Blasioli, and E.S. +Hanada, “The Immediate Effects of Modified Yoga +Positions on Musculo Skeletal Pain Relief”, J Bodywork +Movement Ther, 2013, Online 30.04.2013. +21. B. Sharma, A. Hankey, N. Nagilla, K.B. Meenakshy, and +H.R. Nagendra, “Can Yoga Practices Benefit Health by +Improving Organism Regulation? Evidence from +Electrodermal Measurements of Acupuncture +Meridians”, Int J Yoga, 2014; 7(1) to be published. +22. S. Telles, N. Singh, M. Joshi, and A. Balkrishna, “Post +Traumatic Stress Symptoms and Heart Rate Variability +in Bihar Flood Survivors Following Yoga: A +Randomized Controlled Study”, BMC Psych, 2010; 10: +18. doi:10.1186/1471-244X-10-18. +23. P. Subramanya, and S. Telles, “The Effect of Two Yoga- +Based Relaxation Techniques on Memory Scores and +State Anxiety”, BioPsychSoc Med, 2009; 3: 8. +24. S. Telles, P. Raghuraj, D. Arankalle, and K.V. Naveen, +“Immediate Effect of High-Frequency Yoga Breathing +on Attention”, Indian J Med Sci, 2008; 62: 20-22. +25. N.K. Manjunath, and S. Telles, “Improved Performance +in the Tower of London Test Following Yoga”, Ind J +Physiol Pharmacol, 2001; 45(3): 351-54. +26. V.K. Sharma, S. Das, S. Mondal, U. Goswami, and A. +Gandhi, “Effect of Sahaja Yoga on Neuro-Cognitive +Functions in Patients Suffering from Major Depression”, +Ind J Physiol Pharmacol, 2006; 50(4): 375-83. +Author, vol. and pp. details please in Ref. 18. +Author, initial in Ref. 19. +43 +LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 | +27. K. Vaishali, K.V. Kumar, and P. Adhikari, “Effects of +Yoga-Based Program on Glycosylated Hemoglobin +Level Serum Lipid Profile in Community Dwelling +Elderly Subjects with Chronic Type 2 Diabetes +Mellitus – A Randomized Controlled Trial”, Therapy in +Geriatrics, 2012; 30(1): 22-30. +28. D. Cohen, R. Raymond, and M.D. Townsend, “Yoga and +Hypertension”, J Clin Hyperten, 2007; 9(10): 800-01. +29. R. Nagarathna, and H.R. Nagendra, “Yoga for Bronchial +Asthma: A Controlled Study”, BMJ, 1985; 291: 1077-79. +30. Y.S. Colgrove, N. Sharma, P. Kluding, D. Potter, K. +Imming et al., “Effect of Yoga on Motor Function in +People with Parkinson’s Disease: A Randomized, +Controlled Pilot Study”, J Yoga PhysTher, 2012; 2: 112. +doi:10.4172/2157-7595.1000112. +31. G. Nidhi, R. Shvetakhera, P. Vempati, S. Ratna, and R.L. +Bijlani, “Effect of Yoga Based Lifestyle Intervention on +State and Trait Anxiety”, Ind J Physiol Pharmacol, 2006; +50(1): 41-47. +32. P. Tekur, R. Nagarathna, S. Chametcha, A. Hankey, and +H.R. Nagendra, “A Comprehensive Yoga Programme +Improves Pain, Anxiety and Depression in Chronic Low +Back Pain Patients more than Exercise: An RCT”, +Complement Ther Med, 2012; 20(3): 107-18. +33. M. Javnbakht, K. Hejazi, and M. Ghasemi, “Effects of +Yoga on Depression and Anxiety of Women”, +Complementary Therapies in Clinical Practice, 2009; 15(2): +102-04. +34. L.M. Weinstock, M.A. Kraines, and L.A. Uebelacker, +“Self-Reported Risks and Benefits of Yoga Among +Individuals with Bipolar Disorder”, Bipolar Disorders, +2013; 15: 92-93. +35. G. Duraiswamy, J. Thirthalli, H.R. Nagendra, and B.N. +Gangadhar, “Yoga Therapy as an Add-on Treatment in +the Management of Patients with Schizophrenia : A +Randomized Controlled Trial”, Act PsychScand, 2007; +116(3): 226-32. +36. A. Hankey, “Establishing the Scientific Validity +of Tridosha, part 1: Doshas, Subdoshas and Dosha +Prakritis”, AncSci Life, 2010 Jan.-Mar.; 29(3): 6-18. +37. D. Chopra, “Perfect Health: The Complete Mind/Body +Guide”, Harmony, Paso Robles, 2001. +38. S. Kumari, A. Hankey, and H.R. Nagendra, “Effects of +SMET on the Emotional Dynamics of Managers”, Voice +of Research, 2013; 2(1): 49-52. +39. B. Sharma, A. Hankey, K.B. Meenakshy, and H.R. +Nagendra, “Acugraph 3 Measurements at Jing-Well +Points to Identify Electrodermal Characteristics of Type +2 Diabetes Patients”, Submitted to JAMS. +40. Meridia Technologies Inc. AcuGraph3 Digital Meridian +Imaging, Meridian Technologies, Meridian, Idaho, 2008. +41. K.G. Korotkov, P. Matravers, P.V. Orlov, and B.O. +Williams, “Application of Electrophoton Capture (EPC) +Analysis Based on Gas Discharge Visualization (GDV) +Technique in Medicine: A Systematic Review”, J Alt +Complement Med, 2010; 16(1): 13-25. doi:10.1089/ +acm.2008.0285. +42. A. Joshi, A. Kulkarni, S. Chandran, V.K. Jayaraman, and +B.D. Kulkarni, “Nadi Tarangini: A Pulse-Based +Diagnostic System”, Proceedings of the 29th Annual +International Conference of the IEEE EMBSInternationale, +Lyon, France, 23-26 August 2007. +43. S.D. Mist, M. Aickin, E. Kalnins, J. Cleaver, R. Batchelor, +T. Thorne et al., “Reliability of AcuGraph System for +Measuring Skin Conductance at Acupoints”, Acupunct +Med, 2011; 29(3): 221-26. +44. N. Nagilla, A. Hankey, and H.R. Nagendra, “Effects of +Yoga Practice on Acumeridian Energies: Variance +Reduction Implies Benefits for Regulation”, Int J Yoga, +2013; 6(1): 61-65. +45. S. Chamberlin, A.P. Colbert, and A. Larssen, “Skin +Conductance at 24 Source (Yuan) Acupoints in 8637 +Patients: Influence of Age, Gender and Time of Day”, J +Acupunct Meridian Stud, 2011; 4(1): 14-23. +46. B. Patwardhan, and R.A. Mashelkar, “Traditional +Medicine-Inspired Approaches to Drug Discovery: Can +Ayurveda Show the Way Forward?”, Drug Disc Today, +2009; 14(15-16): 804-11. +47. S. Shilpa, and C.G.V. Murthy, “Development and +Standardization of Mysore Tridosha Scale”, Ayu, 2011; +32(3): 308-14. +48. R. Sharma, “Development and Validation of a Prototype +Prakriti Analysis Tool (PPAT): Inferences from a Pilot +Study”, PMC, 2011; 3: 611, 641. +Dr. H.R. Nagendra, Ph.D. is now Chancellor, +Swami Vivekananda Yoga Anusandhana +Samsthana (S-VYASA), a research institution. +After improving performance of NASA rockets in +the 1960s, Dr. Nagendra returned to India in 1973 +to study yoga, founding S-VYASA in 1986, and in +2002, becoming its founding Vice-Chancellor, now +a fully accredited university, which gained its ‘A’ +grade status this year. S-VYASA is now recognized +as India’s leading institution for research on yoga +and its medical applications, with over 250 research +publications in peer reviewed, indexed journals. +Dr Nagendra has been responsible for trans- +forming India’s image of yoga from one for +eccentric saÚnyÀsÁs, into a vibrant modern +discipline with an expanding evidence base, +increasingly used by the medical profession, the +world around. +| LIGHT ON AYURVEDA JOURNAL, VOL. XII, ISSUE 1, FALL 2013 +44 +Dr. Kashinath G. Metri studied Ayurveda at Rajiv +Gandhi University of Health Sciences, Bangalore, +before completing his MD in Yoga and +Rehabilitation from S-VYASA Yoga University. +Currently he is an Assistant Professor in S-VYASA’s +Division of Yoga and Life Sciences, pursuing his +Ph.D. in Yoga and Ayurveda. He already has four +peer-reviewed publications in indexed journals to +his credit. +Alex Hankey is distinguished Professor of Yoga and +Physical Science at the Yoga University, S-VYASA, +in Bangalore. He completed his PhD in theoretical +physics at MIT where he researched quantum field +theory and elementary particle physics. He +subsequently studied Vedic sciences, including, in +later years, Ayurveda and Jyotish Astrology, under +Maharishi +Mahesh +Yogi. + +Contact +at: + diff --git a/subfolder_0/Yoga as a Safer Form of Physical Activity in Type 2 Diabetes Mellitus_ The Bidirectional Property of Yoga in Establishing Glucose Homeostasis.txt b/subfolder_0/Yoga as a Safer Form of Physical Activity in Type 2 Diabetes Mellitus_ The Bidirectional Property of Yoga in Establishing Glucose Homeostasis.txt new file mode 100644 index 0000000000000000000000000000000000000000..007010cfde3cc24d3942b00f382ab659166061a5 --- /dev/null +++ b/subfolder_0/Yoga as a Safer Form of Physical Activity in Type 2 Diabetes Mellitus_ The Bidirectional Property of Yoga in Establishing Glucose Homeostasis.txt @@ -0,0 +1,122 @@ +Int J Yoga. 2019 May-Aug; 12(2): 174–175. +doi: 10.4103/ijoy.IJOY_57_18 +PMCID: PMC6521752 +PMID: 31143028 +Yoga as a Safer Form of Physical Activity in Type 2 Diabetes Mellitus: +The Bidirectional Property of Yoga in Establishing Glucose Homeostasis +Venugopal Vijayakumar, + Ramesh Mavathur, NK Manjunath, and Nagarathna Raghuram +Department of Yoga and Physical Activity, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, +Karnataka, India +Address for correspondence: Dr. Venugopal Vijayakumar, 4, Conran Smith Road, Gopalapuram, Chennai - +600 086, Tamil Nadu, India. E-mail: dr.venu@yahoo.com +Received 2018 Aug; Accepted 2018 Sep. +Copyright : © 2019 International Journal of Yoga +This is an open access journal, and articles are distributed under the terms of the Creative Commons +Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the +work non-commercially, as long as appropriate credit is given and the new creations are licensed under the +identical terms. +Sir, +Exercise plays a significant role in the management of Type 2 diabetes mellitus (T2DM).[1] Increased +risk of hypoglycemia remains a major concern while administering exercise in T2DM. The risk factors +for exercise include hypoglycemia due to prolonged exercise duration, or intensity.[2] Yoga is +considered as a mild-to-moderate intensity physical activity increasingly used in the management of +T2DM, with positive influence on blood glucose levels, oxidative stress, and other comorbidities.[3] +We report a unique observation in patients with T2DM who underwent a short 10 days yoga +intervention program. In total, 654 individuals diagnosed with T2DM participated in the program from +multiple centers. Every session was conducted by a certified yoga therapist under the supervision of a +physician. Before commencement, participants were given orientation on various aspects of yoga and +diabetes including signs of hypoglycemia. A conventional form of yoga, including asanas, pranayama, +and meditation, was taught 1 h every day. Fasting plasma glucose (FPG) levels were measured at +baseline and at the end of 10 days. No hypoglycemic episode was reported in any of the participating +centers. +We observed a unique pattern during our preliminary data analysis. The reduction in blood glucose +levels was directly proportional to the baseline FPG levels, i.e., higher the baseline FPG, higher was the +reduction in glucose levels. More interestingly, in patients with normal (70–100 mg/dL) and below +normal baseline FPG levels, there was an “increase” rather than further decrease in the plasma glucose +levels [Graph 1]. We observed yoga to work more in a bidirectional manner, trying to establish a +homeostasis in the blood glucose levels. For instance, the mean reduction in glucose levels were +28.73% (96.85 mg/dL) in patients with baseline glucose levels above 300 mg/dL whereas patients with +baseline glucose levels below 70 mg/dL had a mean increase of 19.50% (12.74 mg/dL) [Table 1]. This +implies that yoga does not necessarily reduce blood glucose levels at all times and might help increase +glucose levels in hypoglycemia through autonomic activation.[4] +1,2 +2 +2 +2 +1 +2 +Graph 1 +The linear relation between baseline blood glucose levels and percentage (%) difference after yoga +intervention +Table 1 +Preglucose range and percentage differences from the baseline glucose levels +Preglucose range +(mg/dL) +Premean +(mg/dL) +Postmean +(mg/dL) +Difference +(mg/dL) +Percentage +difference +>300 +337.07 +240.22 +−96.85 +−28.73 +200-300 +235.59 +189.36 +−46.23 +−19.62 +100-200 +136.71 +125.76 +−10.95 +−8.01 +70-100 +86.29 +89.33 +3.04 +3.52 +<70 +65.33 +78.07 +12.74 +19.50 +Overall mean +141.10 +128.70 +12.4 +−5.95 +SD +18.97 +Correlation coefficient (r) +−0.45 +SD: Standard deviation +Hence, we postulate that, in T2DM, yoga tends to establish a homeostasis in blood glucose levels and +has minimal chance to induce hypoglycemia. To the best of our knowledge, this is the first time such a +bidirectional nature of yoga in T2DM is being reported. Yoga could thus prove to be a very safe and +effective form of physical activity, which could be administered to T2DM patients who are at increased +risk of hypoglycemia. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +References +1. Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 +diabetes: A systematic review and dose-response meta-analysis. Eur J Epidemiol. 2015;30:529–42. +[PubMed] [Google Scholar] +2. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and +diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society. +Diabetes Care. 2013;36:1384–95. [PMC free article] [PubMed] [Google Scholar] +3. Innes KE, Selfe TK. Yoga for adults with type 2 diabetes: A systematic review of controlled trials. J +Diabetes Res. 2016;2016:6979370. [PMC free article] [PubMed] [Google Scholar] +4. Jyotsna VP, Ambekar S, Singla R, Joshi A, Dhawan A, Kumar N, et al. Cardiac autonomic function +in patients with diabetes improves with practice of comprehensive yogic breathing program. Indian J +Endocrinol Metab. 2013;17:480–5. [PMC free article] [PubMed] [Google Scholar] +Articles from International Journal of Yoga are provided here courtesy of Wolters Kluwer -- Medknow +Publications diff --git a/subfolder_0/Yoga practice for reducing the male obesity and weight related psychological difficulties.txt b/subfolder_0/Yoga practice for reducing the male obesity and weight related psychological difficulties.txt new file mode 100644 index 0000000000000000000000000000000000000000..55cb757c1e98fabcdc71a211aba336351037c087 --- /dev/null +++ b/subfolder_0/Yoga practice for reducing the male obesity and weight related psychological difficulties.txt @@ -0,0 +1,1506 @@ +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): OC22-OC28 +22 +22 +DOI: 10.7860/JCDR/2016/22720.8940 +Original Article +Introduction +Obesity is a condition of excessive fat accumulation and is a major +risk factor for a number of chronic diseases. It is a health disorder +and is growing in high income countries, as well as in low and +middle income countries [1-3]. This health problem is increasing +in cities like Mumbai in India and the causes are urbanization and +life style changes, among other factors [4-6]. The previous studies +showed that among the Asian Indians, the prevalence of obesity is +high in male populations [7,8]. +BMI (Body Mass Index) is considered as a measure of obesity. It +was observed that for Asian Indians, BMI cut-off points are to be +considered much lesser than the WHO standards for categorizing +the obesity [9-12]. In our study, subjects with BMI of 25kg/m2 or +above were considered as obese. +In general, obesity is caused by an unbalance in the energy intake +and energy expenditure [13]. The causes of obesity are not fully +understood but it is a multi factorial disorder. The present options +for controlling obesity are inadequate and have adverse effects +[14-17]. Yoga is an ancient therapeutic practice based on Patanjali +yoga sutras [18-20]. The Integrated Approach of Yoga Therapy +(IAYT) consists of yogic practices based on ancient yoga texts +and addresses the mind and body in a holistic way. The earlier +studies showed that Yoga practice is useful for stress reduction, +awareness on satiety, awareness on over eating and weight +reduction [21]. The long term effect of yoga after imparting the +training is required to be assessed. The aim of this study was to +assess the final outcome after 3 months, of obesity parameters, +after giving 14 weeks of IAYT training, for adult male, in an urban +setting. +MATERIALS AND METHODS +Participants +The study was a parallel group study with Yoga and Control +groups. After training 14 weeks the Yoga group continued practice +of yoga, for the next 3 months. The Control group was not given +any specific physical activity. +The participants were from north east part of Mumbai. +Advertisement was done and total 80 subjects were enrolled +based on inclusion criteria. After randomization with minimization +of co-factors, 40 subjects were assigned in each group. The IAYT +training was given to Yoga group for 14 weeks and assessments +outcome were reported in an earlier paper [22]. Further the study +was continued and the final results were taken and the outcome is +presented in this paper. +The trial profile is shown in [Table/Fig-1]. Open source software, +titled MinmPy, was used for randomization with minimization of co +Keywords: Body mass index, Overweight, Perceived stress scale, +Skin fold thickness, Waist circumference +Internal Medicine + Section +Yoga Practice for Reducing the +Male Obesity and Weight Related +Psychological Difficulties-A +Randomized Controlled Trial +P +.B. RSHIKESAN1, Pailoor Subramanya2, Ram Nidhi3 +ABSTRACT +Introduction: Obesity is a health disorder and increasing all +over the world. It is also a cause for many non-communicable +diseases. Yoga practice reduces the stress level which may +improve the eating habits and help in weight reduction. +Aim: To assess the final outcome of the effects after 3 months +of the 14 weeks yoga training on obesity of adult male in an +urban setting. +Materials and Methods: This was a randomized controlled trial +with parallel groups (Yoga and Control groups) on male obese. +Total 80 subjects with Body Mass Index (BMI) between 25 to 35 +kg/cm2 were enrolled and randomized into two equal groups in +which 72 subjects (yoga n = 37 and control n=35) completed the +trial. Yoga group mean age ± SD was 40.03±8.74 and Control +group mean age±SD was 42.20±12.06. A 14 weeks special IAYT +(Integrated Approach of Yoga Therapy) yoga training was given +to the Yoga group and no specific activity was given to Control +group. The interim results of this study at 14 weeks were covered +in another article which is under process. After the 14 weeks of +yoga training the Yoga group was asked to continue the yoga +practice for the next 3 months and the Control group was not +given any physical activity. The final outcome is covered in this +paper. +The assessments were anthropometric parameters of body +weight(Wt), BMI (Body Mass Index), MAC (Mid-upper Arm +Circumferences of left and right arm), WC (Waist Circumference), +HC (Hip Circumference), WHR (Waist Hip Ratio), SKF (Skin +Fold Thickness) of biceps, triceps, sub scapular, suprailiac +and cumulative skin fold thickness value), Percentage body +fat based on SKF and Psychological questionnaires of PSS +(Perceived Stress Scale) and AAQW (Acceptance and Action +Questionnaire for Weight related difficulty). Assessments were +taken after 3 months of yoga training, for both Yoga and Control +groups. Within group, between group and correlation analyses +were carried out using SPSS 21. +Results: Improvement in anthropometric and psychological +parameters such as Wt, Percentage body fat, PSS were +observed in the final outcome. Also, some of the improvements +such as AAQW score were lost in the final outcome, compared +to interim results. +Conclusion: The yoga practice is effective for obesity control +for adult male in an urban setting. +www.jcdr.net +P +.B. Rshikesan et al., Yoga Practice for Reducing the Male Obesity and Weight related Psychological Difficulties-A Randomized Controlled Trial +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): OC22-OC28 +23 +23 +Assessments +The Wt (Body Weight), BMI, WC (Waist Circumference), HC (Hip +Circumference), WHR (Waist hip Ratio), A Body Shape Index +(ABSI), Skinfold thickness (SKF) at 4 body points applicable for +men and Mid Upper Arm Circumference (MAC) of left and right +arms were taken. ABSI was calculated based on WC height and +BMI [27-29]. +The scores of Perceived Stress Scale (PSS) and Acceptance and +Action Questionnaire for Weight Related Difficulty (AAQW) were +taken [30-32]. PSS is a validated scale for perceived stress. The +AAQW is a validated scale which assesses the experience based +avoidance and psychological inflexibility associated with food +habits and obesity [32]. +For assessing the SKF, skinfold thickness caliper was used [33,34]. +The assessments were done at four locations applicable for male +[35,36]. The table applicable for men was used for calculating +Percentage Body Fat (PFC), based on the cumulative value of skin +fold thicknesses [35]. The four measures of SKF were at biceps, +triceps, subscapular and suprailiac sites. Each SKF was calculated +from the average of three readings. The cumulative SKF was found +from sum of the four SKFs. The Wt was measured in electronic +weighing scale and circumferences were measured using non +elastic tape. +factors [23]. In the inclusion criteria, BMI was from 23 to 35 kg/m2, +and age was from 18 to 60 years. All the participants were male. +The subjects who had any surgery during previous six months +were excluded. Each participant was given an alpha numeric code +to remove all personal identities. +Sample Size +The minimum sample size was determined based on a previous +study [24]. In the previous study, out of the 4 primary outcome +variables, HC (Hip Circumference) had the lowest effect size and it +was considered for calculating the minimum sample size [24]. An +open source software, G*Power 3.1 was used and the minimum +sample size was determined as 29 [25]. +Intervention +The IAYT yoga training consisted of Lecture, Loosening Exercises, +Suryanamaskara, Asana, Pranayama and Meditation. All practices +were introduced in a slow and progressive manner. Yoga training +was for 90 minutes, for five days in a week. After the 14 weeks +training Yoga group continued their practice at their home. Regular +email, once in a week, was sent to them as a reminder to do +yoga practice and requested them to maintain the food log as +done during the yoga training. During the final assessment of +anthropometric and psychological parameters, after 3 months, all +subjects self reported that they were performing yoga practice. +The control group was not given any specific physical exercise +but they were asked to continue their regular physical activities. +The details of the yoga intervention are shown in [Table/Fig-2]. The +intervention was during March to September 2015. +Components Across both the Groups +All participants were given their respective measurement records +(Pre and Interim at 14 weeks) and the sample meal plan applicable +for sedentary male adults, based on guidelines of National Institute +of Nutrition Hyderabad [26]. +[Table/Fig-1]: Trial profile. +Sr. No. +Yoga practice +Duration in Minutes +1 +Lecture & Counselling +10 +2a +Loosening Exercises +10 +2b +Suryanamaskara +10 +3 +Asana +30 +4 +Pranayama +15 +5 +Meditation +15 +Total duration +90 +[Table/Fig-2]: Five part yoga training details. +P +.B. Rshikesan et al., Yoga Practice for Reducing the Male Obesity and Weight related Psychological Difficulties-A Randomized Controlled Trial +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): OC22-OC28 +24 +24 +Variable Pre Mean ± +Std Dev. +Final Mean ± +Std Dev. +t value +Sig +Means +95% C +Lower +Upper +Yoga group +WT +82.63±10.05 +80.47±9.59 +2.86 +0.007 +2.16 +0.63 +3.68 +MACL +29.98±2.02 +28.21±1.59 +8.34 +0.001 +1.77 +1.34 +2.20 +MACR +30.18±2.04 +28.24±2.07 +5.14 +0.001 +1.94 +1.17 +2.71 +HC +103.50±5.71 +99.46±4.76 +6.15 +0.001 +4.04 +2.71 +5.37 +RAB +19.05±7.01 +15.26.±2.90 +3.54 +0.001 +3.80 +1.62 +5.97 +STOF +32.45±7.82 +26.47±6.69 +3.52 +0.001 +5.98 +2.53 +9.42 +SHOB +27.87±6.97 +23.10±5.61 +3.27 +0.002 +4.77 +1.81 +7.73 +BMI +28.7±2.35 +27.97±2.21 +2.77 +0.009 +0.73 +0.20 +1.26 +SKFT +93.93±22.56 +76.45±11.74 +4.37 +0.001 +17.48 +9.36 +25.60 +PSS +16.51±6.12 +12.16±6.90 +3.93 +0.001 +4.35 +2.11 +6.60 +AAQW +81.24±17.35 +74.76±16.16 +2.46 +0.019 +6.49 +1.15 +11.82 +Control group +WT +79.45±8.85 +78.82±9.16 +1.52 +0.139 +0.63 +-0.22 +1.48 +MACL +32.53±16.53 +28.30±1.86 +1.52 +0.137 +4.23 +-1.42 +9.89 +MACR +32.47±16.73 +28.39±2.04 +1.46 +0.154 +4.09 +-1.60 +9.77 +HC +104.28±6.60 +100.50±5.79 +5.78 +0.001 +3.78 +2.45 +5.10 +RAB +13.70±6.57 +14.77±3.66 +-0.94 +0.354 +-1.07 +-3.37 +1.24 +STOF +27.46±9.37 +24.81±6.10 +1.80 +0.081 +2.65 +-0.35 +5.65 +SHOB +21.76±7.11 +22.2±6.42 +-0.30 +0.765 +-0.43 +-3.36 +2.49 +BMI +27.70±2.05 +27.28±2.55 +1.66 +0.106 +0.42 +-0.09 +0.93 +SKFT +73.65±20.61 +72.12±13.88 +0.46 +0.651 +1.53 +-5.27 +8.33 +PSS +14.29±6.51 +13.06±6.31 +1.42 +0.165 +1.23 +-0.53 +2.99 +AAQW +73.11±14.80 +66.63±14.20 +2.83 +0.008 +5.49 +1.55 +9.42 +[Table/Fig-4]: Within group analysis of normally distributed variables. +Paired sample t test was done for all the above Table/Fig 4 +WT: weight +MACL: Mid upper arm circumference of left hand +MACR: Mid arm circumference of right hand +HC: Hip circumference +RAB: Triceps skin fold thickness +STOF: Suprailiac skin fold thickness +SHOB: Sub scapular skin fold thickness +BMI: body mass index +SKFT: Cumulative skin fold thickness +PSS: Perceived stress scale score +AAQW: Action and weight relayed difficulty score +Variable +Yoga group +Z score +Sig +asymp. +sig (2- +tailed) +Pre Mean +± Std Dev. +Final Mean ± +Std Dev. +t value +Sig +WC +99.58±7.37 97.12-102.04 95.09±6.76 92.84-97.34 -4.79b +0.001 +RAF +14.55±7.19 +12.16-16.95 +11.62±3.14 10.58-12.67 -2.29b +0.020 +WHR +0.96±0.04 +0.95-0.98 +0.96±0.04 +0.94-0.97 +-1.41b +0.158 +PFC +30.78±4.37 +29.32-32.24 +28.16±3.45 27.01-29.31 -3.75b +0.001 +Variable +Control group +Z score +Sig +asymp. +sig (2- +tailed) +Pre Mean +± Std Dev. +Final Mean ± +Std Dev. +t value +Sig +WC +99.28±6.82 96.94-101.63 96.29±7.20 93.81-98.76 -3.12b +0.002 +RAF +10.72±5.00 +9.01-12.43 +10.34±3.06 +9.29-11.39 +-0.57b +0.572 +WHR +0.95±0.06 +0.93-0.97 +0.96±0.05 +0.94-0.97 +-0.02b +0.987 +PFC +27.55±5.17 +25.77-29.33 +27.64±4.65 26.05-29.24 +-0.19c +0.852 +[Table/Fig-5]: Within group analysis of not normally distributed variables. +Wilcoxon signed ranks test was done for Not Normally distributed variables +b- based on positive ranks +c- based on negative ranks +WC: Waist circumference +RAF: Biceps skin fold thickness +WHR: Waist hip ratio +PFC Percentage fat(based on skin fold thickness) +RESULTS +The base line demographic data of age, height and BMI of the +groups are given in [Table/Fig-3]. The outcome of within group +analysis of anthropometric parameters, for the Yoga and Control +Ethical Clearance +The Institutional Ethical Committee (IEC) clearance was taken. +Informed consent +The informed consent from participants was obtained before +recruitment. +Trial Registration +Registered +at +Clinical +Trials +registry +of +India +CTRI/2015/01/005433. +statistical Analysis +Analysis was performed using SPSS software, version 21.0 The +normality test was done by Shapiro wilk test. The Paired sample +t-test was done for all the parameters, for the first and final values, +of both groups, which were found normally distributed. For not +normally distributed parameters, the Wilcoxon signed ranks test +was done. The Between group analysis was done by independent +sample t-test. To find the relative improvement, from Pre to Final +values, among the variables, the differences of Pre to Final values +were correlated, among each other. A two sided, value of p<0.05 +was considered statistically significant. +Variable +Yoga group +Control Group +Pre +95% C +Pre +95% C +Age +40.03±8.74 +(37.12-42.94) +42.20±12.06 +(38.76-46.89) +Height +169.45±7.35 +(167.00-171.90) +169.29±6.37 +(167.17-171.65) +Min +Max +Min +Max +BMI +25.33 +34.84 +25.01 +33.64 +[Table/Fig-3]: Shapiro wilk test was applied for normality. +BMI- Body Mass Index +Pre: Before intervention +Variable +Yoga - Final- +Mean Std +dev +n=37 +Control +-Final- Mean +Std dev +n=35 +t +Sig (2- +tailed) +Diff. in Mean 95% +CI lower/Upper +WT +80.47± 9.59 +78.82± 9.16 +0.75 +0.46 +1.65 (-2.76 - 6.07) +MACL +28.21±1.59 +28.30±1.86 +-0.22 +0.83 +-0.09 (-0.90 – 0.72) +MACR +28.24±2.07 +28.39±2.04 +-0.31 +0.76 +-0.15 (-1.11 – 0.82) +HC +99.46±4.76 +100.50±5.79 +-0.83 +0.41 +-1.04 (-3.53 – 1.45) +RAB +15.26±2.90 +14.77±3.66 +--0.63 +0.53 +0.49 (-1.06 – 2.04) +STOF +26.47±6.69 +24.81±6.10 +1.10 +0.28 +1.66 (-1.35 – 4.67) +SHOB +23.10±5.61 +22.20±6.42 +0.64 +0.53 +0.90 (-1.93 – 3.73) +BMI +27.97±2.21 +27.28±2.55 +1.22 +0.23 +0.68 (-0.43 – 1.80) +SKFT +76.45±11.74 +72.12±13.88 +1.43 +0.16 +4.33 (-1.70 – 10.36) +PSS +12.16±6.90 +13.06±6.31 +-0.57 +0.57 +-0.89 (-4.01 – 2.22) +AAQW +74.76±16.16 +67.63±14.20 +1.98 +0.06 +7.13 (-0.04 – 14.30) +[Table/Fig-6]: Between group analysis. +An independent sample t test was applied between yoga & control groups +WT: weight +MACL: Mid upper arm circumference of left hand +MACR: Mid upper arm circumference of right hand +HC: Hip circumference +RAB: Triceps skin fold thickness +SHOB: Subscapular skin fold thickness +STOF: Suprailiac skin fold thickness +BMI: body mass index +SKFT Cumulative skin fold thickness +PSS: Perceived stress scale score +AAQW: Action and weight relayed difficulty score +groups are given in [Table/Fig-4,5] respectively. The between +group analysis at 6 months, is given in [Table/Fig-6]. The relative +improvements (from Pre to Final) among the variables are given in +[Table/Fig-7]. The comparative data of Pre, Interim and Final are +given in [Table/Fig-8]. +In each group, 50% of the total subjects was having educational +qualification between 10th standard to graduates and 50% was +post graduates or above. Also in each group 50% was in age +group of 18 to 40 and 50% was in age group of 41 to 60 years. +In each of the groups, all the subjects were working and all were +having BMI above 25 Kg/m2. The minimum age in Yoga group was +26 and maximum was 60 whereas in Control group, minimum was +21 and maximum 58. Thus minimization of co factors was done +[23,37,38]. None of the subjects reported any adverse events due +to the intervention. +The combined Pre, Interim and Final results given in [Table/Fig-8], +shows that some of the gain in the interim values was lost during +the final results. +www.jcdr.net +P +.B. Rshikesan et al., Yoga Practice for Reducing the Male Obesity and Weight related Psychological Difficulties-A Randomized Controlled Trial +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): OC22-OC28 +25 +25 +Difference of +final –pre values +WT +MACL +MACR +WC +HC +RAF +RAB +STOF +SHOB +BMI +WHR +SKFT +PFC +PSS +AAQW +WT +1.00 +MACL +-0.01 +1.00 +MACR +0.01 +0.991** +1.00 +WC +0.700** +0.07 +0.07 +1.00 +HC +0.594** +0.00 +0.03 +0.656** +1.00 +RAF +0.202* +-0.09 +-0.07 +0.229* +0.13 +1.00 +RAB +0.361** +-0.08 +-0.05 +0.271* +0.11 +0.624** +1.00 +STOF +0.458** +0.01 +0.00 +0.503** +0.234* +0.350** +0.326** +1.00 +SHOB +0.297** +-0.09 +-0.06 +0.282** +0.241* +0.328** +0.335** +0.420** +1.00 +BMI +0.854** +-0.02 +0.01 +0.509** +0.470** +0.205* +0.358** +0.435** +0.272* +1.00 +WHR +0.318** +0.10 +0.06 +0.670** +-0.12 +0.16 +0.234* +0.427** +0.14 +0.19 +1.00 +SKFT +0.462** +-0.08 +-0.05 +0.455** +0.257* +0.716** +0.723** +0.761** +0.742** +0.443** +0.339** +1.00 +PFC +0.449** +-0.06 +-0.04 +0.457** +0.249* +0.659** +0.693** +0.728** +0.745** +0.445** +0.354** +0.963** +1.00 +PSS +0.14 +-0.291** +-0.300** +0.07 +-0.04 +-0.02 +-0.03 +0.07 +0.04 +0.10 +0.14 +0.03 +0.02 +1.00 +AAQW +0.290** +0.01 +-0.01 +0.295** +0.02 +-0.02 +0.07 +0.19 +0.01 +0.348** +0.358** +0.10 +0.12 +0.260* +1.00 +[Table/Fig-7]: Correlation analysis on improvement from pre to final readings, among variables. +**. Correlation is significant at the 0.01 level (1-tailed). +*. Correlation is significant at the 0.05 level (1-tailed). +Bivariate -Pearson correlation test applied +WT: weight +MACL: Mid arm circumference left +MACR: Mid arm circumference right +HC: Hip circumference +WC: Waist circumference +RAF:Biceps skin fold thickness +RAB: Triceps skin fold thickness +SHOB: Sub scapular skin fold thickness +STOF: Suprailiac skin fold thickness +BMI: body mass index +WHR: Waist hip ratio +PFC: Percentage fat +SKFT: Cumulative skin fold thickness +PSS: Perceived stress scale score +AAQW: Action and weight relayed difficulty score +Sr. No +Group +Parameter +Pre +Interim +Final +Sig Pre Interim +Sig Pre Final +1 +Yoga +WT +82.63±10.05 +81.51±10.00 +80.47±9.59 +0.004 +0.007 +Control +79.45±8.85 +79.22±8.93 +78.82±9.16 +0.353 +0.139 +2 +Yoga +MACL +29.98±2.02 +29.42±1.92 +28.21±1.59 +0.016 +<0.001 +Control +32.53±16.53 +28.10±1.70 +28.30±1.86 +0.118 +0.137 +3 +Yoga +Macr +30.18±2.04 +29.64±2.04 +28.24±2.07 +0.018 +<0.001 +Control +32.47±16.73 +28.10±1.85 +28.39±2.04 +0.125 +0.154 +4 +Yoga +HC +103.50±5.71 +101.29±4.95 +99.46±4.76 +<0.001 +<0.001 +Control +104.28±6.60 +101.38±6.13 +100.50±5.79 +<0.001 +<0.001 +5 +Yoga +WC +99.58±7.37 +98.25±7.12 +95.09±6.76 +0.039 (z score -2.06b) +<0.001 (z score -4.79b) +Control +99.28±6.82 +95.79±8.33 +96.29±7.20 +<0.001 (z score -3.71b) +0.002 (z score -3.12b) +6 +Yoga +Whr +0.96±0.04 +0.97±0.05 +0.96±0.04 +0.069 (z score -1.82c) +0.158 (z score -1.41b) +Control +0.95±0.06 +0.94±0.06 +0.96±0.05 +0.413 (z score -0.82b) +0.987 (z score -0.02b) +7 +Yoga +Pfc +30.78±4.37 +29.66±3.30 +28.16±3.45 +0.051 (z score -1.96b) +<0.001 (z score -3.75b) +Control +27.55±5.17 +27.58±5.29 +27.64±4.65 +0.98 (z score -0.03c) +0.852 (z score -0.19c) +8 +Yoga +Bmi +28.7±2.35 +28.33±2.42 +27.97±2.21 +0.008 +0.009 +Control +27.70±2.05 +27.61±2.01 +27.28±2.55 +0.306 +0.106 +9 +Yoga +Skft +93.93±22.56 +85.52±13.38 +76.45±11.74 +0.032 +<0.001 +Control +73.65±20.61 +72.17±14.55 +72.12±13.88 +0.693 +0.651 +10 +Yoga +Biceps-skfraf +14.55±7.19 +12.70±5.02 +11.62±3.14 +0.156 (z score -1.42b) +0.02 (z score -2.29b) +Control +10.72±5.00 +11.10±3.69 +10.34±3.06 +0.502 (z score -0.672c ) +0.572 (z score -0.57b) +11 +Yoga +Triceps-skfrab +19.05±7.01 +17.87±5.05 +15.26.±2.90 +0.379 +0.001 +Control +13.70±6.57 +13.22±4.24 +14.77±3.66 +0.652 +0.354 +12 +Yoga +suprailiac-skfstof +32.45±7.82 +28.04±5.45 +26.47±6.69 +0.002 +0.001 +Control +27.46±9.37 +25.57±7.06 +24.81±6.10 +0.259 +0.081 +13 +Yoga +Subscapular-skfshob +27.87±6.97 +26.91±5.23 +23.10±5.61 +0.396 +0.002 +Control +21.76±7.11 +22.28±4.98 +22.20±6.42 +0.707 +0.765 +14 +Yoga +Pss +16.51±6.12 +12.59±6.65 +12.16±6.90 +<0.001 +<0.001 +Control +14.29±6.51 +13.51±5.95 +13.06±6.31 +0.493 +0.165 +15 +Yoga +Aaqw +81.24±17.35 +71.54±14.62 +74.76±16.16 +<0.001 +0.019 +Control +73.11±14.80 +69.71±16.28 +66.63±14.20 +0.224 +0.008 +[Table/Fig-8]: Pre- Interim- Final Results +Paired sample t test was applied for all Normally distributed variables and Wilcoxon signed ranks test was applied for Not Normally distributed variables +b- based on positive ranks, c- based on negative ranks +wt: weight +macl: Mid arm circumference left +macr: Mid arm circumference right +hc: Hip circumference +wc: Waist circumference +whr: Waist hip ratio +pfc: Percentage body fat +bmi: body mass index +skft: Cumulative skin fold thickness +skfraf: Biceps skin fold thickness +skfrab: Triceps skin fold thickness +skfshob: Sub scapular skin fold thickness skfstof: Suprailiac skin fold thickness pss: Perceived stress scale score +aaqw: Action and weight relayed difficulty score +P +.B. Rshikesan et al., Yoga Practice for Reducing the Male Obesity and Weight related Psychological Difficulties-A Randomized Controlled Trial +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): OC22-OC28 +26 +26 +Anthropometric Parameters +All parameters except WC, WHR, PFC and SKF of biceps were +normally distributed. +There was consistent improvement from Pre to Interim to Final +result, in the parameters of Wt, HC, BMI, Cumulative skin fold +thickness(SKFT), SKF of biceps (SKFraf) and SKF of suprailiac +(SKFstof) for both the groups. The Skfstof was improved from Pre +to Interim (p<0.002) & Interim to Final (p<0.001) in the Yoga group. +In the Yoga group the improvement in SKFT, in Pre to Final was +more significant (p<0.001) than in Pre to Interim (p<0.05). In Yoga +group alone, MACL and MACR were improved consistently from +Pre Interim to Final (p<0.001 for both MACL and MACR for pre- +final). Control group did not improve in these parameters in the final +result. The WC (p<0.001), WHR, and PFC (p<0.001) were improved +from Pre to Interim and to Final in Yoga group but in Control group +the gain was lost in the final result. The PFC of Control group was +increased in the Final (increase was not significant). +The SKF of triceps (SKFrab), in Control group reduced in Interim +but increased in Final. In the Control group, the SKF of sub scapular +(SKFshob) increased in Interim and remained almost same in the +Final. +The Final results, with respect to the Pre values were as below: +The Wt in the Yoga and Control groups were decreased during the +6 months. The Wt reduction in Yoga group alone was significant +(p<0.007). The upper mid arm circumference of right arm (MACR) +and upper mid arm circumference of left arm (MACL) were +reduced in both the groups but change in Yoga group alone was +significant (p<0.001). The WC was reduced in both the groups +(yoga p< 0.001 and control p<0.002).WHR remained same in +yoga, increased in control but not significant. In Yoga, the PFC, +based on chart, was decreased and was significant (p<0.001) +[35]. In the Control group it was increased but was not significant. +HC was reduced and was significant in both the groups (p<0.001). +The cumulative skin fold thickness was reduced in both the groups +but was significant (p<0.001) in Yoga group alone. The SKFrab +(p<0.001) SKFshob (p<0.002) and SKFstof (p<0.001) and SKFraf +(p <0.02) were reduced in Yoga group. In control group SKFstof +and SKFraf reduced but were not significant. SKFrab and SKFshob +were increased but changes were not significant. The BMI was +reduced in both the groups with significance (p< 0.009) in Yoga +group alone. The cumulative Skin Fold Thickness (SKFT) reduction +was significant (p<0.001) in the Yoga group alone. +Psychological Parameters +The PSS was improved consistently from Pre Interim to Final in the +Yoga group alone (p< 0.001). The AAQW was improved in Control +group in the Pre-Interim (but not significant) and improved during +Pre to Final (p<0.05). +In Yoga group, AAQW was improved during the Pre-Interim but +was increased (worsened) in Final (p<0.001 for Pre-Interim, p< +0.05 for Pre-Final). +Compared to Pre values, the improvement in PSS was significant +in the Yoga group (p<0.001) alone. In both the groups (compared +to Pre values) the AAQW improvement was significant (Yoga +p<0.02 and Control p<0.01). +Correlations +The correlations results with respect to, Pre to Final were as +below: +BMI was positively correlated to WC (r=0.509, p<0.01), SKFT +(r=0.443, p<0.01), HC (r=0.47, p<0.01) and AAQW (r=0.348, +p<0.01). The PSS was not much correlated to BMI. The PSS was +negatively correlated to MACL (r=-0.291, p<0.01) and MACR (r=- +0.300, p<0.01). +DISCUSSION +There was improvement in anthropometric parameters and this +was supportive of the earlier studies [39]. In the Yoga group, PFC +decrease (improvement) was significant (p<0.001) considering the +Pre Final values, though decrease of PFC was not significant during +Pre to Interim. This shows that the 14 weeks IAYT training had +effect in the Final values. The weight reduction was more significant +in Pre to Final than in Pre to Interim, and the weight reduction was +consistent. This indicates that the reduction of weight was due to +fat reduction. The earlier study of 8 week yoga on boys, showed a +significant decrease in percentage body fat [39]. +Earlier short term study on 2 weeks yoga and walking with diet +control (residential study), showed significant improvements +in anthropometric parameters, with no change in WHR [40]. +Another study showed similar results on WHR [41]. In our non +residential study, and without diet control (though sample food +plan information were given to both the groups), the WHR was +increased in Interim (compared to pre) and decreased in Final (with +respect to interim value-but compared to Pre value the Final value +remained same) in the Yoga group. The WHR was decreased in +Interim and increased in Final, in the Control group. But WC and +HC were consistently reduced in Yoga group, in Pre to Interim and +Pre to Final. WC was increased from Interim to Final in the Control +group. This shows that in the Yoga group, the fat stored centrally +and at peripherally was reduced in a similar way. Similar trend was +noted in a short duration trial on obese adults [40]. In the Control +group the WHR improvement (decrease) may be due to less fat +reduction in peripheral area than in abdominal area in the Interim +value. The decrease of WHR of Yoga group, in the Final may be +due to more decrease of WC than HC. This could be due to yoga +practices of the abdomen area. +The MAC was measured as part of anthropometric measurement +in the earlier studies also [41]. But we assessed both the right and +left MAC. In our study MAC reduction was significant for Yoga +group alone (p<0.001) both during Pre Interim and Pre Final, which +shows some reduction of fat or skin muscle in the upper limb +similar to the earlier short duration studies [40]. +The SKFT was significant in the Yoga alone (p<0.05 in Pre Interim +and p<0.001 in Pre Final).This supports that there is reduction +in MAC skin fold muscle or fat in the upper arms due to yoga +practice which included the Suryanamaskara and Asana requiring +active movement of upper arms, for one third of the yoga duration. +The consistent reduction of fat/muscle in upper arms in Final value +also shows the effectiveness of IAYT for obesity control. +This also shows that in long term yoga practice can give more +balanced reduction at different parts of the body like upper arm +and waist, compared to the Control group. In the Control group, +reduction in waist area was lesser and also there was lesser +reduction in upper arms. This may be due to their varied regular +physical activities. In our study, Yoga group SKFT and PFC +reduced consistently from Pre Interim to Final unlike in the Control +group and the anthropometry and skin fold thickness give the best +predictors for obesity assessment [42]. +In Yoga group SKFraf, SKFrab, SKFshob and SKFstof were also +consistently reduced from Pre Interim to Final value. In the Control +group SKFraf , SKFshob and SKFstof reduced but SKFrab got +increased from Interim to the Final. This may be due to lesser +physical activities using hand and shoulder. The reduction in +weight in the Yoga group was in all parts. The Control group, doing +their regular physical activities like walking etc. did not get weight +reduction in all parts. +In AAQW and PSS scores, there was difference in Pre values in +the groups [30,32]. Earlier studies showed Psycho Immunological +effects of yoga and reduction of various stress levels [43-45]. +Previous study showed that the decrease in weight related +www.jcdr.net +P +.B. Rshikesan et al., Yoga Practice for Reducing the Male Obesity and Weight related Psychological Difficulties-A Randomized Controlled Trial +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): OC22-OC28 +27 +27 +experiential avoidance is linked to more weight loss in a male +female combined batch [46]. But in the Yoga group the AAQW +score increased from Interim to final and in the Control group it +was decreased in the Final. The significance of reduction in AAWQ +was lost in Yoga group. This may be due to lesser yoga practices +of meditation such as MSRT (Mind sound resonance technique) +which are having a group effect and was part of the yoga training +of 14 weeks. During Interim to Final, the subjects were doing yoga +alone at their home in unsupervised situations. In control group +AAQW score reduction was almost same as Pre to Interim and +Interim to Final. There was no group activity for the Control group +and each was continuing their own regular physical activities +similar to pre interim period. +The PSS was validated using college students or workers [30]. +Our all subjects were working. The PSS is used for measuring the +perceived stress [47]. In our study PSS reduced with significance +(p<0.001) consistently in Pre Interim and Pre Final in yoga group +alone. The yoga practice reduced anxiety and depression scores +in mixed male female obese group of grade 2 obesity, BMI 31.37 ± +6.64 with psychological problems [48]. Improvement in depression +and anxiety was mostly correlated with improvements in WC and +HC [48]. Our study showed that yoga practice during Interim and +Final also reduced the perceived stress in obese male of BMI +28.7±2.3.In IAYT module there are many components such as +Suryanamaskara Pranayama Body awareness etc which reduces +the stress levels [24]. This shows that in the Final, the stress level +was reduced and that also might have improved their food habits +and promoted weight reduction. +The Pre Final correlation results show that BMI was positively +correlated to WC, SKFT, HC and AAQW. These correlations +were supportive to earlier short terms studies [48]. The PSS was +negatively correlated to MACL(r=-0.291, p<0.01) and MACR(r=- +0.300, p<0.01).Higher MAC indicate chronic energy deficiency +[49]. Thus anthropometric and psychological parameters are +found to be correlated in obese and the long term yoga practice +improves these parameters. +Previous studies showed that short and long term yoga interventions +reduce anxiety and mood changes [44,50]. The psychological +stress increases cortisol secretion and abdominal fat in an RCT on +female [51]. The mindfulness practices modify eating disorders. +Our study support that the reduction of abdominal fat in male is +consistent with reduction in perceived stress reduction. +Strengths Limitations and Future Scope +Our study is one of the earliest RCTs on male obesity and long term +yoga (six months) in urban setting along with assessments of PSS +and AAQW. It was reported that people with some belief in yoga +join to such programme [21]. Though all our subjects were new to +yoga this point is relevant. Future studies can be taken in different +cross sections and in different cities where the eating habits and +consumption of junk food could be different. The accurate food +log plays a vital role in control of the eating and the smart phone +or web based methods will be easier than hand written food log +[52,53]. The age group in our study was large to get more sample +size and for longer period study. However the age distribution was +similar in both groups by minimization of co factors. Also the urban +human habits of junk food eating, sedentary life etc., are common +for all age groups. Further studies can be done with smaller range +of age groups and at various cities (probably having varying food +habits). +CONCLUSION +The anthropometric parameters and percentage body fat showed +improvement in the Final result. Some of the improvements +including AAQW score obtained during the 14 weeks training was +lost in the Final value. The PSS score was improved consistently. +The fat reduction was effective at central and peripheral parts in +the Interim to Final result. Reduction of abdominal fat on male is +correlated to reduction in perceived stress. The yoga practice is +effective for obesity control for adult male in urban setting. +References + +[1] +WHO Obesity. 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Nagar, Bengaluru‑560 019, Karnataka, India. +E-mail: hrishipb@gmail.com +Financial OR OTHER COMPETING INTERESTS: None. +Date of Submission: Jul 13, 2016 +Date of Peer Review: Aug 02, 2016 + Date of Acceptance: Aug 20, 2016 +Date of Publishing: Nov 01, 2016 + Kannieappan LM, Deussen AR, Grivell RM, Yelland L, Dodd JM. Developing a +[34] +tool for obtaining maternal skinfold thickness measurements and assessing inter- +observer variability among pregnant women who are overweight and obese. +BMC Pregnancy Childbirth. 2013;13:42. + Durnin JV, Womersley J. Body fat assessed from total body density and its +[35] +estimation from skinfold thickness: measurements on 481 men and women aged +from 16 to 72 years. Br J Nutr. 1974;32(1):77–97. + Donoghue WC. How to measure your % bodyfat. 1999;22. Available from: http:// +[36] +www.amazon.com/dp/B00072CPFY + Saghaei M. 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J Diabetes Sci Technol. +2014;8(2):203–08. diff --git a/subfolder_0/Yoga versus physical exercise for cardio-respiratory fitness in adolescent school children A randomized controlled trial.txt b/subfolder_0/Yoga versus physical exercise for cardio-respiratory fitness in adolescent school children A randomized controlled trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..7d959c0102522ce113451225ee1136070b895e6c --- /dev/null +++ b/subfolder_0/Yoga versus physical exercise for cardio-respiratory fitness in adolescent school children A randomized controlled trial.txt @@ -0,0 +1,441 @@ +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +International Journal of Adolescent Medicine and Health. 2018; 20170154 +Vhavle Satish1 / Raghavendra Mohan Rao2 / Nandi Krishnamurthy Manjunath1 / Ram Amritanshu3 / +Udupa Vivek4 / Hassan Ratnakar Shreeganesh4 / Shashidhara Deepashree3 +Yoga versus physical exercise for +cardio-respiratory fitness in adolescent school +children: a randomized controlled trial +1 Swami Vivekananda Yoga Anusandhana Samsthana,Department of Life Sciences,Bengaluru,India +2 Centre for Academic Research,HCG Foundation,Healthcare Global Enterprises Ltd.,#8,P Kalinga Rao Rd,Sampangiramana- +gara,Bengaluru-560027,India,E-mail: raghav.hcgrf@gmail.com +3 Healthcare Global Enterprises ltd.,Department of CAM,Sampangiramanagara,Bengaluru,India +4 Divine Park,Department of Research and Development,Saligrama,Udupi,India +Abstract: +Background: Yoga is very effective in improving health especially cardio-respiratory fitness and also overall +performance in adolescents. There are no large numbers of randomized controlled studies conducted on com- +paring yoga with physical activity for cardio-respiratory fitness in adolescent school children with large sample +size. +Objective: Aerobic training is known to improve physical and cardio-respiratory fitness in children. Cardio- +respiratory fitness is an important indicator of health in children. In this study we evaluate the effects of yoga +versus physical exercise training on cardio-respiratory fitness in adolescent school children. +Subjects: Eight hundred two school students from 10 schools across four districts were recruited for this study. +Methods: In this prospective two arm RCT around 802 students were randomized to receive daily one hour +yoga training (n = 411) or physical exercise (n = 391) over a period of two months. VO2 max was estimated using +20 m shuttle run test. However, yoga (n = 377) and physical exercise (n = 371) students contributed data to the +analyses. Data was analysed using students t test. +Results: There was a significant improvement in VO2 max using 20 m Shuttle run test in both yoga (p < 0.001) +and exercise (p < 0.001) group following intervention. There was no significant change in VO2 max between +yoga and physical exercise group following intervention. However, in the subgroup with an above median +cut-off of VO2 max; there was a significant improvement in yoga group compared to control group following +intervention (p = 0.03). +Conclusion: The results suggest yoga can improve cardio-respiratory fitness and aerobic capacity as physical +exercise intervention in adolescent school children. +Keywords: adolescent, aerobic training, exercise, VO2 max, yoga +DOI: 10.1515/ijamh-2017-0154 +Received: September 6, 2017; Accepted: October 24, 2017 +Introduction +Sedentary lifestyle and lack of physical activity is known to not only affect health and cause sickness absen- +teeism in adolescent school children; but is also known to affect performance and all round development. +Sedentary lifestyle and eating habits are important causes of adolescent obesity. Physical activity is a primary +factor associated with the improvement of physical fitness [1], since an increased level of physical activity in +children and adolescents improves physical fitness, this is also known to have a positive effect on health [2]. +Physical fitness is defined as “the ability to perform daily tasks with vigour and alertness, without undue +fatigue and with ample energy to enjoy leisure-time pursuits, and to meet unforeseen emergencies” [3], [4]. +Reduced physical fitness is also associated with several non-communicable diseases that affect people’s health +[5]. There are two major components of physical fitness – one mainly related to health and the other related to +motor skills that pertain more to performance [6], [7]. Cardio-respiratory endurance or fitness (e.g. ability of the +blood vessels, heart, and lungs to take in, transport and utilize oxygen) is one such measure of physical fitness +and health outcomes. An important capacity that should be assessed in adolescents is cardio-respiratory fitness +Raghavendra Mohan Rao is the corresponding author. +©2018 Walter de Gruyter GmbH,Berlin/Boston. +1 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Satish et al. +DE GRUYTER +[8]. It is known, in fact, that over the last decades the overall fitness level and in particular, cardio-respiratory +fitness of the general population has decreased [9] leading to an increase in health conditions related to physical +inactivity [10], [11]. +Maximal oxygen consumption during physical activity (VO2 max) is an important indicator of cardio- +respiratory fitness. The 20 m shuttle run test (20 mSRT/beep test) has been initially validated by Léger and +Gadoury [12] and Metsios et al. [13], who have found a strong correlation with standard laboratory maximal +oxygen consumption (VO2 max) assessment and the 20 mSRT. The psychometric properties of the shuttle test +is a valid field measure for children and adolescents [14]. This test does not need much space and multiple +participants can execute it concurrently. Cardio-respiratory fitness is known to have positive associations with +high-density lipoproteins, systolic blood pressure, diastolic blood pressure [15], [16], BMI, measures of body +fat [17], and arterial stiffness [18]. A positive association has been also found between cardio-respiratory fitness +and measures of insulin sensitivity [15], [18] although this relationship is stronger in boys than in girls [18]. +Several studies have shown that a structured physical exercise intervention is known to improve cardio- +respiratory fitness and VO2 max on both maximal and sub-maximal exercise testing [19]. Preliminary studies +with yoga also show improved cardio-respiratory fitness in both healthy populations and populations with +cardio-respiratory problems. Peak expiratory flow, resting heart rate, systolic blood pressure are some of the +variables widely studied. In a recent study practice of suryanamaskar in healthy volunteers showed reduced +cardio-respiratory stress (lower heart rate, lower ventilation and CO2 output) compared to bicycle exercise at +similar work intensities [20]. +An earlier uncontrolled study has also shown increase in aerobic power (VO2 max) following yoga in medical +students [21]. +However there are no studies to our knowledge that have evaluated and compared effects of yoga on VO2 +max in adolescent school children with physical exercise as a control intervention. In this study we evaluate the +effects of yoga on aerobic capacity (VO2 max) in healthy adolescent school children using BEEP test protocol. +Materials and methods +In this study 10 schools spanning four districts were randomly chosen if they had adequate student strength +(min 80 in each class). The study was approved by the institutional review board of the institution and written +consent was obtained from the student’s parent/guardian and assent was obtained from the students. All tests +and assessments were carried out in the presence of their class teachers. The students underwent a screening +by a physician and were recruited only if he/she satisfied the selection criteria: (1) Higher primary and high +school children of both sexes (2) Age between 12 and 15 years. (3) Minimum 40 students in each section and +minimum of two sections in each class. +Exclusion criteria include: (1) Those with congenital heart disease, motor and mental retardation (2) Those +with h/o epilepsy, severe exercise induced asthma (3) Fevers or infection at time of screening and recruitment. +We performed a random sampling of the eligible selected schools in each taluk and selected 10 schools with +adequate student strength in class 8–9 among 24 schools which satisfied the selection criteria. Schools selected +were imparted both yoga and physical training for different class/sections in each school for 2 consecutive +months. Eighty students were selected from each school. Parameters were assessed at beginning and after end +of intervention before their annual exams. +In each school the students were randomized to receive yoga or physical exercise. Following baseline assess- +ments students were randomized to yoga group (n = 411) and physical exercise group (n = 391) using computer +generated random numbers. Allocation concealment was done using opaque envelopes with group assign- +ments. +A maximal multistage 20 m shuttle run test was designed to determine the maximal aerobic power of +schoolchildren, healthy adults attending fitness class and athletes performing in sports with frequent stops +and starts (e.g. basketball, fencing and so on) [22]. +The procedure of the test involves continuous running between 2 lines 20 m apart in time to recorded beeps. +For this reason the test is also often called the ‘beep’ or ‘bleep’ tests. The test participants stand behind one of +the lines facing the second line, and begin running when instructed by the CD or tape. The speed at the start is +quite slow. The participant continues running between the two lines, turning when signalled by the recorded +beeps. After about 1 min, a sound indicates an increase in speed, and the beeps will be closer together. This +continues each minute (level). If the line is not reached in time for each beep, the participant must run to the +line turn and try to catch up with the pace within two more ‘beeps’. Also, if the line is reached before the beep +sounds, the participant must wait until the beep sounds. The test is stopped if the participant fails to reach +the line (within 2 m) for two consecutive ends. There are several versions of the test, but one commonly used +2 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Satish et al. +version has an initial running velocity of 8500 m/h, which increases by 500 m/h each minute [23]. For the Beep +test done at baseline there were yoga (n = 377) and physical exercise (n = 371) students. For post assessment +there were (n = 370) in yoga and (n = 361) in the physical exercise group. +Yoga intervention involved a series of asanas, pranayama, meditation and relaxation given over a one hour +period daily 6 days a week for 2 months. The intervention was imparted by teachers of the school who are +trained in an intensive residential yoga camp. Basically the class began with loosening exercises, suryanamaskar +(sun salutation) stretches followed by yogic relaxation in the supine position. This was followed up with few +asanas in standing, supine, prone and sitting and then relaxation while supine and pranayama. +The control intervention involved one hour of physical training and play daily 6 days a week for 2 months. +The intervention was imparted by the physical education teachers in each school. The students performed loos- +ening exercises followed by aerobic workout like jogging, jumping, sit-ups, abdomen crunches, shoulder, back +and leg stretches, aerobic games like football for boys, Kho Kho for girls and relaxation with breath awareness +while supine for a few minutes. +Results +There was a significant increase in level within the yoga (t = −9.2; p < 0.001) and physical activity groups +(t = −6.4; p < 0.001) following the intervention period. However, there was no significant change in level be- +tween yoga and physical activity groups (t = −1.53; p = 0.13). There was no significant increase in round within +yoga (t = −0.58; p = 0.557) and physical activity group (t = −2.11; p = 0.36) following intervention period. How- +ever, there was a significant difference in number of rounds between yoga and physical activity group (t = −1.95; +p = 0.05). Though, there was a significant increase in VO2 max within yoga (t = −9.44; p < 0.001) and physical +activity group (t = −6.65; p < 0.001) following intervention between group effects were not significant (t = −1.63; +p = 0.10) (See Table 1). +3 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Satish et al. +DE GRUYTER +Table 1: Comparison of level, round and VO2 max between yoga group and physical activity group. +Level, round, and VO2 mean and SD for yoga and PA group +Level (no.) +Round (no.) +Vo2 max, mL/kg/min +Group +Pre +Post +Δ +Pre +Post +Δ +Pre +Post +Δ +PA (n = 391) +4.89 ± 1.78 +5.28 ± 1.76b +0.39 ± 1.22 +4.77 ± 2.54 +4.42 ± 2.34a +−0.35 ± 3.28 +30.93 ± 6.11 +32.25 ± 6.02b +1.32 ± 3.93 +Yoga (n = 411) +5.04 ± 1.67 +5.56 ± 1.68b +0.52 ± 1.15 +4.58 ± 2.37 +4.67 ± 2.35 +0.09 ± 3.07c +31.35 ± 5.70 +33.12 ± 5.83b +1.77 ± 3.80 +Total (n = 802) +4.96 ± 1.73 +5.42 ± 1.72 +0.46 ± 1.19 +4.67 ± 2.45 +4.54 ± 2.35 +−0.13 ± 3.18 +31.15 ± 5.90 +32.7 ± 5.93 +1.55 ± 3.87 +Within groups: a= p ≤ 0.05,b= p ≤ 0.001. Between groups c = p < 0.05. +4 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Satish et al. +When median cut-off of VO2 max at baseline was considered, there was a significant difference between +the groups with improved change in VO2 max in Yoga group compared to Physical activity in those with me- +dian cut-off 31 at baseline (t=2.237 p = 0.03). Whereas in those with median cut-off (<31) both groups showed +improvements in post measure following intervention (See Table 2). +Table 2: Comparison of yoga vs. physical activity in a subgroup population of VO2 max (mL/kg/min) cut-off of 31. +Group +Pre, mL/kg/min +Post, mL/kg/min +Δ, mL/kg/min +VO2 max (median cut off ≤31) + Yoga (n = 186) +26.27 ± 2.63 +29.07 ± 4.36 +2.81 ± 3.99 + Physical activity (n = 201) +26.03 ± 2.79 +28.47 ± 4.19 +2.45 ± 3.87 + p-Value +0.163 +0.367 +VO2 max (median cut-off >31) + Yoga (n = 225) +35.55 ± 3.83 +36.46 ± 4.66 +0.911 ± 3.39 + Physical activity (n = 190) +36.11 ± 4.03 +36.25 ± 4.98 +0.137 ± 3.65 + p-Value +0.650 +0.026a +There was a significant increase in mean heart rate within yoga (t = −8.79; p < 0.001) and physical activity +group (t = −6.66; p < 0.001) on beep test with a near significant change between groups (t = −1.80; p = 0.07) (See +Table 3). +5 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Satish et al. +DE GRUYTER +Table 3: Comparison of MHR, distance and Mets between yoga group and physical activity group. +MHR, distance, and Mets means and SD for YOGA and PA group +MHR +Distance in (m) +METs +Group +Pre +Post +Δ Pre-post +Pre +Post +Δ +Pre +Post +Δ Pre-post +PA (n = 391) +56.79 ± 3.91 +57.64 ± 3.85a +−0.85 ± 2.52 +729.86 ± 331.41 +797.17 ± 324.15ab −67.31 ± 209.12 +8.87 ± 1.8 +9.23 ± 1.71ab +−0.36 ± 1.2 +Yoga (n = 411) +57.01 ± 3.8 +58.20 ± 3.73a +−1.18 ± 2.73 +751.16 ± 309.6 +847.85 ± 320.7a +−96.69 ± 203.5d +9.00 ± 1.7 +9.49 ± 1.7ab +−0.49 ± 1.12 +Total (n = 802) +56.90 ± 3.84 +57.93 ± 3.80 +−1.02 ± 2.63 +740.78 ± 320.4 +823.14 ± 323.16 +−82.37 ± 206.64 +8.94 ± 1.71 +9.37 ± 1.70 +−0.42 ± 1.14 +Within groups: a = p ≤ 0.001. Between groups: b = p ≤ 0.05, +6 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Satish et al. +There was a significant increase in metabolic equivalent within yoga (t = −8.85; p < 0.001) and physical activ- +ity group (t = −6.14; p < 0.001) without any significant between group difference (t = −1.61; p = 0.11) (See Table +3). +Both groups were able to cover a longer distance on beep test following intervention yoga (t = −9.63; +p < 0.001) and physical activity group (t = −6.36; p < 0.001) with no significant change between groups (See +Table 3). +Discussion +The results from this study suggest that both yoga and physical activity improved aerobic capacity in young +adolescent children. There was a 5.3% increase in aerobic capacity with yoga compared to 4.1% with physical +exercise. There was 8.5% increase in distance in physical exercise compared to 11.4% in yoga group. There was +a 3.9% increase in Mets in physical exercise compared to 5.2% increase in Mets in yoga group. There were no +significant differences between yoga and physical exercise with respect to cardio-respiratory fitness. However, +in those with an above median cut-off of VO2 max at baseline there was a significant improvement in VO2 max +following yoga compared to physical activity intervention. +The findings of this study do not accurately reflect maximal aerobic power as the aerobic power or maximal +oxygen uptake was recorded using a sub maximal exercise using a field test as compared to maximal exercise in a +laboratory setting. However, the findings of the study reveal that other indices of cardio-respiratory fitness such +as endurance (speed and distance), stamina (fatigability), etc. that clinically reflect cardio-respiratory fitness also +improved with yoga and physical exercise intervention. The modest incremental improvement in this cardio- +respiratory fitness could be because of breath training during postures (asana) and pranayama (regulated nostril +breathing) that those in the yoga group were subjected to. +Our findings are similar to earlier observations that have shown only 5% increment in aerobic capacity +following aerobic exercise training in children. This is the maximum improvement in aerobic capacity seen +following aerobic training in children compared to that of adults [24]. Cardio-respiratory fitness reflects the +ability of the cardiovascular and respiratory systems to supply oxygen to the working muscles during heavy +dynamic exercise. It is usually measured by indirect calorimeter in a laboratory setting as maximal aerobic +power or maximal oxygen uptake (VO2 max), which is the highest rate of oxygen uptake achieved during heavy +dynamic exercise done using a cycle ergometer. However, field measurements using sub maximal exercise as +in beep test use a age predicted score that is valid [25]. Secondly, VO2 max has traditionally been defined as +the greatest amount of oxygen uptake that a participant can use in a progressive exercise test, identified by a +levelling or plateau of values at very high exercise intensities. Since children do not often display such a plateau, +some have been reluctant to label top values as VO2 max but rather as peak VO2. That peak VO2 values do, in fact +represent the greatest VO2 achieved in such tests (when certain criteria of heart rate and respiratory exchange +ratio are observed) has been documented with supramaximal studies [26]. Third, VO2 max should be expected +to be most closely linked to mitochondrial density of the contracting muscles reflecting a maximal delivery +of oxygen to the metabolic machinery of the muscle cell during activity. This if often influenced by both lean +body mass and true cardiovascular fitness (ability to generate stroke volume and cardiac output). Rowland et +al. found that body fat content and true cardiovascular fitness accounted for approximately equal amounts of +the performance variance [27] indicating that obesity may not just be the lone factor determining VO2 max/kg +that determines both stroke volume and cardiac output. This is further validated by the fact that ventricular +myocardial function is independent of age [28]. +This study was carried out in schools spread over several districts in rural South India where protein en- +ergy malnutrition and anaemia are widely prevalent. This study was done in schools where mid-day meals +were provided by the government to tackle malnutrition among school going children. Improvement of cardio- +respiratory performance among children suggests yoga is a feasible intervention in improving aerobic fitness +and performance that reflects health status of the children [29]. The findings of this study are important given +the fact that this study was done in rural settings where education infrastructure is relatively poor compared to +their urban counterparts. Further, earlier studies have shown that that ventilation and carbon dioxide output +were significantly higher in those practicing suryanamaskar compared to bicycle exercise at maximum inten- +sity of VO2 max indicating that suryanamaskar imposed less cardio-respiratory stress than bicycle exercise. Our +yoga program could have also facilitated less cardio-respiratory stress than exercise as seen in earlier studies +[20]. This is particularly important as exercise could induce cardio-respiratory stress in those with anaemia +and malnutrition [30]. Yoga could therefore be a better intervention than exercise if we consider this setting; +however, studies are needed to test this hypothesis in these settings. This study validates the feasibility and im- +portance of physical exercise training and yoga in school children. Teachers of these schools underwent training +to impart and teach yoga to children makes yoga a feasible intervention to adopt in schools along with phys- +7 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +Satish et al. +DE GRUYTER +ical training. However, unlike the popular perception that Yoga is not an aerobic training, the results suggest +otherwise. +Conclusion +The results suggest yoga does improve cardio-respiratory fitness and aerobic capacity as physical exercise in- +tervention in adolescent school children. Yoga practices involve a combination of aerobic exercises (breathing +during postures, regulated nostril breathing (pranayama), endurance and fitness (sun salutation and asanas), +strengthening and core stabilization (isometric contraction during asanas) and that facilitates cardiorespiratory +fitness in adolescent children. Controlled studies are needed to explore if the relaxation component has any role +in improving cardiorespiratory fitness in adolescent children. +Acknowledgements +We acknowledge the Dept. of AYUSH and Dept. of Education, Govt. of Karnataka. +References +[1] Zahner L,Puder JJ,Roth R,Schmid M,Guldimann R,Pühse U,et al.A school-based physical activity program to improve health and fitness +in children aged 6–13 years (“Kinder-Sportstudie KISS”): study design of a randomized controlled trial [ISRCTN15360785].BMC Public +Health.2006;6:147. +[2] Mesa JL,Ruiz JR,Ortega FB,Wärnberg J,González-Lamuño D,Moreno LA,et al.Aerobic physical fitness in relation to blood lipids and +fasting glycaemia in adolescents: influence of weight status.Nutr Metab Cardiovasc Dis.2006;16(4):285–93. +[3] Services USD of H& H.Europe Co.President’s Council on Physical Fitness and Sports: Physical Fitness Research Digest.2008. +[4] Pate RR.The evolving definition of physical fitness.Quest.1988;40(3):174–9. +[5] Greenberg H,Raymond SU,Leeder SR.The prevention of global chronic disease: academic public health’s new frontier.Am J Public +Health.2011;101(8):1386–90. +[6] Caspersen CJ,Powell KE,Christenson GM.Physical activity,exercise,and physical fitness: definitions and distinctions for health-related +research.Public Health Rep.1985;100(2):126–31. +[7] Simons-Morton BG,Parcel GS,O’Hara NM,Blair SN,Pate RR.Health-related physical fitness in childhood: status and recommendations. +Annu Rev Public Health.1988;9(1):403–25. +[8] Wang C,Chen P +,Zhuang J.A national survey of physical activity and sedentary behavior of Chinese city children and youth using ac- +celerometers.Res Q Exerc Sport.2013;84(Suppl 2):S12–28. +[9] de Moraes Ferrari GL,Bracco MM,Matsudo VK,Fisberg M.Cardiorespiratory fitness and nutritional status of schoolchildren: 30-year evo- +lution.J Pediatr (Rio J).2013;89(4):366–73. +[10] Finley CE,LaMonte MJ,Waslien CI,Barlow CE,Blair SN,Nichaman MZ.Cardiorespiratory fitness,macronutrient intake,and the +metabolic syndrome: the Aerobics Center Longitudinal Study.J Am Diet Assoc.2006;106(5):673–9. +[11] Barlow CE,DeFina LF,Radford NB,Berry JD,Cooper KH,Haskell WL,et al.Cardiorespiratory fitness and long-term survival in “low-risk” +adults.J Am Heart Assoc.2012;1(4):e001354. +[12] Léger L,Gadoury C.Validity of the 20 m shuttle run test with 1 min stages to predict VO2 max in adults.Can J Sport Sci.1989;14(1):21–6. +[13] Metsios GS,Flouris AD,Koutedakis Y,Nevill A.Criterion-related validity and test–retest reliability of the 20 m square shuttle test.J Sci +Med Sport.2008;11(2):214–7. +[14] Castro-Pinero J,Artero EG,Espana-Romero V,Ortega FB,Sjostrom M,Suni J,et al.Criterion-related validity of field-based fitness tests in +youth: a systematic review.Br J Sports Med.2010;44(13):934–43. +[15] Ondrak KS,McMurray RG,Bangdiwala SI,Harrell JS.Influence of aerobic power and percent body fat on cardiovascular disease risk in +youth.J Adolesc Heal.2007;41(2):146–52. +[16] Chaudhary S,Kang MK,Sandhu JS.The effects of aerobic versus resistance training on cardiovascular fitness in obese sedentary females. +Asian J Sports Med.2010;1(4):177–84. +[17] Hussey J,Bell C,Bennett K,O’Dwyer J,Gormley J.Relationship between the intensity of physical activity,inactivity,cardiorespiratory +fitness and body composition in 7–10-year-old Dublin children.Br J Sports Med.2007;41(5):311–6. +[18] Boreham CA,Ferreira I,Twisk JW,Gallagher AM,Savage MJ,Murray LJ.Cardiorespiratory fitness,physical activity,and arterial stiffness: +the Northern Ireland Young Hearts Project.Hypertension.2004;44(5):721–6. +[19] Dobbins M,Husson H,DeCorby K,LaRocca RL.School-based physical activity programs for promoting physical activity and fitness in +children and adolescents aged 6–18.Cochrane database Syst Rev.2013;(2):CD007651. +[20] Sinha B,Sinha TD,Pathak A,Tomer OS.Comparison of cardiorespiratory responses between Surya Namaskar and bicycle exercise at +similar energy expenditure level.Indian J Physiol Pharmacol.2013;57(2):169–76. +[21] Balasubramanian B,Pansare MS.Effect of yoga on aerobic and anaerobic power of muscles.Indian J Physiol Pharmacol.1991;35(4):281–2. +8 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM +Automatically generated rough PDF by ProofCheck from River Valley Technologies Ltd +DE GRUYTER +Satish et al. +[22] Paradisis GP +,Zacharogiannis E,Mandila D,Smirtiotou A,Argeitaki P +,Cooke CB.Multi-stage 20-m shuttle run fitness test,maximal oxy- +gen uptake and velocity at maximal oxygen uptake.J Hum Kinet.2014;41(1):81–7. +[23] Léger LA,Mercier D,Gadoury C,Lambert J.The multistage 20 metre shuttle run test for aerobic fitness.J Sports Sci.1988;6(2):93–101. +[24] Armstrong N,Welsman JR.Assessment and interpretation of aerobic fitness in children and adolescents.Exerc Sport Sci Rev. +1994;22:435–76. +[25] Mayorga-Vega D,Aguilar-Soto P +,Viciana J.Criterion-related validity of the 20-M shuttle run test for estimating cardiorespiratory fitness: a +meta-analysis.J Sports Sci Med.2015;14(3):536–47. +[26] Armstrong N,Welsman J,Winsley R.Is peak VO2 a maximal index of children’s aerobic fitness? Int J Sports Med.1996;17(5):356–9. +[27] Rowland T,Kline G,Goff D,Martel L,Ferrone L.One-mile run performance and cardiovascular fitness in children.Arch Pediatr Adolesc +Med.1999;153(8):845. +[28] Perrault HM,Turcotte RA.Do athletes have “the athlete heart?”Prog Pediatr Cardiol.1993;2(2):40–50. +[29] Stone MR,Rowlands AV,Middlebrooke AR,Jawis MN,Eston RG.The pattern of physical activity in relation to health outcomes in boys. +Int J Pediatr Obes.2009;4(4):306–15. +[30] Shouval R,Katz S,Nagler A,Merkel D,Ben-Zvi I,Segev S,et al.Gender disparities in the functional significance of anemia among appar- +ently healthy adults.Eur J Haematol.2017;98(5):435–42. +9 +Brought to you by | Göteborg University - University of Gothenburg +Authenticated +Download Date | 1/26/18 1:02 PM diff --git a/subfolder_0/alterations in auditory middle latency evoked potentials during meditation on a meaningful symbol om.txt b/subfolder_0/alterations in auditory middle latency evoked potentials during meditation on a meaningful symbol om.txt new file mode 100644 index 0000000000000000000000000000000000000000..8dab0356fd86fd41314eb1f8147b23fd55a2771e --- /dev/null +++ b/subfolder_0/alterations in auditory middle latency evoked potentials during meditation on a meaningful symbol om.txt @@ -0,0 +1,8 @@ + + + + + + + + diff --git a/subfolder_0/effect of sirsasana ( headstand) practiceon autonomic and respiratory variables.txt b/subfolder_0/effect of sirsasana ( headstand) practiceon autonomic and respiratory variables.txt new file mode 100644 index 0000000000000000000000000000000000000000..1bd82b8f91333096ee760b13d415c4dece3a0eea --- /dev/null +++ b/subfolder_0/effect of sirsasana ( headstand) practiceon autonomic and respiratory variables.txt @@ -0,0 +1,28 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/heart rate and respiratory changes accompanying yogic conditions of single thought and thoughtless states.txt b/subfolder_0/heart rate and respiratory changes accompanying yogic conditions of single thought and thoughtless states.txt new file mode 100644 index 0000000000000000000000000000000000000000..c9e600c979b9dd8581b7caff2240eff86ad34d7f --- /dev/null +++ b/subfolder_0/heart rate and respiratory changes accompanying yogic conditions of single thought and thoughtless states.txt @@ -0,0 +1,7 @@ + + + + + + + diff --git "a/subfolder_0/influence of Yoga-Based Personality\302\240Development Program on\302\240Psychomotor Performance and self-efficacy in school children.txt" "b/subfolder_0/influence of Yoga-Based Personality\302\240Development Program on\302\240Psychomotor Performance and self-efficacy in school children.txt" new file mode 100644 index 0000000000000000000000000000000000000000..061d5495430eb43074d661dc46659b89d6218ba9 --- /dev/null +++ "b/subfolder_0/influence of Yoga-Based Personality\302\240Development Program on\302\240Psychomotor Performance and self-efficacy in school children.txt" @@ -0,0 +1,1032 @@ +June 2016  |  Volume 4  |  Article 62 +1 +Original Research +published: 15 June 2016 +doi: 10.3389/fped.2016.00062 +Frontiers in Pediatrics  |  www.frontiersin.org +Edited by: +Venkata Bharadwaj Kolli, +Creighton University, USA +Reviewed by: +Munis Dundar, +Erciyes University, Turkey + +Karen Schepman, +Cardiff University +School of Medicine, UK +*Correspondence: +Singh Deepeshwar + +deepeshwar_singh@hotmail.com +Specialty section: +This article was submitted to +Child and Adolescent Psychiatry, +a section of the journal +Frontiers in Pediatrics +Received: 29 March 2015 +Accepted: 30 May 2016 +Published: 15 June 2016 +Citation: +Das M, Deepeshwar S, +Subramanya P and Manjunath NK +(2016) Influence of Yoga-Based +Personality Development Program +on Psychomotor Performance and +Self-efficacy in School Children. +Front. Pediatr. 4:62. +doi: 10.3389/fped.2016.00062 +I +Madhusudan Das, Singh Deepeshwar*, Pailoor Subramanya and +Nandi Krishnamurthy Manjunath +Yoga and Life Sciences Laboratory, Swami Vivekananada Yoga Research Foundation, Bangalore, India +Selective attention and efficacy are important components of scholastic performance in +school children. While attempts are being made to introduce new methods to improve +academic performance either as part of curricular or extracurricular activities in schools, +the success rates are minimal. Hence, this study assessed the effect of yoga-based +intervention on psychomotor performance and self-efficacy in school children. Two +hundred ten school children with ages ranging from 11 to 16 years (mean age ± SD; +13.7  ±  0.8  years) satisfying the inclusion and exclusion criteria were recruited for +the 10-day yogä program. An equal number of age-matched participants (n  =  210; +mean ± SD; 13.1 ± 0.8 years) were selected for the control group. Participants were +assessed for attention and performance at the beginning and end of 10 days using trail +making task (TMT) A and B, and self-efficacy questionnaire. The yoga group showed +higher self-efficacy and improved performance after 10 days of yoga intervention. The +performance in TMT-A and -B of the yoga group showed a significantly higher number +of attempts with a reduction in time taken to complete the task and a number of wrong +attempts compared with control group. Results suggest that yoga practice enhances +self-efficacy and processing speed with fine motor coordination, visual–motor integra- +tion, visual perception, planning ability, and cognitive performance. +Keywords: yoga, self-efficacy, attention, trail making test, academic performance +INTRODUCTION +Scholastic performance in school children depends on multiple factors. Memory, attention, and +motor speed are some of the important intrinsic factors, which play a major role in an individual’s +performance. Motivation to perform can also be influenced by self-efficacy (1). Self-efficacy is +defined as “an individual’s judgment of his/her own capabilities to organize and execute the tasks +to achieve optimal performance” (2). High self-efficacy is related to a number of positive physical, +social, and psychological outcomes. A longitudinal study of 390 adolescents, reported lower levels of +depression and delinquency with positively correlated emotional self-efficacy (the perceived ability +to handle negative emotions and express positive emotions) (3). Another study on low self-efficacy +in students and patients reported severity of social anxiety and associated social impairment (4). +Therefore, attempts are being made to create structured activities within the curriculum, which can +enhance an individual’s scholastic behavior and performance. But, these programs with focused +TABLE 1 | Characteristics of the participants. +Participants +Yoga group +Control group +n +M ± SD +n +M ± SD +Age (years) +210 +13.78 ± 0.89 +210 +13.08 ± 0.84 +Gender +Male +140 +13.75 ± 0.91 +124 +13.18 ± 0.83 +Female +70 +13.84 ± 0.88 +86 +12.93 ± 0.83 +Socioeconomic status +High +48 (23%) +32 (15.24%) +Middle +148 (70.5%) +162 (77.14%) +Lower +14 (6.5%) +6 (6.7%) +Educational status +Up to 6 years +52 (24.76%) +63 (30%) +Up to 8 years +123 (58.57%) +119 (56.67%) +Up to 10 years +35 (16.67%) +28 (13.33%) +2 +Das et al. +Yoga and Psychomotor Performance in School Children +Frontiers in Pediatrics  |  www.frontiersin.org +June 2016  |  Volume 4  |  Article 62 +objectives have resulted in improvement of the student’s perfor- +mance, but not behavior. +Yoga is an ancient Indian discipline that aims at developing +an integrated personality, where the growth of physical, mental, +social, and spiritual planes is equally focused (5, 6). Manjunath +and Telles reported that practicing yoga (including postures, +regulated breathing, relaxation techniques, and meditation) can +improve the ability to plan and execute a given cognitive task in +school children (7). Furthermore, several studies have demon- +strated the positive impact of yoga in terms of enhanced attention, +concentration, and memory (visual and spatial memory) (8, 9) +in school children. It was demonstrated that the combination of +yoga practices can improve motor speed (10), while an individual +technique (called cyclic meditation) involving focused attention +can improve perception (11). +In addition, the beneficial effects of yoga in improving hand +steadiness, which is suggestive of better attention and concen- +tration (8) has been documented. Furthermore, a recent report +suggested an improvement in motor skills and visual discrimina- +tion following the practice of a yoga-based breathing technique +(Kapalabhati), compared with breath awareness (12). +It is evident from these earlier studies that combination of +yoga practices in general, and selected individual yoga techniques +in isolation, can positively influence an individual’s perception +and motor performance. The studies mentioned above provide +some evidence for the use of yoga in improving motor function, +attention, and perception, which are important for scholastic +performance. However, there are no comprehensive studies +with larger sample size, controlled environment, and longer +duration of intervention available to understand the influence +of a customized yoga module on an individual’s performance +and behavior. +Hence, this study was designed to evaluate changes in psy- +chomotor performance and self-efficacy following a specially +designed personality development yoga camp for school children. +MATERIALS AND METHODS +Participants +Four hundred twenty healthy school children with ages rang- +ing between 13 and 16 years were recruited. Two hundred ten +children (M = 13.78; SD = 0.89) were from a self-selected 10-day +yoga-based “Personality Development Camp” (PDC) at a yoga +institution, in South India. An equal number of age-matched sub- +jects (M = 13.08; SD = 0.84) without any experience of yoga were +selected as control group from a school within the same locality. +The inclusion criteria included (i) between 13 and 16 years of +age, (ii) English as the medium of instruction in the school, (iii) +willingness to participate in the study, and (iv) no hospitalization +in the last 3 months. The exclusion criteria included (i) any his- +tory of neurological or psychiatric disturbances and (ii) learning +disability if any (i.e., slow learner). The study was approved by the +Institutional Ethics Committee (Res/IEC-SVYASA/003/2013) of +the yoga institution. Since the selected age group included minors +(below 18 years of age), signed informed consent was obtained +from their parents and guardian (Principal of the School). +Demographic details of the participants are given in Table 1. +Design +Eligible subjects from the PDC camp at the yoga institution who +were willing to participate in the study were stratified based on +age and academic status and were assigned to the yoga group. +The yoga group and the control group were assessed before and +immediately after 10  days. They were assessed similar to the +experimental group on days 1 and 10 during which time the +subjects were asked to continue with their normal routine. +Intervention +The 10-day “Personality Development Camp” (PDC) of 10 h per +day was designed for children below 17 years of age. The 10-h +routine consisted of physical postures (Asanas), voluntary regu- +lated breathing (Pranayama), meditation (Dhyana), relaxation +techniques, internal cleansing practices (Kriyas), and reciting +hymns from traditional yoga texts, music, yoga games, and happy +assembly. Kriyas are yogic cleansing exercises, which are per- +formed to cleanse the body and assist with the natural removal of +waste products (13). Details of the intervention are summarized +in Table 2. +Assessments +Each subject was assessed in two sessions, one using trail making +tasks-A and -B (TMT) (14) and the second using self-efficacy +questionnaire for children (SEQ-C) (15). Although trail making +tasks are very simple, it has been hypothesized that they reflect +various cognitive processes including attention, visual search and +scanning, sequencing and shifting, psychomotor speed, abstrac- +tion, flexibility, ability to execute and modify a plan of action, and +ability to maintain two trains of thoughts simultaneously (12). +During the TMT session, subjects were assessed individu- +ally by seating them on a comfortable chair. Trail making task +“A” involved subjects drawing lines connecting 25 consecutive +circled numbers in a numerical sequence (i.e., 1–2–3, etc.) as +rapidly as possible. In task “B,” the subjects were directed to draw +lines to connect 12 consecutive circled numbers and 12 con- +secutive letters in an alternate numeric and alphabetic sequence +(i.e.,  1–A–2–B, etc.) as rapidly as possible. Time (in seconds) +taken for completing the task was noted by using a stop watch. +TABLE 2 | Summarized 10-day Yoga intervention program. +Sl no. +Name of intervention +Duration +1. +Asana session +• Standing posture +• Sitting postures +• Prone posture +• Inverted postures +• Supine postures +2 h +2. +Pranayama session +• Sectional breathing +• Thoracic breathing +• Diaphragm breathing +• Hyperventilation (Bhastrika and Kapalbhati) +• Balancing of the breath (NadiShuddhi, AnulomVilom) +1 h +3. +Cleansing techniques (Kriyas) +• Trataka (eye-cleansing techniques) +• Sutra Neti and JalaNeti (nasal tract-cleansing +techniques) +• VamanDhouti and LaghuShankaPrakshalana +(GI tract-cleansing techniques) +Twice +4. +Gita Chanting session +• Chanting (18 verses from Bhagavad Gita) +• Yogic discourse +1 h +5. +Creativity hour +• Karma yoga +• Designing and arts +• Tree plantation +• Debate +• Stories +2 h +6. +Bhajan session +• Devotional songs +• Patriotic songs +1 h +7. +Game session +• Yogic games +• Group awareness +1 h +8. +Happy assembly +• Cultural program +• Team work +2 h +3 +Das et al. +Yoga and Psychomotor Performance in School Children +Frontiers in Pediatrics  |  www.frontiersin.org +June 2016  |  Volume 4  |  Article 62 +The errors committed during the task completion were scored +removing accurately (16). +Self-efficacy questionnaire for children was developed by +Muris (15) to assess general self-efficacy across three domains: +academic, social, and emotional situations. The SEQ-C is a +24-item self-reported measure with eight items for each domain. +Each item is rated on a 5-point Likert scale with 1 being “not at +all” and 5 being “very well.” Both assessments were arranged on +separate days at the same time for the two groups (i.e., Yoga and +Control). The SEQ-C was administered as a group test, and the +subjects were seated comfortably. +Procedure +The TMT and self-efficacy questionnaire (SEQs) questionnaires +were administered on children of both the groups (yoga and con- +trol) on Day 1 and Day 10 of personality development yoga camp. +The data collection lasted for 20 min. The yoga groups underwent +for 10 days yoga practices, whereas control group were asked to +continue with their normal routine. The yoga educator was blind +to the hypothesis of the study. After 10 days of yoga intervention, +all children were asked to complete the same questionnaires. +The researchers explained about the study and gave stipulated +instructions of the manuals to children for better understanding. +Children were not given feedback as to their performance on +designing experiments or any of the measures. +While data extraction, TMT scores were extracted based on +wrong attempts, right attempts, and total attempts to see the error +affect of the children. The extraction of TMT also included the +completion time for the task, i.e., time duration in seconds. The +SEQ-C was extracted based on the responses on three domains +of self-efficacy, i.e., (i) social self-efficacy, which has to do with +the perceived capability for peer relationship and assertiveness; +(ii) academic self-efficacy, which is concerned with the perceived +capability to manage one’s own learning behavior, to master +academic subjects, and to fulfill academic expectations; and (iii) +emotional self-efficacy, which pertains to the perceived capability +of coping with negative emotions. +Data Analysis +The raw data were obtained from Trail Making Tasks A and B as +well as SEQ and tabulated separately. The raw data were analyzed +using Statistical Package for Social Science (SPSS) Version 20. +Data of different variables were tested with the Kolmogorov– +Smirnov test for normality. Since, we had two Groups, i.e., yoga +and control, and two states, i.e., day 1 and day 10, repeated +measures analysis of variance (RM-ANOVA) was carried out for +each assessment. For Trail making tasks (A and B), RM-ANOVA +was performed with one “Within-subjects” factor, i.e., state (day 1 +and day 10), which in turn had four subdomains (wrong attempt, +right attempt, total attempt, and time taken) and one “Between- +subjects” factor, i.e., groups (yoga and control). Similarly, for +self-efficacy, RM-ANOVA was performed with one “Within- +subjects” factor, i.e., states (day 1 and day 10), which in turn had +three subdomains (academic, social, and emotional) and one +“Between-subjects” factor, i.e., groups (yoga and control). This +was followed by a pairwise comparison between the mean values +of day 1 and day 10 assessments with Bonferroni correction. The +alpha level was set at p < 0.05. +RESULTS +TMT +For Trail making task “A” (TMT-A), the repeated measures +ANOVA showed a significant difference for Between-subjects +factor, i.e., groups [F(1,418) = 12.38; p < 0.001; η2p = 0.029] as well as +for Within-subjects factor, i.e., states [F(3,1254) = 2164.29; p < 0.001; +η2p  =  0.84] and for sub domains of TMT-A assessments, i.e., +wrong attempt [F(1,418) = 29.45; p < 0.001; η2p = 0.06], right attempt +[F(1,418) = 30.10; p < 0.001; η2p = 0.07], total attempt [F(1,418) = 0.55; +p > 0.05; η2p = 0.001], and time taken [F(1,418) = 58.83; p < 0.001; +η2p = 0.13]. The interaction between subdomains of TMT assess- +ments × groups [F(3,1254) = 12.24; p < 0.001; η2p = 0.028] and +State × Groups [F(1,418) = 61.24; p < 0.001; η2p = 0.13] were also +significant. +After 10 days, in the Trail making task “A” (TMT-A), pairwise +comparisons with Bonferroni correction showed a significant +increase in the “right attempt” scores (p  <  0.001) with the +TABLE 3 | The groups mean values ±SD of the trail making task (TMT) A and B for yoga and control groups in two states (pre and post). +Assessments +Variables +Groups +Pre M ± SD +(median) +Post M ± SD +(median) +Pre Interquartile +range +Post Interquartile +range +% +Change +T +p-Values +Trail making +task A +Wrong +attempt +Yoga +0.61 ± 1.26 (0) +0.05 ± 0.26 (0) +1 +0 +91.80 +6.396 +0.000 +Control +1.14 ± 1.88 (0) +0.46 ± 1.01 (0) +1 +0 +59.65 +5.000 +0.000 +Right +attempt +Yoga +24.39 ± 1.25 (25) +24.95 ± 0.26 (25) +1 +0 +2.30 +−6.379 +0.000 +Control +22.87 ± 1.87 (25) +23.54 ± 1.01 (25) +1 +0 +2.93 +−4.934 +0.000 +Total +attempt +Yoga +24.88 ± 0.76 (25) +25.00 ± 0.07 (25) +0 +0 +0.48 +−2.239 +0.026 +Control +23.91 ± 0.60 (25) +23.95 ± 0.44 (25) +0 +0 +0.17 +−0.736 +0.463 +Time +duration (s) +Yoga +35.92 ± 17.43 (32) +26.48 ± 9.88 (25) +11.5 +10 +26.28 +11.128 +0.000 +Control +62.84 ± 26.99 (33) +64.23 ± 22.30 (33) +18 +16 +2.21 +−1.441 +0.151 +Trail making +task B +Wrong +attempt +Yoga +1.20 ± 2.27 (0) +0.07 ± 0.31 (0) +2 +0 +94.17 +7.329 +0.000 +Control +0.51 ± 0.94 (0) +0.36 ± 0.80 (0) +2 +0 +29.41 +1.836 +0.068 +Right +attempt +Yoga +22.82 ± 2.26 (24) +23.94 ± 0.31 (24) +2 +0 +4.91 +−7.265 +0.000 +Control +24.50 ± 0.93 (24) +24.63 ± 0.80 (24) +2 +0 +0.53 +−1.731 +0.085 +Total +attempt +Yoga +23.73 ± 0.98 (24) +23.98 ± 0.19 (24) +0 +0 +1.05 +−3.722 +0.000 +Control +24.93 ± 0.54 (24) +25.00 ± 0.07 (24) +0 +0 +0.28 +−1.672 +0.096 +Time +duration (s) +Yoga +72.03 ± 28.38 (68) +48.98 ± 15.21 (47) +35.5 +19 +32.00 +13.853 +0.000 +Control +36.23 ± 13.38 (58) +34.72 ± 11.87 (60) +30 +31 +4.17 +3.118 +0.002 +TABLE 4 | Descriptive statistics groups mean values ±SD of the self-efficacy questionnaire for yoga and control groups in two states (pre and post). +Assessments +Variables +Groups +Pre +M ± SD +(median) +Post +M ± SD +(median) +Pre +Interquartile +range +Post +Interquartile +range +% +Change +T +p-Values +Self-efficacy +questionnaire +(SEQ) +Academic +domain +Yoga +25.51 ± 7.12 (25) +29.71 ± 5.11 (30) +11 +6 +15.95 + −7.108 +0.000 +Control +30.10 ± 6.44 (32) +30.46 ± 6.15 (32) +10 +10 +1.19 +−1.754 +0.081 +Social domain +Yoga +24.00 ± 5.94 (23) +28.86 ± 4.63 (29) +8 +6 +20.25 +−10.495 +0.000 +Control +27.79 ± 5.48 (28) +28.36 ± 5.25 (29) +8 +7 +2.05 +−2.947 +0.004 +Emotional +domain +Yoga +22.26 ± 5.65 (21) +27.98 ± 5.00 (28) +7.3 +7 +25.70 +−13.173 +0.000 +Control +25.56 ± 5.20 (25) +26.19 ± 4.95 (26) +7.3 +7 +2.46 +−3.318 +0.001 +Total score +Yoga +71.96 ± 15.68 (70) +86.66 ± 11.10 (86) +21 +13 +20.43 +−12.725 +0.000 +Control +83.49 ± 14.69 (84) +85.04 ± 14.01 (85) +22 +21 +1.86 +−3.812 +0.000 +4 +Das et al. +Yoga and Psychomotor Performance in School Children +Frontiers in Pediatrics  |  www.frontiersin.org +June 2016  |  Volume 4  |  Article 62 +reduction in the “wrong attempt” scores (p < 0.001) in the yoga +group, while there was no difference in the control group. Also, +the “total numbers” attempted were significantly higher (p < 0.05) +and the “time taken” was significantly lower (p < 0.001) in the +yoga group compared with control group. +Similarly, for Trail making task-B (TMT-B), the repeated +measures ANOVA showed a significant difference in “Between- +subjects” factor, i.e., groups [F(1,418)  =  12.38; p  <  0.001; +η2p = 0.029] as well as for “Within-subjects” factor, i.e., states +[F(3,1254) = 2164.29; p < 0.001; η2p = 0.84], and for sub domain +of TMT-B assessments, i.e., wrong attempt [F(1,418)  =  28.91; +p < 0.001; η2p = 0.06], right attempt [F(1,418) = 29.7; p < 0.001; +η2p = 0.07], total attempt [F(1,418) = 1.01; p > 0.05; η2p = 0.002], and +time taken [F(1,418) = 66.19; p = 0.001; η2p = 0.14]. The interaction +between TMT-B assessments × groups [F(3,1254) = 12.24; p < 0.001; +η2p  =  0.028] and state  ×  groups [F(1,418)  =  61.24; p  <  0.001; +η2p = 0.13] was also significant. +Pairwise comparisons between mean values of the yoga group +showed a significant increase in the scores of “right attempts” +(p < 0.001) with the reduction of “wrong attempts” (p < 0.001). +Additionally, yoga practices, improved “total attempts” (p < 0.001) +with the reduction in the time taken (p < 0.001). On the other +hand, there were no significant changes in the control group +(p > 0.05) scores of day 1 to day 10. The group mean values, SD, +median, and interquartile range of trail making task (A and B) of +both the groups on day 1 and day 10 are given in Table 3. +Self-efficacy +For self-efficacy, the repeated measures ANOVA showed a +significant difference “Between-subjects” factor, i.e., groups +[F(1,418) = 18.94; p < 0.001; η2p = 0.043] and states [F(1,418) = 181.29; +p < 0.001; η2p = 0.30]. The test of Within-subjects effect showed +that there were significant interaction between states × groups +[F(1,418) = 119.13; p < 0.001; η2p = 0.22] and subdomains of assess- +ments × states [F(3,1254) = 107.02; p < 0.001; η2p = 0.20]. +The pairwise comparisons with Bonferroni correction for the +yoga group showed a significant increase in the scores of aca- +demic domains (p < 0.001), the social domain (p < 0.001), and +emotional domain (p < 0.001), whereas there were no significant +changes in the scores of the control group on day 1 to day 10. +The group mean values, SD, median, and interquartile range of +the SEQ of both the groups on day 1 and day 10 with percentage +change (%) are given in Table 4. +The partial correlation showed that there was a significant +inverse relationship between total self-efficacy score and the time +duration of the test in Trial A (r = −0.41; p = 0.04) and in Trial +B (r = −0.21; p = 0.003) of yoga group, which suggest that with +increasing self-efficacy, the duration of the test was reduced in +5 +Das et al. +Yoga and Psychomotor Performance in School Children +Frontiers in Pediatrics  |  www.frontiersin.org +June 2016  |  Volume 4  |  Article 62 +trial A and trial B compared with the control group. This suggests +that the self-efficacy was higher in yoga group with improved +performance as compared with control group. +DISCUSSION +The results of this study revealed that the school children who +performed regular yoga practices showed higher self-efficacy +and improved performance compared with control group who +continued with their normal routine. It also showed a positive +relationship between self-efficacy and performance after adjust- +ing for age, gender, and education levels in yoga group. +Self-efficacy and executive functions, especially motor +performance, play a major role in the scholastic behavior of +an individual. Self-efficacy in an individual measures the con- +fidence and ability to execute specific behavior. It suggests that +high self-efficacy motivates proactive behavior (17). Hence, this +study made an attempt to understand the changes in different +dimensions of self-efficacy and executive functions (based on a +trail making task). +Our results are consistent with the earlier studies that 10-day +yoga practice improves visual perception (7) with significant +decrease in the number of errors in repeated trials (10, 18). +Previous studies demonstrated that the daily yoga intervention +has a significant impact on key classroom behaviors (19, 20) +and improvement in academic performance, especially reading, +as well as social and peer interactions in most of the children +(21,  22). Berger et  al. demonstrated that yoga had sustained +effects with improvements in behavior, especially in the child’s +ability to pay attention in class, organizational skills with home- +work, and decreased impulsive behavior (23, 24). Recently, a +long-term study showed a reduction in time taken to complete +neurocognitive tasks after practicing vihangam yoga meditation +in school children and also suggested that meditation improves +mental functions, such as attention span (25), processing speed, +attention alternation ability, and performance (26). This may be +due to functional reorganization of brain activity patterns for +focused attention and cognitive monitoring that takes place with +mental practice, and this meditation-related changes are crucially +associated to a functional reorganization of activity patterns in +prefrontal cortex and in the insula (27). Yogic relaxation and +meditation techniques have been shown to improve informa- +tion processing speed (26, 28) in practitioners. In the context of +attention, the TMT have been suggested to tap more complex +attention or information processing, immediate memory and +performance on recall capacity (29, 30) after yoga practice. +Telles et  al. studied 90 school children (45 in 2 groups) with +ages ranging between 9 and 13 years and reported improvement +in static motor performance (31) and a significant improvement +in motor speed task on 53 adults and 152 children (10) after +10 days yoga intervention. A systematic review article mentioned +that yoga and meditation intervention nurture mindfulness and +may be a feasible and effective method of building resilience in +childhood and adolescence (32). Fifty-seven healthy male adult +volunteers showed significant improvements in psychomotor task +performance (33 34), attention span, processing speed, attention +alternation ability, and performance in interference tests  (26) +after yoga practices. Yoga may be an effective method to increase +awareness and performance in cognitive, emotional, or social +behavior (35). Our results are in concurrence with the above +studies. All above mentioned studies have a common limitation, +i.e., small sample size (21–24), suggesting less statistical power, +no proper controlled group, no controlled environment or noise +(26), and a short duration of yoga practices (1–2 h/day) (21–24). +Whereas in this study, we had a large sample size (n = 210 in +yoga and equal participants in controlled group) with controlled +environment and comparably long duration of intervention as +mentioned above. +The trail making task evaluates fine motor coordination, +visual–motor integration, visual perception, and cognitive +planning ability (36). Our study reflects the positive effects +of yoga on academic performance, processing speed, and +attention in school children. It was reported earlier that yoga +practice improves ability of the individual to control visual +distraction leading to increased ability for prepotent inhibi- +tion or orientational processing (orients to specific objects +in the attentional field) (37) and reduces planning time and +improves execution time (7). This effect could be a major +factor for lowering time duration for matching alphabets with +relevant numbers implying that automatic-response generation +was lower in the yoga group compared with control group in +this study. Electroencephalography (EEG) (38) and functional +magnetic imaging (39) studies implicated frontal lobe activation +during performance of TMT and while matching component +of alternating letters of the alphabets and consecutive numbers +activated the left dorsolateral prefrontal cortex, precentral gyrus, +cingulate gyrus and medial frontal gyrus, and supplementary +motor area, which are sensitive to executive functioning (40). +These neuroimaging studies suggest that the improvement in the +performance of TMT in this study may be due to the improve- +ment of frontal lobe activation in school children following +10 days of intense yoga practice. Another study reported that +a short-term yogic practice was associated with a physiological +relaxation responses (41), leading to enhanced performance +speed on color naming (42), decreased automatic responses +(43, 44), and reaction time involving an attentional task (45–48) +suggest yoga may enhances parasympathetic dominance with +improved frontal lobe activation. +Yoga brings about positive changes in behavior and mental +health of school children (24, 49). The results of this study are +in accordance with the earlier findings indicating a significant +relationship of self-efficacy with academic achievements (50). +Yoga practices in this study showed positive changes toward +the three domains of self-efficacy, i.e., academic domain, social +domain, emotional domain, and overall total domain. The +social self-efficacy pertains to children’s capability to deal with +social challenges, academic self-efficacy refers to children’s per- +ceived capability to master academic affairs, and self-regulatory +efficacy deals with children’s capability to resist peer pressure to +engage in high risk activities (51). Mindfulness-based mental +training study showed reduced level of stress and enhances +mindfulness self-efficacy awareness and attention training, and +positive states of mind (52). Similarly, this training also testi- +fied lowering of psychological distress, such as tension–anxiety, +FIGURE 1 | Evidence-based beneficial effects of yoga in school +children. +6 +Das et al. +Yoga and Psychomotor Performance in School Children +Frontiers in Pediatrics  |  www.frontiersin.org +June 2016  |  Volume 4  |  Article 62 +confusion–bewilderment, fatigue–inertia, and vigor–activity +parameters in medical students (53). Further studies on yoga +practices showed improvement in greater awareness of the +feelings associated with stress, and it may enhance coping +abilities possibly as part of the process of developing mindful- +ness or related to cognitive, emotional, or social development +(23,  54, 55). This leads to academic performance, alertness, +and academic excellence that are concerned with the quantity +and quality of learning attained with yoga or mental training +intervention. The academic performance and alertness in +school children was high who practiced yoga and reported low +stress in children (56). The regular practice of yoga can improve +Sattva Guna (balanced personality trait) among students paving +the way for their academic excellence. The academic excellence +is essential to provide opportunities for students to work +together to improve their understanding of concepts in their +academic core that helps students to train problem solving and +collaborative learning strategies (6). Another major component +for higher academic performance is better planning ability with +self-regulatory behavior (57). Studies suggest that yoga-based +education program improve planning and execution skills in +school boys (58). In addition to this, the beneficial effects of +meditation on middle school children showed an increased +state of restful alertness and greater capacity for self-reflection, +self-control, and flexibility as well as improved academic per- +formance that may facilitate the growth of social–emotional +capacities necessary for regulating the emotional labiality and +interpersonal stress of adolescence (59). +The findings of this study extended previous research on either +self-efficacy or psychomotor performance in children, which +were assessed simultaneously in this study. Yoga group children +reported higher self-efficacy particularly in academic, social, and +emotional domain with greater improvement in performance of +psychomotor skills and executive functions, which require selec- +tive attention, concentration, and visual scanning abilities, and +reduced the planning and execution time in TMT task. +Evidence-based previous scientific studies supporting the +findings of the preset study on the effect of yogic practices on +psychological, behavioral, and cognitive abilities in children +are given in Figure 1. Yoga practices reduce visual, audio, and +mental distractions, which helps in reducing stress and anxiety +in children. Once mental distraction reduced, the mental abilities +will be increased with the improvement in their behavioral skills. +The findings of this study are interesting and straightforward, +and the study has a major limitation in the selection of school +children that was not random in the control group because of +unavailability of non-yoga practitioner children in the yoga +institute. There was also no follow-up, and so, it is not known +whether improvements in test performance and self-efficacy are +sustained. Despite of aforementioned limitations, the results of +our study suggest that yoga-based intervention in school children +can improve attention, motor function, and different domains of +personality. Initial research on the usefulness of yoga for children +and adolescents is promising, more systematic studies including +long-term randomized controlled trials (RCTs) with follow-up +and active control groups are needed. +AUTHOR CONTRIBUTIONS +All authors listed have made substantial, direct, and intellectual +contribution to the work and approved it for publication. +SUPPLEMENTARY MATERIAL +The Supplementary Material for this article can be found online +at http://journal.frontiersin.org/article/10.3389/fped.2016.00062 +REFERENCES +1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. +Psychol Rev (1977) 84:191–215. doi:10.1037/0033-295X.84.2.191 +2. Bandura A, Cervone D. Differential engagement of self-reactive influences +in cognitive motivation. Organ Behav Hum Decis Process (1986) 38:92–113. +doi:10.1016/0749-5978(86)90028-2 +3. Caprara GV, Gerbino M, Paciello M, Di Giunta L, Pastorelli C. Counteracting +depression and delinquency in late adolescence. 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J Altern Complement Med (2013) 19:35–42. doi:10.1089/ +acm.2011.0282 +45. Telles S, Nagarathna R, Nagendra HR. Autonomic changes during “OM” +meditation. Indian J Physiol Pharmacol (1995) 39:418–20. +46. Pradhan B, Nagendra H. Immediate effect of two yoga-based relaxation +techniques on attention in children. Int J Yoga (2010) 3:67–9. doi:10.4103/ +0973-6131.72632 +47. Luders E, Kurth F, Mayer EA, Toga AW, Narr KL, Gaser C. The unique brain +anatomy of meditation practitioners: alterations in cortical gyrification. Front +Hum Neurosci (2012) 6:34. doi:10.3389/fnhum.2012.00034 +48. Telles S, Singh N, Bhardwaj AK, Kumar A, Balkrishna A. Effect of yoga or +physical exercise on physical, cognitive and emotional measures in children: a +randomized controlled trial. Child Adolesc Psychiatry Ment Health (2013) 7:37. +doi:10.1186/1753-2000-7-37 +49. White LS. Yoga for children. J Pediatr Nurs (2009) 35:277–83, 295. +50. Tenaw Y. Relationship between self-efficacy, academic achievement and +gender in analytical chemistry at Debre Markos College of teacher education. +Afr J Chem Educ (2013) 3:3–28. +51. Muris P. Measure – the self-efficacy questionnaire for children. J Psychoeduc +Assess (2007) 25:341–55. doi:10.1177/0734282907300636 +52. Chang VY, Palesh O, Caldwell R, Glasgow N, Abramson M, Luskin F, et al. +The effects of a mindfulness-based stress reduction program on stress, mind- +fulness self-efficacy, and positive states of mind. Stress Heal (2004) 20:141–7. +doi:10.1002/smi.1011 +53. Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness- +based stress reduction lowers psychological distress in medical students. Teach +Learn Med (2003) 15:88–92. doi:10.1207/S15328015TLM1502_03 +54. Smith JA, Greer T, Sheets T, Watson S. Is there more to yoga than exercise? +Altern Ther Health Med (2011) 17:22–9. +55. Melville GW, Chang D, Colagiuri B, Marshall PW, Cheema BS. Fifteen minutes +of chair-based yoga postures or guided meditation performed in the office +can elicit a relaxation response. Evid Based Complement Alternat Med (2012) +2012:501986. doi:10.1155/2012/501986 +8 +Das et al. +Yoga and Psychomotor Performance in School Children +Frontiers in Pediatrics  |  www.frontiersin.org +June 2016  |  Volume 4  |  Article 62 +56. Kauts A, Sharma N. Effect of yoga on academic performance in relation to +stress. Int J Yoga (2009) 2:39–43. doi:10.4103/0973-6131.53860 +57. Tseng MH, Chow SM. Perceptual-motor function of school-age children +with slow handwriting speed. Am J Occup Ther (2000) 54:83–8. doi:10.5014/ +ajot.54.1.83 +58. Rangan R, Nagendra HR, Bhat GR. Planning ability improves in a yogic +education system compared to a modern. Int J Yoga (2008) 1:60–5. +doi:10.4103/0973-6131.41033 +59. Rosaen C, Benn R. The experience of transcendental meditation in mid- +dle school students: a qualitative report. Explore (NY) (2006) 2:422–5. +doi:10.1016/j.explore.2006.06.001 +Conflict of Interest Statement: The authors declare that the research was con- +ducted in the absence of any commercial or financial relationships that could be +construed as a potential conflict of interest. +Copyright © 2016 Das, Deepeshwar, Subramanya and Manjunath. This is +an open-access article distributed under the terms of the Creative Commons +Attribution License (CC BY). The use, distribution or reproduction in other forums +is permitted, provided the original author(s) or licensor are credited and that the +original publication in this journal is cited, in accordance with accepted academic +practice. No use, distribution or reproduction is permitted which does not comply +with these terms. diff --git a/subfolder_0/psychophysiological effects of colored light.txt b/subfolder_0/psychophysiological effects of colored light.txt new file mode 100644 index 0000000000000000000000000000000000000000..beaab2334d57d776192c9543b3d21fd39ee065da --- /dev/null +++ b/subfolder_0/psychophysiological effects of colored light.txt @@ -0,0 +1,322 @@ +© International Digital Organization for Scientific Information +ISSN: 1817-3055 +Online Open Access +W +J +Med +Sci +Corresponding Author: Dr. Shirley Telles, Swami Vivekananda Yoga Research Foundation, # 19, Eknath Bhavan, Gavipuram Circle, K.G. Nagar, +Bangalore-560 019, India +21 +Volume 1 Number (1) : 21-23, Jan-Jun, 2006 +Psychophysiological Effects of Colored Light Used in Healing +Naveen K. Visweswaraiah and Shirley Telles +Swami Vivekananda Yoga Research Foundation, Bangalore, India +Abstract: Chromotherapy uses colored light for healing. The present study assessed the physiological effects of blue and +red light in normal volunteers, as these colors were believed to have opposite physiological effects. Fifteen male volunteers +(age range 17 to 29 years) were studied in two sessions each. Each session lasted for 40 min, with a test period of 30 min, +preceded and followed by two 5-min periods without colored light. Throughout both sessions, subjects lay supine with +eyes closed. The room was illuminated with ordinary light during the pre and post periods of both sessions. During the +test period, blue light was used for one session, while red light was used for the other. The heart rate, skin resistance, finger +plethysmogram amplitude, breath rate, blood pressure and electroencephalogram (EEG) were measured. There was a +significant reduction in the breath rate during exposure to blue light and the diastolic blood pressure reduced immediately +after exposure to blue light, compared to the preceding period (t-test for paired data). The results suggest that blue light +reduces physiological arousal, supporting the claim that blue light can be used to induce physiological rest. Red light did +not have a stimulating effect in this study. +Key words: Colored light % respiration % blood pressure % physiological rest +INTRODUCTION +blue light is used to manage insomnia, while red light is used +Chromotherapy or color therapy uses color (usually in +the form of colored light) to produce beneficial or healing +MATERIALS AND METHODS +effect [1]. It is well established that color may be used to help +people feel physically and emotionally more comfortable in +Subjects: Fifteen healthy male volunteers between 17.0 and +their surroundings [2]. There have been reports that the mean +29.0 years of age (group average age±SD., 23.8±2.8 years) +anxiety and stress scores were higher for subjects who remained +participated in the study. +in an office with red walls, whereas the mean depression +score was higher for subjects who stayed in an office with +Design of the study: Recordings were done on consecutive +blue walls [3]. It was also shown that following exposure to +days. The total period of assessment was 40 min, with a +red color, there was a reduction in skin resistance [4], suggesting +30-min test period preceded and followed by two 5-min +increased sympathetic activity. In contrast, blue or violet +periods. During these two 5-min periods the room was +colored rooms were correlated with lowest and most stable +illuminated with white light. For both days of assessment the +blood pressure readings [3]. +two 5-min periods were the same, while the test periods +The reports cited above discussed the effects of colors +were different. For randomization, subjects' names were drawn +when the subject was viewing them. In chromotherapy, colored +out in the form of a lottery, to assign the subjects to two +lights are used while the subjects' eyes are closed [5]. Light +groups. The first group of subjects was exposed to blue light +transmission through the eyelids has been estimated with a +during the test period of Day 1 (BL session) and red light during +visual threshold response and was found to vary according to +the test period of Day 2 (RD session). For the subjects of the +the wavelength [6]. Estimated light transmission was different +second group the order of the BL and RD sessions was +for different colors, viz., 0.3% for blue, 0.3% for green and 5.6% +reversed. +for red light. The present study was designed to assess the +physiological effects of exposure to colored light when the +Recording conditions: Recordings were done in a sound +subjects’ eyes were closed, as used in chromotherapy. Blue and +attenuated cabin (4.0 m x 2.5 m x 3.2 m). Subjects were asked +red light were specifically selected, as they are believed to have +to lie with eyes closed, on a bed which was illuminated by +opposite physiological effects. Based on this assumption +red or blue light using four incandescent, focusing, color bulbs +for depression [1]. +World J. Med. Sci., 1 (1): 21-23, 2006 +22 +of 40 W each, at a fixed distance of 1.4 m from the subject. +During the control periods a single, 60 W, incandescent, white +bulb, illuminated the room. +Assessments: The electrocardiogram (EKG), respiratory rate, +finger plethysmogram, skin resistance and electroencephalogram +(EEG) were recorded using a 10-channel polygraph (Polyrite, +Recorders and Medicare, Chandigarh, India). The EKG was +recorded using standard limb lead I configuration and an AC +bio-amplifier with 1.5 Hz high pass and 75 Hz low pass filter +settings. Respiratory rate was monitored with a thermistor worn +as a clip at the nostril. To assess the digit pulse volume (DPV), +a photoplethysmogram was placed on the left thumb at the +junction of the nail and the skin. Skin resistance was recorded +using Ag/AgCl disc electrodes attached to the volar surfaces of +the distal phalanges of the right index and middle fingers. +Electrode gel (Medicon, Chennai, India) was used and a constant +current of 10 microamperes was passed between the electrodes. +The signal was processed through a DC preamplifier. The EEG +was recorded with Ag/AgCl disk electrodes placed at O1 and O2 +positions, according to the standard 10-20 system for electrode +placement [7], as a bipolar recording. The blood pressure (BP) +was recorded at the beginning and end of the test periods using +a standard mercury sphygmomanometer, auscultating over the +right brachial artery. The diastolic pressure was noted as the +reading at which the Korotkoff sounds appeared muffled. +Data extraction and analysis: The heart rate in beats per +minute was obtained by continuously counting the QRS +complexes in successive 60-second periods. The rate of +respiration was similarly calculated by counting the number +of respiratory waves also in successive 60-second +epochs continuously and noting the respiratory rate as +cycles per minute. The skin resistance trace was sampled +every 20 seconds. The amplitude of the digit pulse volume was +sampled from the peak of the pulse wave at 20-second +intervals [8]. The EEG record was visually assessed to detect +sleep episodes. +For both the blue and red light sessions, the data of the +test and the post periods were compared with those of the +respective preceding periods using the t-test for paired data. +RESULTS +There was a significant reduction in the breath rate during +blue light in the present study [6]. +the test period of the BL session, compared to the preceding +The digit pulse volume reflects blood flow through the +white light period (p<0.001). The diastolic blood pressure value +skin. A reduction in digit pulse volume suggests narrowing +was significantly lower immediately after exposure to blue light +of cutaneous blood vessels. Reduced skin blood flow was +(p<0.001). The digit pulse volume was significantly reduced in +shown to occur when subjects were alert, as while solving +the post period of the BL session (p<0.001) and also in the post +arithmetic problems mentally [9] and also in response to +Table 1: +Heart rate in beats per minute (bpm), breath rate in cycles per +minute (cpm), Skin resistance (SR, kiloOhms), digit pulse +volume (DPV, cm), systolic and diastolic BP (mmHg). Values +are group mean±SD +Heart +Breath +Systolic +Diastolic +rate +rate +SR +DPV +BP +BP +Sessions +(bpm) +(cpm) +(kiloOhms) +(cm) +(mmHg) +(mmHg) +Blue light +Before +72.4 +19.8 +141.0 +1.05 +111.8 +71.3 +±6.8 +±2.5 +±90.5 +±0.5 +±8.4 +±6.3 +During +71.0 +18.4** +146.2 +1.14 +# +# +±5.6 +±2.1 +±84.8 +±0.45 +# +# +After +72.6 +18.9 +122.1 +0.59** +109.5 +68.1** +±6.7 +±2.6 +±62.8 +±0.4 +±6.6 +±4.3 +Red light +Before +72.4 +19.3 +132.5 +1.06 +111.3 +70.3 +±6.9 +±2.3 +±64.8 +±0.52 +±9.2 +±7.0 +During +71.1 +19.1 +139.8 +1.15 +# +# +±7.1 +±2.9 +±72.9 +±0.62 +# +# +After +71.6 +19.0 +132.8 +0.66** +112.9 +71.9 +±7.9 +±2.7 +±66.8 +±0.51 +±8.6 +±7.8 +**p<0.001 t-test for paired data, comparison with pre: # data not taken +period of the RD session (p<0.001). Visual assessment of the +EEG did not show any differences between the BL and RD +sessions. Also, there were no sleep episodes during any of the +sessions. The group mean values±SD are provided in Table 1. +DISCUSSION +In the present study there was a significant decrease in +the rate of respiration when subjects were exposed to blue +light and it remained lower in the subsequent period. The +diastolic blood pressure was also significantly lower +immediately after exposure to blue light. There were no +changes during the exposure to red light. There was a significant +decrease in the digit pulse volume in the control period after +exposure to both blue and red light. +In chromotherapyz blue light is used in the management +of insomnia, as it is believed to reduce physiological arousal [1]. +The present results (decreased breath rate and diastolic +blood pressure) support this idea. The results also show +similar trends to those reported in previous studies which +described the effects of blue color when the subject was looking +at it (i.e., increased skin resistance, reduced BP). Hence though +it was shown that the estimated light transmission through the +eyelids is greater for red (5.6%) than for blue light (0.3%), +significant effects were seen following eyes closed exposure to +World J. Med. Sci., 1 (1): 21-23, 2006 +23 +alerting stimuli [10]. The change that occurred during the +3. +Kwalleck, N., C.M. Lewis, A.S. Robbins, 1988. Effects +control periods after exposure to both blue and red light, +of office interior colors on workers’ mood productivity. +suggested that the subjects were more alert during the post +Perceptual and Motor Skills, 66: 123-128. +periods of both sessions compared to the respective baseline. +4. +Jacobs, K.W. and F.E. Hustmyer, 1974. Effects of four +The decrease in the digit pulse volume suggests peripheral +primary colors on GSR, heart rate and respiration rate. +vasoconstriction and hence an increase in peripheral vascular +Perceptual and Motor Skills, 38: 763-766. +resistance. It is known that increases in peripheral resistance +5. +Singh, S.J., 1983. New horizons in chromotherapy. +increase the diastolic blood pressure [11]. However these +Lucknow: Prakrithi Vani Council for Medical Research. +results are not contradictory to the decrease in the diastolic +6. +Ando, K. and D.F. Kripke, 1996. Light attenuation by +blood pressure immediately after exposure to blue light, as the +the human eyelid. Biological Psychiatry, 39: 22-25. +changes in digit pulse volume occurred in the control period +7. +Jasper, H.H., 1958. The 10-20 electrode system of the +while being exposed to white light. +international federation. Electroencephalography and +In summary, the results suggest that blue light reduces +Clin. Neurophysiol., 10: 371-375. +physiological arousal, whereas red light does not have this +8. +Roy, M. and A. Steptoe, 1991. The inhibition of +effect. While the exact mechanism by which color can influence +cardiovascular responses to mental stress following +physiological functions is not known, it is thought that +aerobic exercise. Psychophysiology, 28: 689-699. +following cortical interpretation of the stimulus, the affective +9. +Delius, W. and E. Kellerova, 1971. Reaction of +response determines the autonomic change [12]. The results +arterial and venous vessels in the human forearm and +support the claim that blue light can be used to induce +hand to deep breath or mental strain. Clinic. Sci., 40: +physiological rest, but they do not support the idea that red +271-282. +light has a stimulating effect. +10. Blessing, W.W., L.F. Arnolda and Y.H. Yu, 1998. +REFERENCES +rabbits reflects a patterned redistribution of cardiac +1. +Amber, R.B., 1983. Color therapy: Healing with color. +11. Ganong, W.F., 1987. Review of medical physiology. +New York: Aurora Press. +Thirteenth Edn., Connecticut: Appleton and Lange. +2. +Ainsworth, R.A., L. Simpson and D. Cassell, 1993. +12. Nakshian, J.S., 1964. The effects of red and green +Effects of three colors in an office interior on mood and +surroundings on behavior. J. General Psychol., 70: +performance. Perceptual and Motor Skills, 76: 235-241. +143-161. +Cutaneous vasoconstriction with alerting stimuli in +output. Clin. Exper. Pharmacol. Physiol., 25: 457-460. diff --git a/subfolder_0/therapeutic application of cold chest pack.txt b/subfolder_0/therapeutic application of cold chest pack.txt new file mode 100644 index 0000000000000000000000000000000000000000..77c4ed17e03b3c0fad4cb7bbffa7ca07c7321533 --- /dev/null +++ b/subfolder_0/therapeutic application of cold chest pack.txt @@ -0,0 +1,268 @@ +© International Digital Organization for Scientific Information +ISSN: 1817-3055 +Online Open Access +W +J +Med +Sci +Corresponding Author: +Dr. Shirley Telles, Swami Vivekananda Yoga Research Foundation, # 19, Eknath Bhavan, Gavipuram Circle, +K.G. Nagar, Bangalore-560 019, India +18 +Volume 1 Number (1): 18-20, Jan-Jun, 2006 +Therapeutic Application of a Cold Chest Pack in Bronchial Asthma +N.K. Manjunath and Shirley Telles +Swami Vivekananda Yoga Research Foundation, Bangalore, India +Abstract: In natural medicine, application of a cold chest pack for 30 min daily over a period of time is believed to improve +lung functions in bronchial asthmatics. However there has been no scientific evaluation of this treatment. Hence the present +study was carried out on 15 medication-free bronchial asthma patients (2 males) with ages from 19 to 42 years. The peak +expiratory flow rate (PEFR, in l/min) was recorded before, during and after a 30 min application of a cold chest pack. +This treatment was carried on for 21 days, during which the patients received other naturopathy treatments such as fasting, +diet changes, hydrotherapy, massage, magnetotherapy, color therapy and application of mud packs, along with yoga +therapy. The PEFR and symptom scores of the patients were assessed on Days 1 and 21. The results were analyzed using +a two factor ANOVA and paired-t-test, which showed a significant increase in the PEFR recorded on Day 21 compared +to Day 1 values, as well as immediately after the chest pack compared to the before values on day 21. Also, the symptom +scores have significantly reduced following the 21 days of naturopathy treatment. The results suggest that (I) an application +of a cold chest pack increases the PEFR as an immediate effect and (ii) this effect is augmented following 21 days of other +naturopathy treatments along with yoga. +Key words: Cold chest pack % bronchial asthma % naturopathy % bronchodilation +INTRODUCTION +application and yoga therapy) in bronchial asthma patients [6]. +The reversible bronchoconstriction which is characteristic +in PEFR, VC, FVC, FEV1, FEV/FEC%, MVV (Maximum +of bronchial asthma was observed to respond favorably to +Voluntary Ventilation) and absolute eosinophil count. The +changes in diet [1], yoga practices [2-4] and to other +patients reported a feeling of well being, freshness and +non-pharmacological externally applied treatments [5]. The +comfortable breathing. Hence it was concluded that +earliest study on yoga suggested that Transcendental Meditation +Naturopathy and yoga helps in inducing positive health, +was a useful adjunct in treating bronchial asthma [2]. A later +alleviating the symptoms of disease by acting at physical +controlled trial with fifty three patients each in yoga and control +and mental levels. +groups showed greater improvement in for drug treatment, peak +A cold chest pack which is used as a treatment of choice in +flow rate and decreased weekly attacks of asthma following two +weeks of yoga [3]. Another study evaluated the effect of a +single yoga technique (kunjal) and showed definite subjective +and objective improvements during the week they practiced +yoga as well as improved symptoms after three weeks [4]. +Apart from yoga, several non-pharmacological treatments have +been shown to be beneficial in the treatment of bronchial +asthma. The changes in ventilatory function was examined in +37 patients with steroid-dependent intractable asthma (SDIA) +following spa therapy [5]. There were significant improvements +in Forced Vital Capacity (FVC), Peak Expiratory Flow Rate +(PEFR), which suggested that the spa therapy improves the +condition of small airways disorder in patients with SDIA. +Another study evaluated the usefulness of Naturopathy +intervention (a combination treatments including massage, +hydrotherapy, color therapy, fasting and diet therapy, mud +The results suggested that there was a significant improvement +naturopathy along with hot foot and arm bath for bronchial +asthma is believed to reduce pulmonary congestion, decrease +pulmonary mucus membrane irritation and increase the depth of +respiration [7]. Since there are no studies conducted to evaluated +the effects of a cold chest pack in isolation on pulmonary +functions in bronchial asthma patients, the present study was +conducted to evaluate the immediate effect of a cold chest pack +on the Peak Expiratory Flow Rate (PEFR) and whether the +immediate effect would change after 21 days of treatment with +other natural remedies and yogic practices in bronchial asthma +patients. +MATERIALS AND METHODS +Patients: 15 patients (2 males) with bronchial asthma +diagnosed based on the standard criteria (6) were included in +World J. Med. Sci., 1 (1): 18-20, 2006 +19 +the study. Their ages ranged from 19 to 42 years (group +average±SD., 31.1±4.6 years). None of the patients were on +medication during the study. Both seasonal and perennial +asthmatics were included. +Assessments: The Peak Expiratory Flow Rate (PEFR) was +recorded using the Wright peak flow meter (Airmed Clement +Clarkes International, England) as per the standard method +of Wright and Mckerrow [8]. The subjects were instructed to +take a maximal inspiration and blow into the mouth piece of +the device rapidly and forcefully, while standing. The values +of PEFR achieved in 3 successive attempts were recorded and +the highest of 3 values was taken for analysis. Symptom +scores were recorded depending upon the presence of (I) +breathlessness, (ii) cough with expectoration and (iii) wheezing. +The three symptoms were scored as ‘1 = present’ or ‘0 += absent’. In addition to the baseline record, the PEFR was +also recorded before, during and immediately after a cold +chest pack applied once daily from Day 1 to Day 21. +Design of the study: Assessments were done on the first day +(Day 1) and on the last day (Day 21) of a 21 day naturopathy +treatment, at a nature cure hospital in South India. Also, the +PEFR was recorded before, during and immediately after a cold +chest pack daily. +Specific intervention: The chest pack, consisted of a cotton +cloth, approximately 2.5 m long and 0.5 m wide, which was +soaked in water at room temperature and wrung out completely. +It was then applied over the chest, covering both front and back, +followed by a wrapping of woolen flannel of the same +dimensions as the cotton cloth [9]. The pack was removed +after 30 min. +Other treatments: Apart from a chest pack, various other +naturopathy treatments were given such as hydrotherapy +[steam bath, arm bath, foot bath, enema, spinal bath and hip +bath (90 min)], fasting (3 days with fruit juices) and diet +therapy (controlled vegetarian diet twice a day), magnet and +color therapy (60 min), acupuncture (15 min), mud packs +(90 min) and massage therapy (45 min), along with yoga +therapy [yoga postures, voluntarily regulated breathing, +cleansing practices and meditation (120 min)] for all the +patients during the 21 days of treatment. +Data analysis: The data were analyzed using (I) the two factor +analysis of variance (ANOVA), for the PEFR readings made +before, during and after the chest pack, where Factor A = Day +has been related to different factors, viz. (I) circulatory effects, +1 versus Day 21 and Factor B = the 3 assessments (before, +during and after the chest pack) and (ii) the t-test for paired data +was done for Day 21 versus Day 1 comparisons of PEFR values +and symptom scores. +Table 1: PEFR values (l/min) recorded before, during and immediately +after a cold chest pack application. (N = 15). Values are group +mean±SEM +Days +Before +During +After +Day 1 +164.70 +154.70 +172.70 + +±17.90 +±19.10 +±19.50 +Day 21 +180.80 +225.30 +247.30*# + +±26.60 +±28.20 +±28.40 +* p<0.05, paired t-test, after compared to respective before values +# p<0.05, 'after' of Day 21 versus 'after' of Day 1 +Table 2: Peak expiratory flow rate (l/min) and symptom scores (out of 3). +Values are group mean±SEM +Days +PEFR + Symptom scores +Day 1 +164.70 +2.70 + +±17.90 +±0.23 +Day 21 + 230.00** + 0.50* + +±84.80 +±0.25 +* p<0.05, ** p<0.002, t-test for paired data, Day 21 versus Day1 +RESULTS +Two factor analysis of variance (ANOVA): The two factor +ANOVA showed a significant difference between Day 1 and +Day 21 values of PEFR, i.e., Factor A. [F = 12.26, the F value +for DF = 1, 84 at the 0.002 level (two tailed) = 11.66, hence +p<0.002. Here the actual DF = 1, 84 were chosen as the nearest +values in the probability table]. The difference between the +3 assessments (before, during and after) was not significant. +The t-test for paired data: The PEFR showed a significant +increase after 21 days of naturopathy treatments (p<0.02). +Also, there was a significant increase in the PEFR immediately +after a cold chest on the Day 21. The group mean values±SD are +detailed in Table 1. The symptom scores have significantly +reduced following the 21 days of naturopathy treatment +(p<0.05). The group mean values±SD are detailed in Table 2. +DISCUSSION +The present study showed that (I) as an immediate effect +an application of a cold chest pack increases the PEFR and +(ii) this effect is more following 21 days of various naturopathy +treatments. The symptom scores reduced after 21 days of +different naturopathy treatments. +Twenty one days of different naturopathy treatments +caused an increase in the baseline PEFR and reduced the +symptom scores. Also, the increase in PEFR following the +application of a cold chest pack was more after the 21 days of +treatment. The immediate effect of a cold chest pack application +since the application is believed to cause vasoconstriction of +blood vessels in the skin over the chest and (ii) the cold +stimulation may also increase overall sympathetic tone, +hence bringing about bronchodilation. This is especially +World J. Med. Sci., 1 (1): 18-20, 2006 +20 +important as it is generally understood that there is sympathetic +3. +Nagarathna, R. and H.R. Nagendra, 1985. Yoga for +beta receptor hyposensitivity in bronchial asthma, along with a +bronchial asthma: A controlled study. British Med. J., +adrenoreceptor +hypersensitivity +and +parasympathetic +291: 1077-1079. +hypersensitivity [10]. In summary, a cold chest pack is useful +4. +Singh, V., A. Wisniewski, J. Britton and A. Tattersfield, +to relieve symptoms bronchoconstriction both as an immediate +1990. Effect of yoga breathing exercises (pranayama) +effect and over a period of three weeks. +on air way reactivity in subjects with asthma. Lancet, +Since chest pack is used as a treatment of choice for +335: 1381-1383. +bronchial asthma along with other naturopathic treatments at +5. +Tanizaki, Y., H. Kitani, M. Okazaki, T. Mifune, +various naturopathy hospitals, it is important to carry on +F. Mitsunobu, K. Ochi, H. Harada and I. Kimura, 1992. +further investigations to understand the underlying mechanisms +Spa therapy improves ventilatory function in the +better. Also, since the present study had no non-intervention +small airways of patients with steroid-dependent +control group, it is not possible to ascribe the improved PEFR +intractable asthma (SDIA). Acta Medica Okayama, +to the chest pack alone (either as an immediate effect or the +46: 175-178. +result of a 21 day longitudinal follow up) or even to the effect of +6. +Sathyaprabha, T.N., H. Murthy and B.T.C. Murthy, +different naturopathy treatment modalities. Further studies with +2001. Efficacy of Naturopathy and Yoga in Bronchial +randomized control trials are required to substantiate these +Asthma-A self controlled matched scientific study. +preliminary results. +Indian J. Physiol. Pharmacol., 45: 80-86. +REFERENCES +Hyderabad: Prakruthi prakashan. +1. +Farrel, K.M., 1985. Gastroesophageal reflex, esophageal +expiratory flow as a measure of ventilatory capacity. +disfunction and asthma. In: Weiss, B.E., S.M. Segal and +British Med. J., 2: 1041-1047. +M. Stein (Eds.). Bronchial asthma-mechanisms and +9. +Institute of Naturopathy and Yogic Sciences, 1998. Nature +therapeutics. Boston: Little, Brown and Company Inc., +cure treatment. Bangalore: Institute of Naturopathy and +pp: 494-499. +Yogic Sciences. +2. +Wilson, A.F., R. Honsberger, J.T. Chiu and H.S. Novey, +10. Szentivanyi, A., 1968. The beta adrenergic theory of +1975. Transcendental Meditation and asthma. +the atopic abnormality in bronchial asthma. J. Allergy, +Respiration, 32: 74-80. +42: 203-225. +7. +Lindlahr, H., 1974. The practice of nature cure. +8. +Wright, B.M. and C.B. Mckerrow, 1959. Maximum forced diff --git a/subfolder_0/yoga therapy for non insulin dependent diabetes mellitus a controlled trial.txt b/subfolder_0/yoga therapy for non insulin dependent diabetes mellitus a controlled trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..2c6edd9944763ad5aa47d4386b87c8fc919ddef7 --- /dev/null +++ b/subfolder_0/yoga therapy for non insulin dependent diabetes mellitus a controlled trial.txt @@ -0,0 +1,5 @@ + + + + +